Volume 2 / Number 4 / 2008

HealthMED
Journal of Society for development of teaching and business processes in new net environment in B&H

EDITORIAL BOARD Mensura Kudumovic Dzenana Jusupovic Azra Kudumovic Technical editor Eldin Huremovic Lectors Mirnes Avdic Adisa Spahic Members Borut Poljsak (Ljubljana) Josip Vincelj (Zagreb) Budimka Novakovic (Novi Sad) Dragana Stoisavljevic (Banja Luka) Bakir Mehic (Sarajevo) Mirsada Hukic (Sarajevo) Slavica Ibrulj (Sarajevo) Farid Ljuca (Tuzla) Emina Nakas-Icindic (Sarajevo) Fatima Jusupovic (Sarajevo) Amira Duric (Sarajevo) Aida Hasanovic (Sarajevo) Dijana Avdic (Sarajevo) Ago Omerbasic (Sarajevo) Address of the Sarajevo, Bolnicka BB Editorial Board phone/fax 00387 33 640 407 HealthMed_bih@yahoo.com Published by DRUNPP, Sarajevo Volume 2 Number 4, 2008 ISSN 1840-2291 EBSCO Publishing (EP) USA http://www.epnet.com Editor Secretaries

Sadržaj / Table of Contents
Estimation of exhumed male persons’ stature based on bayesian analysis Procjenjivanje visine ekshumiranih osoba muškog spola na
Anisa Masovic, Nermin Sarajlic ***

osnovu bayes-ove analize ................................... 187-191 Liver function in patients with diabetes mellitus type 2 and hyperlipidemia Funkcija jetre u oboljelih od dijabetes melitusa tip 2 i hiperlipidemijom .......................................................... 192-197
Farid Ljuca, Esad Alibasic, Sabina Nuhbegovic ***

Dietary factors as protectors or predictors for lung cancer: survey control study Faktori ishrane kao zaštitni faktori ili faktori rizika za karcinom pluća: pregledno kontrolno istraživanje ..... 198-205
Suvad Dedic, Nurka Pranjic

Socio-Demographic and Health Characteristics of Frequent Attender in Family Practice Sociodemografske i zdravstvene karakteristike čestih korisnika u porodičnoj medicini .............................. 206-213
Zaim Jatic, Dzanana Jatic

***

Adi Rifatbegovic, Ermina Iljazovic, Nedret Mujkanovic, Azra Pasic, Emir Halilbasic, Mufid Burgic ***

Basal cell carcinoma of orbital region Bazocelularni karcinom orbitalne regije .............. 214-218

***

Effects of Specific Forms of Extramedullary Fixation in Treatment of Diaphyseal Small Bone Fractures Efekti specifičnih oblika ekstramedularne stabilizacije na sanaciju prijeloma dijafiza malih kostiju ......... 219-224
Zoran Hadziahmetovic, Narcisa Vavra – Hadziahmetovic ***

Adipokines and Acute Coronary Syndrome Adipokini i Akutni Koronarni Sindrom .............

Emina Nakas-Icindic, Amina Valjevac, Asija Zaciragic ***

225-233

Fatima Jusupovic, Arzija Pasalic, Jasmina Mahmutovic, Dijana Avdic, Azra Kudumovic

Relation of disseased towards feding aditions vitamins and minerals Odnos bolesnika prema prehrambenim dodacima vitamina i minerala ............................................................ 234-238

Volume 2 / Number 4 / 2008

HealthMED
Journal of Society for development of teaching and business processes in new net environment in B&H

Sadržaj / Table of Contents

Asija Zaciragic, Amina Valjevac, Orhan Lepara, Azra Alajbegovic ***

Does serum C-reactive protein concentration correlate with blood pressure values in patients with probable Alzheimer’s disease? Da li koncentracija C-reaktivnog proteina u serumu korelira sa vrijednostima krvnog pritiska kod pacijenata sa mogućom Alzheimerovom bolesti? ............... 239-245

Application of cognitive behavior therapeutic techniques for prevention of psychological disorders in police officers Primjena kognitivno-bihevioralnih psihoterapijskih tehnika u prevenciji psihičkih poremećaja kod policajaca .................................................... 288-292
Sibila Sijaric-Voloder, Dzejna Capin

Nesina Avdagic, Esad Cosovic, Emina Nakas-Icindic, Zakira Mornjakovic, Asija Zaciragic, Almira Hadzovic-Dzuvo ***

The effects of spirulina platensis on biohumoral markers of renal function in gentamicin-induced acute tubular necrosis in rats Efekti spiruline platensis na biohumoralne markere bubrežne funkcije kod gentamicinom-uzrokovane akutne tubularne nekroze kod štakora ....................................................... 246-252

CASE REPORT

Trisomy 18 – Edwards’ syndrome Trisomija 18 – Edwardsov sindrom ..................... 293-297
Izeta Aganovic-Musinovic, Mirela Djurovic, Zimka Seremet

PROFESSIONAL PAPERS

Anthropometric values for boys aged 14 – 15 years who actively train basketball in comparison to boys of the same age who do not train any sports Antropometrijske vrijednosti kod dječaka uzrasta 14 – 15 godina koji aktivno treniraju košarku u odnosu na dječake iste dobi koji nemaju sportskih aktivnosti .......... 253-264
Dijana Avdic, Fatima Jusupovic, Mensura Kudumovic ***

Influence of malignant disease on physical and mental health in patients with oncology disease Uticaj malignog oboljenja na tjelesno i duševno zdravlje onkoloških bolesnika ................................................. 298-304
Amela Dzubur, Dragana Niksic, Esad Pepic, Amna Pleho Kapic

PREVIEW PAPERS
Dijana Avdic, Edin Buljugic

Aida Vilic-Svraka, Zlatko Vucina, Aida Filipovic-Hadziomeragic, Mirsada Mulaomerovic ***

Methods of removing infectious and laboratory’s waste in clinic centers Metode uklanjanja infektivnog i laboratorijskog otpada u kliničkim centrima .............................................. 265-272

Osteophorosis, how prevent and how treat it Osteoporoza, kako spriječiti, kako liječiti .......
***

305-306 307-308

Instructions for the autors ...............................

Repulsing of harmful rodents in specific environmental conditions of pharmaceutical factory Suzbijanje štetnih glodavaca u specifičnim uvjetima na području farmaceutske tvrtke ................................. 273-282
Suad Habes, Sandra Mramor-Muzevic, Sefkija Muzaferovic ***

The relationship between myocardial viability and collateral circulation Odnos vijabilnosti miokarda i kolateralne cirkulacije ........................................ 283-287
Aida Hasanovic

HealthMED - Volume 2 / Number 4 / 2008

Estimation of exhumed male persons’ stature based on bayesian analysis
PROCJENJIVANJE VISINE EKSHUMIRANIH OSOBA MUŠKOG SPOLA NA OSNOVU BAYESOVE ANALIZE
Anisa Masovic, Nermin Sarajlic Institut of Forensic Medicine, Medical School, University of Sarajevo, Bosnia and Herzegovina

Summary The basis in the process of identifying exhumed skeletal remains is the identification of a biological profile and, within it, stature estimation as one of the most important parameters. Since 1996, the estimation of war victims’ stature in the territory of Bosnia and Herzegovina has been carried out based on formulae obtained through research on American population. In this study, stature estimation was carried out by applying a Bayesian analysis on 105 exhumed and identified male persons from the territory of the northwest Bosnia, namely of 78 left humeri, 105 left femurs, 96 left tibia and 80 left fibulas. 369 persons from the Sarajlić’s study were used as a reference sample. Stature estimation formulae were developed by applying the Bayesian analysis and were compared with the formulae obtained by Ross and Konigsberg and Sarajlić and associates. Results show that the formulae developed in this study are more precise for the estimation of exhumed persons’ stature than the models compared, except for the formula for tibia, where the Sarajlić’s formula proved to be more accurate. Key words: Forensic anthropology, stature estimation, Bosnian population, Bayesian analysis.

Sažetak U procesu identifikacije ekshumiranih posmrtnih ostataka osnovu predstavlja određivanje biološkog profila, u sklopu kojeg je i procjenjivanje visine kao jedan od najvažnijih parametara. Od 1996 godine na području Bosne i Hercegovine procjenjivanje visine ekshumiranih žrtava rata, vršeno je na osnovu formula dobijenih ispitivanjem na američkoj populaciji. U ovoj studiji procjenjivanje visine je izvršeno primjenom Bayes-ove analize na 105 ekshumiranih i identificiranih osoba muškog spola sa područja sjevero-zapadne Bosne, i to 78 lijevih humerusa, 105 lijevih femura, 96 lijevih tibija i 80 lijevih fibula. Kao referentni uzorak korišteno je 369 osoba iz Sarajlićeve studije. Primjenom Bayes-ove analize su razvijene formule za procjenjivanje visine, koje su komparirane sa formulama dobijenim po Ross-ovoj i Konigsberg-u, te Sarajliću i suradnicima. Rezultati su pokazali da formule razvijene u ovoj studiji preciznije procjenjuju visinu ekshumiranih osoba u odnosu na komparirane modele, izuzev formule za tibiju, gdje se Sarajlićeva formula pokazala tačnijom. Ključne riječi: forenzička antropologija, procjena visine, bosanska populacija, Bayes-ova analiza 187

Journal of Society for development of teaching and business processes in new net environment in B&H

Since 1996. although the authors themselves warned about the injudicious use of population specific formulae on other populations. as well as from 177 exhumed men killed during war operations in the territory of Bosnia and Herzegovina and Croatia (7). Maximum lengths of all four bones were measured (9). victims of the recent war. using these data as reference samples. based on which formulae for stature estimation were developed on the basis of the length of long limb bones. 188 In their study. thereby contributing to more imprecise estimation of the stature of small and tall persons. which implies the determining of sex and the estimation of age and stature. A lower non-explained variability meant the prediction model was more reliable and more accurate. a need arose for the development of formulae that would give smaller deviations and more precise data. 96 left tibia. Journal of Society for development of teaching and business processes in new net environment in B&H . The stature of persons while still alive was obtained based on antemortem data collected from their families.Volume 2 / Number 4 / 2008 Introduction In the course of the recent war in Bosnia and Herzegovina (1992-1995). Stature estimation formulae developed from the Bosnia and Herzegovina population were being obtained by a regressive analysis method (6). which was the main objective of this study. Ross and Konigsberg presented new formulae for estimation of the stature of people from the Balkans by applying a Bayesian analysis and using bones of unidentified Bosnians and Croats. Due to an insignificant difference in the length of the left and right side of the skeleton.000 persons is still going on. as well as about the obligatory taking into account a secular trend in the development of a population (4). 105 left femurs. more than 30. In addition to the aforementioned. the length of long limb bones were being obtained through readings of x-ray photographs of cadavers. The data were processed by applying descriptive statistics. In addition to DNA analysis.2). Even today identification is greatly hampered by a large number of mixed skeletal remains exhumed from mass graves and especially from secondary and tertiary mass graves (1.HealthMED . they used samples from 545 white persons from World War II. which also could have influence on obtaining of precise results (6). the Trotter and Gleser’s formulae (3) developed from American Whites have been used to estimate the stature of the Bosnia and Herzegovina population. The development of a sceleton is influenced by many factors which make differences in the proportion of bones in different geographical areas and it is these features that provide for a possibility to establish differences among populations.000 persons went missing and the search for more than 10. Data on the length of bones and the stature of 369 exhumed and identified persons from the Sarajlić and associates’ study were taken as a reference sample (10). The prediction based on the Bayesian analysis from this study was compared with the models presented by Ross and Konigsberg (7) and Sarajlić and associates (10). through calculation of non-explained variability. Stature estimation is one of the most important procedures in the forensic-anthropologist analyses of skeletal remains. In 2002. the following was used for research: 78 left humeri. regressive-correlative analysis and models as per Bayes’ Theorem. they were using data from literature (8). the left side was arbitrarily taken for the research. which is considered to give more distinctive variations as the distance from the mean value is greater. Since not all the persons had all the bones. identification also implies the designing of a biological profile. Everything mentioned thus far indicates to the necessity of developing models for estimating exhumed male persons’ stature based on a Bayesian analysis and their correlation with the formulae obtained by Sarajlić and associates (6) and Ross and Konigsberg (7). Materials and methods The research included 105 exhumed and identified male persons from the territory of the northwest Bosnia at the age ranging from 19 to 65 years. Therefore. 80 left fibulas. groups and individuals (5). As they did not have data on the stature of the exhumed persons while still alive.

018 Lfib +/. LT: left tibia Graph 3. which.is a stature variant in an analysed (target) sample .52 ŝ = 55.is a stature variant in a reference sample r .58 + 3. is applied for stature estimation based on the length of long bones.58 ŝ = 61. is as follows (7) where: α and β – are coefficients of a simple linear regressive model with stature as an independent variable and the length of bones as a dependant variable in a reference sample . tibia (LT) and fibula (Lfib).94 Deviations of performed estimations from original measurings from the sample are graphically presented by dispersion clouds. Comparison of original data with estimation for femur Based on the above presented application of the Bayes’ Theorem.59 LH +/.744 LT +/.3. with the indication of standard error in estimation (+/-): ŝ = 55.663 LF +/. Comparison of original data with estimation for fibula 189 Journal of Society for development of teaching and business processes in new net environment in B&H . Comparison of original data with estimation for tibia Lfib: left fibula Graph 4.3.actual value of the length of a bone for an observed case LH: left humerus Graph 1.4. femur (LF).is a coefficient of a simple linear correlation between the stature and the length of a bone for a reference sample lb .62 ŝ = 70. Comparison of original data with estimation for humerus LF: left femur Graph 2.Volume 2 / Number 4 / 2008 Results The formula.66+2.77 + 3. as per Bayes’ Theorem.is mean stature in an analysed sample . formulae for predicting stature were developed based on the length of long bones (in centimetres) for humerus (LH).3.75 + 2.HealthMED .

and according to Sarajlić 117. which is in compliance with todates researches (3. secular trend in the development of a population and. It follows from the aforementioned that the smallest standard er190 ror was obtained when applying the formula using the tibia length.HealthMED . Predictions based on humerus gave the following results in terms of non-explained variability: according to the prediction from this study – 231. the least precise stature estimation was obtained when applying the formula using the humerus length for stature estimation.Volume 2 / Number 4 / 2008 In order to numerically test whether the prediction based on the Bayesian analysis from this study gives more reliable (more precise) data compared to the models presented by Ross and Konigsbergu (7) and Sarajlić (10).7. The comparison with the Sarajlić and associates’ model was not possible. Predictions based on fibula gave the following results in terms of non-explained variability: according to the prediction from this study – 114. The difference in results is probably the consequence of parameters they used in their study.524. a non-explained variability was calculated. fibula (3.7. consequently. Predictions based on femur gave the following results in terms of non-explained variability: according to the prediction from this study – 1662. Identical results were obtained when predicting stature based on the femur length. according to Ross and Konigsberg – 563.621 compared to the Ross and Konigsberg’s model in which it amounts 451.558. estimation of exhumed male persons’ stature was carried out based on the length of long bones of both extremities. When prediction based on humerus was concerned. They made a study on the Balkan population and had at their disposal the length of the bones of exhumed persons from Bosnia and Herzegovina and Croatia. and according to Sarajlić – 196. The male sex was included as the largest number of missing persons in Bosnia and Herzegovina is of male sex. according to Ross and Konigsberg – 2088.394. However. The greatest standard error and. Although Ross and Konigsberg used a Bayesian analysis in their study. and according to Sarajlić – 1885. formulae for stature prediction were obtained based on a Bayesian analysis.621.569. because they did not present formulae for humerus. 7) indicating that stature estimation is more precise when the length of long limb bones is used. When applying formulae on samples used in this study.569.19. femur (3. Predictions by tibia gave the following results in terms of non-explained variability: according to the prediction from this study – 275. A lower non-explained variability means the prediction model is more reliable and more accurate. The non-explained variability as calculated as per the model from this study was 1662. and according to Ross and Konigsberg 451. the comparison of the model from this study with the Ross and Konigsberg’s model showed that the non-explained variability is smaller when stature estimation is carried out based on the model from this study and it amounts 231.58).53). They used data on American Whites from World War II as a reference sample. In order to test whether the prediction based on the Bayesian analysis and resulting from this study gives more precise data on stature estimation compared to other prediction models. they did not have data on the actual height of the exhumed persons for whom they had data on the length of the bones and used data from literature (8) instead. Discussion In this research. tibia (3.94). probable non-relevance of data they applied as reference samples are possible reasons for greater deviations in the application of their formulae compared to the results in this study. which means that the use of tibia gives most precise results in stature estimation.302. This way.506. deviations are evident when compared with this study in which the same model was used.62). consequently. a non-explained variability or mean square deviation (MQD) was calculated as per the following model: non-explained variability = ∑ (soriginal – ŝobtained through estimation)2 number of actual measurings The obtained expression for the non-explained variability is in direct relationship with the deviation in estimation from the original measuring. Differences among populations. the standard error was: for humerus (4.18. as per the Sarajlić and asso- Journal of Society for development of teaching and business processes in new net environment in B&H .

