Pregabalin in the Treatment of Peripheral and Central Chronic Neuropathic Pain.

Background: Pregabalin is a first-line therapy of pain with additional positive effects on the states of depression and anxiety that often occur in patients with chronic pain, thus improving their quality of life. Objective: The aim of this study was to demonstrate the efficacy of pregabalin in reducing neuropathic pain and improving quality of life in patients with peripheral and central chronic neuropathic pain in Bosnia and Herzegovina. Also, the aim was to monitor the safety of therapy with pregabalin. Methods: The study included patients with neuropathic pain lasting more than 3 months. Based on the underlying disease, patients were divided into 5 groups: DM-patients with diabetes mellitus, M-patients after stroke, D-patients with lower back pain, MS-patients with multiple sclerosis, and P group-patients with spinal cord injury. During the baseline visit, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was used to assess neuropathic pain. During two follow-up visits (1.5 and 3 months after baseline), the 36-Item Short-Form Health Survey (SF 36) was used to assess the effectiveness of therapy on quality of life. The safety of the treatment was evaluated by monitoring the incidence of adverse drug reactions. Results: The study included 125 patients. During treatment with pregabalin, there was a statistically significant reduction in pain intensity in the DM, M, D and MS groups. In group P, the decrease in pain intensity was not statistically significant (p = 0.070). There was a significant improvement in different parameters of the quality of life in all analyzed groups, with the most prominent effects in the DM group. The effectiveness of treatment was rated as "good" and "very good" in more than 70% of subjects in each group. The expected side effects of treatment were recorded in 27.1% of patients in the DM group, in 20.0% in the M group and in 22.2% in the MS group. Unexpected side effects of treatment were observed in one patient (2.1%) in the DM group. Assessment of tolerability of the applied treatment showed "good" and "very good" response in 68.7% of patients in DM group, 73.3% in M group, 74.5% in D group, 88.9% in MS group and 85.8% in P group. Conclusion: Pregabalin is a safe and effective drug in treatment of neuropathic pain of different etiology.

Non-interventional Pilot Study Evaluating the Efficacy and Safety of Lysozymebased Therapy in Patients with Non-infectious Sore Throat.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of lysozyme-based oral antiseptic in the therapy of non-infectious sore throat in teachers. MATERIALS AND METHODS: A non-interventional, prospective, pilot study was conducted with two examinations. The first was performed as part of a general medical examination. If a non-infectious sore throat was confirmed by clinical checkup and all other inclusion and non-exclusion criteria confirmed, patients were offered to be enrolled in the study. After signing the informed consent form, patients were advised to use lysozyme-based lozenges, six times a day, for a period of five days. A telephone call follow-up examination was performed within 24 hours from the therapy completion. RESULTS: This was a pilot study involving 25 adult patients of both genders. Lysozyme-based lozenges showed positive effects in relieving the symptoms of non-infectious sore throat in teachers. At the same time, the lozenges showed excellent tolerability, and no side effects were reported during the study. 92% of patients confirmed they would take the same medicine again due to the same problem. CONCLUSION: The results of this "proof-of-concept" study indicated that lysozyme-based antiseptic could be effective and safe in the treatment of non-infectious sore throat in teachers and should be further evaluated as treatment option in this condition.

Effects of Different Antihypertensive Drug Combinations on Blood Pressure and Arterial Stiffness.

INTRODUCTION: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). AIM: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. METHODS: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). RESULTS: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). CONCLUSION: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.

Neuroenhancing Substances Use, Exam Anxiety and Academic Performance in Bosnian-Herzegovinian First-Year University Students.

