Enver Zerem

Expenditures for drugs are increasingly burdening already insufficient funds for health protection. This is especially evident in less developed European countries such as Bosnia and Herzegovina. The question is whether such analyses can help save funds for financing treatment for diseases, with an emphasis on a more rational choice of drug for appropriate indication, whereby clinical complications of hypertension would be prevented and patients would have quality of their lives improved. Focus of research has been set on analysis of use of antihypertensive drugs in Bosnia and Herzegovina in the time-period January 2013-March 2015. Use of all drugs for treatment of hypertension in that time-period in the country has been shown in an unbiased manner. The study is designed as retrospective-prospective comparative research of use of antihypertensive drugs in BiH in a certain time-period. Data are collected from relevant drug utilisation database which has been established in Bosnia and Herzegovina since 2013. We have calculated financial expenditure for prescribed antihypertensives in the time- period of 2013, 2014 and Q1 2015. Use of antihypertensives at the country level for this time-period is BAM 200,242,218. At the country level, physicians are most often opting for combination therapy: ACE inhibitors + diuretics (20.2%) and ACE inhibitors + Ca channel antagonists (18.0%). In this research, it has been shown that modern drugs are used for treatment of hypertension in Bosnia and Herzegovina. These drugs are used in the same order as they are prescribed in developed countries.

The First Mediterranean Seminar on Science Writing, Editing & Publishing (SWEP 2016) was held in Sarajevo, Bosnia & Herzegovina from 2nd to 3rd December 2016. It was organized by Academy of Medical Sciences of Bosnia and Herzegovina, running concurrent sessions as part of its Annual Meeting titled " "Days of AMNuBiH - Theory and Practice in Science Communication and Scientometrics". Hotel Bosnia in the city centre was the chosen venue. On the first day, nineteen presentations on various issues of science writing and publication ethics were delivered by speakers from Croatia, Serbia, Macedonia, Albania, Bosnia & Herzegovina and the UK (Asim Kurjak, Milivoj Boranić, Doncho Donev, Osman Sinanović, Miro Jakovljević, Enver Zerem, Dejan Milošević, Silva Dobrić, Srećko Gajović, Izet Mašić, Armen Yuri Gasparyan, Šekib Sokolović, Nermin Salkić, Selma Uzunović, Admir Kurtčehajić, Edin Begić and Floreta Kurti). Each presentation had a take-home message for novice and seasoned authors, encountering numerous problems in non-Anglophone research environment. Lecturers, who were internationally recognized editors of regional journals, generously shared their experience of adhering to the best ethical guidance. Elegant presentations by Srećko Gajović (Editor-in-Chief of the Croatian Medical Journal) and Armen Yuri Gasparyan (past Chief Editor of the European Science Editing) showcased their accomplishments that strengthened ties between authors from all over the world. Gasparyan reflected on educational resources of editorial associations, such as the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE), and called not just to declare the adherence to, but also to enforce their ethical guidance in daily practice. Editors of Medical Archives, Croatian Medica Journal, Vojnosanitetski Pregled, Psychiatria Danubina, Acta Informatica Medica, Materia Socio-Medica, The Donald School Journal of Ultrasound in Obstretics and Gynecology, Acta Medica Saliniana and Medicinski Glasnik presented their editorial strategies aimed at attracting best authors and resolving problems with authorship, conflicts of interest, and plagiarism. Topical education on science writing and editing was considered as an inseparable part of continuing professional development in biomedicine. Armen Yuri Gasparyan (UK) was offered an opportunity to interact with more than 70 participants, attending the SWEP 2016 on the second day. The lecturer talked about author contributions, disclosures of conflicts of interests, plagiarism of ideas and words, research performance and impact indicators, and targeting ethical journals. Topics were presented in a way to help non-Anglophone authors, reviewers and editors avoid common ethical problems. Dr Gasparyan stressed the importance of regularly arranging such meetings across Balkan and Mediterranean countries to eradicate plagiarism and other forms research misconduct. The organizers of the SWEP 2016 awarded selected keynote speakers with certificates of lifetime achievement in journal editing, and decided to run the Seminar annually with support of Balkan and Mediterranean editors and publishers. The SWEP 2016 marked a turning point in the process of regional developments since all attending editors opted for nurturing enthusiasm of the organizers and launching the Mediterranean Association of Science Editors and Publishers (MASEP). The Seminar was a great success with its impressive scientific and social activities. It attracted more than 100 students, researchers, editors, and publishers from Bosnia & Herzegovina and neighbouring countries. Proceedings, in the form of short reports, were published in Acta Informatica Medica and archived in PubMed Central. New friendships were forged between regional experts in editing and young specialists during those unforgettable two days of intensive discussions and informal interactions (a-y).