2002. Hardbound: Academic Press. Trotter M. Am J Phys Anthrop. Estimation of stature from long bones of American Whites and Negroes. 6(1): 62-67. 6(1): 62-67. The comparison of results for fibula was possible only with the formulae developed by Sarajlić and associates. Data collection procedures for forensic skeletal material. 2006. Cihlarž Z. 2004. Gleser GC. New formulae for estimating stature in the Balkans.com Journal of Society for development of teaching and business processes in new net environment in B&H 191 .18.Volume Set.1885.19. Gleser GC. All formulae developed in this study give more precise estimation of exhumed persons’ stature compared to the formulae developed by Ross and Konigsberg on the Balkan population. 8. 5. 4. when comparing models from this study with the models developed by Ross and Konigsberg and Sarajlić and associates. Moore-Jansen PH. 1994. CRC press. A possible explanation for the obtained results of comparison for tibia. obnovljeno i dopunjeno izdanje (Zečević D and Associates. The University of Tennessee. New York. 2. Three. 10: 463-514. 47(1): 165–167. with the utilization of regression analysis (10). Corresponding author: Anisa Masovic Institut of Forensic Medicine. Janty RL. Selak I. Medical School. 1997. Secular trend in growth of schoolchildren in Yugoslavia. A reevaluation of stature based on measurements of stature taken during life and of long bones after death. Konigsberg LW. University of Sarajevo Bosnia and Herzegovina e-mail: anisa_mas@hotmail.2088.HealthMED . the most precise results in stature estimation were obtained when applying the formulae developed in this study. Zagreb. The effect of ageing on stature. and as per Ross and Konigsberg’s model . 1-3. 2008.Volume 2 / Number 4 / 2008 ciates’ model . 1951. Predictions based on tibia. Conclusion The results of research show that stature estimation based on the length of humerus. Sarajlić N. X-ray measurings of the tibia length. Paediatr Croat. 9: 311-324. Zečević D. Ross AH. 6. Sarajlić N. Selak I. 3. Klonowski EE. p 189-191. 52 (1): 25-35. Knoxville. Saukko P. Klonowski EE. William G. 11. Encyclopedia of Forensic Sciences. Bosn. 12. Gleser GC. Cihlarž Z. Trotter M. Coll Anthropol. 1988. where the formula developed by Sarajlić and associates proved to be the most precise one. Tomazo-Ravnik T. Bralić I. Basic Med Sci. Stature estimation for Bosnian male population. J Forensic Sci. which were used by Sarajlić and associates. Eckert. Bosn. 1958. 12: 121–33. perhaps lies in the fact that tibia is a bone that is most difficult to measure.. femur and fibula by applying Bayes’ Theorem is more precise compared to the models developed by Sarajlić and associates. J Basic Med Sci. as Ross and Konigsberg did not use this bone. 1 edition. 2006. show that the lowest values of non-explained variability were obtained by using the Sarajlić and associates’ model. 48. Introduction to forensic sciences. Ousley SD. 4. 1952. Knupfer G. which indicates to the necessity of developing adequate models specific for a population. Trotter M. Stature estimation for Bosnian male population. Sigel J. Sekularne promjene rasta i razvoja (Secular Changes in Growth and Development). Literature 1. Only stature estimation based on the length of tibia and utilizing regressive analysis gives more precise results than this research. consequently. Forensic Medicine and Deontology. 7. Am J Phys Anthrop. p 252-284. with the utilization of the regression analysis. Am J Phys Anthrop. 2000. i suradnici. 10. The lowest values of non-explained variability and. J. 9. could have been more precise than the measuring of the tibia length carried out on an osteometric table and used in this study. Sudska medicina i deontologija. Report of investigations no. 4th reprinted and supplemented edition). 16:79-123. The obtained results confirm that the formulae obtained by applying a Bayesian analysis on Bosnia and Herzegovina population give statistically more precise results in the estimation of the stature of exhumed male persons in Bosnia and Herzegovina than the previously derived Ross and Konigsberg’s models on the Balkan population (7) and Sarajlić’s models. they were followed by those based on this study and the greatest were those using the Ross and Konigsberg model.

prothrombin time. alanine-amino transferase (ALT). gamma-glutamyl transpeptidase (GGT). Journal of Society for development of teaching and business processes in new net environment in B&H . hyperlipidemia Sažetak Uvod: Jetra igra važnu ulogu u metabolizmu glukoze i masti. University of Tuzla. Postoji uzajamni odnos između bolest jetre i dijabetesa. Sabina Nuhbegovic1 1 2 Department of physiology. conjugated and unconjugated). 192 Conclusion: Poorly regulated glucose homeostasis and hyperlipidemia may contribute to liver injury. aspartate-amino transferase (AST). To analyze liver function we have measured following parameters: bilirubin (total. Aim of this research was to analyze the liver function in patients with diabetes mellitus type 2 and hyperlipidemia. alkaline phosphatase (ALP). Abnormalnosti metabolizma masti. liver function. glukoze mogu biti posledica bolesti jetre i obrnuto. Data have been analyzed by Student t. konjugovani i nekonjugovani). Bosnia and Herzegovina Summary Introduction: Liver plays an important role in metabolism of glucose and lipids. There is a mutual relation between liver disease and diabetes. Za procjenu stanja funkcije jetre u svim grupama pacijenata urađena je analiza slijedećih funkcionalnih parametara: bilirubini (ukupni. aspartat-amino transferaza (AST).Volume 2 / Number 4 / 2008 Liver function in patients with diabetes mellitus type 2 and hyperlipidemia FUNKCIJA JETRE U OBOLJELIH OD DIJABETES MELITUSA TIP 2 I HIPERLIPIDEMIJOM Farid Ljuca1. from time to time. HbsAg. Key words: diabetes mellitus type 2. albumin. Medical faculty. Pacijenti i metode: Ovo istraživanje je retrospektivno-prospektivna studija u kojoj je analizirano 120 pacijenata koji su podijeljeni u 2 grupe: 1) oboljeli od dijabetesa tipa 2 sa hiperlipidemijom (n=60). antiHbsAg. 2) oboljelih od dijabetesa tipa 2 sa normalnim lipidnim statusom (n=60). Cilj ovog istraživanja je bio analizirati funkciju jetre u oboljelih od dijabetesa tipa 2 sa hiperlipidemijom. Patients and methods: This research has been retrospective-prospective study in which 120 patients have been analyzed divided into 2 groups: 1) patients with diabetes mellitus type 2 and hyperlipidemia (n=60). Esad Alibasic2. screening of liver function and lipid profile in patients with diabetes mellitus type 2. U ovu studiju su uključeni samo oni oboljeli od dijabetesa tipa 2 koji su na terapiji više od dvije godine. Dom zdravlja Kalesija. In this study only patients who had diabetes mellitus type 2 diagnosed more than two years were included. antiHCV. Chi square or Fischer’s test Results: This study has shown that liver function in patients with diabetes mellitus type 2 and hyperlipidemia was more injured than in those with normal lipid status. It is necessary to make. Lipid and glucose metabolism abnormalities may be a consequence of liver disease and reverse. 2) patients with diabetes mellitus type 2 and with normal lipid status (n=60). Bosnia and Herzegovina Family medicine department.HealthMED .

25% fibrosis and 1–8% cirrhosis (8). Incidence of cirrhosis in diabetic patients is increased. In patients with diabetes mellitus type 2 with or without obese. Patients and methods Patients This research has been retrospective-prospective study in which 120 patients have been analyzed divided into 2 groups: 1) patients with diabetes mellitus type 2 and hyperlipidemia (n=60). Diabetic patients develop macrovascular complications such as: coronary artery disease. Non-alcoholic steatohepatitis (NASH) is a variant of liver steatosis in that beside lipid accumulation in hepatocites there is lobular inflammation and steatonecrosis. HbsAg. and 80% patients with cirrhosis have glucose intolerance (9). funkcija jetre. Spectra of clinical symptoms in patients with liver steatosis and steatohepatitis vary from asymptomatic increase of liver enzymes to severe liver disease with fibrosis and nodular regeneration. Mallory bodies similar to those seen in alcoholic liver disease. gama-glutamil transpeptidaza (GGT).Volume 2 / Number 4 / 2008 alanin-amino transferaza (ALT). Patients with NASH may develop progressive liver disease and complication such severe that liver transplantation is needed (7). lipid synthesis increased and lower level of oxidation and decreased lipid outtake from the liver. antiHbsAg. neuropathy and foot problems (2). but mechanism is that long-term of lacking of insulin facilitates glycogen synthase activity. The most frequent clinical symptom is hepatomegalia. protrombinsko vrijeme. antiHCV. There is high prevalence prevalence of NASH in patients with diabetes mellitus type 2 treated by insulin (6). NASH should be considered as a cause of chronic increase of liver enzymes in asymptomatic diabetic patients especially in those who are obese and with hyperlipidemia. 2) patients with diabetes mellitus type 2 and with normal lipid status (n=60). and the most patients have normal or mild abnormal transaminase level and normal serum bilirubin level. Aim of this research was to analyze the liver function in patients with diabetes mellitus type 2 and hyperlipidemia. alkalna fosfataza (ALP). Lipid and glucose metabolism abnormalities may be a consequence of liver disease and reverse. Glycogen synthesis in the liver of diabetic patients at the onset of disease is insufficient due to abnormal activation of glycogen sinthase. Usporedba između ispitivanih grupa pacijenata je napravljena pomoću Studentovog t testa za kontinuirane varijable i Hi kvadrat ili Fisher-ovog testa za kategoričke varijable. nephropathy. Diabetes mellitus increases risk for steatohepatitis that can progresses in cirrhosis (10.HealthMED . hiperlipidemija Introduction Liver plays an important role in metabolism of glucose and lipids. 30% of them have liver steatosis and inflammation. In addition to that gluconeogenesis increased lead to glycogen accumulation (3). Potrebno je napraviti povremeni skrining funkcije jetre i lipidnog statusa u oboljelih od dijabetesa tipa 2. There is a mutual relation between liver disease and diabetes. albumin. In this study only patients who had diabetes mellitus type 2 diagnosed more than two 193 Journal of Society for development of teaching and business processes in new net environment in B&H . In diabetic patients having steatohepatitis. Level of glycemia control correlates with lipid accumulation (4). Steatosis can be microvesi- cular and macrovesicular and it may progress into fibrosis and cirrhosis. Rezultati: Ovo istraživanje je pokazalo da je funkcija jetre u oboljelih od dijabetesa tipa 2 sa hiperlipidemijom je više oštećena nego u onih sa normalnim lipidnim statusom Zaključak: Loše regulirana glikemija i hiperlipidemija mogu dovesti do oštećenja funkcije jetre. Glycogen accumulation in the liver has been observed in 80% diabetic patients. 11). cerebrovascular disease and peripheral vessels disease (1) and microvascular complications such as: retinopathy. Liver biopsy is obviously the best method for detection of lipid accumulation in the liver (5). Ključne riječi: dijabetes melitus tip 2. Glycogen accumulation in the liver is wellknown complication in diabetes is observed in 40–70% cases. NASH is most frequent in obese diabetic patients. Lipids are accumulated in triglyceride form and it might be duo to increased lipid intake lipids in the liver. In patients with chronic diabetes Glycogen accumulation in the liver is present.

Figure 1. Serum GGT level in patients with DM 2 and increased serum lipid parameters Figure 4. Results Serum concentration of aspartat aminotransferase (AST) was higher in patients with DM 2 having increased level of lipid status parameters than in those with normal ones (p<0.Volume 2 / Number 4 / 2008 years were included. Figure 5. It has been done at Department Radiology. Chi square or Fischer’s test. Serum AST level in patients with DM 2 and increased serum lipid parameters Serum level of ALT was statistically higher in patients with DM 2 and increased serum lipid parameters than in those with normal ones (p<0. Data have been analyzed by Student t. alkaline phosphatase (ALP). Serum level of ALT in patients with DM 2 and increased serum lipid parameters 194 Journal of Society for development of teaching and business processes in new net environment in B&H .001). UKC Tuzla. aspartate-amino transferase (AST). Serum ALP level in patients with DM 2 and increased serum lipid parameters Platelets counts in serum in patients with DM 2 and increased serum lipid parameters and in those with normal ones have not been statistically different. gamma-glutamyl transpeptidase (GGT). Figure 2. albumin. To all diabetic patients blood glucose level (fasting and 2 hours postprandial) and HbA1c have been measured. antiHCV.0001). To analyze liver function we have measured following parameters: bilirubin (total.HealthMED . prothrombin time. antiHbsAg. All tests have been measured routine methods on AR and Dimension RxL devices at UKC Tuzla. Ultrasonography has been done to determine presence of steatohepatitis. alanine-amino transferase (ALT). Platelet count in patient with DM 2 and increased serum lipid parameters Prothrombine time was in referent range and had no difference among values in patients with DM 2 and increased serum lipid parameters and in those with normal ones. conjugated and unconjugated). HbsAg. Figure 3. There was no difference between serum levels GGT and ALP in patients with DM 2 and increased serum lipid parameters and in those with normal ones.

Volume 2 / Number 4 / 2008 Figure 6. ALT and conjugated bilirubin le195 Journal of Society for development of teaching and business processes in new net environment in B&H . Serum total bilirubin level in patients with DM 2 and increased serum lipid parameters There were no statistically significant difference between serum unconjugated bilirubin levels in patients with DM 2 and increased and normal serum lipid parameters. Figure 9. Figure 10. Serum unconjugated bilirubin level in patients with DM 2 Serum conjugated bilirubin level in patients with DM 2 and increased serum lipid parameters was statistically higher than in those with normal serum lipid parameters (p<0. triglycerides and cholesterol level and serum AST.HealthMED . anti HbsAg and anti HCV cases in patients with DM 2 and increased serum lipid parameters and in those with normal ones. however in all patients level was in referent range. Serum protein level in patients with DM 2 There was no difference among negative and positive HbsAg. Figure 8. Prothrombin time in patients with DM 2 and increased serum lipid parameters Serum bilirubin level in patients with DM 2 and increased serum lipid parameters was statistically higher than in those with normal ones. serum LDL. Figure 11.001). Serum conjugated bilirubin level in patients with DM 2 There was no difference among serum protein and albumin levels in patients with DM 2 and increased serum lipid parameters and in those with normal ones. Serum albuminlevel in patients with DM 2 There was positive correlation among Hb1c. Figure 7.

Due to additional risk of hyperglycemia and hyperlipidemia for cardiovascular and other diseases.57 0. The strongest level of correlation was among Hb1c. screening of liver function and lipid profile in patients with diabetes mellitus type 2. from time to time. serum LDL. Discussion Diabetes mellitus (DM) is one of the most frequent metabolic disease causing micro. serum lipid parameters and liver functional parameters in patients with DM 2 Liver functional parameter AST ALT Conjugated bilirubin Hb1c LDL 0. HDL and conjugated bilirubin (table 1).71 vels. 17). nephropathy.69 -0. cerebrovascular disease and peripheral vessels disease (1) and microvascular complications such as: retinopathy. they should be tested in DM (13). Other liver functional parameters did not correlate with Hb1c and serum lipid parameters in patients with DM 2. ALT and conjugated bilirubin were higher in patients with DM 2 having increased level of lipid status parameters than in those with normal ones There was positive correlation among Hb1c. There was negative correlation among Hb1c.91 HDL -0. ALT and conjugated bilirubin). Correlation among Hb1c. Several research studies have shown similar results about additional harmful effect of abnormal lipid metabolism on the function of different organs in patients with DM (14. LDL and conjugated bilirubin. The strongest level of correlation was among Hb1c.Volume 2 / Number 4 / 2008 Table 1. HDL and liver functional parameters (AST.HealthMED .75 Triglycerides 0. The strongest level of correlation was among Hb1c.64 0. neuropathy and foot problems (2). 15. HDL and conjugated bilirubin.16. LDL and conjugated bilirubin (table 1). ALT and conjugated bilirubin le196 vels. ALT and conjugated bilirubin).58 0.52 0. Patients with DM develop macrovascular complications such as: coronary artery disease. HDL and liver functional parameters (AST.72 0. metabolism abnormalities and their influence to function of different organs.86 0.73 Cholesterol 0. All complications develop faster and they are more severe if patients with DM have hyperlipidemia. Our results have shown negative correlation among Hb1c. This study has shown that liver function in patients with diabetes mellitus type 2 and hyperlipidemia was more injured than in those with normal lipid status. It is necessary to make.60 -0. Conclusion Poorly regulated glucose homeostasis and hyperlipidemia may contribute to liver injury. Serum concentration of AST. triglycerides and cholesterol level and serum AST.and macrovasculcar complications (12). Journal of Society for development of teaching and business processes in new net environment in B&H . The strongest level of correlation was among Hb1c.

Shamsi TS. Manfredini G. J Hepatol 32(2): 209-17. Norris JR. 6. 17. 14. Lipid management--treatment goal and strategy. Khazanie PG. Lund SS. Kreider M. Sustained postprandial decrease in plasma levels of LDL cholesterol in patients with type-2 diabetes mellitus. Nippon Rinsho. 2008. Curr Treat Options Neurol 6: 443-450. Vaag AA.7(3):228-34. 2007. Khan SR. or cholestatic disease. Gastroenterol 5: 316-329. Nawab S. Diabet Care 26(suppl 1): S5-S20. Afkhami-Ardekani M. Katbamna B. 2007. Koshiyama H. Egan KS. Tavill AS (1997) Nonalcoholic fatty liver (NASH syndrome). Ferrannini E. Gastroenterol 107: 1103-1109. Long S. Indian J Med Res. Caro JF (1990) Liver pathology in morbidly obese patients with and without diabetes. Baig NA. 2006.126(5):471-4. VandeWerve G (1990) Influence of long-term diabetes on liver glycogen metabolism in the rat. Beckman JA (2002) Diabetes and atherosclerosis. Zein NN. Bacon BR. Pories WJ. Silverman JF. Shojaoddiny-Ardekani A. Triglyceride profile in dyslipidaemia of type 2 diabetes mellitus. Kernan WN. Chapman MJ. 4. Rubin R (2001) Liver disease and diabetes mellitus. Clin Lab Med 21(1): 193207. 5. Amarapurkar D. 8. Trop Gastroenterol 23(1): 3-5.Volume 2 / Number 4 / 2008 Literature 1. Herrine SK. Wiesner RH.HealthMED . 10. O’Brien KF. 13. Rohner-Jeanrenaud F. JAMA 287: 2570-2581. Leggett N. Anonymous (2003) The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Abdulkarim AS. Lanfranchi A.ba Journal of Society for development of teaching and business processes in new net environment in B&H 197 . Smidt UM. Samaha FF. Jensen T. Persing DH (2000) Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C. Diebet Care 25: 815-821. 16:1-14. serum lipids & serum insulin in type 2 diabetes patients.18(5): 270-3.ljuca@untz. 3. Neuschwander-Tetri BA (1994) Nonalcoholic steatohepatitis: an expanded clinical entity. Parving HH. 2. Inzucchi SE (2004) Type 2 Diabetes Mellitus and Insulin Resistance: Stroke Prevention and Management. 15. Lebovitz HE. Gadi R. 7. 2007. Freed MI (2002) Evaluation of Liver Function in Type 2 Diabetic Patients During Clinical Trials. Scand J Clin Lab Invest. Janney CG. Frandsen M. J Coll Physicians Surg Pak. 64(11):21026. 12. Farahvash MJ. 2008. O’Connor BJF. Petersen M. Diab Vasc Dis Res. 11. 16. Curr Diab Rep. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. 4 Suppl 3:S5-8. Das HS (2002) Chronic liver disease in diabetes mellitus. Metabol 39: 1082-1088. alcohol. Am J Gastroenterol 85:13491355. Dyslipidemia in type 2 diabetes mellitus. Metabolic syndrome and type 2 diabetes: lipid and physiological consequences. Ayub N. Corresponding author: Farid Ljuca Zavod za fiziologiju Medicinski fakultet Bosna i Hercegovina e-mail: farid. Effect of vitamin C on blood glucose. 9.

kao i zaštitni faktori u ishrani. and questions related to the consumption of specific nutritive are alimentation. Those are especially beans’ fibers. The data was collected by using anonymous questionnaire. village. alimentation. Results: Incidence of lung cancer was significantly higher among interviewees living in rural areas in comparison to the ones living in urban areas (63% vs. grapefruit. as well as protective factors in alimentation. Metode: Ispitanike je činilo 200 pacijenata Klinike za plućne bolesti Tuzla. fish (OR=1. olives etc.HealthMED . Key words: nutritive factors. There were no significant differences between experimental and control groups by age and sex. The research is conducted with the aim of identifying risk.38). Those are related to the occurrence of lung cancer at Tuzla Canton interviewees. the one serving as predictor for develop198 ment of lung carcinoma was deficiency of olives (OR=1. It seems that the greatest obstacle at choice of nutritive which would act as protective factors for the development of lung cancer is low social status. month and year. Among nutritional factors. grapefruit (OR=1.Volume 2 / Number 4 / 2008 Dietary factors as protectors or predictors for lung cancer: survey control study FAKTORI ISHRANE KAO ZAŠTITNI FAKTORI ILI FAKTORI RIZIKA ZA KARCINOM PLUĆA: PREGLEDNO KONTROLNO ISTRAŽIVANJE Suvad Dedic¹. week.30%.001). Control group were hundred patients who did not have lung cancer disease.45) and garlic luk (OR=1.001). Bosnia and Herzegovina ² Department of Occupational Medicine. a koji su u vezi sa nastankom karcinoma pluća u ispitanika Tuzlanskog kantona. garlic. as well as differences between environments one lives in.26). Bosnia and Herzegovina Summary Introduction: It is estimated that one third of the lung cancers is due to the nutritional factors. Eksperimentalnu skupinu činilo je 100 pacijenata kojima je dijagnosticiran karcinom pluća. so that ones with worse social status were lung cancer patients (Z=-4.916. Conclusion: Lung cancer can be prevented by consumption of adequate alimentation rich with protective factors. Nurka Pranjic² ¹ Clinic of lung disorders and tuberculosis. P =0.47). University Clinic Centre Tuzla. Experimental group were hundred patients with lung cancer disease. city vs. Sažetak Uvod: Procijenjeno je da su faktori ishrane odgovorni za nastanak jedne trećine karcinoma pluća. P=0. There is a significant difference among different social statuses. and amount of consumption of them. Medical school University of Tuzla.demographic. Methodology: Interviewees were two hundred patients of the Tuzla Lung Diseases Clinics. lung cancer. Istraživanje je provedeno s ciljem da se otkriju faktori rizika. Time span for the consumption of nutritive was a day. It contains social . a kontrolnu skupinu 100 pacijenata kojima nije dijagnosticiran karcinom Journal of Society for development of teaching and business processes in new net environment in B&H .