OBJECTIVE: The aim of this study was to assess the relationship between the use of neuroenhancing substances, exam anxiety and academic performance among first-year Bosnian-Herzegovinian (BH) university students. METHODS: In a cross-sectional study, an ad hoc questionnaire was delivered to a sample of BH first-year university students. The following data were collected: socio-demographic features, consumption of neuroenchancing substances, the Westside Test Anxiety Scale (WTAS) and academic performance. RESULTS: A total of 214 students were included. Consumption of lifestyle substances, coffee, energy drinks, nicotine, alcohol, and marijuana, for the purpose of neuroenhancement increased during the week before the exams. OTC cognitive enhancer use was reported by 31.0%, and of benzodiazepines by 1.5% of students. No psycostimulants were used. A high to extremely high exam WTAS score was reported in 38.3% students. The exam WTAS score was positively correlated with consumption of coffee (rho=0.31; P<0.001), energy drinks (rho=0.18; P=0.009), and nicotine (rho=0.22; P=0.001), and negatively correlated with last exam grade (rho=-0.33; P<0.001). The exam WTAS score was a significant independent predictor (OR=0.55; 95% CI 0.31 to 0.97, P=0.039) for self-assessed academic performance. Self-assessed academic performance was positively correlated with last exam grade (rho=0.15; P=0.043). CONCLUSIONS: Although first-year BH university students do not seem to use either prescription or illicit psycostimulants, the consumption of nicotine, alcohol, and marijuana is worrying. However, the consumption of these neuroenhancing substances seems not to be related to better self-assessed academic performance. Finally, exam anxiety seems to be a significant problem among BH first-year university students.

An Instrument for Rating Quality of Life Related to Sore Throat in Patients Suffering from Acute Pharyngitis or Tonsillitis.

INTRODUCTION: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. OBJECTIVE: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. METHOD: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). RESULTS: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach's alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. CONCLUSIONS: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.

Efficacy of carbocisteine in the treatment of chronic obstructive pulmonary disease and impact on the quality of life.

Aim To investigate the effects of carbocisteine treatment in the reduction of frequency of productive cough episodes, preventing disease progression and improving the quality of life as well as the tolerability of the administered treatment and patient compliance during the study. Methods This observational, non-interventional, multicenter, cohort study included 501 patients with chronic obstructive pulmonary disease (COPD) who were administrated carbocisteine capsules 375 mg and followed up during the next 15 days. The patients were observed at 3 points, baseline and two additional assessments. General clinical condition of patients, along with the spirometry testing at all three points were examined. Thr quality of life was assessed on the 1st and 3rd observation with Leicester Cough Questionnaire. Tolerability and patient compliance were measured throughout the study. Results There was a significant change of forced expiratory volume in 1 second (FEV1) status between the second and third observation (p=0.002). Examination of general symptoms showed a statistically significant reduction in cough by 74.9%, in sputum production by 48.5%, in dyspnea by 29% and in fatigue by 50%. After the administration of carbocisteine the median value of overall quality of life was 3.79 (3.63 - 3.89). Conclusion 375mg carbocisteine capsules were found to be effective and well-tolerated in the treatment of COPD, with a small percentage of reported mild adverse reactions and with a significant improvement of quality of life.

Gender Differences in Biochemical and Electroneurographic Parameters of Median and Ulnar Nerve.

INTRODUCTION: In this article are demonstrated differences in the aspects of the metabolic syndrome (MSy) between genders, as well as the association of MSy and neuropathy. THE AIM: The aim of our study was that in patients with newly discovered metabolic syndrome of both sexes make comparison of fasting blood glucose levels and after oral glucose tolerance test, as well as neurophysiological parameters of n.medianus and n.ulnaris. PATIENTS AND METHODS: All participants were examined dermatologically. The analysis included the 36 male and 36 female respondents with a newly discovered MSy. RESULTS: The average age of men was 52.75±7.5 (40-65) years and women 52.1±7.7 (38-67) years. The average value of fasting blood glucose in women was 5.86±0.87 (4.5-8) mmol/L, and non significantly higher in men (p=0.0969) as 6.19±0.8 (4.7-8) mmol/L. Average values of blood sugar 120 minutes after oral glucose tolerance test were not significantly different (p=0.7052), and was 5.41±1.63 (3.3-9.7) mmol/L in women and 5.27±1.52 (2.7-9.8) mmol/L in men. Median motor velocity were significantly higher in women for n.medianus on the left (p=0.0024), n.ulnaris on the left (p=0.0081) and n.ulnaris on the right side (p=0.0293), and the median motor terminal latency were significantly longer in n.ulnaris on the left (p=0.0349) and n.ulnaris on the right side (p=0.011). There was no significant difference in the sensory conductivity velocity in n.medianus and n.ulnaris between the groups, but the amplitude with the highest peak of the sensory response was significantly higher in n.medianus on the left (p=0.0269) and n.ulnaris on the left side (p=0.0009) in female patients. CONCLUSION: The results indicate that there are differences in neurophysiological parameters of the investigated nerves between the genders, and that tested nerve structures in the course of MSy are affected slightly more in men. There were no significant differences in skin changes between genders.

