Intensive Intervention on Smoking Cessation in Patients Undergoing Elective Surgery: The Role of Family Physicians.

Background and Objectives: The aim of this study was to determine the role of physicians in the intensive intervention and education regarding the smoking cessation of patients undergoing elective surgery under general anaesthesia. Materials and Methods: A randomised prospective study was conducted in family physicians' clinics in which smokers of both sexes, aged 21-65 years, without cognitive impairments, and who were not addicted to psychoactive substances voluntarily participated. Four weeks preoperatively, 120 smokers were randomised into two equal groups; the intervention group (IG) underwent an intervention for the purpose of smoking cessation and the control group (CG) underwent no intervention. Biochemical tests were performed in order to determine the smoking status of the participants in the phase of randomisation, one week preoperatively, as well as 40, 120, and 180 days and 12 months postoperatively. The examinees of the IG talked to the physician five times and received 140 telephone messages, leaflets, and motivational letters along with the pharmacotherapy, while the participants in the CG received little or no advice on smoking cessation. Results: The results of this study confirmed a significant influence of the intervention and education on the smoking abstinence in the IG compared to the CG (p < 0.001). The smokers in the IG had 7.31 (95% CI: 2.32-23.04) times greater odds of abstinence upon the 12-month follow-up than the smokers in the CG. The smokers in the IG who did not stop smoking had a lower degree of dependence and smoked fewer cigarettes (p < 0.0001) compared to those in the CG, as well as a multiple times higher prevalence of short- and long-term abstinence. Conclusions: It can be concluded that the intensive intervention and education can motivate patients preparing for elective surgery to stop smoking in the short- and long term.

Citation metrics and scientometrics.

I read the article "Scientometrics and academia" by Dr. Zerem and colleagues. My perspective on citation metrics and scientometrics is more cautious. Therefore, in this article, I present my viewpoint on this subject. Read more in the PDF.

Prevalence of Cigarette Smoking and Influence of Associated Factors among Students of the University of Banja Luka: A Cross-Sectional Study.

Background and Objectives: Cigarette smoking among the youth population has increased significantly in developing countries, including Bosnia and Herzegovina. However, no extant literature assesses the prevalence of tobacco use, nor identifies factors associated with smoking. This study determined the prevalence of cigarette smoking among a specific cohort of students and assessed factors related to tobacco use in this population. Materials and Methods: This cross-sectional study included 1200 students at all faculties of Banja Luka University. Data were collected from questionnaires adapted from the Global Youth Tobacco Survey (GYTS) and the Global Health Professional Student Survey (GHPSS) standardized questionnaires and were analyzed using descriptive statistics, Pearson's χ2 test, and logistic regression. Results: When the prevalence of cigarette smoking within the last thirty days was recorded, we found that 34.1% of students smoked within this period. Nearly three-quarters (74.9%) of the student population had smoked or experimented with cigarette smoking. However, medical students were 27.2% less likely to smoke than their counterparts from other faculties. Overall, 87% of all students were aware of the harmful effects of cigarette smoking, 79% were aware of the harmful effects of secondhand smoke, and 65% reported that it was difficult to quit. Increased spending of personal money was associated with a higher probability of smoking, while exposure to secondhand smoke increased the odds of smoking by 62%. Conclusion: Policies, strategies, and action plans should be introduced in order to reduce the prevalence of smoking among university students and to create a smoke-free environment at the various universities involved.

Cigarette smoking and medical students.

Despite its well known harmful effects on health, tobacco use is widespread throughout the world. Approximately one third of the global population become smokers at the age of 15 years or more. The prevalence of smoking between genders is lessening. Earlier, men used to smoke three to four times more than women globally. The nicotine content of cigarette is small (10 to 12 mg) and a smoker inhales about 1.1 to 1.8 mg of nicotine from each cigarette smoked to its entire length; this plant alkaloid stimulates the central nervous system, causes either ganglionic stimulation in low doses or ganglionic blockade in high doses, and smokers can develop a moderate to heavy physical dependence. Among other numerous substances, several are cancerogenic, and about 98 percent of lung cancer deaths are caused due to tobacco smoke. Nicotine addiction is often more severe than alcohol addiction. Smoking also may complicate anesthetic management, and passive smoking increases the rate of perioperative airway complications in the children of smokers, too. Preoperative abstinence from tobacco is required for surgical patients and it offers an opportunity for smokers to quit permanently. Physicians have an important role in helping smokers to quit tobacco or e-cigarettes, but if a doctor is a smoker himself, his antismoking influence may be deficient. Since a significant percentage of medical students are smokers, it is worth influencing them to stop the habit. The best way is to introduce tobacco modules, stimulating students to participate in anti-smoking campaigns, offer non-smoking hospitals, non-smoking university campuses, non-smoking dormitories, and to provide medical assistance to student smokers who wish to quit.