calcium. Spinach contains glutathione. the enzyme that has the protective characteristic against the oxidative damage of the tissue. (1) Selene present in the food decreases the occurrence of the chemical induced tumors on few locations. as well as the lung is increasing (5).Volume 2 / Number 4 / 2008 pluća. salty. increases the produce of the collagen. Fruits and vegetables represent protective factors in the development of the lung cancer because of the contents of the useful ingredients (carotenoids. ishrana. mjesečnoj i godišnjoj učestalosti unosa i količini istih.26).demografska pitanja.oxidant effects and by the degradation of the free radicals that contributes to the decreasing of the substances that are the potential causes of the cancer in the human body. Prediktori za razvoj karcinoma pluća među faktorima ishrane su smanjen unos zaštitnih faktora u ishrani: masline (OR=1. (1-2) Specific micro nutrition such as retinol.001). The plant fibers are shortening the exposition time of the potential carcinogens decreasing the time of the food passing through the intestinal tract (3). Podaci su prikupljeni upotrebom anonimnog upitnika.grad. they have stronger protective role when continuously consumed.alicin. greasy and fried food represent the risk factors for the occurrence of the cancer of the abdominal organs. Broccoli contains three active protective substances that inactivate carcinogen compounds: sulphoraph. and the protection depends on the doses/ amount of the intake of those protectors (4-5). Big part of different types of cancers is potentially related to the nutrition habits and factors. Rezultati: Značajno veća učestalost karcinoma pluća bila je zastupljena u ispitanika koji su živjeli na selu u odnosu na one koji su živjeli u gradu (63% vs. but it can be rightfully said that nutritional factors can modify its process. Considering the different cultural nutrition habits in different countries we can talk about the international risks as well as the protective factors of cancer (2). 199 Journal of Society for development of teaching and business processes in new net environment in B&H .HealthMED . The mechanism of the nutrition effect to the development of the carcinogenesis has not been illuminated yet. E.916. D and E vitamin. C and minerals. grašku zatim grejfruta. bijelog luka. all carotenoids and Vitamin C are considered the protective factors in the development of the lung cancer (4-7). Protective characteristics of the vitamins can be explained by the anti. Zaključak: Kacinom pluća se može spriječiti odgovarajućim unosom zaštitnih faktora u ishrani naročito vlakana u grahu. 30%. vitamins A.) Because of the insufficient intake of the fruit and vegetable the risk of getting the cancer of many organs. Ključne riječi: faktori ishrane. sedmičnoj.carabinol. alcohol. pitanja u vezi sa unosom pojedinačnih nutritijenata u ishrani.licopen. P =0. whereby obstructs the penetration of the malignant cell in the environment. and the onion .38). carrot retinol and beta carotene.45) i bijeli luk (OR=1. Vitamin E. kao i razlike u odnosu na mjesto življenja selo.001). Vitamin C inactivates O2 radicals at the cell level. Potential protective vitamins characteristics are at the centre of the investigation at present.47). Pickled vegetables. tomato . so it is estimated that the nutritious factors are responsible for the one third of the cancer occurrence (13). especially the A. grejpfrut (OR=1. riba (OR=1. Vitamin A controls the growth and the differentiation of the cells (decreases the risk of the development of the gastrointestinal and respiratory cancer). Selene compounds have antioxidant characteristics and the important role in the metabolism of the glutathione-peroxidaze. but not the lungs (4). selenium block the process of the carcinogenesis. karcinom pluća Introduction Epidemiological studies indicate the strong relation between the nutritious factors and the occurrence of the particular types of cancer. It is assumed that 30 % of cancer mortality could be evaded by the modification of the eating habits through one’s life. P=0. Pacijenti koji su imali lošiji imovinski status imali su signifikantno veću učestalost oboljevanja od karcinoma pluća u odnosu na one sa boljim imovinskim statusom (Z=-4. C. Između kontrolne i eksperimentalne skupine nisu postojale signifikantne razlike po dobi i spolu. maslina i drugih. a prema dnevnoj. Theoretically. citrus fruit bioflavonoid and vitamin C. buraniji. beta-carotene and indol . Čini se da najveći problem u odabiru namirnica koje bi bile protektivni faktor za razvoj karcinoma pluća čini loš imovinski status stanovništva. koji sadrži socio.

1 x monthly. vitamins in supplements 200 ( how often: never. 1x weekly.HealthMED . 2-4 x weekly. 8-10). Subjects and methods Control study involved 200 patients who are cured at the Clinic for the lung diseases and tuberculosis University . Multivariate analysis of variance (ANOVA. Control group was formed of 100 examinees that are not diagnosed with the lung cancer. half of plate. Experimental group was formed of the incidence diagnosed with the lung cancer. or peas(contain fibers). fish. Statistical analysis During the statistical analysis of the results standards method of descriptive statistics were used (central tendency and dispersion measures).05. In Bosnia and Herzegovina. milk. 5-6 x weekly. 2-5 olives (regular consumption frequency . Therefore. 2-4 x weekly. 1-3x monthly. half of plate –broccoli.6 x weekly and daily). peas.Volume 2 / Number 4 / 2008 by the decreasing of the excretion of the tertiary galls and fatty acids (6-7). lettuce. 1-2 dcl natural fruit juice-lemon. lentil. blackberry. fruit and vegetables) help in elimination of the toxins in the body. pepper. 5-6 x yearly. education.never. and daily). age. daily). Habits. ( regular consumption frequencynever. intake of one plate of beans. location. Through the answers to the questions the intake of the fruit and vegetables.types of nutritionist or micro nutritionist were created in accordance to the questionnaires done before for the conducted research (3-10). spinach. bulb. 1-3x monthly. lentil. and contains one of the next components: vitamins. 1-3x monthly. 1x weekly. Research has been done by the method of the poll. herbs. egg plant. 5. multivariate regression analysis) was performed to test the relationship between predictive variables (13. 1x weekly. and in that way protect from the cancer (4. 1-3 x yearly. The results were presented as regression coefficient β (R). The other part of the questions referred to the evaluation of the food.never. raspberry. Diet enriched by the fibers (bean. 56x weekly. The first part of the questions was made of the questions containing: demographic information (gender. family history of the lung cancer. Supplements to the diet are every active substance that is taken orally for the sake of diet enrichment. Journal of Society for development of teaching and business processes in new net environment in B&H . ages 50-79 (77%). banana. 2x yearly. total carotenoids. answers about the regular menu of the 13. has been estimated. the continuing increase of the incidence and the death rate of the lung cancer are noted. intake: intake half of plate –fresh. 2 x monthly.types of nutritionist or micro nutritionist). meat. asset. working status.clinical centre of Tuzla since the 1st January 2007 to the 31st December 2007. or medical plants. or any other malignant disease. 2-4 x weekly. Micro.76.Whitney non parametric test to assess the differences between experimental and control group subjects. (11) The aim is to identify the nutrition risk factors for the occurrence of the lung cancer and to estimate the relation of the protective nutrition factors and the lung cancer diseased in Tuzla Canton. and daily). onion. adjusted odds ratio (OR) with 95% confidence intervals (CI). We used Mann. 5-6x weekly. cultural characteristics and the assets influence the eating habits and the choice of the nutrition’s. half of plate – grapefruit. 2-4 x weekly. Reliability of the questionnaire is tested by the Cronbach alpha coefficient of the consistency and in the total sample is sufficient >70% and the sum is α = 0. orange. Statistical hypothesis were tested on the significance level of Alfa = 0. preparations ( intake frequency: 1-3 x monthly. 1 x weekly.carotene and Vitamin C protect the cells from the oxidant DNA damages.nutritionist such as retinol. fried or boiled carrot.blueberry. satisfaction with the financial situation). and daily). apple. their concentrates or extracts or their mixture (with the premises that is not the medicament). B. minerals. and the instrument of the poll was the questionnaire which has been designed specially for this research. Results Lung cancer is the disease which in Tuzla Canton has 9 fold higher incidences at male when compared to female population. tomato or carrot ( regular consumption frequency . green salad.

001).001) only in experimental when compared to control group.174.11%.819).43%. P= 0.001 0.001). patients’ group when compared to healthy group. P= 0. 86% at control cer disease have statistically significant lower group and 78% at patients group.mily history of lung cancer (82%). Significant diffeeducational level when compared to the healthy rence for family predisposition to becoming ill of (Mann.HealthMED . (P=0. ewees when compared to the group which didn’t There is significant difference in social status at have lung cancer disease (28% vs.Volume 2 / Number 4 / 2008 Lung cancer patients in a statistically significant better than majority.273. P= 0. lives in villages when compared to the patients There was significantly higher number of smokers living in the cities (63% vs. In the total sample majority has declared that there is no fa(29% vs. that is.001 Journal of Society for development of teaching and business processes in new net environment in B&H 201 . 59% estimates to be as wealtmanner belong to the pensioned group of intervi.Whitney test.001). P= 0. The interviewees suffering from the lung can.001 0. no one One of the parents Brother or sister Uncles/aunts Grandfather or his brother or sisters Other relatives Smoking status I have never smoked I quit this year I quit 2 years ago I smoked less than 10 years I smoked more than 20 years I smoked more than 30 years I have been smoking more than 40 years Control group N (%) 11 (11) 5 ( 5) 38 (38) 24 (24)* 7 ( 7)* 15 (15)* 45 (45) 43 (43) 12 (12) 6 ( 6) 29 (29) 54 (54) 8 ( 8) 3 ( 3) 0 ( 0) 86 (86) 6 ( 6) 1 ( 1) 1 ( 1) 2 ( 2) 4 ( 4) 36 (36) 7 ( 7) 2 ( 2) 17 (17) 18 (18) 13 (13) 7 ( 7) Experiment group N (%) 29 (29) 18 (18)* 46 (46)* 2 ( 2) 2 ( 2) 3 ( 3) 30 (30) 63 (63) 7 ( 7) 1 ( 1) 9 ( 9) 59 (59) 17 (17) 10 (10) 4 ( 4) 78 (78) 15 (15)* 4 ( 4) 1 ( 1) 0 ( 0) 2 ( 2) 9 ( 9) 1 ( 1) 5 ( 5) 4 ( 4) 16 (16) 29 (29) 36 (36) P 0.lung cancer was not noticed in experimental when ficantly greater incidence of lung cancer patients compared to control group (z= -1.001).hy as others.203 * Mann Whitney non parametric test 0. z= 4. Z= -6. 7%.916. and 31% practically lives in poverty.001 0. Table 1 Distribution of the interviewees (N=200) according to the demographic characteristics and the groups Demographic characteristics of examiners Educational level Uncompleted primary school Completed primary school High school Completed High school Academy Faculty Location Town Country Near the industrial facilities Financial situation compared with other Much better than the others Better then the majority Similar to the majority Somehow less then the majority Much less than the majority Much less than the rest Family predisposition for the lung cancer No. Poverty is important determito the group which didn’t have lung cancer disease nant at becoming sick of lung cancer. Signi.001. They also in a statistically significant manner be. P= 0. 10 % of lung cancer patients is well off.Lung cancer patients have worse social status (z= long less to the group of employed when compared -4.203). P=0.

The deficiency of our kitchen is in the shortage of the intake of: vegetables with fibers (beans.001 Intake of the vitamins A. Among the 60 % of the interviewees there is drinking habit of consuming the natural fruit juice in their diet.001 Intake of meat and meat products Rarely 10 ( 10) 5 ( 5) Often 90 (90) 97 (97) 0. bulbs.508 Plate of beans. raspberry. peas. and fish and increased/often intake of meat and meat products.001 Half of portion blueberry. Nutrition and micro. blueberry. As for this habit. green salad.001 Half of plate of grapefruit. very rarely: 5-6 x yearly. ± (dichotomized often and rarely): often: 1x monthly. milk and dai- Table 2 Distribution of the nutrition and micro.nutrition input and in the interviewees diet (N=200) according to the frequency and the group Fruit and vegetable* Rarely 16 (16) 13 ( 13) Often 84 ( 84) 87 ( 87) 0. there is almost no difference in taking the fruit and vegetable among the lung cancer patients and in the control group. 1-3 x monthly and never. 002 Mann Whitney non parametric test * (dichotomized often and rarely): often: 2-4 x weekly. 2x monthly and daily.HealthMED . bulb.040 Intake of milk and dairy products Rarely 13 ( 13) 5 ( 5) Often 87 (87) 95 (95) 0. green beans. lettuce. banana.001 Garlic Rarely 33 (33) 18 (18) Often 67 (67) 82 (82) 0.nutrition in a diet according to the frequency Control group N (%) Experimental group N (%) P 202 Journal of Society for development of teaching and business processes in new net environment in B&H .Volume 2 / Number 4 / 2008 Culture and eating habits of our interviewees have the next characteristics: >80 % of all interviewees consume the right amount of fruit and vegetable. spinach. blackberry. apple Rarely 48 (48) 29 (29) Often 52 (52) 71 (71) 0. lettuce.4 x weekly to daily. raspberry Rarely 75 (75) 90 (90) Often 25 (25) 10 (10) 0. C and E in a supplement± 87 (87) 96 (96) Very rarely often 13 (13) 4 ( 4) 0. but the less of half eat the right amount of carrot weekly.001 2-5 olives Rarely 75 (75) 94 (94) Often 25( 25) 6 ( 6) 0.070 Half of plate of carrot Rarely 55 (55) 66 (66) Often 45 (45) 34 (34) 0. Among the lung cancer patients 87 % are of those who have the habit of consuming the fruit and vegetable 2. pepper Rarely 21 ( 21) 25 (25) Often 79 (79) 75 ( 75) 0. peas Rarely 45 (45) 81 (81) Often 55 (55) 19 (19) 0. and lentil).091 1-2 dcL natural juice of citrus fruit Rarely 31 (31) 40 (40) Often 69 (69) 60 (60) 0. There is enough consuming of vegetables that have active substances such as broccoli. daily: 1x weekly. 5-6 x weekly.300 Half of plate of broccoli. egg plant.001 Fish Rarely 98 (98) 80 (80) Often 2 (02) 20 (20) 0. lentil. olive. green salad and pepper (75 % the right amount). blackberry. spinach. 1-3 x yearly and never. egg plant.

261.436.514 0.946 1.001 0.811 0.113 0. blackberry Grapefruit.187 0.835 0.001 0.033 0.993 0.913 0.033 0.817 0.2.952 0.HealthMED .117 0. raspberry and blackberry Often intake of grapefruit.000 P 0.678 0. C.044 (0.854) 0.001 0. banana.1..123 (0. apples Decreased intake of fish Decreased consumption of preparations vitamins A. C and E in the supplement. green beans.3.054.359 (0. lentil Olive Blueberry.587.2.001 0.986 0.177 1.959 0.846.051) 2.001 0.0.190 0..884 0. E in a supplement Garlic OR ( 95% CI) 1. E in a supplement Often intake of garlic Often consumption of meat and meat products Often consumption of milk and dairy products Model 1 β0* 0.519 (0.895) 2.993 0.852 0.687 0.001 0. C.001 0. P=0.986 0.060 0.913 1.6.624 0.006 0.857) 1. as for the frequent milk and dairy products consumption (87% vs. beans peas and lentil Decreased olive intake Decreased intake of blueberries. banana.986 1.430) 1.760. 95%. raspberry.047 (1.2.001 0.nutrition’s Fruit and vegetable Fresh.532 (0.588 (0.419.. egg plant.002) Table 4 Estimation of the relative risk for the lung cancer due to the decreased intake of the nutrition and micro. milk and their products among the lung cancer patients and the control group (P= 0.for the diseased group ±β2.685-2.973) P 0. bulbs.. peas. 4.488 (1.040).897.nutrition a diet Often intake of fruit and vegetable Decreased intake of the fresh.001 Journal of Society for development of teaching and business processes in new net environment in B&H 203 . lettuce.303 0. Beans.613) 1.590) 1.Volume 2 / Number 4 / 2008 Table 3 Predictors of the lung cancer due to the decreased intake (rare) or often intake of the significant nutrition’s and micro nutrition’s in a diet of the interviewees of the experimental and the control group. Decreased intake of green beans.006 (1. apple Fish Vitamins A.001 0.000 Logistic regression analysis *β0. There is no regular consumption of the vitamins A.619 0.002 0.503 Model 1 β2± 0.295.459) 3.5. There is statistically significant difference of the consumption frequency of the meat.322 (0.044. 657 0.926 0. Lung Cancer Intake of the nutrition or micro.260 (1.915) 2.519 0.for the control group ry products.407 0.3. fried or boiled carrot Natural fruit juice Broccoli. fried or boiled carrot Often intake 1-2 dcL natural fruit juices Often intake of broccoli spinach.812) 1.023 0.965 0.nutrition in the total sample Decreased intake of nutrition and micro. bulbs. egg plant.

That doesn’t mean that we have to stop this good habit in our diet. in Bosnia and Herzegovina diet fruit and vegetable intake is represented in the sufficient amount. so it is hard to reveal which nutrition factor except the smoking represent the cancerous risk (4. The same groceries are the protective factors from the emergence of the lung cancer. In our circumstances that is especially related to the rural population.04).26). According to the results non-consumption or decreased consumption of the vitamins in a supplement represents the protective factor (regression linear analysis of the risk factors). grapefruit. Traditionally. raspberry. Discussion and conclusion Last years in the world many researchers have been done which involve risky population groups with the main aim to identify the risk factors that are significant for the development of the lung cancer (6. We have revealed that the adequate intake of grapefruit. Protective factors for the development of the lung cancer in our interviewees’ diet are: increased intake of grapefruit.025. According to the regression analysis statistically significant predictors for the development of the lung cancer among the nutrition factors are: deficit of the fibers intake in a diet enriched by them such as beans. frequent garlic intake (P=0. 13.39). so we couldn’t note their clear significant protective role. blueberry. lentil. Statistically significant risk factor for the lung cancer exists in the decreased intake of the protective factors in a diet: olive (OR=1. Diseased significantly less consume 204 fish. banana and apple (β= -0. and protective role of the diet rich with beta carotene in results of the next studies (2. 95% CI 0.38). garlic. peas.033).002) and the consumption of the sufficient amount of grapefruit. then grapefruit. 18-19). and 2). enough amount of the carrot. once a week when compared to the control group (P=0. in 4 studies (5. Lung cancer can be prevented by the intake of the right amount of the protective factors in a diet especially fibers in beans. grapefruit (OR=1. Decreased daily intake of the fresh. vitamin preparations in a supplement and garlic.812). 15. Lung cancer can be prevented by the adequate intake of the protective factors in diet especially fibers in beans.033) and decreased consumption of the vitamins A.588. 21). garlic. fish. olive and others.Volume 2 / Number 4 / 2008 Predictors for the development of the lung cancer among the nutrition factors are the deficiency of the fibers intake in the diet of the beans. 12). P= 0. olive and others. In 2 studies it has been supposed that fruit has the protective role (14-15).023).006). peas and lentil. At the researches it has been noted that diet enriched by fruit had clear protective role in a development of the lung cancer. Smoking is strongly connected to the bad life style.8972.45) and garlic (OR=1. peas. Journal of Society for development of teaching and business processes in new net environment in B&H . C and E in the supplement (P= 0. In the control group the risk factor is increased due to the continuing intake of the vitamin in the supplement (OR=1. Consequently our results are in accordance with the results of the others studies. Evidences related to the diet richen with retinol are combined with the decrease risk of the lung cancer noted in many studies (8.47).001). Many studies about the diet and lung cancer have been focused to the hypothesis that the diet rich with antioxidants can protect from the oxidative damage of DNA and considering that protect from the carcinoma (9). P=0. then grapefruit.133.001. We have not noted significant differences among the lung cancer patients and in the control group for this habit. fried or boiled carrot in our research presents significant relative risk for the lung cancer (OR= 1. banana and apple can decrease the cancerous risk as the decreased intake of milk and dairy products in a smokers’ diet. and it’s not the protective factor in two studies (16-17). fish. pulse. data was not shown). 20). peas and lentils (P=0. fish (OR=1. banana and apple. decreased consumption of the fish (P=0. 10.HealthMED . banana and apple (P=0. Results of the logistic regression analysis indicate that the significant protective factors among the smokers for the development of the lung cancer are only the decreased intake of milk and dairy products (β= 1.