Public health aspects of the family medicine concepts in South eastern europe.

INTRODUCTION: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. AIM: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health. RESULTS: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.

The toxic effect on leukocyte lineage of antimicrobial therapy in urinary and respiratory infections.

INTRODUCTION: Antimicrobials are widely used in infectious diseases. Only the timely intervention will contribute to the positive outcome of the disease. Unjustified use of antimicrobial prophylaxis may have adverse effects, i.e., result in bacterial resistance to existing antimicrobials, as well as toxic effects on leukocyte lineage and other parameters of the blood. GOAL: The goal of this study was to confirm that the antimicrobial therapy of urinary, gynecological and respiratory infections has a toxic effect on leukocyte lineage. Followed by lowered immunity and the emergence of risk for health complications especially in oncology and other immunodeficient patients for whom to apply pharmacotherapy it is necessary to have adequate immunity, or white blood cell count that is greater than 4.0 x 10(9)/L. MATERIAL AND METHODS: A prospective-retrospective study was conducted on a sample of 30 patients in a Primary Health Care Center in Gracanica during the period from March 01, 2013 until April 01, 2014. Testing of this sample was conducted by survey on health status and treatment, or on taking of antimicrobial therapy and other treatment regimens, with the referral diagnosis and determination of leukocytes count in by hematology counter SYSMEX. Results of leukocytes below and close to the lower reference values were statistically analyzed by Students t-test. RESULTS: Mean WBC count in the group treated with antimicrobial therapy was 3.687 +/- 0.83 x 10(9)/L, in the group which during repeated infection did not use the antimicrobial therapy 5.09 +/- 1.04 x 10(9)/L, and in the control group of healthy subjects 7.178 +/- 1.038 x 10(9)/L. Statistical analysis with Student's t test indicate highly significant differences between group of patients that used antimicrobial therapy with the group of patient that did not used antimicrobial during repeated infection (t = 6.091; p = 0.0001), as well as significant differences in mean WBC count of both of these groups and the controls (t = 4.984; p = 0.0001, and t = 8.402, p = 0.0001). CONCLUSION: Use of antimicrobial drugs leads to serious toxic reactions, or leukopenia. Indications for the use of antimicrobial therapy must be strictly followed, because banal, frequent infections are not indication for antimicrobial therapy. It is necessary to know the types of infection causes. Important is the proper and timely selection of antimicrobial therapy. When selecting the drug we should bear in mind its antimicrobial activity, pharmacokinetic and toxic properties, as well as patient health status. Possible is also the application of preventive medicine as well as other manner of solving infection.

Pedobarography in diagnosis and clinical application.

INTRODUCTION: Pedobarography as a new diagnostic tool enables measuring the pressure between the foot and the floor during dynamic loading. Dynamic analysis of the foot shows advantage over static analysis due to its capabilities for detecting high load points in certain diseases and in certain phases of walking. Pedobarography as a new method in the context of rehabilitation include wide range of clinical entities. GOAL: To show the advantages of pedobarography as new diagnostic and rehabilitation method in prevention programs. MATERIAL AND METHODS: A prospective study included 100 patients with diabetes mellitus type 2. Research was conducted in the Primary Health Care Center of the Sarajevo Canton and the Center for Physical Medicine and Rehabilitation. The test parameters were: Test of balance-symmetric load for the test, the number of comorbidity, clinical examination of foot deformity, test with 10 g monofilament, HbA1c. From the total sample 45 patients (Group I) were selected, aged 50-65 years, which underwent pedobarography (on the appliance Novel Inc., Munich with EMED™ platform) and robotic fabrication of individual orthopedic insoles, followed by control pedobarography. Plantar pressure was determined using standard pedobarography, computer recorded parameters: peak pressure (kPa), force (Ns), area (cm). RESULTS: The average age of the respondents was 59.4±11.38 years; altered results on the balance test were present in 34% of patients; 61% of respondents have ≤2 comorbidity. In the total sample, the average number of foot deformity was 2.84. Flat feet have 66% of respondents, and valgus position 57%. The average HbA1c values were 7.783±1.58% (min.5-max.15.0). All subjects (45) after the first, and after the second measurement of peak pressure, have values above 200 kPa, or are in the designated zone of peak pressure that needs to be corrected. In a study was determined the correlation between the number of deformities and peak pressure, the number of deformities and the area upon which plantar pressure act, test with 10g monofilament and peak pressure. CONCLUSION: Within the framework of prevention programs early diagnosis, detection of sensitivity disorders, adequate treatment and taking load from the feet with the help of pedobarography, are of great importance for the patient suffering from diabetes.

