Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations.

BACKGROUND: Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources. METHODS: We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach. RESULTS: While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers. CONCLUSIONS: Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.

Effect of commercial or depurinized milk on rat liver growth-regulatory kinases, nuclear factor-kappa B, and endonuclease in experimental hyperuricemia: comparison with allopurinol therapy.

Hyperuricemia is a biochemical hallmark of gout, renal urate lithiasis, and inherited purine disorders, and may be a result of enormous ATP breakdown or purine release as a result of cardiovascular disease, hypertension, kidney disease, eclampsia, obesity, metabolic syndrome, psoriasis, tumor lysis syndrome, or intense physical training. The beneficial role of dairy products on hyperuricemia management and prevention is well documented in the literature. The primary aim of our experimental study was to examine the effect of milk dietary regimen (commercial 1.5% fat UHT milk or patented depurinized milk) compared with allopurinol therapy on experimental hyperuricemia induced by oxonic acid in rats. Principal component analysis was applied on a data set consisting of 11 variables for 8 different experimental groups. Among the 11 parameters measured (plasma uric acid and the liver parameters NFκB-p65, Akt kinase/phospho-Akt kinase, ERK kinase/phospho-ERK kinase, IRAK kinase/phospho IRAK kinase, p38/phospho-p38, and DNase), Akt/phospho Akt and ERK/phospho-ERK signaling were extracted as the most discriminating. We also compared the content of various potentially toxic compounds (sulfur compounds, ketones, aldehydes, alcohols, esters, carboxylic acids, and phthalates) in untreated commercial milk and depurinized milk. Of all the compounds investigated in this study that were observed in commercial milk (24 volatile organic compounds and 4 phthalates), 6 volatile organic compounds were not detected in depurinized milk. For almost all of the other compounds, significant decreases in concentration were observed in depurinized milk compared with commercial milk. In conclusion, a depurinized milk diet may be recommended in nutritional treatment of primary and secondary hyperuricemia to avoid uric acid and other volatile, potentially toxic compounds that may slow down liver regeneration and may induce chronic liver diseases.

Congenital toxoplasmosis in premature twins.

In the course of the study "Toxoplasmosis and Prematurity" 330 blood samples from twins were examined. Our findings in a series of 21 premature twins (maternal sera were also examined) are reported in this paper. Toxoplasma antibodies were detected by the Sabin-Feldman test and specific IgM antibodies by the Remington test. The classical form of congenital toxoplasmosis was present in five pairs of twins, while toxoplasmosis was subclinical at birth in both twins of three pairs. The pattern of disease varied very much in seven pairs of twins. In one twin of two pairs signs of disease were present, while his cotwin appeared unaffected but with strongly positive result of SFT. The most interesting observation, however, is that in three pairs, one twin was infected and had evident congenital toxoplasmosis, while his cotwin was not, as proven by the disappearance of the Toxoplasma antibodies. This finding undoubtedly indicates the importance of whether the placenta is intact or not for the transmission of the infection.

Erythropoietin in premature infants.

The regulation of erythropoiesis during the first three months of life was studied in 30 premature infants who had haemoglobin concentrations which were lower than in term in fants of the same postdelivery age. Erythropoietin and erythropoiesis inhibitors were measured by means of an exhypoxic polycythaemic mouse bioassay. The percentage of haemoglobin F was determined as well. An increased erythropoietin level was detected only in six infants older than six weeks, whose blood haemoglobin concentration was lower than 100 g/l, while in serum from other babies erythropoietin was undetectable by the method used. Erythropoiesis inhibitors were present in 80% of the samples tested. The results presented indicate that in premature infants erythropoiesis is regulated through erythropoietin and that inhibitors of erythropoiesis take part in this regulation as well, but that the haemoglobin level at which erythropoietin is increased is lower in preterm infants than in term babies.

[Dislocation of the elbow as a clinical problem with reference to rehabilitation]. / Luksacije lakta kao klinicki problem sa osvrtom na rehabilitaciju

In the period from 1970 till 1974, 106 patients with the clean luxation without the injury of the bone supstrate were treated. From that number there were 68 men and 38 women. In the total anaesthesia the reposition and imobilisation in the upper arm longeta were performed. This longeta was removed after three weeks and then the rehabilitation was continued (medical school). Functional results are neat.

An improved UV-spectrophotometric method for routine barbiturate monitoring.

A simple, rapid, quantitative, low-cost UV-differential spectrophotometric method for the routine monitoring of phenobarbital in serum and cerebrospinal fluid is described. This method can also be used for monitoring methylphenobarbital (Phemiton) and primidone (Mysoline), since the major active metabolite of both drugs is phenobarbital. The basis for our procedure is Goldbaum's method (Anal. Chem., 24, 1604 (1952)). This method was improved with several modifications including a single extraction technique with dichloroethane, which has produced a very simple but still accurate method. The whole analysis takes less than 20 minutes. This procedure is accurate in the range from 1-100 mg/1 of phenobarbital in serum or cerebrospinal fluid.