HealthMED - Volume 2 / Number 4 / 2008

Literature
1. Pranjić N. Bolesti modernog doba i ishrana (Diseases of modern time). U: Pranjić N (ur) Zdravstvena ekologija (Environmental health). Medicinski fakultet Univerziteta u Tuzli 2006; pp 111-120. 2. Shibata A, Paganini-Hill A, Ross RK, et al. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 1992; 66:673-79. 3. Niki E. Interaction of ascorbate and Alpha tocopherol. In: Third Conference on vitamin C. Burns J. J. Rivers J.M. Machlin JL (eds). The N. York Academy of sciences. N. York 1997, pp 123-31. 4. Margetts BM, Jackson AA. The determinants of plasma beta- carotene: interaction between smoking and other lifestyle factors. Eur J Clin Nutr 1996; 50:236-38. 5. Axelsson G, Liljeqvist T, Andersson L, et al. Dietary factors and lung cancer among men in west Sweden. Int J Epidemiol 1996; 25:32-39. 6. Bandera EV, Freudenheim JL, Marshall JR, et al. Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control 1997; 8:828-40. 7. Darby SC, Whitley E, Doll R, et al. Diet, smoking and lung cancer: a case-control study of 1000 cases and 1500 controls in South-West England. Br J Cancer 2001; 84:728-35. 8. Bjelke E. Dietary vitamin A and human lung cancer. Int J Cancer 1975; 15: 561-65. 9. Peto R, Doll R, Buckley JD, et al. Can diatary betacarotene materially reduce human cancer rates? Nature 1981; 290: 201- 208. 10. Fontham ET, Pickle LW, Hienszel W, et al. Dietary vitamins A, and C, and lung cancer among men in west Sweden. Int J Epidemiol 1996; 25: 32-39. 11. Ferković V. Registar malignih neoplazmi Tuzlanskog kantona 2001/ 2002 (Register of malign diseases in Tuzla Canton 2001/ 2002). Tuzla, PrintCom 2004. 12. Carol L, David J, Charles L, George D, Graham M, Victo H. Social class differences in lung cancer mortality: risk factor explanations two Scotish cohort studies. International J Epidemiol 2001; 30: 268- 74.

13. Gao CM, Tajima K, Duroishi T, et al. Protective effects of raw vegetables and fruit against lung cancer among smokers and ex- smokers: a casecontrol study in the Tokai area of Japan. J Cancer Res 1993; 84: 594-00. 14. Fraser GE, Beeson WL, Philips RL. Diet and lung cancer in California seventh day adventists. Am J Epidemiol 1991; 133: 683-93. 15. Steinmetz KA, Potter JD, Folsom AR.Vegetables, fruit and lung cancer in Iowa women’s health study 1993; 53: 536-43. 16. Feskanich D, Ziegler RG, Michaud DS, et al. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Inst 2000; 92: 1812-23. 17. Kromhout D. Essential micro-nutritients in relation to carcinogenesis. Am J Clin Nutr 1987; 45: 1361-67. 18. Churg A. Lung cancer cell type and occupational exposure. In: Samet JM (ed) Epidemiology of lung cancer. Marcel Dekker New York, Ny 1994; pp 413-36. 19. Mayne ST, Janerich DT, Greenwald P. Et al. Dietary beta- carotene and lung cancer risk in US non- smokers. J Natl Cancer Inst 1994; 86: 3338. 20. Voorrips LE, Goldbohm RA, Verhoeven DT, et al. Vegetable and fruit consumption and lung cancer risk in the Netherlands cohort study on diet and cancer. Cancer Causes Control 2000; 11: 10115. 21. Boffetta P, Agudo A, Ahrens W, et al. Multi canter case- control study of exposure to environmental tobacco smoke and lung cancer in Europe. J Nat Cancer Inst 1998; 90:1440-50.

Corresponding author: Suvad Dedic Clinic of lung disorders and tuberculosis, University Clinic Centre Tuzla, Bosnia and Herzegovina email: dedicsuvad@gmail.com

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HealthMED - Volume 2 / Number 4 / 2008

Socio-Demographic and Health Characteristics of Frequent Attender in Family Practice
SOCIODEMOGRAFSKE I ZDRAVSTVENE KARAKTERISTIKE ČESTIH KORISNIKA U PORODIČNOJ MEDICINI
Zaim Jatic1,2, Dzanana Jatic1
1 2

Public Institution Medical Centre of the Sarajevo Canton, Bosnia and Herzegovina Medical Faculty of Sarajevo University, Department for Family Medicine, Bosnia and Herzegovina

Summary Aim: to estimate the prevalence of frequent attenders (FA), comparing to their socio-demographic characteristics, health indicators and health care service usage indicators. Methods: Retrospective and longitudinal medical charts review of patients registrated in four family medicine offices. Medical charts of 434 randomly chosen patients were screened for socio-economic data, health status indicators and health care system usage indicators. Results: Prevalence of FA is 23,3%. Significant correlation has been found between frequent visits and elderly people (t=2,1, df=432, P<0,05), retired and unemployed people (r=0,104, P<0,05), and people living in rural and suburban areas.(r=0,123, P<0,01) FAs had more chronic diseases. (F=51,6; P<0,01) The most associated diseases found in FA are neoplasms (OR=2,86;95%CI:1,42,5,80), diabetes mellitus (OR= 2,16;95%CI:1,53,3,04) and mood disorders (OR=2,03; 95%CI:1,13,3,63). FA significantly use more health care services to others (P<0,001). Discussion: FAs use significantly more health care system services. Notably, high percentages of the referrals, hospital days, sick leave days and home visits were observed. 206

Conclusion: FAs are usually characterized as older people with a bad socio-economic background, living in the rural or suburb areas with a poor physical and mental health. It is crucial for the family medicine team to develope a strategy how to deal with the FA. Key words: frequent attendees, office visits, Family medicine, general practice, primary health care, health indicators, socio-demographic characteristics, Sažetak Cilj: Procjena prevalencije čestih korisnika (FA) i poređenje njihovih socio-demografskih karakteristika, indikatora zdravlja i indikatora upotrebe zdravstvenog sistema. Metod: Retrospektivno, longitudinalno ispitivanje zdravstvenih kartona pacijenata registriranih u timovima porodične medicine. Pregledani su socio-ekonomski podaci, indikatori zdravlja i indikatori upotrebe zdravstvenog sistema u 434 slučajno izabrana kartnona. Rezultati: Prevalencija čestih korisnika je 23,3%. Nađena je signifikantna povezanost između čestih korisnika i starije dobi (t=2,1, df=432, P<0,05), penzionisanih i nezaposlenih (r=0,104,

Journal of Society for development of teaching and business processes in new net environment in B&H

HealthMED - Volume 2 / Number 4 / 2008

P<0,05) i osoba koje žive na selu i predgrađu.(r=0,123, P<0,01) Česti korisnici imaju prosječno više hroničnih bolesti. (F=51,6; P<0,01) Najčešće udružene bolesti kod ovih pacijenata su neoplazme (OR=2,86;95%CI:1,42,5,80), diabetes mellitus (OR= 2,16;95%CI:1,53,3,04) i poremećaji raspoloženja (OR=2,03; 95%CI:1,13,3,63). Oni i signifikantno više koriste usluge zdravstvenog sistema od drugih pacijenata.(P<0,001). Diskusija: Česti korisnici znatno više koriste zdravstveni sistem. Posebno su visoki procenti upućivanja specijalistima, bolničkih dana, dana bolovanja i kućnih posjeta. Zaključak: Česte korisnike karaterizira starija dob, loši socio-ekonomski uslovi, stanovanje na selu i predgrađu, loše fizičko i mentalno zdravlje. Bitno je da timovi porodične medicine razviju strategiju rada sa čestim korisnicima Key words: česti korisnici, ljekarski pregledi, porodična medicina, opšta praksa, primarna zdravstvena zaštita indikatori zdravlja, socio-demografske karakteristike, Introduction Researches dating back from the second half of the 20th century point out that the small percentage of patients were responsible for the majority of the visits paid to the family physician (1). Since then, a significant number of researches regarding the causes and reasons why people frequently use the services of family medicine have been conducted. These patients are called frequent attenders (FA), constant attenders, high users or high utilizers. Patients that frequently visit family doctors significantly use more resources of health care system. Researches conducted in countries with different health systems show similar results. A group of 4 to10% of patients called frequent attendees make up about 21to 60% of all visits. (2, 3) It has also been proven that FAs have more mental and physical illnesses, social and economic problems and that they are under increasing emotional stress. (4, 5) Frequent visits lead to the consumption of limited health resources, cause an overload of medical professionals and spread frustration among the members of Family Medicine team. This Research

has shown that the female sex- that is divorced females, widows and women above 65- is a dominant sex when the socio-demographic features of these patients are taken into consideration. (2, 3, 4, 6, 7, 8) FAs are the perfect choice for the ‘’superficial examination’’ and for the referrals to specialists. (9) They have lower educational status, more often choose experienced doctors and doctors who does not use the appointment system, and they are more satisfied with health services. (10) FA, also, often have elements of low quality health care, they have a notion that the physicians don’t understand complexity of their problems which is a cause to a dysfunctional relationship between doctor and patient. (11, 12, 13) There are various definitions of FAs: those who visit family doctors more than 5 times (14), more than 9 times (2), more than 10 times (3) more than 12 times annually (3, 8, 15, patients who have a number of visits above 75th percentile per year (16, 17) or above of 90th percentile for age and sex group. (7, 9, 18) Some FAs are defined as patients who visit the family medicine offices more than average people from their age and sex group. (19, 20) Sometimes FA is defined as a person who has twice or more consultation than an average patient from the same age and sex group. (21) Weight of patient’s medical record greater than 100 g is a turning point which separates FAs from other patients.(22) It must not be forgotten that the term FA sometimes in the medical jargon has a derogatory meaning for people who cause “an unnecessary and unwelcome workload’’ and “Thick-file case”. (12, 13, 23) There are other numerous, mostly pejorative names, used by health professionals for these patients. (25) In the survey FAs are defined as persons who had more visits than 75th percentile (Q3) for his/ her sex group in the year of 2006. A visit is defined as encounter between a patient and a doctor ‘’face to face’’. Aims 1. Estimation of the prevalence of frequent attenders (FA); 2. Estimation and comparison of socio-demographic characteristics of frequent attenders and non-frequent attenders (NFA); 207

Journal of Society for development of teaching and business processes in new net environment in B&H

household members. place of residence. There are twelve doctors in these family medicine offices and 10253 registered patients. number of chronic diagnosis. max = 97). longitudinal study based on data obtained from 434 randomly selected medical charts belonging to patients from four family medicine offices (1 urban. ie mean and standard deviation (SD). 2 suburban and 1 rural) in Canton of Sarajevo. as well as demographic data and presence of chronic diseases. P>0.048.05) 208 Journal of Society for development of teaching and business processes in new net environment in B&H . 3. Methods Retrospective. and a group of adults without regular jobs (M of age=44.05) Work status of the patients also has a significant impact on the number of frequent visits. the leading diseases. Statistics of patients’ visits Results Number of patients Number of visits Mean Median Std.05). 05) The largest percent of the FA is in the group of pensioners (M of age=68.Volume 2 / Number 4 / 2008 3.05). Comparison of the health care services between FA and NFA. (r=0. c) Indicators for use of health care resources: the number of visits during a year of 2006. Patients from the sample had 5706 visits in the year of 2006. Pearson’s correlation coefficient was used for measuring correlation between FA and NFA.6 11 7. sex.HealthMED . SD 14. The Q3 value was 19 for men and 16 for women regarding the visits. the number of hospital days. Deviation Minimum Maximum Percentiles 25 50 75 Female 273 3439 12. All analyses above were calculated using the statistical package SPSS for Windows release (15. The sample was consisted of 273 female (62. b) Health indicators: smoking status.7 2 47 7 10 16 Male 161 2267 14. number of days of sick leave. the number of prescribed drugs. (r=0.(r=0. Small and non-significant differences were found between groups of different marital status. P<0. Table 1. SD 18.0.46. Determination of the health features of frequent attenders and comparison to notfrequent attenders. The medical sheet for a period of one year (2006) has been analyzed according to three main parameters: a) Socio-demographic features: age.9 2 64 8 13 19 Total 434 5706 13. The average age was 59.3) is significantly higher than mean age of NFA. SD=10. 4.5. the number of referrals to specialists. Odds ratio and 95% confidence interval were calculated to measure the strength of the association between the presence of disease and the occurrence of frequent visits. 1. significant differences were found between age groups. Mann-Whitney Test was used for testing means of health service usage indicators because data hadn’t been regularly distributed.0 13 8.9%) and 161 men (37.3% of all analyzed medical charts).17 2 64 8 12 17 Socio-Demographic Characteristics There were no significant differences between the numbers of visits of female and male patients. marital status.2) (t=2. df=432. the number of home visits. However.27 years (SD = 17. Medical charts of patients who had only one visit in 2006 are not included in the survey. (r=0. belonging to above mentioned four FM offices have been analyzed. SD=10. P<0. (M=58.15 12 8. Results 434 medical charts out of 10253 registered patients.105. P<0.8). Mean age of FAs (M=62. Continuous data is presented through out a descriptive statistics.1%).9.05). There were not significant differences between groups of type of households (r=0.2).035. min = 7. Female sex representatives do not use the frequent visits services as much.5.).104. The number of FAs with more visits than Q3 was 101 (23. The number of FA grows linearly with increasing of the age. P>0.036. P>0.

0%) (47.53. FAs had significantly more chronic diseases (M=3.8%) The highest percentage of FAs live in a rural parts (29.2%) (28.0%) 273 161 18 36 139 206 35 279 78 59 3 15 267 17 97 53 331 78 25 Total (62.Married .6%).4%) (86.03.3%) (18.1%. 3.31).3%) (11. Dorsopathies [M40-M54] (13.6%) 0.2%) (16.5%) (61.1%) (8.40-59 .70).3%.6%) (94. P<0. Neoplasms [C00-D48] (6. 2.Volume 2 / Number 4 / 2008 Table 2 Socio-demographic characteristics FA Female Male Age groups .Widow/er .6%) (26.90.2%) (71. Journal of Society for development of teaching and business processes in new net environment in B&H 209 . 5.7%) (24.3%) in the urban parts of Canton of Sarajevo. 10. 2. 4.Other 66 35 1 5 33 52 10 73 15 12 0 1 65 2 28 6 81 14 6 (24.3%) (18.63).43). 95%CI:1.4%) (73. P<0.01) Health Indicators Smoking prevalence among FAs is 23. 7.123. Diseases of oesophagus. 5.66 (SD 1. odds ratio (OR) and 95% confidence interval (95%CI).Pensioner . 2.0%. OR= 1. (F=51. 2.5%) (79. COPD [J44] (8.97.6%) (13.48. 95%CI:0.Never married Household .89).8%) (78.6.9%) (23.1%) (88.4%.1.20-39 .Disciple Marital status . Mood disorders [F30-F39] (9. OR= 2.9%) (22.7%) (88. OR= 2. Other forms of heart disease [I30-I52] (19. (r=0.1%) (4.19. 95%CI: 1.42.7%) (25.7%.7%).60-79 .7%) (75.23).63. Essential hypertension [I10] (58.62) .048. Disorders of lipoprotein metabolism and other lipdaemias [E70] (5. 3. (r=0.7%. 95%CI: 1. 9.5%. OR= 1.0%) and the smallest percentage (17.16.27. Diabetes mellitus [E10-E11] (22. OR= 1.HealthMED . 6. 95%CI: 0. 1.Student .5%) (8.≥80 Working status .37.8%.44.9%) (11. 95%CI: 1. OR= 2. 3.2%) (21. total percentage.8%) (28.24. 95%CI: 0.5) of chronic diseases. 1. suburbs (26.Family (spouse and/or children) . Ischemic heart diseases [I20-I25] (12. OR= 1. 8.5%) (17. Table 3 shows diseases significantly associated with frequent visits.3%. SD 1.9%) (24.4%) (5.54).04).9%.3%) (24.Employed . OR=0. P>0.5%) (82.Single .0%) (13.1%.05) (5. There were not significant differences with smoking prevalence of NFAs (23.05) All patients had an average of 2.3%) (74.1%) (76. 1.3%) (32. 95%CI:0.05.39.1%) (64.9%) (37. 95%CI: 1.8%) (71.4%) (12.0%) 207 126 17 31 106 154 25 206 63 47 3 14 202 15 69 47 250 64 19 NFA (75. SD 1.8%) (20.2%) (76.13.83.7%) (3. OR= 1. 1.8%) (47. 95%CI: 0.34.01) These are top ten diseases or disease groups followed with ICD-10 cods.3%) (75. stomach and duodenum [K20-K29] (15.3%) (0%) (6.56).7%) (100%) (93.67) than NFAs (M=2.≤19 . 2.85.Divorced .5%) (3. OR= 1.Biro .1%) (76.64.86.80).