Comparative Review of Education Programs of Family Medicine (FM) in Bosnia and Herzegovina and Several Transition Countries.

Family Medicine as an independent medical discipline is relatively young in the countries of Southeast Europe. Still are used the old models of all forms of education in this module, although most countries accepted Bologna undergraduate teaching concept and already implement it with greater or lesser success. Measuring the effects of the qualities of these concepts and models is not done systematically nor in uniform manner, so it could not be compared by the unique variables measuring the quality of education curricula, and especially the quality of education level of the graduates at the first, second and third degree courses and other forms of education. This paper provides a comparative overview of the state of education in the area of family medicine in the region. It creates comparison according to the study duration for undergraduate and postgraduate studies, doctoral studies and specialized studies in specified areas. What stand out are the proposals to improve education in the field of family medicine in the region.

Assessment of diabetic polyneuropathy and plantar pressure in patients with diabetes mellitus in prevention of diabetic foot.

INTRODUCTION: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. MATERIAL AND METHODS: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. RESULTS: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That's a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). CONCLUSION: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes.

The toxic effect on leukocyte lineage of antimicrobial therapy in urinary and respiratory infections.

INTRODUCTION: Antimicrobials are widely used in infectious diseases. Only the timely intervention will contribute to the positive outcome of the disease. Unjustified use of antimicrobial prophylaxis may have adverse effects, i.e., result in bacterial resistance to existing antimicrobials, as well as toxic effects on leukocyte lineage and other parameters of the blood. GOAL: The goal of this study was to confirm that the antimicrobial therapy of urinary, gynecological and respiratory infections has a toxic effect on leukocyte lineage. Followed by lowered immunity and the emergence of risk for health complications especially in oncology and other immunodeficient patients for whom to apply pharmacotherapy it is necessary to have adequate immunity, or white blood cell count that is greater than 4.0x10(9)/L. MATERIAL AND METHODS: A prospective-retrospective study was conducted on a sample of 30 patients in a Primary Health Care Center in Gracanica during the period from March 01, 2013 until April 01, 2014. Testing of this sample was conducted by survey on health status and treatment, or on taking of antimicrobial therapy and other treatment regimens, with the referral diagnosis and determination of leukocytes count in by hematology counter SYSMEX. Results of leukocytes below and close to the lower reference values were statistically analyzed by Students t-test. RESULTS: Mean WBC count in the group treated with antimicrobial therapy was 3.687±0.83 x10(9)/L, in the group which during repeated infection did not use the antimicrobial therapy 5.09±1.04 x10(9)/L, and in the control group of healthy subjects 7.178±1.038 x10(9)/L. Statistical analysis with Student's t test indicate highly significant differences between group of patients that used antimicrobial therapy with the group of patient that did not used antimicrobial during repeated infection (t=6.091; p=0.0001), as well as significant differences in mean WBC count of both of these groups and the controls (t=4.984; p=0.0001, and t=8.402, p=0.0001). CONCLUSION: Use of antimicrobial drugs leads to serious toxic reactions, or leukopenia. Indications for the use of antimicrobial therapy must be strictly followed, because banal, frequent infections are not indication for antimicrobial therapy. It is necessary to know the types of infection causes. Important is the proper and timely selection of antimicrobial therapy. When selecting the drug we should bear in mind its antimicrobial activity, pharmacokinetic and toxic properties, as well as patient health status. Possible is also the application of preventive medicine as well as other manner of solving infection.

Frequency of substance abuse among adolescents.