An exploration of bioactive peptides: My collaboration with Ervin G. Erdös.

This paper provides a brief historical sketch of the science of biologically active peptides. It also offers the story of how Ervin G. Erdös, a pioneer in the study of metabolism of various peptides, influenced me through collaborations that span many years. I worked in Dr. Erdös's research laboratories in Oklahoma City, Dallas, and Chicago, and we shared research interests through visits across the Atlantic between the former Yugoslavia and the United States. Among other findings, we discovered angiotensin-converting enzyme in the retina, which opened up a new research direction for many scientists interested in serious ocular diseases. This tribute to my mentor paints a portrait of a man who, in addition to his dedication to science and his seminal discoveries about the metabolism of peptides, took the time to invest in training many young scientists. His fine personal qualities explain why all of those who worked with him hold him in such high regard.

Four decades of ocular renin-angiotensin and kallikrein-kinin systems (1977-2017).

This review offers a contemporary history of the renin-angiotensin (RAS) and kallikrein-kinin (KKS) systems with emphasis on how these complex systems affect the eye. It describes the types of communication (cross-talk) between the two systems and evaluates their potential role in the development of diabetic retinopathy, diabetic macular edema, age-related macular degeneration, glaucoma, and uveitis. In addition to detailing the important physiological actions of components of the RAS and KKS, possibilities are suggested for new therapeutic avenues in the treatment of common ocular diseases. Historical notes indicate the major events in this research area, marking four decades from the first publication on the discovery of renin and angiotensin converting enzyme in the eye to the present time.

Global knowledge of medicine: Experiences from Tuzla and Banjaluka, Bosnia & Herzegovina.

When English became lingua franca, a significant change in the language of scientific publication in Central and Eastern European countries occurred; many journals instead of the local language, and German, French or Russian used English. The shift occurred due to the intention of both the journal editors and contributors to achieve international recognition and inclusion of the journal in prestigious international medical databases. As a consequence, publications in English are cited on average six times more frequently than those in German, Japanese or French. In the Northern part of Bosnia and Herzegovina (B&H), three medical journals are published in English. However, these journals are not yet included in the Medline indexing base. In unenviable socio-economic state such as B&H, one cannot expect enough quality submissions to recognized journals. Gross domestic product per capita in 2012 in B&H, neighboring Croatia, Serbia and Slovenia was 9,545; 21,314; 13,020 and 27,474 US$, respectively. Thus gross domestic expenditure on research and development in 2009 of about 0.02%, 0.85%, 0.923% and 1.86% in these states clearly shows incapability of B&H to support adequately recognized scientific research. Temporarily, the main goal for the majority of the medical professionals is to keep health of patients in modest circumstances, and reproduce new generations of qualified practitioners. For that reason, there is a long way to reach the noble point of "the internationally recognized evaluation criteria" for assessing scientific accomplishments.

Influence of the green tea leaf extract on neurotoxicity of aluminium chloride in rats.