0 876.6 40.6 24.0 2489.0 1042. (7.9 0.0 614.7%) (6.5 46.1 49.4 N 5706.1 0.0 627.2 9.Volume 2 / Number 4 / 2008 Table 3 Most common diseases of FA Disease 1 2 3 4 5 Essential hypertension (I10)** Diabetes mellitus (E10-E11)** Other forms of heart disease (I30-I52)** Mood disorders (F30-F39)* Neoplasms (C00-D48)** * P<0.9%) 178 58 54 26 15 NFA (53.9% to 54. Working status had significant impact on number of visits.0 1241. 7.0 1526.3-4.4%) (9. However.7 3.01 75 38 30 16 13 FA (74.3%) (22.0 N 3217. Significant differences on the level P< 0.0 74.0 53.8 6.2 2.0 1072.9 3.5 4. 21.5%) Table 4. 15.4 0. 26) In this research marital sta- Journal of Society for development of teaching and business processes in new net environment in B&H .6%) (29.1 3.9 M 9. our patients had a much higher mean of visits to those in Croatia and Slovenia.0 33.0 54.2 SD 7. (2.8 16.5 55.0 *P<0.6 NFA % 56.6 1193.8%) (4.0 358. 15. This could be explained by the fact that pensioners are elderly people and probably have less income.4 13.0 3.0 2235.4 65.4 2. (2.9 50.5 0. 3.3%) used among 33.3 28.5 1.0 184. unemployed patients have more visits per year than others.8%) (12.3 7.05 ** P<0.1% services out of 7 health service usage indicators.0 Home visits 40.0 66. Also. 8.5%) (17.4 79. 18) or less frequently.01 for all indicators ** Counted for the group of patients with regular jobs Health service usage indicators FAs (23.3%) (37.HealthMED .0 43. 28) Non-significant differences were fond between sex groups in this study.1%) (19.4 1.2 2. FAs prevalence in this study is very similar to results of studies conducted in neighboring Croatia (total FAs prev210 alence 22%) (16) and Slovenia (24%) (10).3 1.7%). the general population.0 542.4 1.0 999.3 1.8 13. 26.0 Total M 13.01 were found between FAs and NFAs Discussion The Research of the prevalence of FAs can include population of registered patients in the medical clinics (2.0 % 34.9 29. Pensioners were more in number to those in other groups.5%) 253 96 84 42 28 Total (58. 7. 14. Most results of the research link FAs with older age and female sex. 26. (9. 27. 3.1 SD 4. 15.0 34.2 8.1 1. 29) Many of researches highlighted the importance of the influence of marital status on the number of visits. 25) The first type of studies have considerably greater prevalence than the second type (5-26%vs. Both these results match the researches conducted in different countries. 27. 7.5 0. 5.2 SD 8. 22.6 45.0 1948.7%) (15.0 7. Health service usage indicators (data for year 2006) Indicator* Office Visits Medications Specialists Referrals/ consultation Referrals in the laboratory Days spent in hospital Sick leave days** FA N 527. 21.2 1.5 45. 8.5 M 5.4%) (16.2%) (7.5 106.1 1.7 1.

it is a common thing to have FAs who have unrecognized and unsolved medical problems. Continuous monitoring of those diseases through out a longer period of time is the next step which needs to be ensured for these patients. 9. It has been shown that FAs had more diseases. which requires special care for this group of patients. diabetes mellitus. 27) The first step is the identification of FAs and their health and other problems. The third step is to resolve social and other problems. the lack of healthcare information systems and poor and ineffective cooperation with other health levels. 211 Journal of Society for development of teaching and business processes in new net environment in B&H . patients with specific chronic illnesses such as hypertension. reflects their need and vulnerability (17). which implicate the second step. Other researches also emphasize the specificity of hypertension and diabetes (31) The fact that they feel the need for frequent doctor visits. as well as low socio-economic status. Iatrogenic factor is characterized with a lack of information for patients. excessive and unnecessary tests and treatments. a limited level of information about patients in medical charts (a lack of essential parameters about of income. 34. especially with those who have a very large number of visits. obstacles associated with the regulation of drugs prescription. 18. (3) crisis patients. especially. there is a certain percentage of patients who can be identified as FAs. coming form the rural and suburban parts of the country. diabetes. (2. other forms of heart disease. somatoform disorders) Level of patients satisfaction is not explored. the level of stress. Most of them really have a serious chronic illnesses. and (5) patients with multiple problems.’’(31) An analysis of families and communities capabilities to help patient is needed. 25. 7. 35. 33) It is often an indication of undiagnosed problems.9%).(17) Smaller group of patients. heart diseases. In addition. Significantly greater percentage of FAs in the rural and suburban group could be explained by the influence of low education level. sick leave days and home visits. Such results match with other researches. 8. (28. 16. diabetes mellitus. 26) Especially there were high percentages of the referrals to other specialists. FAs have significantly more chronic diseases and are frequent consumers of the services and resources of the health system.HealthMED . a low level of quality of management of chronic diseases (especially hypertension. 26. the FAs used significantly more health care system services then more numerous groups of NFAs. There is a need to assess and heal a so called “iatrogenic factor’’ that is common in FAs.(16. and most importantly with a poor physical and mental health. Conclusion In all health systems. if possible. specific education and detailed information about patients’ jobs. although the divorced group had largest percentage FA (28. There is a vast amount of evidence that FAs have more chronic physical and psychiatric issues. 30) The results of this study are similar to others.(19) It is very important that family medicine team members to develop a strategy how to deal with the FA. health illiteracy. (4) chronically somatizing patients. especially hidden depression. Limitation to this study is a relatively small number of analyzed medical charts. especially essential hypertension. These are the people mostly defined as elderly men and women with a bad socio-economic background. 32) A higher percentage of Fas in family medicine office may be indicator of low quality level of he- alth care and an improper use of health systems. 15. 36) There are other possible causes for such a high percentage of FAs estimated in this study such as: poor health of our residents in comparison to other countries.(9. Smoking is not connected with frequent visits as results of other researchs. (19. polypharmacy. 3.(28. It is possible to divide these patients into the following subgroups: “(1) patients with entirely physical illnesses. mood disorders and neoplasms. and other forms of heart disease. only 4 FM offices in Canton of Sarajevo. mood disorders and neoplasms. the poor work organization FM teams.thoroughly planning and management of those chronic diseases. with the engagement of all available resources. hospital days. depression and malignant diseases). family cycles and family relations. 11.Volume 2 / Number 4 / 2008 tus correlated non-significantly with the number of visits. (2) patients with clear psychiatric illnesses.

associations and outcome. use of medical services and GP characteristics. 1995. Gill P. Backett EM.Psychosomatics. Kujundzić Tiljak M. Humphrey B. Parry G. Bellon JA. Heartsink patients: a study of their general practitioners. Kovacić L. Collins M. Heywood P. Br J Gen Pract. Gomez MJ. 20.42(5):416-22. 2004.Croat Med J. 2006 May-Jun. Carney TA. Fink P. Joukamaa M. Westhead JN. Väisänen E & Wynne LC () Developing a family systems approach to rural healthcare: dealing with the “heavy-user” problem. 19. Beem EE. 2005. Alexander WD.Defining frequent attendance in general practice. Med. 212 Journal of Society for development of teaching and business processes in new net environment in B&H . 2008 Apr 15. Jeffrey G. Mattsson B & Lynoe N (1995) Patients frequently consulting general practitioners at a primary health care centre in Sweden -a comparative study. Guy S. Rapić M. Novaković D.Characteristics of frequent attenders at a community health center. 7. Families. Mathers N. Neal R. Gill D. 14: 12 3. Jackson JL. Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice. Practitioner 1974. Br J Gen Pract. 15. Fam. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Disability and depression among high utilizers of health care. Katić M. 3(4): 318 . Frequent attenders at a health centre. Cashman SB.Frequent attenders in general practice: medical.323.J Am Board Fam Med. 49: 91-100. Literature 1. J Fam Pract 1982. Hannay D. Kroenke K. J Psychosom Res.19(3):265-75.14: 291-302. et al.1:109-115 2. Ursan A.304. 1993. Studies of a general practice (II) The doctor’s job in an urban area. psychological and social characteristics. Pract. Pract.Psychological distress as a predictor of frequent attendance in family practice: a cohort study. 4. Murray Boyle C. Ann. Defining frequent attendance: evidence for routine age and sex correction in studies from primary care settings.Volume 2 / Number 4 / 2008 Future researches in our region should involve a greater number of patients in more FM offices and secondary health care.9:21.32: 239-241. Scand J Soc Med 23: 251-257. They have to focus on finding ways for easier FAs identification. 11:424-430.47:115–130. 2000.1982. Pickvance D. Larivaara P. 16.HealthMED . Frequent consulters in general practice: a systematic review of studies of prevalence. Scaife B. Evans JCG. 2000. J R Coll Gen Pract. Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Sharpe M. Bai Y. 2001 Sep-Oct. Scand J Prim Health Care. Hockley B. Goodridge DMG An analysis of fat folders. 21.45:293-296. 1999. Systems & Health.52:561–562. Howe A. Zaletel-Kragelj L. Smith P.159:1069– 1075. 213:696-702 9. Br J Gen Pract. Savageau JA. 14. Svab I. 1996 .45(5): 620-4. Katon W.11:38-43. 1994. Vedsted P. et al. Arch Intern Med. Olesen F. 2001 Sep. BMJ 1954. Vegnuti M.35(276):33740. Vrca Botica M. 23. Lovasić S. 17(4): 298 .50: 361-365. 1985 Jul. McArdle C. Frequent attenders in general practice: a study from Slovenia. Svab I. Smits FT. 2002.51(468):567-9. 5. 10. 2001 Jul. patient satisfaction. Frequent Attenders of Finnish Public Primary Health Care: Sociodemographic Characteristics and Physical Morbidity. Dowrick CF. Br J Gen Pract. Frequent attenders in general practice: a retrospective 20-year follow-up study. Bindels PJ. Kersnik J. 6. McLoughlin M. 1999. Fam. Von Korff M. 13. Pallister R. Botica I. Fam.Frequent attenders in family practice in Croatia: retrospective study. GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms. 12. Jones N. Frequent attenders in general practice: quality of life. 18.19(3): 174-7 11. 8. Karlsson H. Andersson SO. Mohrs JJ. 22.J R Coll Gen Pract. Brown T. Stories from Frequent Attenders: A Qualitative Study in Primary Care. Dowrick C. Browne GB. Scand J Prim Health Care. Munk-Jřrgensen P.BMC Fam Pract. Lehtinen V. effective preservation and continuity of health care and finding efficient management methods of health and other FAs problems. Ormel J. van Weert HC. 17. Arch Gen Psych 1992. Heady AJ. Hodgson P.

52:1000-1001. 35.29:189-198 31. natural history. Pain. Psychosom Med 1997. Frequent attenders in primary health care A cross-sectional study of frequent attenders’ psychosocial and family factors. 28.Wessely S.48:1856-1857 25. 24-25 26. Crayford T.HealthMED . Heywood PL. 36. Corresponding author: Zaim Jatic Public Institution Medical Centre of the Sarajevo Canton. J Psychosom Res. 42:157-166. 27. Fam Pract 15: 198-204. Pract. Lehtinen V.76:417-26. Is frequent attendance in primary care disease-specific? Fam. GP frequent consulters: their prevalence. 322. Blackie GC. 33. Aiarzaguena JM. Lahti I. Br J Gen Pract 2002.1998. (1998) Understanding patient-initiated frequent attendance in primary care: a case-control study. Neal RD.com Journal of Society for development of teaching and business processes in new net environment in B&H 213 . Aranguren J & Retolaza A. Patients with medically unexplained symptoms. Iatrogenic factors and chronic pain.Volume 2 / Number 4 / 2008 24. Pedrero E.23:444-452. medication abuse.59: 597-604. 1997. 48: 895-898. and contribution to rising workload. Survey on frequent attenders . Morley S. Pither CE. Frequency of patients’ consulting in general practice and workload generated by frequent attenders: comparisons between practices. 51:421-7. Kouyanou K. Cameron IH & Dowell AC (1998) An assessment of the attributes of frequent attenders to general practice. Dawes M. BMJ 2001. Stewart P. University of Oulu. 767-771 29. HK Pract 2007. Wilkie A. Reid S. Kokki-Saarinen T: Frequent attender profiles: different clinical subgroups among frequent attender patients in primary care. Br J Hosp Med 1994. 1998. Pither C. Jyväsjärvi S. Gill D. Jordan K.a study to analyze the associations between frequency of attendance and chronic illness and socio-economic factors in an outpatient clinic. Tsui WSW. Joukamaa M. Bosnia and Herzegovina e-mail: jaticzaim@gmail. Chu DWS. Croft P. Foster A. Doktorska disertacija. Wessely S. and psychiatric morbidity in chronic pain patients with and without medically unexplained symptoms. Rabe-Hesketh S. 32. Dowell AC. 2006. Kouyanou K. Karlsson H. Hotopf M. Leung KWM. 34. chronic diseases and reasons for encounter in a Finnish health centre . O’Dowd T: Clinically inexplicable frequent attenders in general practice. 1998. Clayden AD. Heywood PL. Br J Gen Pract. 30. Báez K. Wessely S. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. Wessely S. Br JGen Pract. Sharpe M. 2001. Br J Gen Pract 48: 1824-1827. Grandes G. A comparative study of iatrogenesis. Mayou R.

Bosnia and Herzegovina Department of pathology. tumor koji rijetko metastazira. Cilj rada je da se utvrdi učestalost ovog karcinoma u odnosu na druge dijelove kraniofacijalne regije. Najefikasnija terapija tumora ove regije je radikalna hirurška ekscizija a kod veoma uznapredovalih stadija hirurška i/ili radio terapija a nekada i hemioterapija. Emir Halilbasic1.). University clinical center of Tuzla. There was no significant difference between ages 214 for men and women diagnosed with this tumor. Azra Pasic1. Gender distribution showed female dominance in male to female ratio of 1:1. Mufid Burgic1 1 2 Department of plastic and reconstructive surgery. Surgery clinic. its distribution in terms of patient’s gender and age. kao što su orbitalna regija i nos. Nedret Mujkanovic1. U statističkoj obradi dobijenih podataka koristit će se metode deskriptivne statistike sa izračunavanjem srednje vrijednosti i standardne devijacije. as well as clinical stage in time of the diagnosis. Najčešće se pojavljuje na kraniofacijalnim regijama i to vrlo često na lokalizacijama koje su vrlo kompleksne za hirurški rad. In statistical analysis of acquired data the methods of descriptive statistics were used. orbital region Sažetak Bazocelularni karcinom je maligni tumor kože. a za utvrđivanje značajnosti razlika koristit će se χ2 test uz prihvatanje signifikantnosti na nivou p<0.HealthMED . 127 cases of basal cell carcinoma located in craniofacial region were analyzed through data obtained during the 5-year period (2004.Volume 2 / Number 4 / 2008 Basal cell carcinoma of orbital region BAZOCELULARNI KARCINOM ORBITALNE REGIJE Adi Rifatbegovic1*. 11% of all diagnosed basal cell carcinoma found in craniofacial region were those localized in orbital subregion. Ermina Iljazovic2. Policlinic for laboratory diagnostics. Ovaj tumor predstavlja najčešći maligni epitelni nemelanositni tumor u ovoj regiji. – 2000. The basal cell carcinoma represents the most common epithelial non-melanocytic tumor in this region.001. diagnostic procedure used. and for the proper level of results significance p was made to be <0. Ovaj rad predstavlja retrospektivnu studiju. It usually found in craniofacial region. Data was obtained from different aspects of medical history records. sporog rasta koji nastaje nekontroliranim bujanjem temeljnog (bazalnog) sloja kože. U ovom radu anlaizirali smo 127 dijagnostikovanih bazocelularnih karcinoma u petogodisšnjem vremen- Journal of Society for development of teaching and business processes in new net environment in B&H . and in 80% of cases the clinical stage at which basal cell carcinoma was diagnosed was I. such as orbital and nasal regions. and through surgical treatment of choice. Njegova polana i starosna distribucija i klinički stadij u kojem je bolest dijagnostikovana. Bosnia and Herzegovina Summary Basal cell carcinoma is slow growing malignant skin tumor characterized by uncontrolled growth of the basal skin layer. clinical findings. sometimes in cases of well progressed tumor invasion it also includes and/or radiotherapy.5. The most effective treatment of this tumor is radical surgical excision. rarely even chemotherapy.001. Predstavlja vrlo čest. The goal of this retrospective study was to determine the prevalence of this tumor in different parts of craniofacial region. in locations that make rather simple surgical procedures appear complex. University clinical center of Tuzla. It represents very common type of tumor that rarely yields in metastases. Key words: basal cell carcinoma.

upper eyelid and lateral angle of eye 23.5. The most common localizations are as follows: lower eyelid 48. 1999). and in people with pale-looking skin (Hurt i Santa Cruz. 2003. BCC in head and neck regions can invade deeper structures and can have endo. This type of subregional distinction is made because of easer orientation.000 men and 350. followed by chemotherapy when needed.1% of cases (Patel. Rosai. 2004). Rad predstavlja retrospektivnu studiju u kojoj smo iz istorija bolesti sagledali: anamnestičke podatke.Volume 2 / Number 4 / 2008 skom periodu (2000-2004).6%. It represents very common type of tumor that rarely yields in metastases.. orbitalna regija Introduction Basal cell carcinoma (BCC) is slow growing malignant skin tumor characterized by uncontrolled growth of the basal skin layer. BCC metastases occur in 0. Vance. Fatal outcome is very rare in case of basal cell carcinoma. Elkins i Guo. dijagnostičke procedure i primjenjenu hirurško-terapijsku mjeru. Eyelid tumors are relatively frequent finding in clinical practice. medial angle of eye 27. The most effective treatment of tumors in this region is radical surgical excision. Thigpen. 2004). although they also occur in different bare parts of the body such as hands.) BCC is most common epithelial non-melanocytic tumor of this region. BCC of lower eyelid Picture 2. During a large study which involved 900. It is often necessary to clinically determine if the suspicious lesion is in fact tumor or some local inflammatory reaction since in some cases the appearance is very similar. Radiation with 20-50 year latency period and long-term contact exposure to arsenic. U odnosu na sve dijagnostikovane bazocelularne karcinome kraniofacijalne regije na orbitalnoj regiji dijagnostikovan je u 11% slučajeva.9%. as well as UV radiation are all considered to be important risk factors in development of BCC. Polna distribucija muškarci u odnosu na žene nalazi se u omjeru 1:1. detailed localization of pathological process and different surgical approach. 2006) usually localized in places that are much complex for surgical treatment such as eyelids and nose. Postoperative defects are often very complex for proper closure since the radical excision is absolute priority and since reconstruction must be functionally impeccable as well as aesthetically flawless (Picture 1. BCC has a tendency to occur in skin regions that are chronically exposed to sun. klinički nalaz. Prosječna starosna dob je skoro identična a u 80% slučajeva karcinom je dijagnostikovan u kliničkom stadiju I. but on the other hand untreated lesions locally do invade deeper tissue structures. and for those diagnosed in late stages surgical and/or radiotherapy.000 people (550. It can be exulcerated in late stages of the disease.and perineural spread which can additionally complicate the course of the disease and proper treatment. and 23-38% for Caucasian women (Ramsey. and very rarely on the parts of the body that are usually cover with clothes.5%) (Tiftikcioglu i sar. This skin tumor most commonly occur in the regions of head and neck (91. Radically excised BCC with reconstructive procedure planned 215 Journal of Society for development of teaching and business processes in new net environment in B&H . Frequency of occurrence for men and women is 2:3. if treatment is adequate. 2. and 3.000 women) it was found that BCC incidence for men was 475 and 250 for women which then translated in to 33-39% risk for Caucasian men. and upper and lower eyelid. 1999). Orbital region presents a bilateral facial subregion that is further divided into four distinct parts: medial and lateral angle of eye.0028 to 0.HealthMED . Picture 1. It has a very good prognosis.5% (Cook i Bartley. Ključne riječi: Bazocelularni karcinom. Tumors of this region are very common in clinical practice.