INTRODUCTION: Drug addiction is one of the most prominent problems in many countries in transition, including Bosnia and Herzegovina. Age limit of drug addiction is shifted to the younger age groups, especially is troubling the increase in number of injection drug users. Our study was aimed to investigate the habits, attitudes and practices related to drug use among young people from the area of Sarajevo city. We can still feel the effects of the war, among which are the most important life without closest relatives, banishment and various types of war and post-war trauma. GOALS: To determine the frequency of substance abuse among adolescents; Identify potentially relevant biological, psychological and socio economic characteristics of the adolescents; To explore adolescents attitudes towards drug use; Examine the general level of knowledge of adolescents about drugs and their effects. MATERIAL AND METHODS: The study was conducted on randomized sample of 502 students in two primary and three secondary schools in Sarajevo and Gracanica. To study used survey method. Survey instrument was a self-made questionnaire with the research variables. The obtained data were processed by a computer and statistically correlated. The study is of combined, retrospective, prospective and transversal type. RESULTS: To the question "How many times have you consumed cannabis in the last 30 days" about 6% of the respondents have tried once or twice, while 1.5% use it daily, ecstasy have tried one or two times 2.25%, while 0.5% have daily use. Based on the obtained results it can be concluded that students at schools in Sarajevo consumed drugs 50% more than the children in Gracanica. Analyzing the age at which the subjects consumed the drug for the first time, we came to the conclusion that in the third year of high school only 8% of adolescents have tried any drugs before they turned 15 years. This percentage among eighth graders is about three times higher. CONCLUSION: Presented research results clearly suggest a strong contamination of the living environment of young people with different types of psychoactive substances. Offer of drugs is extensive and distribution network covers all the places where young people visits, including schools. It is clear that today's teenagers sooner or later hear about drugs, see, get in touch with a "junkie" and have a chance to take the drugs if they want to. From our research, we found that the following factors: Marital status of parents, employment of parents, the number of family members, type of school and satisfaction with oneself are not crucial for the eventual drug use among young people. While, the biological status of the parents, educational status of parents, financial status of parents, the tendency of parents tobacco and alcohol use, adolescents' attitude to parents, the harmony of relationships between parents, school performance, positive attitude toward the so-called light drugs, represent significant risk factors for adolescent populations.

Frequency of depression in diabetic patients in the family medicine.

INTRODUCTION: Depression often accompanies various physical illnesses. OBJECTIVES: Screening for unidentified depression in patients diagnosed with Diabetes mellitus. DESIGN AND METHOD: a retrospective, descriptive study. SUBJECTS: 100 diabetic patients, 53% female and 47% male, age group 18-85. Hopkins Symptom Checklist-25 questionnaire was used on a random sample of diabetic patients in two family medicine outpatient clinics in Health Centre Ilidza and Center, Sarajevo, in period February-May 2007. The cutoff score of > or = 1.75 was used. The occurrence of depression was analyzed with respect to the duration of Diabetes mellitus, type of treatment and average value of fasting blood glucose over the last six months. RESULTS: 36% of subjects scored positive for depression symptoms, 31% of subjects in the group having the illness up to one year, 80% in the group having the illness for 11-15 years. There is a statistically significant difference in depression positive score between the group of patients using insulin, and to the group using oral hypoglycemic therapy, 73% vs. 20% (p< 0.05). In the group with average value of fasting blood glucose < or = 7 mmol/l, 15% of the patients have a positive oepression score, versus 66% of them in the group with blood glucose levels of 13-15mmol/l. CONCLUSION: The number of newly found depressions in diabetic patients increases with the duration of Diabetes mellitus and with higher levels of fasting blood glucose. A systematic screening by family doctors can help identify diabetes-related depression.

[Assessment of active exercises in cervical pain syndrome]. / Ocjena efikasnosti aktivnih vjezbi kod sindroma bolnog vrata.