The aim of this study was to evaluate whether anemia identified earlier than 3 months postengraftment in modern era could be predictive of anemia at 12 months. Cross-sectional and cohort studies based on retrospective analysis of existing clinical records were performed. Data on recipient's age at transplantation, follow-up serum creatinine (SCR) and hemoglobin (Hb) on day 7 (D7), at month 1 (M1) and at month 3 (M3) postengraftment were collected. Outcome was anemia identified at 12 months (M12) postengraftment. There were 75 patients on D7, 74 at M1 and 61 at M3. Multiple linear regression model that included recipient's age at transplantation, Hb and creatinine on D7 and tested the risk for anemia at M12 retained only the age in the model, with the coefficient of 0,84 (P=0,001). The same model at M1 retained Hb and age, with the coefficients of 0,26 (P=0,03) and 0,81 (P=0,0002), respectively and at M3 it retained Hb and age, with the coefficients of 0,41 (P=0,004) and 0,70 (P=0,003), respectively. Anemia identified at M1 after renal transplantation is predictive of anemia at M12.

The aim of this study was to evaluate the results of percutaneous drainage with single-session alcohol sclerotherapy in the treatment of symptomatic simple renal cysts. Thirty patients (16 men and 14 women, average age 54,7+/-11,3 years) with simple renal cysts were treated by ultrasound guided percutaneous aspiration and single-session alcohol sclerotherapy. Patient demographics, clinical characteristics, treatment outcome and complications were analyzed. Average reduction of cyst volume was 91,2%. Complete and partial resolution occurred in 10 (33%) and 14 (47%) cysts, respectively. Six cases were defined as failure with reduction of cyst volume <80%. Flank pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 8 patients. The hospital stay was one day for all patients. Treatment of simple renal cysts is indicated when the cysts are sufficiently large and cause complaints or when associated with complications. Percutaneous treatment with alcohol sclerotherapy of benign renal cysts can be performed safely and effectively.

The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67+/-9.96 and whose disease lasted 3.8+/-4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention.

The most frequent causes of the stenosis are as follows: Schatzki rings, structures as the complications of GERB', postcorrosive and postoperative at nosis. The Balloon dilatation is one from the therapeutic procedures of stenosis of the esophagus. By the clinic research is included 12 patients with the stenoses of the esophagus of the various cause. It is used the balloon dilatator (Olympus) of the diameter 16 and 18 mm, and the analysis 40 mm. In 11 patients the balloon dilatation was successful and led to the walking of the esophagus for endoscope. Only in one patient the dilatation was unsuccesful, because was applied two years after the occurrence of the stenosis caused by the corrosive esophagisitis. It is concluded that the balloon dilatation of the therapeutic procedures of the choice in stenosis of the esophagus.

To determine types and frequency of side effects of antihypertensive drugs in patients with diabetes mellitus (DM) type 2 and hypertension. We performed a prospective study of 79 patients with DM type 2 and hypertension, randomly selected by systematic sampling, who were followed over a period of six months. Patients were assessed at baseline and once a month measuring following parameters: types of used antihypertensive drugs and frequency of side effects, the values (mmHg) of systolic (SBP) and diastolic blood pressure (DBP). Out of 79 patients, 48/79 (60.8%) were males and 31/79 (39.2%) were females. The median age in males was 53 years (IQR=48 to 55 years), in females was 53 years (IQR=49 to 56 years). There was no statistically significant difference in median age between males and females (P=0.368). There is a statistically significant difference in the values of SBP [χ2(5)=312.296, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001] and DBP [χ2(5)=216.051, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001] over a period of six months follow-up. The drug side effects were noted in 9/79 (11.4%) patients between 1-2 months, in 6/79 (7.6%) between 2-3 months, in 1/79 (1,3%) between 3-4 months. The most common side effect was cough (11/79 or 13.9%) associated with the combination of ACE inhibitor and thiazide diuretics. In 5/79 (6.3%) patients there were reports of: flushing, palpitations, headache, dizziness and leg edema associated with Ca blockers. The most common side effect of antihypertensive treatment was cough (13.9%) associated with the combination of ACE inhibitor and thiazide diuretic.

Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.

Lobus v. azygos (lobe of the azygos vein, azygos lobe) is an accessory lobe of the right upper lobe of the lung that corresponds to the anatomical variety. The presence of expansive lesions in it represents unusual radiographic findings. This paper presents the case of a patient with an extensive expansion process in azygos lobe, radiologically diagnosed by standard radiography (X-ray) and Multislice Computed Tomography Scan (MSCT). The process was subsequently treated surgically and confirmed histologically as a non-small-cell lung adenocarcinoma.

In this paper we are presenting the application of Multislice CT Scan (MSCT) as a part of radiological treatment in a female patient with avascular necrosis of head and neck of the right femur, which occurred as a consequence of developmental hip dysplasia. The left hip joint of the patient was previously replaced by a prosthetic implant.

The aim of this work is to show possibilities of treating echinococcus cyst, with special emphasis on PAIR method, showing two different cases (hydatid and multilocular cyst). In the period of three years in our department it has been treated 7 children who had cystic echinococcosis of different type, different localization, different number of cystic changes as well as different curing methods. Four patients were treated by PAIR method. Prior to all these patients were treated as per certain therapy scheme, conservatory by albendazole and then exposed to PAIR method. Two completely cured (Echinococcus granulosus), third(Echinococcus multilocularis) in final phase and fourth at the early beginning of cure treatment (E. granulosus). There were no complications such as febrile, rupture and possible dissemination. Hydatidosis is still primarily surgical disease but open surgical procedures are rapidly losing on their importance in therapy sense, comparing with new treating methods of percutaneous aspiration under sonographic and CT guidance, with pre-medication with albendazole.

To evaluate results of ultrasound guided percutaneous catheter drainage (PCD) for local septic complications of chronic pancreatitis. Between 1999 and 2002, PCD was used in 19 patients with chronic pancreatitis for 6 infected acute pseudocysts, 3 post-necrotic abscesses, 3 abscesses following pancreatic resections, 6 abscesses with none of the precipitating factors present (no acute episode or recent surgical/endoscopic interventions) and a tuberculous peritoneal empyema. In 17 patients, collections were unilocular. Trocar technique was used in 14 patients and Seldinger technique in 5. Sixteen patients were successfully treated with PCD alone (mean drainage duration = 32 days) without abscess recurrence during the follow-up period (mean = 35.6 month). Surgical treatment was necessary in 3 patients. Pseudocyst recurrence occurred in another patient after 9 months. PCD should be considered as the initial therapy for chronic pancreatitis local septic complications. Surgery is reserved for patients in whom PCD fails.

The primary treatment goals in patients with gastroesophageal reflux disease (GERD) are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis and prevention of complications. The severity of GERD is directly correlated with the degree and duration of oesophageal acid exposure and is highly pH dependent. Healing of reflux esophagitis is directly correlated with the intragastric pH &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3.5. In patients with GERD, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H2-receptor antagonist [H2RA] or a proton pump inhibitor [PPI]). The relief of symptoms and the long-term control of the disease are the primary aims of therapy for the majority of patients. The efficacy of antisecretory drugs in healing GERD depends on the strength and duration of acid suppression within a 24 h period, and the duration of the treatment. PPIs are more effective for acid-related symptoms and higher endoscopic healing rates in comparison with H2-RAs. Most PPIs (except pantoprazole) inhibit the bioactivation of clopidogrel to its active metabolite as they are associated with the loss of the beneficial effects of clopidogrel as well as an increased risk of reinfarction. Some clinicians reported their experiences that the generic has sometimes shown less effective than the corresponding branded PPIs. We conducted the overview of the effectiveness of PPIs in the treatment of patients with both categories of GERD; nonerosive reflux disease (NERD) and erosive reflux disease (ERD). We also report about interactions between PPIs and other drugs and differences between generic and branded PPIs.