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Picture 3. Postoperative result Aim The aim of this study was to determine the prevalence of basal cell carcinoma (BCC) occurring in orbital region diagnosed in University Clinical Center of Tuzla during 5-year period (01.01.2000. – 31.12.2004.), its distribution in terms of patient’s gender and age, as well as its clinical stage in time of the diagnosis. The study included 127 cases of BCC localized in orbital region during the 5-year time period. It is a retrospective study during which patient medical history was used for acquiring general data, as well as data on clinical finding, diagnostic procedures and surgical treatment. Following variables were analyzed: general patient data, age, gender; clinical finding: characteristics of suspected lesion (anatomical localization and size). Proper diagnosis was based on adequate biopsy and pathohistological verification of tumor. Biopsy of suspected lesion can be done by curettage, deep layer aspiration, incision and excision. Excision biopsy stands for complete removal of tumor tissue together with “clean” (tumor-free) margin, and thus is of great diagnostic and treatment value. Incision biopsy stands for surgical removal of only a small part of tumor tissue, usually when tumor is too large and has complex location which makes the subsequent total removal impossible. Surgical excision presents very effective way in treatment of all kinds of skin tumor in many different locations. The size

of “tumor-free” margin varies depending on pathohistological type of tumor, as well as on size and tumor localization, but 3-5 mm margin usually suffice. When large defect is present after the removal of tumor, a reconstructive surgical treatment is necessary. Histomorphologic analysis of excised lesion and resection margins was done using standard 5µm thick paraffin cut slices, dyed using standard H&E method. Imunohistochemical analysis was done for a certain number of undifferentiated malignant primary and secondary lesions using three-step imunoperoxidase method with streptavidine. In statistical analysis of acquired data the methods of descriptive statistics were used including χ2 test used in difference determination, and for the proper level of results significance p was made to be <0,001. Results During 5-year period (01.01.2000. – 31.12.2004.) in University clinical center of Tuzla, 881 basal cell carcinoma (BCC) occurring in craniofacial region was diagnosed. 127 of them were localized in orbital region (11%), 51 of which were diagnosed in men, and 76 in women. Mean age for both male and female was about the same (Table 1.). This study showed that BCC was usually verified in clinical stage I (Graph 1.)

Graph 1. Prevalence of different clinical stages for BCC

Table 1. Mean age of patients diagnosed with BCC in orbital region in respect to gender
Orbital region Type of skin tumor M Basal cell carcinoma 66 Mean age F 65 Min. 39 Min. i max. age M Max. 89 Min. 33 FŽ Max. 86

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Discussion One of the most important characteristics of skin as an organ lays in its sensory function to communicate with surroundings, but it is also the largest organ of the human body that provides protection from all potentially harmful external influences. All of the frequently exposed parts of skin such are those in the regions of face, neck and hands, that are often under constant influence of multiple external factors such as UV radiation, weather and climate conditions, diet, nicotine and alcohol with time accumulate effects of such destructive impact. Different world studies conclude increase in skin cancer incidence, especially in past few decades (Corona, 1996; Collins at all., 2004). In USA alone every year it is expected about 1 million newly diagnosed cases of skin cancer, mostly basal (BCC) and sqamuos cell carcinoma (SCC), while in Holland, in accordance with national cancer registry, predictive calculations about increase in incidence for these tumors surge up to 80%. 20 654 patients with skin cancer were newly diagnosed in the year 2000., and it is expected that the number of those patients for the year 2015. will be 37 342 (de Vries at all., 2005). Various epidemiological studies showed that patients who are diagnosed with BCC and SCC have greater risk of developing some other malignant disease, although the exact assessment of such risk is not yet known (Karagas at all., 1998). Orbital region is very specific and very complex region for surgical interventions that often necessitates team work form both plastic and ophthalmologic surgeon. That is why the frequency, size and the type of tumor occurring in this region are of much interest. During our study, 127 skin tumors were verified in this region, which is completely in accordance to data obtained from different relevant literature. It was found that these types of skin tumors are somewhat more often diagnosed in women (60%), which also coincide to data in available world literature. It was found that BCC is more often diagnosed (95%) than SCC, mostly in women, while SCC is much more rarely verified with equal distribution in both genders. Many different studies throughout the world also present similar results (Szepietowski, 2004; Salomon at all., 2004; Rubin at all., 2005). During the gen-

der and age distribution analysis it was shown that diagnosed tumors occur in both male and females mostly between third and ninth decade. In men there is a peak in incidence somewhere between sixth and eighth decade, while in women such peak occurs in seventh and eighth decade. The highest number of diagnosed skin tumors in both genders was in clinical stage I (80%), and clinical stage II (17%), which is in accordance to data obtained during a study that was done in Izmir, Turky, where 78% of skin tumors was verified in clinical stage I, with maximal diameter measuring 20 mm (Ceylan at all., 2003). Tumors with sizes 2-5cm in diameter (T2) are large tumors where excision almost always results in large tissue defects. Such defects in this region present exceptional problem in terms of its reconstruction. It is often necessary to excise, in variation to its localization, whole eyelid or at least large part of both upper and lower eyelid including medial or lateral angle of eye. Reconstruction of such defect in delicate orbital subregion often presents complex surgical problem. If surgical excision requires resection all of the eyelid structures, then it is necessary to reconstruct complete eyelid ad integrum. Smaller defects are usually closed via direct suturing or using full thickness skin graft from an adequate donor site, while larger defects are reconstructed via local skin flaps in combination with conjunctiva free flaps from the opposite side or buccal mucosa and auricular cartilage, or with cartilage from nasal septum. Excision radicality should be pathohistologically verified during operative procedure, which means prior immediate reconstruction. Because of the region’s specificity and its deep structures, it is clear that any mistake made during the operative procedure may result in very grave consequence for the patient. Conclusion Out of all diagnosed BCC in craniofacial region, 11% was localized in orbital subregion. Male to female distribution ratio was 1:1,5. Average age in both genders was almost identical, and BCC was in 80% of the cases diagnosed in clinical stage I. When diagnosed in clinical stage I, BCC does not require complicated surgical approach. 217

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HealthMED - Volume 2 / Number 4 / 2008

BCC with large diameters are sometimes associated with excessive surgical procedures, and radiotherapy with or without chemotherapy follows. Every BCC classified as T1 have good prognosis following surgical treatment. Literature
1. Hurt MA., Santa Cruz DJ (2003) Tumors of the skin. In: Fletcher CDM, Diagnostic histopathology of tumors, 2nd ed, Vol 2, Churchill Livingstone, Edinburg: 1373-1380. 2. Rosai Juan (2004) Tumors and tumorlike conditions. In: Rosai and Ackerman’s Surgical pathology, 9th ed, ed by Rosai Juan, Vol. 1, Mosby: Edinburgh, 136. 3. Ramsey ML (2004) Basal Cell Carcinoma. www. eMedicine.com 4. Tiftikcioglu YO., Karaaslan O., Aksoy HM., Aksoy B., Kocer U (2006) Basal cell carcinoma in Turkey. The Journal of dermatology 33(2):91-95. 5. Patel MS., Thigpen JT., Vance RB., Elkins SL., Guo M. (1999) Basal cell carcinoma with lung metastasis diagnosed by fine-needle aspiration biopsy. The Southern Medical Journal 92(3): 321-324. 6. Cook BE., Bartley GB (1999) Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology 106(4):746-750. 7. Corona R (1996) Epidemiology of nonmelanoma skin cancer: a review. Ann Ist Super Sanita 32(1): 37-42. 8. Collins GL., Nickoonahand N., Morgan MB (2004) Changing demographics and pathology of nonmelanoma skin cancer in the last 30 years. Seminars in cutaneous medicine and surgery 23(1):80-83. 9. Karagas MR., Greenberg ER., Mott LA., Baron JA., Ernster VL (1998) Occurrence of Other Cancers among Patients with Prior Basal Cell and Squamous Cell Skin Cancer. Cancer Epidemiology, Biomarkers & Prevention, Vol. 7, 157-161. 10. Meads SB., Greenway HT (2006) Basal Cell Carcinoma Associated with Orbital Invasion: Clinical Features and Treatment Options. Dermatol. Surg. 32:442-446.

11. Salomon J., Bieniek A., Baran E., Szepietowski JC (2004) Basal cell carcinoma on the Eyelids: Own Experience. Dermatol Surg 30:257-263. 12. Szepietowski JC (2004) Basal cell carcinoma on the eyelids: Own experience. Dermatol. Surg. 30: 257-263. 13. Rubin P, Mykula R, Griffiths R.W. (2005) Ectropion following excision of lower ejelid tumours and full thickness skin graft repair. Britis Journal of Plastic surgery 58:353-360. 14. Ceylan C., Ozturk G., Alper S (2003) Non-Melanoma skin cancers between the years of 1990 and 1999 in Izmir, Turkey: demographic and clinicopathological characteristics. J Dermatol. 30(2):123-131. 15. Meads SB., Greenway HT (2006) Basal Cell Carcinoma Associated with Orbital Invasion: Clinical Features and Treatment Options. Dermatol. Surg. 32:442-446. Corresponding author: Adi Rifatbegovic, Department of plastic and reconstructive surgery, Surgery clinic, University clinical center of Tuzla, Bosnia and Herzegovina e-mail: adi.rifatbegovic@bih.net.ba

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Volume 2 / Number 4 / 2008 Effects of Specific Forms of Extramedullary Fixation in Treatment of Diaphyseal Small Bone Fractures EFEKTI SPECIFIČNIH OBLIKA EKSTRAMEDULARNE STABILIZACIJE NA SANACIJU PRIJELOMA DIJAFIZA MALIH KOSTIJU Zoran Hadziahmetovic1. Bosnia and Herzegovina Institute for physical medicine and rehabilitation.3%) ostheosynthesis. Results. Narcisa Vavra – Hadziahmetovic2 1 2 Clinic for emergency medicine. Bosnia and Herzegovina Summary In the article according to the previously set parameters is correlated efficacy of two forms of extramedullary ostheosynthesis in case of diaphyseal small hand and foot bones fractures. Clinical Center of Sarajevo University. loosening of the screws and plate (1). after the end of the treatment all implants were identified in the primary set position. Research goal is to determine definite functional and radiography parameters after fractures and bone changes (24 fractures. 6 bone tumors/ cysts) after implementation of the Extramedullary Fixation with Kirschner wires and Cerclage – EFIKS ostheosynthesis and use of technique with plates and screw. Opposite to this extramedullary fixation of fractures with the use of screws and plates is still leading and irreplaceable as the method in case of joint and metaphyseal fractures. Reduction of movement in neighboring joints was in ratio + 50 . plate bending (1). angulations at the point of fracture (1). Conclusion. Fist injury was present in 22. bone healing 219 Journal of Society for development of teaching and business processes in new net environment in B&H . In case of ostheosynthesis with use of plate and screws complications were noticed in 3 (10%) ostheosynthesis. extramedullary ostheosynthesis. Complete healing of the fractures was in 25 (83.6%) ostheosynthesis. Key words. and foot in 4 cases.05). In case of 2 patients there were open fractures (Gustilo I/II). Material and methodology. In the EFIKS group of ostheosynthesis complications were noted in 2 (6. slower bone healing (1). EFIKS ostheosynthesis have the possibility for wider application in surgery and it is complete acceptable alternative to those who does not have the plates and screws.100 .HealthMED . break of the cerclage wire (1). Clinical Center of Sarajevo University. Two groups of 15 ostheosynthesis among 26 patients were selected. Extramedullary stabilization of fracture and bone changes within the tested sample and the two specific group of patients with different forms of extramedullary ostheosynthesis did not show statistically significant differences in the final radiology and functioning results according to the set parameters of research (p>0.

2). savijanje ploče (1). and which are caused by bending or fracture of the ostheosintetic material after the fragments are kept in bad (“mal”) position. Redukcija kretnji na susjednim zglobovima je bila u omjeru + 50 . Ekstramedularna stabilizacija prijeloma i koštanih promjena u ispitivanom uzorku i dvije specifične grupe ispitanika sa različitim oblicima ekstramedularnih osteosinteza nija pokazala signifikantne razlike u konačnim radiografskim i funkcionalnim rezultatima prema zadanim parametrima istraživanja (p>0.3%) osteosinteza. angulations or contraction of the fragments. angulacija na mjestu prijeloma (1). Kod osteosinteze sa pločicom i vijcima komplikacije su evidentirane kod 3 (10%) osteosinteze. What is also important is the limited contact between the implant and the bone („low contact plate/ no contact plate“) with which principles of the „biological fixation” of the fracture are achieved. razlabavljenje vijaka i ploče (1). especially when it is a case of unstable fracture of fist and foot. Regardless of the fixation type used (tension band. What is the crucial problem in case of isolated intramedullary adaptation ostheosynthesis is the control over the bone axis disorder such as: torsion. Rezultati.Volume 2 / Number 4 / 2008 Sažetak U radu se prema zadanim parametrima korelira efikasnost dva oblika ekstramedularne osteosinteze kod prijeloma dijafiza malih kostiju šake i stopala. wire loop. Zaključak. koštano cijeljenje Introduction When discussing about the ostheosynthesis of the small bones still today there is an always present problem of ostheosintetic material selection as well as adequate fixation of the fractures. poor healing with the consequential deformities and biomechanical disorders (5. With this preserved are elements of moderate elasticity. EFIKS osteosinteza ima mogućnost šire praktične hirurške primjene i potpuno je prihvatljiva alternativa za one koji ne raspolažu pločicama i vijcima. Po završenom liječenju svi implantati su bili identificirani u primarno postavljenoj poziciji. Majority of authors as only or alternative solution see in preference for Kirschner wires or screws positioned intramedullary (adaptation ostheosynthesis). Potpuna sanacija prijeloma je bila kod 25 (83.external fixator. Materijal i metode. a stopala kod 4 ispitanika.6%) osteosinteze. Cilj istraživanja je utvrđivanje definitivnih funkcionalnih i radiografskih parametara poslije prijeloma i koštanih promjena (24 prijeloma. Selektirane su dvije grupe od po 15 osteosinteza kod 26 pacijenata. screws. better biological tolerance as well as presence of the sufficient compression between fragments (3. This often escalates to the lack of healing. Povreda šake je bila kod 22. plates. usporeno koštano cijeljenje (1). 6 koštanih tumora/cista) nakon provođenja Ekstramedularne FIksacije Kirschner iglama i Serklažom – EFIKS osteosinteze i tehnike korištenjem pločica sa vijkom.6).100. as well as movement of the fracture.HealthMED . which leads to loosening of the complex screw . Nasuprot tome ekstramedularna fiksacija prijeloma sa vijcima i pločicama još uvijek je suverena i nezamjenjiva kao metoda u situacijama zglobnih i metafizarnih prijeloma Ključne riječi. rigidness. so it is reserved exclusively for the 220 Journal of Society for development of teaching and business processes in new net environment in B&H . even in situation when there are complex fractures of one or multiple bones (serial fractures of metacarpal/tarsal bones). U grupi EFIKS osteosinteza komplikacije su zabilježene kod 2 (6. That is usually stabile extramedullary or instable intramedullary fixations which are linked to the especially adapted instruments as well as implants of various sizes and shapes (7). Kod 2 pacijenta prijelomi su bili otvoreni (Gustilo I/II). Today in use is the large number of fixation techniques for the diaphyseal fractures small bones fractures.7 mm according to AO authors(1. pucanje serklažne žice (1). external fixator) the main goal is to achieve positive fixation effect trough dynamic compression where with mobility and muscle activity compressive to the point of fracture will increase. When eventually thinking of external fixation in case of small diaphyseal fractures of foot and fist that it is very inappropriate in case of load or muscle activity. ekstramedularna osteosinteza. What is actually in use in these situations is the use of generally mini plates of 2.05).4).

joint destructions arthrodesis 6. original model of extramedullary fixation of the fractures (Extramedullary Fixation with Kirschner Wires and Cerclage . without open presentation of the fracture site and with fluoroscopic guidance of the fragment until reduction and fixation of the fracture.HealthMED . cerclage (8) 1.joint destructions . Multiple MTC fractures 1. This initiated further research in terms of determining definite functional results after conducted EFIKS ostheosynthesis and other extramedullary ostheosynthesis under same conditions of traumatic substrate which will give an answer about: • process of bone healing in case of fractures and bone fusions (arthrodesis) by use of elastic and non elastic (rigid) extramedullary ostheosynthesis of the small diaphyseal fractures • surgical applicability of these two forms of ostheosynthesis Matherial and research methods At the Clinical Center of Sarajevo University within Clinics for Emergency Medicine as well as Plastic and Reconstructive Surgery in a time period from January 1st 2006 until December 31st Table 1 Indications for implantation of the ostheosintetic material in certain fractures types Tension band (Zuggurtung) 1. increase of periosteal necrosis in large segmented bone fields (endangered local vascularization). periaticular and and rotation multiple fractures of the joints 2. multi-fragmented fractures with shortening 2. Voluminous implants which are implanted in proclaimed surgical procedures often leads to huge surgical and post-surgical hazard. reduced elasticity of the bone and others. Due to this large number of authors modified their implantation techniques giving priority to the minimally invasive surgical procedures. open fractures fracture 6. fractures with segment bone loss 3.10). stable fractures Tension screw (8) 1. unstable long and bone loss skew or spiral diaphyseal 5.EFIKS) in comparison to intramedullary ostheosynthesis much better with less complications (7. soft tissue destruction. Research goal Previous experimental and clinical researches indicated that the radiography and functional treatment results of the small bone diaphyseal fractu- res with specific.11).unstable long and skew or spiral diaphyseal fracture 2.transfersal fractures. open fractures and rotation 4.arthrodesis Screw / Kirsch. fractures with segment 5.Volume 2 / Number 4 / 2008 larger defects of the soft tissue and the bone as temporary procedure. wire intramedullary. multi-fragmented fractures with shortening 3. Among other complications we should mention migration of alanthesis which can have extensive consequences (9. Multiple MTC fractures 4. This have as a consequence progression of primary state and occurrence of above mentioned complications (8). transversal stable fractures 7. joints fractures Plate with screws (8) Extramedullary fixation with Kirschner wires and cerclage 1. joint destructions arthrodesis Journal of Society for development of teaching and business processes in new net environment in B&H 221 .

. and 6 months. 3 cysts) and 12 patients which have implanted 15 plates 2. The shortest follow up time (functional and radiography finding) was after 3. 7 patients had open fractures (Gustilo I/II) within the EFIKS group in 4 cases. The followed parameters were: radiography healing of the fractures. and not later than 48 hours. Clinical. while in case of all bone changes (tumors/cysts) previously were conducted adequate diagnostic procedures (CT. 3. and than after 1. Fixation of sub capital fracture of the V metacarpal bone (B).HealthMED . Ratio between men and women was 21: 5. Selection of ostheosintetic material or type of the surgical procedure was within indication field presented at the Table 1.). Removal of the drainage was done after 4872 hours. Surgical technique Surgical treatment approach to all fractures was in terms of classic surgical procedures which were conducted immediately after the injury. EFIKS ostheosynthesis.7/3. We used two forms of extramedullary ostheosynthesis at feet and hands as follows: 14 patients with 15 EFIKS ostheosynthesis (11 diaphyseal.AO (13 fractures. Average age of the respondents was 33. osteoplastic replacement of proximal phalanges of IV and V finger with II metacarpal bone and double arthrodesis PIP and MTCP joints on IV and V finger. functioning and radiography testing of ostheosynthesis effectiveness was performed in all cases immediately after the surgery. and longest after 6 months. 1 bone tumor. In all cases drainage of the wounds was done with one drain.4 years (ranging between 12 and 53 years). 222 A B C Figure 1 (♂ 1962) Amputation of II and III hand finger with complete loss of proximal phalanges of IV and V finger and sub capital fracture of the V metacarpal bone – adaptation fixation intramedullary with Kirschner wires (A). Patients were stimulated to perform movements early. and in case of 1 patient (serial fractures) we used plates and screws on 3 metacarpal bones (Figure 2) and also in one patient on metacarpal and proximal phalange. fixation of the implant in relation to the bone and soft tissues. angiography . deformities occurrence. Average duration of hospitalization was 8 days. 1 cyst) of phalanges and metacarpal/metatarsal bones.Volume 2 / Number 4 / 2008 2007 we have treated 26 patients (24 fractures and 6 bone tumors/cysts). development of infection.5 mm with screws . Neither one patient was immobilized. In one case there was double fixation with the EFIKS ostheosynthesis at the same hand. 1 bone tumor. In case of foot fractures walking and partial load was recommended to all patients after 3 months. Healing of the V metacarpal bone with complete fusion at position of arthrodesis after 5 months. Satisfactory functioning effect (C). Antibiotics were prescribed as prophylaxis. MRI. Fractures and bone changes on hands were present among 22 patients and among 4 patients on foot. grip in case Journal of Society for development of teaching and business processes in new net environment in B&H . Under general anesthesia we surgically treated 22 patients while 4 patients had regional anesthesia.