Aluminium may have an important role in the aetiology/pathogenesis/precipitation of Alzheimer's disease. Because green tea (Camellia sinensis L.) reportedly has health-promoting effects in the central nervous system, we evaluated the effects of green tea leaf extract (GTLE) on aluminium chloride (AlCl3 ) neurotoxicity in rats. All solutions were injected into the cornu ammonis region 1 hippocampal region. We measured the performance of active avoidance (AA) tasks, various enzyme activities and total glutathione content (TGC) in the forebrain cortex (FbC), striatum, basal forebrain (BFb), hippocampus, brain stem and cerebellum. AlCl3 markedly reduced AA performance and activities of cytochrome c oxidase (COX) and acetylcholinesterase (AChE) in all regions. It decreased TGC in the FbC, striatum, BFb, hippocampus, brain stem and cerebellum, and increased superoxide dismutase activity in the FbC, cerebellum and BFb. GTLE pretreatment completely reversed the damaging effects of AlCl3 on AA and superoxide dismutase activity, markedly corrected COX and AChE activities, and moderately improved TGC. GTLE alone increased COX and AChE activities in almost all regions. GTLE reduces AlCl3 neurotoxicity probably via antioxidative effects and improves mitochondrial and cholinergic synaptic functions through the actions of (-)-epigallocatechin gallate and (-)-epicatechin, compounds most abundantly found in GTLE. Our results suggest that green tea might be beneficial in Alzheimer's disease.

The renin-angiotensin system and its blockers.

Research on the renin-angiotensin system (RAS) has contributed significantly to advances in understanding cardiovascular and renal homeostasis and to the treatment of cardiovascular diseases. This review offers a brief history of the RAS with an overview of its major components and their functions, as well as blockers of the RAS, their clinical usage and current research that targets various components of the RAS. Because angiotensin-converting enzyme (ACE) metabolizes two biologically active peptides, one in the kallikrein-kinin system (KKS) and one in the RAS, it is the essential connection between the two systems. ACE releases very powerful hypertensive agent, angiotensin II and also inactivates strong hypotensive peptide, bradykinin. Inhibition of ACE thus has a dual effect, resulting in decreased angiotensin II and increased bradykinin. We described the KKS as well.

Simvastatin-lnduced nocturnal leg pain disappears with pravastatin substitution.

INTRODUCTION: Statins have similar side effects that do not always occur at the same rate among the various statins. We present a case of simvastatin-induced muscle toxicity that disappeared when pravastatin was substituted for the original drug. CASE OUTLINE: A 74-year-old male, a nonsmoker, complained of severe nocturnal leg cramps. The patient also complained that similar painful cramping occurred when he walked rapidly or jogged. Because some components of his lipid panel exceeded the'desirable' range, and as he had a history of myocardial infarction, his family physician prescribed simvastatin (40 mg/day). The patient had taken this medication for the past eight years. The painful nocturnal episodes started two years ago and affected either one or the other leg. Four months ago we discontinued his simvastatin and prescribed pravastatin (80 mg/day). At a follow-up visit six weeks later, the patient reported that his leg pains at night and the pain experienced after brisk walking had disappeared. Four months after the substitution of pravastatin for simvastatin, the patient reported that his complete lack of symptoms had continued. CONCLUSION: These painful muscle cramps were probably caused by an inadequate vascular supply to the calf and foot muscles. Perhaps a combination of advanced age and atherosclerotic changes created a predisposition for the simvastatin-induced leg cramps. Pravastatin differs from simvastatin in several ways.l It is not metabolized by cytochrome P450 (CYP) 3A4 oxidases, and thus is not influenced by CYP 3A4 inhibitors like simvastatin. Also, simvastatin is associated with single-nucleotide polymorphisms located within the SLCO1B1 gene on the chromosome 12 and established myopathy, while pravastatin lacks this association. These differences may contribute to increased tolerance to pravastatin in this particular case.

Seven decades of angiotensin (1939-2009).

Two research groups in both North and South America independently discovered that renin released a novel vasopressor agent. The Argentine group named it hypertensin, and called its plasma protein substrate hypertensinogen. The group from the United States named it angiotonin. In 1958, Braun Menendez and Irvine Page suggested that the peptide should be named angiotensin. The combined name eventually became commonly used to avoid linguistic confusion. Research scientists and physicians today acknowledge that studies of the renin-angiotensin system (RAS) have greatly improved our understanding of several diseases. Certainly, medical practice profited significantly from the synthesis and application of numerous pharmacological agents that antagonize either the biosynthesis or pharmacological responses of endogenously generated angiotensin II. Ultimately, discovery of the renin-angiotensin system led to many studies that resulted in therapies for vascular disease. This article briefly reviews research related to the discovery of angiotensin and indicates the importance of additional studies related to the RAS.