GOALS: The goals of the research were: a) to identify possible serious and specific causes of neck pain; b) to identify psychological and social barriers for recovery; c) to determine the degree of dysfunction caused by nonspecific neck pain; d) reduce pain; e) improve functioning and reduce disablement; f) prevent recurrences and development of chronic forms. ATTENDEES AND METHODS: As a sample for this research we selected patients with the verified neck pain syndrome, 120 of them in total which we divided into two groups with 60 patients. One group is treated with the classic rehabilitation method and the other cohort underwent active exercises during a six months period. For testing we used WAD scale and NDI questionnaires, which are approved all around the world and described in available literature. RESULTS: In the time period from January 3rd until December 31st 2006 there was a total of 6163 specialist evaluations, first or control ones. During the same time period physical rehabilitation started 516 patients with the neck pain syndrome from which: 426 women (82.3%) and 90 men (17.7%). Majority of patients axial neck pain was diagnosed or not complicated neck pain syndrome (G 54.2), but for the patient in Center for physical rehabilitation much more frequent is cervical brachial compared to the reference data. In baseline, demographic and clinical data for the 120 respondents did not have significant statistical deviations. Average patient's age is 47 years, with very low variation coefficient. Variation coefficient; V(A) = 13 % (very low) V(B) = 13% (very low). Also within baseline, the pain (VAS) and self estimated functionality impairment (NDI), was also similar for both groups. All respondents N = 120 had the initial evaluation of functioning status 3. After 6 months reevaluation we gave significant differences in clinical state levels of the patients from the training (A) and the control group (B). If we analyze the relationship between frequencies, we can conclude that the patients--but not all, which exercised in their homes, have better functional status and reduced pain, and 10% of them did not have any problems. But, also 15% of patients that did not exercise within home program have improvement in clinical status, which can be explained with the usual, spontaneous remission of the neck pain syndrome. DISCUSSION AND CONCLUSION: According to the results of the conducted research, continuous and long lasting exercised to strengthen the neck muscled with the home exercise program are efficient in the treatment of patients suffering from neck pain syndrome. Ten percent of the patients that exercised did not feel the subjective problems, which 60% of them had significant reduction of pain, reduction in use of analgesics and anti rheumatic medications, with improvement in local and general functioning status as well as daily activities in life and work, and that is statistically highly significant advantage compared to the patients that did not exercise. Work in the department of physical and family medicine, organized at the local community level, provides good basis for the scientific research and possibility to implement prevention programs, with necessary interdisciplinary and cooperation between teams. The perspectives are the following: In general, evidence degree for a neck pain is quite low. Determination of guidelines for better systematization of therapy is important prerequisite for the future efficacy researches of various concepts.

[Depressive disorder: importance, frequency & recognizing physical symptoms]. / Vaznost, ucestalost i javljanje tjelesnih simptoma u sklopu depresivnog poremecaja.

OBJECTIVE: Depression is more than just a mood disorder, it is a real illness that not only affects one's mood and thoughts but also appetite, sleep patterns and one's self esteem. Today by primary care physician every fourth patient is diagnosed with depressive disorder where 15% of them try or commit suicide. Objective is to correlate importance, frequency, & recognizing physical symptoms who indicate depressive disorder. METHODS: Research pooled sample of 33 female patients who seek medical attention with numerous physical pains which had no organic cause (n = 33). Participant's average age was 46. They were mainly unemployed and single mothers with one or more children. Seven physical symptoms were observed before, during diagnosis and their existence after two months of anti-depression therapy. They are: a) headaches; b) rapid heartbeat; c) dizziness or hightheadedness; d) shortness of breath; e) increased sweating; f) stomach aches; g) nausea. Research took place between June and December 2007 in the office of family medical practice. Data was collected & analyzed using program SPSS14. RESULTS: In the beginning of disorder, the physical symptoms are milder and increasing with time and development of disorder. The most common physical symptoms, headaches, rapid heartbeat, dizziness or lightheadedness, and nausea are present before and after anti-depressive or anxiolytic therapies. Statistical analysis differentiating number of symptoms before and after therapy shows 5% decrease. After two months of treatment physical symptoms, headaches, rapid heartbeat, and nausea remain where dizziness or lightheadedness, stomach aches, increased sweating or breath-shortness largely respond to therapy. CONCLUSION: The research shows physical symptoms take significant place in recognizing depressive disorder. They are accompanying symptoms of depressive disorder. Most common physical symptoms of depressive disorder are: headaches, rapid heartbeat, dizziness or lightheadedness, and nausea. There is significant statistical difference in the number of physical symptoms before and after anti-depressive and anxiolytic therapies.

Echocardiographic monitoring of patients with heart failure.

Twenty seven patients diagnosed as having systolic heart failure with Ejection Fraction (EF) of less than 40% by echocardiography were monitored over a period of 3 years. The monitored parameters included clinical symptoms, diastolic dysfunction, therapies and survival during three years of treatment. The results indicate a beneficial effect of treatment with high doses of ACE-inhibitors, spironolactone and beta-blockers in improving clinical symptoms and diastolic function. The survival rate was similar to that in the developed European countries.