But within research done by Burge identical secondary movements of the fragments were noticed also when using plates and 223 Journal of Society for development of teaching and business processes in new net environment in B&H . III and V metacarpal bone (A). It is for sure that locus minoris resistentiae of EFIKS ostheosynthesis is the possibility that the lever effect can occur. A migration of the spiral metacarpal fracture to. which happened in one case and it is also confirmed during the experimental research (11). bending of the plate with poor position of the fragments in case of metatarsal fracture – 1.6%) cases with EFIKS ostheosynthesis noticed is the break of one of the cerclage wires inn case of transversal diaphyseal fracture of the metacarpal bone – 1. All movements in the neighboring joints of the hand and foot were minimally reduced + 50 100. After 2 and 4 weeks inflammation is coupled with the targeted antibiotic therapy.HealthMED . Fist grip was satisfactory. angulations at the point of fracture with defect of the primary base on the V metatarsal bone – 1. except in two cases where is was difficult to achieve for one patient in EFIKS ostheosynthesis group (amputation injury) and one with arthrodesis II MTCP joint with plate and screws. By forming the successful bone basis. Repositioning and fixation with plates 2.7 mm and free screws (B) Results In all cases early functional mobility is achieved. 11). without consequences on final healing. without need for additional correction. and than by comparison of its effects with the intramedullary forms of adaptation ostheosynthesis. By radiography all implants are identified in the primary set position. first in experimental research. Verification of full bone healing in case of fractures or fusion in case of arthrodesis is noticed in 25 (83. as well as baropodometric evaluation of plantar foot pressure distribution and supportive walk analysis. one new choice for all diaphyseal fractures of the fist and foot as situations of very quality bridging of the bone defects with its ostheoplastic replacement (7.3%) ostheosynthesis. and which must be prevented that the fracture is the medium locus of the dyaphisis. This can lead to loosening of the basic components. movements in neighboring joints. Discussion B Figure 2 (♂ 1950) Spiral fractures of II. and even compared to the rigid ostheosynthesis with plates and screws is without any doubt. In 3 (10%) cases with implanted plate and screws: slower healing of metacarpal fracture is noticed – 1 which required additional bone stimulation. Good functional results is conditioned by the graduate induced movements and dosage of the load during the post surgery period. Selection of adequate thickness of the Kirschner wires and number of the cerclage wires at the risk segments of the bone this complication can be successfully avoided. Two patients had signs of local inflammation without involvement of the bone or ostheosynthesis. Baropodometric evaluation of walk and posture in 4 cases of patients with ostheosynthesis of the foot was adequate (analysis 5 months after surgery) without need for correction. loosening of the screws and plate without What EFIKS ostheosynthesis definitely showed. primarily cerclage wire. with normal bone healing. In 2 (6.Volume 2 / Number 4 / 2008 of fist fractures. but with healed fracture – 1.

et al. The post–manufacture manipulation of implants. Brida V. Lippincott comp.Volume 2 / Number 4 / 2008 screws. London. Tokyo. 2001..05). Paris.12 8.HealthMED . 5. Burge P. Hemoptysis due to migration of a fractured Kirschner Wire. The cardiac migration of a Kirschner wire a case report. Foot and Ankle Trauma. Boyes JH.Riv Chir Mano. Hadžiahmetović Z. 11. Krasni J. Philadelphia – Toronto. 4 (3): 27-30. This have great importance in indicated fusions (arthrodesis) where we can expect even resorption of the bone ends and where rigid ostheosynthesis done with plates prevents additional activity of the dynamic-compressive link of muscle-ligamenttendons apparatus. Churchill Livingstone. 1989: 345–62. Kirchwehm WW. Barcelona. 7 ed. Scurran BL. et al. Jelić I. Wahl D. Anic D. 2: 13–4. Binning TA. when bending of the plate and loosening of the screws occurred (8). Corresponding author: Zoran Hadziahmetovic Clinic for emergency medicine. 301 . 2006. Although we did not evaluated fractures of the joints it is certain that within selection of alenthesis is leading decision for plates and screws. Osteosinteza tehnikom ekstramedularne fiksacije prijeloma Kirschner iglama i serklažom (EFIKS). 10. 1995. Elasticity of the EFIKS ostheosynthesis is additional factor which leads to avoidance of the large rigid diaphyseal segments which for sure adds additional stimulating effects to the healing which is the advantage of the biological fragments fixation. Stuttgart – New York. 1) 9 . Chest. New York. 2000. Internal fixation of the metacarpals and phalanges. 3. Tex Heart Inst J. Schneider R. Početna klinička iskustva u liječenju dijafizarnih prijeloma malih kostiju tehnikom originalne ekstramedularne osteosinteze. JBJS. Heidelberg. Opposite to this extramedullary fixation of fractures with the use of screws and plates is still leading and irreplaceable as the method in case of joint and metaphyseal fractures. Literature 1. AO principles of fracture management. Berlin. 76 – B – 650 – 5. Med Arh 2006 . Thieme. 7. et al. Conclusion Extramedullary stabilization of the fractures and bone changes within the tested sample and two specific groups of respondents with use of difference forms of extramedullary ostheosynthesis did not show statistically significant differences in the final radiography and functional results according to the set parameters of the research (p>0. Kenwright J. 4. Owen G. Hong Kong. Dialoge. Third edition. 24(4): 359–61. Hadžiahmetović Z. 2. In. Bosnia and Herzegovina e-mail: HealthMed_bih@yahoo. supl. Also in our research. 119: 1285– 6..543 9. Both methods showed sufficient achievement of stabilization and have full support in treatment of simple and complex diaphyseal fractures of short and medium bones as well as arthrodesis of the IP and MTP/MCP joints. 1997 . Willenegger H. Springer – Verlag. Foster GT. :(3). 2001. Because of the simple implants (Kirschner wire and wire for bone cerclage) as well as necessary instruments EFIKS ostheosynthesis have possibility for wider practical application in surgery and it is cost acceptable for those institutions which lack plates and screws. Fractures of internal metatarsals. Gooship AE. honestly in only 2 cases (at each group one patient) there were these complications. Orlić D. Tr Glas. The influence of induced Micromovement Upon the healing of Experimental. 60 (6. 2006. The Hand. Allgower M. Muller ME. Clinical Center of Sarajevo University. Manual of internal fixation. Murphy WM. 1985. 6.com 224 Journal of Society for development of teaching and business processes in new net environment in B&H . 2000. Ruedi TP. Baumgart F. Figura MA.

Kod gojaznih osoba produkcija adipokina je poremećena te je uočen visok nivo leptina i resistina i nizak nivo adiponektina. Leptin has been observed to stimulate angiogenesis. trombogenesis and inflammation. University of Sarajevo. This paper summarizes the role of three adipokines: leptin. In patients with established coronary atherosclerosis increased body weight is an independent predictor of an acute coronary syndrome. which has protective effects on coronary blood vessels is suppressed. Poremećen odnos adipokina je povezan sa inzulinskom rezistencijom. Sada se zna da je masno tkivo multifunkcionalni organ koji proizvodi hormone. In obesity high level of leptin. Now it is recognized as a multifunctional organ involved in the production of hormones. atherosclerosis and metabolic syndrome. Leptin and resistin show proinflammatory effects upregulating cytokine production in macrophages and might lead to destabilization of coronary atherosclerotic plaque. Leptin. In obese subject the production of adipokines is impaired. Amina Valjevac1. aterosklerozom i metaboličkim sindromom. povećana tjelesna masa je nezavistan prediktor nastanka akutnog koronarnog sindroma. adiponektin i resistin su adipokini koji dovode do koronarne endotelne disfunkcije. acute coronary syndrome Sažetak Donedavno se smatralo da je jedna od osnovnih fiziološka uloga masnog tkiva da pohranjuje energiju. growth factors and cytokines named adipokines. Resistin also impair coronary vasodilatation but via bradykinin pathway. The exact mechanism of obesity induced coronary heart disease is not fully elucidated. adiponectin and resistin are adipokines that are implicated in coronary endothelial dysfunction. platelet aggre- gation. Medical Faculty. In obese subject the production of adiponectin. Key words: Adipokines. Current research is aimed to determine links between adipokines and coronary heart disease. Recent studies demonstrated that high plasma leptin and low adiponectin levels as observed in obese subjects impair coronary acetylcholine-mediated vasodilatation in vitro and in vivo. Kod pacijenata sa razvijenom koronarnom aterosklerozom. faktore rasta i citokine koji se jednim imenom zovu adipokini. resistin. Bosnia and Herzegovina Summary Adipose tissue has traditionally been considered as a tissue devoted mainly to energy storage. and atherothrombosis in obese human. adiponectin. leptin.Volume 2 / Number 4 / 2008 Adipokines and Acute Coronary Syndrome ADIPOKINI I AKUTNI KORONARNI SINDROM Emina Nakas-Icindic1. resistin and adiponectin in acute coronary syndrome and implicates theirs possible appliance in clinical practice.HealthMED . trombogeneze i inflamacije. Istraživanja su usmjerena u cilju razjašnjenja povezanosti adipokina i bolesti koronarnih krvnih sudova. Leptin. procesa za koje se zna 225 Journal of Society for development of teaching and business processes in new net environment in B&H . These processes are known to precipitate atherosclerotic plaque rupture and acute coronary syndrome. and low level of adiponectin have been observed and implicated in insulin resistance. resistin. Asija Zaciragic1 1 Institute of physiology and biochemistry. Mehanizmi kojima gojaznost dovodi do koronarne bolesti nisu u potpunosti rasvijetljeni.

The vulnerability of a plaque to disruption appears to be determined by the presence of a large lipid-rich core. Nedavno objavljene studije su pokazale da visok nivo leptina i nizak nivo adipokina. numerous adipocyte-derived proteins and peptides have been discovered. Besides leptin. Ključne riječi: Adipokini. Adipokines are known to contribute to the chronic low grade inflammation state observed in obese patients. resistina i adiponektina u akutnom koronarnom sindromu kao i da implicira njihovu moguću primjenu u kliničkoj praksi. Obesity is an independent risk factor for development of atherosclerosis. Clinical significance of adipokines measurement during acute coronary syndrome is also discussed. even in the early stages of disease. growth factors and cytokines acting via endocrine. paracrine and autocrine modes (1). Weight loss is associated with a decrease in the serum levels of most of these adipokines. a thin fibrous cap. Journal of Society for development of teaching and business processes in new net environment in B&H . Adipose tissue is now recognized as a multifunctional organ producing proteins and peptides named adipokines. and an inflammatory cellular infiltrate. Istovremeno višak masnog tkiva dovodi do smanjenog stvaranja adiponektina. Leptin was one of the first adipocyte-derived hormon which signals the status of energy stores and its secretion can reduce appetite and increase energy expenditure (2). Resistin također inhibira koronarnu vazodilataciju ali preko bradikinina. with the exception of adiponectin. It encompasses unstable angina. Endothelial dysfunction is present in patients with atherosclerosis. Dysfunctional endothelium encourages the recruitment of leukocytes into the arterial wall and thereby predisposes to inflammation and plaque disruption. resistin. leptin. Underlying mechanism precipitating acute coronary syndrome in a majority of cases. Uočeno je da leptin stimulira angiogenezu. inhibira vazodilataciju koronarnih krvnih sudova preko acetilholina in vitro i in vivo. non-ST and ST segment elevation myocardial infarction and sudden ischemic death. agregaciju trombocita i aterotrombozu kod gojaznih osoba. adiponectin and resistin have been given much attention in research lately. characteristic feature of coronary artery disease is enhanced coronary vasoconstriction (5). Ovaj članak ima za cilj da sumira ulogu navedena tri adipokina: leptina. In addition to plaque disruption and thrombosis. The exact mechanism by which increased body weight leads to coronary artery disease is not fully understood. akutni koronarni sindrom Introduction Adipose tissue has traditionally been considered as a tissue devoted mainly to energy storage.Volume 2 / Number 4 / 2008 da potiču ruturu aterosklerotskog plaka i nastanak akutnog koronarnog sindroma. In the same time they participate in the development of obesity-related comorbidities. uočen kod gojaznih osoba. which is increased (3). The term acute coronary syndrome refers to a range of acute myocardial ischemic states. Adipokines might play an important role in initiation and progression of atherosclerotic plaque rupture enhancing endothelial dysfunction. immune response and thrombogenesis but the findings regarding exact mechanism of their action are contradictory and inconclusive. adiponektin. metabolic syndrome and atherogenesis (1) 226 Circulating adipokine levels are elevated in obese and insulin-resistant states in animals and humans. Aim of this paper is to summarize current findings regarding the role of adipokines in acute coronary syndrome and possible appliance of adipokines blocking and boosting agents in clinical setting. Leptin i resistin djeluju proinflamatorno dovodeći do povećane ekspresije citokina u makrofazima. Adipokines are hormones. procesa koji može biti okidač destabilizacije koronarnog aterosklerotskog plaka. Since the initial identification of leptin. is coronary atherosclerotic plaque rupture and consequent thrombus formation. In patients with established coronary atherosclerosis increased body weight is an independent predictor of an acute coronary syndrome (ACS) (4). such as insulin resistance.HealthMED . koji djeluje protektivno na koronarne krvne sudove.

Volume 2 / Number 4 / 2008 Table 1. but also produced by other tissues including the heart (6). Adipokines Leptin Physiological function Energy and glucose homeostasis ↑2 Trombogenesis ↑ 18 Immunity ↑ 1 Haematopoesis ↑ 17 Insulin sensitivity ↑ 31 Energy expenditure ↑ 31 Fatty acid oxidation ↑ 31 Vasodilatation ↑ 25 No production ↑ 25 Inflammation ↓ 1 Cell proliferation ↓ 22 Tissue remodeling ↓ 22 Glucose production ↑ 34 Inflammation ↑ 40 Insulin sensitvity ↑ 44 Complement activation ↑ 43 Acute phase protein synthesis ↑ 1 Hypothalamic–pituitary axis ↑1 activation↑ 1 Thermogenesis ↑1 Coagulation ↑1 Inflammation ↑ 1 Cellular proliferation ↑1 Cellular differentiation ↑1 Related diseases Obesity ↑ 11 Atherosclerosis ↑ 12 Obesity ↓23 Dislipidemia ↓ 23 Atherosclerosis ↓ 23 Nonalcoholic fatty liver disease ↓40 Nonalcoholic steatohepatitis ↓40 Diabetes mellitus type 2 ↓ 23 Cancer ↓1 Obesity ↑ 34 Insuline resistance ↑ 34 Atherosclerosis ↑ 36 Obesity ↑ 44 Diabetes mellitus type 2 ↑ 44 Obesity ↑43 Obesity ↑ 3 Acute and chronic inflamatory diseases ↑3 Atherotrombosis ↑6 Chronic inflammation ↑1 Malignancy ↑1 Obesity ↑ 3 Anorexia ↑3 Insuline resistance ↑3 Coronary heart disease ↑6 Obesity ↑1 Hyperglicemia ↑1 Hyperlipidemia ↑6 Atherotrombosis ↑6 Adiponectin Resistin Vistatin Adipsin IL-6 TNF-α PAI-1 Trombogenesis ↑ 6 Leptin Leptin is a 16 kDa protein predominantly expressed and secreted in adipose tissue. d. Its intracellular domain belongs to the Janus kinase signal transduction and translation system (Jak2/STAT3)(7). Leptin exerts its effect by binding to its receptors which are expressed abundantly in many dif- ferent cells including cardiomyocites and coronary arteries. Leptin receptors are classified as short (ObR a. f). secreted (ObRe) and long (ObRb). ObRb receptor is present in coronary arteries and considered to be involved in full cellular signaling process (8).c.HealthMED . The production of cardiomyocyte derived leptin is increased by both endothelin-1 and angiotensin II suggesting a paracrine or autocrine role of leptin 227 Journal of Society for development of teaching and business processes in new net environment in B&H . Plasma leptin concentrations reported in normal. Main adipokines outline: most important physiological functions and involvment in diseases. healthy humans are 3–5 ng/mL and in morbidly obese humans leptin concentrations are elevated and range from 90–95 ng/mL (7).

The primary cardiac response to leptin in terms of physiological function appears to be a negative inotropic response which has been shown primarily in cardiomyocytes and which is mediated by endogenously produced nitric oxide (NO) (10). Leptin has been linked to all processes underling acute coronary syndrome. and at the same time it induces oxidative stress (18). but the coronary vascular effects of leptin are largely uncharacterized. epidemiologic studies have shown a strong association between hyperleptinemia and risk for coronary artery disease (12. Plasma leptin levels were found to be significantly higher in patients presenting with acute coronary syndrome compared to the patients with stable angina and healthy subjects (14). (16) were first to report that leptin increases coronary blood flow approximately 40% in patients undergoing cardiac catheterization and that this vasodilatation is independent of nitric oxide (NO) synthase. High circulating plasma leptin levels in obesity are thought to play a role in the hastened development of coronary artery disease (11). Adiponectine can function as full length proteine which binds to AdipoR1 (adiponectin receptor 1) or smaller globular fragment Journal of Society for development of teaching and business processes in new net environment in B&H . Knudson et al. Leptin receptors antagonists called muteins could promiuse as a possible therapy in patients with coronary atherosclerotic disease and acute coronary syndrome (20). Again. Several studies suggested that leptin affects coronary vascular resistance but the findings are inconclusive. (8) recently demonstrated that increasing plasma leptin concentrations to levels similar to those observed in obese subjects (10–90 ng/mL) significantly impaired acetylcholine-mediated vasodilatation in vitro and 228 in vivo. But. Earlier studies have demonstrated that leptin is vasoactive in noncoronary vascular beds (2. few studies to date have examined the effects of leptin on the coronary circulation. Knudson et al. Dubey et al. Therefore. several clinical. Adiponectin concentration ranges from 1. Leptin leads to Tcell proliferation. phagocytosis and upregulation of cytokine production in macrophages. concentrations of leptin found in obese subject appear to have deleterious effects on coronary endothelial function and myocardial blood flow acutely. In addition. leptin has been observed to stimulate angiogenesis. leptinmediated coronary vasodilatation in the studies was only observed at extremely high leptin concentrations (160 ng/mL) which are rarely seen in obese subjects. There are still numerous unresolved issues regarding the exact nature of leptin’s effects on coronary arteries and during acute coronary syndrome.0 mg/dL in normal healthy subjects (1). On endothelial cells leptin has been shown to upregulate endothelin-1 and NO synthase. (19) analized angiographically simple and complex lesions on coronary arteries in patients presenting with unstable angina pectoris and found leptin to be an independent predictor of complex lesion suggesting its potential role as useful biomarker for risk stratification in patients with unstable angina. Therefore. Leptin correlated positively with interleukin-6 and high-sensitivity C-reactive protein in patients with acute coronary syndrome suggesting its possible role in systemic inflamation and in asssesing the risk for developing acute coronary syndrome. In contrast. Adiponectin expression and release from adipocytes are stimulated by activation of peroxisome proliferator-activated receptor PPAR-γ. and atherothrombosis in human obesity (1). Adiponectin Adiponectin is 30 kDa protein mostly secreted by adipose tissue.15). Damaging effect of leptin on acutely ischemic myocardial tissue might be inhibited with novel pharmacological tools targeting leptin receptors. with the development of specific ObR antagonists a clear and consistent consensus will be reached regarding the role of leptin on ischemic myocardial tissue. (17) demonstrated that high pharmacologic concentrations of leptin induce nitric oxide–dependent vasodilatation of coronary arterioles in animal models.Volume 2 / Number 4 / 2008 in the regulation of cardiac functions particularly under pathological conditions (9). a key transcriptional factor involved in adipocyte differentiation (21). Matsuda et al. 13). On the contrary. platelet aggregation.9–17. However.HealthMED . normal concentrations of leptin (4 ng/mL) do not affect vasodilatation to acetylcholine.

(25) found that patients with acute coronary syndrome (ACS) had significantly lower adiponectin levels than those without ACS. as well as beta-blocking drugs which are used during myocardial infarction have been shown to mimic the action of adiponectin (32). Although resistin cell receptors are yet to be identified. demonstrate many of the therapeutic effects of adiponectin. metformin. In myocardial tissue. A study by Date et al. Whether the therapeutic effects of the PPAR-γ agonists are mediated via induction of adiponectin remains to be investigated. resistin levels are substantially higher in human inflammatory cells (33). In one study resistin depressed functional recovery from ischemia in isolated perfused rat hearts. Although it was detected in adipose tissue of obese subjects. Also. In this respect. healthy subjects with angiographically normal coronary arteries. Studies regarding resistin effect on ischemic myocardium are scarce and conflicting. Those subjects with higher transcardiac adiponectin gradients exhibited higher coronary flow reserves. The obvious discrepancy requires further research. there is a reduction in local epicardial adiponectin production (26). Adiponectin is associated with induction of antiinflammatory cytokine production (IL-10 and IL-1) (29). Promising results obtained from numerous animal experiments and human epidemiological studies support the role of adiponectin as a potential drug target in treating obesity-related chronic low grade inflamatory diseases. An alternative approach is to use pharmacological or dietary intervention to increase the suppressed endogenous adiponectin production in obesity. vasoprotective. direct action of resistin in the heart and specifically on cardiomyocytes has been described. decreased circulating adiponectin levels in obesity are associated with an increased risk of coronary artery disease and myocardial infarction (24). or to enhance adiponectin actions in its target tissues. and myocardial infarction in patients presenting with chest pain (23). cardiac mortality. it is interesting to note that the PPAR-γ agonists thiazolidinediones (TZDs). and anti-inflammatory properties (31). Within the last year a few studies examining the role of adiponectin in coronary vasomotor function have been published. AdipoR1 is expressed in substantially greater abundance compared to AdipoR2 (22).e. such as insulinsensitizing. Another recent study by Takano et al. in humans with coronary artery disease. Epicardial adipose tissue produces adiponectin. (36) and Dick et al. 229 Journal of Society for development of teaching and business processes in new net environment in B&H . an effect which appeared to be dependent on NF-kB activity (38). Wolk et al.HealthMED . (28). great cardiac vein concentration minus left coronary artery concentration) in 22 nondiabetic. found a positive correlation between transcardiac adiponectin gradient and acetylcholine-induced increases in coronary artery diameter.. Furthermore. Mouse adult cardiomyocytes treated with resistin show a reduction in insulin-stimulated glucose uptake (35). (27) observed a significant correlation between coronary flow reserve and the transcardiac adiponectin gradient (i. Studies by Kougias et al. In addition. Direct supplementation of recombinant adiponectin in human subjects would be extremely expensive. Plasma resistin concentration is in the range of 3–13 ng/ml in healthy subjects with levels approaching 40 ng/mL in obese individuals (34). It has also been shown that adiponectin plays a role in endogenous antithrombosis (30). Plasma adiponectin levels correlate inversely with body fat content and in obese subjects low plasma adiponectin level is an independent predictor of all-cause mortality. which increase adiponectin production in both humans and rodents. independent of a variety of cardiovascular risk factors. (37) demonstrated that resistin alters coronary vasomotor responses in vivo and in vitro imparing coronary vasorelaxation to bradykinin in both porcine and canine coronary circulations. such as rosiglitazone and pioglitazone. The authors concluded that adiponectin plays a role in coronary endothelial function (as assessed by acetylcholine-mediated coronary vasodilation). In contrast. resistin reduced infarct size in mice subjected to coronary artery occlusion and reperfusion (39).Volume 2 / Number 4 / 2008 binding to AdipoR2 (adiponectin receptor 2). another commonly used antidiabetic drug. Resistin Resistin is 12 kDa protein named after the observation that it leads to insulin resistance.

Discussion Increased adipose tissue in obese subject produces more adipokines such as leptin and resistin which have recently been implicated in the pathogenesis of acute coronary syndrome affecting coronary vasculature. non-STelevation myocardial infarction and ST-elevation myocardial infarction. and other adipokines affect cardiac pathology. adiponectin. increased adipose tissue suppresses the production of an adipose tissue hormone. Resistin might reflect an inflammatory processes occurring in mononuclear cells during acute coronary syndrome. Thus. (41) reported that resistin levels were elevated in patients presenting with unstable angina. Serum resistin levels positively correlated with CKmax. It remains to be assessed whether the predetermined ranges of plasma adipokines concentration could be used as a useful biomarker for stratification of patients with coronary heart disease. Lubos et al. It has not been assessed whether elevated concentrations of adipokines during myocardial ischemia changes during and after acute coronary syndrome. Journal of Society for development of teaching and business processes in new net environment in B&H . CK-MBmax.HealthMED . There are numerous challenges facing investigators in this field. (40) reported increased serum resistin levels in patients with acute coronary syndrome and in patients with stable angina pectoris (SAP) compared with the healthy subjects. Important among these is the fundamental question of precisely how leptin. Because of diverse myocardial ischemia and ischemic impairment in AMI\ UAP\SAP patients. cTnImax.Volume 2 / Number 4 / 2008 Qiao at al. which has protective effects on coronary vasculature. Plasma concentration of leptin and resistin is associated with the extent of coronary occlusion during acute coronary syndrome while plasma concentration of adiponectin correlates inversely with the degree of myocardial ischemia. increased sympathetic activity causes release of renin and elevation of plasma leptin concentration could be due to increased plasma angiotensin II levels. Disruption of physiologic adipokine plasma levels and perturbations in adipokine signaling within the coronary vascular wall culminates in coronary endothelial dysfunction. adiponectin. Serum resistin levels increased with the severity of myocardial impairment and therefore might play a role as a diagnostic marker. WBC and hsCRP. This task will undoubtedly be facilitated and expedited with the eventual development of new pharmacological tools targeting specific adipokine systems. the inflammatory factors might be released in different degrees. This remains a challenge for future investigations which are important not only to fully understand the role of adipokines in cardiac regulation but in terms of potential for the development of novel cardiac therapeutic targets. the net effect of increased adipokine production may not reflect the actions of a single individual substance. followed by unstable angina pectoris (UAP) and SAP. The highest serum resistin values were found in acute myocardial infarction (AMI). alterations in adipokine biology may be a major precipitating factor in the initiation of coronary artery disease in individuals with metabolic disease. Leptin concentration in obese range (10-90 ng/mL) was found to impair acetylcholine mediated coronary relaxation and could be attributable to prolonged myocardial ischemia (8). On the other hand. Average 230 plasma leptin concentration in patients with myocardial infarction is in the lower obese range and significantly higher compared to the patients with unstable angina. During myocardial infarction. as such. which is known to stimulate leptin release. inflammatory processes and thrombogenesis and thus predisposing the rupture of coronary atherosclerotic plaque. A second major challenge is to understand how the various adipokines interact with each other since numerous adipokines with diverse biological properties can be released simultaneously and.

J Endocrinol 181: 1–10. Koshida R. Nickola MW. Am J Physiol Heart Circ Physiol. Swafford NA. a more clear insight will be gained regarding their exact role in acute coronary syndrome. Arterioscler Thromb Vasc Biol 18:928–933. and Tavernier J. Teragawa H. 11. Ledbury S. 14. Kirshenbaum LA. Packard CJ. Hypertension. 2005. Eyckerman S. Lavens D. Chayama K. Stevenson JC. Liu R. Rajapurohitam V. Present and future biochemical markers for detection of acute coronary syndrome. 7. 2008. Ren J. 1998. Leptin resistance extends to the coronary vasculature in prediabetic dogs and provides a protective adaptation against endothelial dysfunction. Wallace AM. Pegg GG. 2000. Literature 1. Leptin attenuates cardiac contraction in rat ventricular myocytes. Body mass index: a risk factor for unstable angina and myocardial infarction in patients with angiographically confirmed coronary artery disease.. Gazzola C. Vandekerckhove J.115:911-919. 3. J Mol Cell Cardiol. Ren J. Karmazyn M. Hypertension. Bloom S. Perticone F. 279–286. 2006. Walton C. Effect of Lifestyle Modification on Adipokine Levels in Obese Subjects with Insulin Resistance. Zeng H.from friend to foe for cardiovascular function. Aldis S. J Allergy Clin Immunol. 13. Corica F. Hall JE. Eriksson S. Potential Role of Adipocytokine Leptin in Acute Coronary Syndrome. 2003. Horton ES. Role of NO. Leptin causes nitric-oxide independent coronary artery vasodilation in humans. Ghatei M. Asian Cardiovasc Thorac Ann. 2008. 36:501–505. 41:265–274. Wang H. Lennon RJ.1998. Nakagawa K. Somers VK. Saito M. Plasma leptin and the risk of cardiovascular disease in the west of Scotland coronary prevention study (WOSCOPS). Javadov S. Leptin receptors are expressed in coronary arteries. 16. Brands MW. The ins and outs of leptin receptor activation. Int J Obes Relat Metab Disord 27:566–573. Purdham DM. Hyperleptinemia as a component of a metabolic syndrome of cardiovascular risk. Wolk R. Fantuzzi G. Zhang C.. Colligan PB. Shibata H. Adipose tissue. and hyperleptinemia causes significant coronary endothelial dysfunction. Purdham MD. 2003. Karmazyn M. 8. 10. 2004. Corsonello A. Zeidan A.Volume 2 / Number 4 / 2008 Conclusion Adipokines are involved in all stages of acute coronary syndrome initiation and progression. 2005. With the use of drugs affecting adipokines plasma level in future research. Peelman F. Shepherd J. 2003. Fukuda Y. McMahon AD. 2002. 4. and Sattar N. Gaw A. Leptin-dependent platelet aggregation in healthy. Kelly A. Dincer UD. Zabeau L. Margetic S.HealthMED . Hypertens Res. Journal of Society for development of teaching and business processes in new net environment in B&H 231 . 18. Am J Physiol Heart Circ Physiol 289: H48-H56. Mullooly C et Al. 2. and Hill RA.43(56):427-95. Brilakis ES. Knudson JD. and inflammation. 2003. Malara A. Ientile R. Leptin and hyperleptinemia . Buemi M. Dincer Ü D. FEBS Lett 546: 45–50. 289:H1038–46. Godsland IF. An autocrine role for leptin in mediating the cardiomyocyte hypertrophic effects of angiotensin II and endothelin-1. Samson WK. 12. Circulation 104: 3052–3056. 5. et al. 2005. Higashi Y. 9. 2001. Loddo S. Wold LE. Cardiovascular Research 79. Knudson DJ. Wang GJ. overweight and obese subjects. Obesity Research: 11:1048–1054. 26:147–52. Pettersson K. 2003. Leptin: a review of its peripheral actions and interactions. 17. 2006. Int J Obes Relat Metab Disord 26: 1407– 1433. Hamdy O. adipokines. Chronic leptin infusion increases arterial pressure. De Domenico D. Crit Rev Clin Lab Sci. 15. Circulation. Signalling mechanisms underlying the metabolic and other effects of adipokines on the heart. Akahane R. Dubey L. Rajapurohitam V. 31:409–414.108:2206–2211. Dick GM. Wittfooth S. 16:124128. Leyva F. Shek EW. et Al. Matsuda K. Berger P. 6. Monzillo LU. Proudler AJ.

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2008. 39. 2008 Epub ahead of print 43. J Mol Cell Cardiol 2007. Fain JN. Hamdy C et al. Medical faculty University of Sarajevo. Chen Z. Zhe-rong Xu. Sudlow FF. Peeples JM. 2007. Wang H. Lubos E. in the coronary circulation. James J. Xiao-zhi Qiao. Espinola-Klein C. Farias M. Richards AM. 2007. an adipocytokine. Xu X. Chang CC. Morris M. Tune JD. Corresponding author: Emina Nakas-Icindic Institut of physiology and biochemistry. Release in vitro of adipsin. Gao J. Rupprecht H. 38. offers protection against acute myocardial infarction. Knudson JD. Madan AK. Lackner K. III. Curr Med Chem. Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris. Bickel C. Tichansky DS. Resistin worsens cardiac ischaemia-reperfusion injury. Schnabel R. Tiret L. Ma H. 2007. 44.349: 400–407. ž 42. Post F. Messow C. Pemberton CJ.Visfatin: structure. Katz PS. 40.HealthMED . Am J Physiol Heart Circ Physiol 291:H2997–H3002.193(1):121–128. Wu X. Lu L. Nesbit AS.Expression of adiponectin and its receptors in livers of morbidly obese patients with non-alcoholic fatty liver disease.. but not acetylcholine. Yang X. J Gastroenterol Hepatol. Yun-mei Yang.43:601–609. Peetz D. Metabolism: 56(11):1583-90. and soluble tumor necrosis factor receptor 2 by human omental adipose tissue as well as by the nonfat cells and adipocytes. Bosnia and Herzegovina e-mail: nakasicindic@yahoo. Resistin. 2006. Resistin. Resistin impairs endothelium-dependent dilation to bradykinin. Cheema P. vascular cell adhesion molecule 1.Volume 2 / Number 4 / 2008 37. Dick GM. J Zhejiang Univ Sci B.com Journal of Society for development of teaching and business processes in new net environment in B&H 233 . Biochem Biophys Res Commun 2006. function and relation to diabetes mellitus and other dysfunctions. Xiao SY. angiotensin 1-converting enzyme. 15(18):1851-62. 8(12): 875–880 41. Li-ai Yang. Gomez V. acute coronary syndrome and prognosis results from the AtheroGene study. Adeghate E. Athero-sclerosis. Rothwell SE.

aminokiseline. carbs. minerali. masne kiseline). aminoacids. lipids). stands for the single forms or mixtures of feeding materies that serves as additions to food as its’ complement.(3). Proizvodi sa vitaminskim dodacima nisu tako ko234 risni. koje služe kao dodaci prehrani u smislu njezinog obogaćivanja ili se uzimaju direktno u koncentriranom obliku (vitamini. (1) Feeding is basic human need for existence. vitamins. Products with vitamine additions aren’t so usefull as evidenton usefull meaning of fruits and vegetables intake. or these are taken directly in concentrated form (vitamins. mineraly Sažetak Pod prehrambenim dodacima podrazumijevaju se pojedinačni oblici ili mješavine hranjivih materija. Vitamins and minerals can enter in organism in two ways. Bosnia and Herzegovina Summary The term. University of Sarajevo. Jasmina Mahmutovic1. Key words: feeding additions. Introduction The term feeding additions. aminoacids. vitamini. Azra Kudumovic2 1 2 Faculty of Health. Bosnia and Herzegovina Faculty of Medicine. lipids). kao što su dokazi o korisnom učinku voća i povrća. te dati ocjenu korištenja voća i povrća u ishrani ispitanika.protective materies (vitamines and minerals). Arzija Pasalic1. Cilj je bio analizirati znanje i praksu bolesnika prema prehrambenim dodacima vitamina i minerala. proteins. feeding additions stands for individual forms or mixtures of feeding materies that serves as feeding additions in order to complete it or they are taken directly in concentrated form (vitamins. bjelančevine. Vitamins and minerals can be taken into organism in two ways: by taking of food or by taking of mineral and vitamin additions. proteins. mineral materies. mineral matheries. lipids) and mikronutrtients. mineralne materije. Dijana Avdic2.Volume 2 / Number 4 / 2008 Relation of disseased towards feding aditions vitamins and minerals ODNOS BOLESNIKA PREMA PREHRAMBENIM DODACIMA VITAMINA I MINERALA Fatima Jusupovic1. Ključne riječi: Prehrambeni dodaci. Journal of Society for development of teaching and business processes in new net environment in B&H . with food or as additions. the basic nutrition materies which can be divided in two groups:macronutritiens – the primar source of energy (proteins .HealthMED . The products with vitamin additions aren’t that useful as evidential usage of fruits and vegetables. University of Sarajevo. Vitamini i minerali mogu u organizam doći dvojako. In process of feeding. ili sa hranom ili putem prehrambenih dodataka. The aim was to analyze the situation and practice of patients and their attitude towards vitamins and minerals and evaluate the taking of fruits and vegetables in everyday feeding. In process of planing of feeding it is taken care of that daily meal plan includes various groceries in order to secure needed intake of all anutritive and protecive materies (2).

Questioning is divided in four parts: status of qustioned persons.Volume 2 / Number 4 / 2008 The aims of the work  Analasys of knowledge and practice of patient towards feeding additions vitamins and minerals  Give evaluation of fruit and vegetables using in patients' feeding Material and methods The used method of work is questionaire consisting 30 questions. Results and discussion There were totaly 297 patients. whilie others were unemployed.36 %. The most of users didn’t answer at all or mentioned any reason. attitude that during intake of various food in organism isn’t necessary to take other supplements. use 30. the questioning was realised in decembre 2007.55 %). artifitial preparats of vitamins and minerals in their feeding. According to research.61 %. the second place belongs to A + C + E (23.22 %. and less (49. and the least used are multimineral additions 3. In case of dissease ). use multivitamin additions ( 26. Graphic 2. several times a day 9. the most of them are with finished high school (65.71 %. while others are with finished primary school. most of the questioned patients follow the instructions of producer about recomended daily doses (68. Vitamins and mineral additions. 27. The most often used feeding additions of minerals and vitamins by the patients treated in UKC Sarajevo Patients hospitalised in KC Univerzity of Sarajevo. university and two-year higher educational level 18.HealthMED . More than a half live in urban area. there was the largest number of employed (44.83 %) advisess doctor or pharmacist.01 % of questioned patients use after meal.09 %. and others 22.30 % of questioned (ex. It is very signifficant to point out that quite number of patients are affraid of side effects of these additions.55 % live in the country As for employment.68 %). fruit and vegetablesin feeeding of qustioned ones.but signifficant percentage belongs to common shops (19. students 4.48%. 35. during meal and even number consume before meal. Frequency of using of feeding additions. disseases and hospitalised in several clinics of Clinical centre University of Sarajevo. The usual place of getting of feeding additions and minerals by patients treated in UKC Sarajevo Feeding additions of minerals and vitamins are ussualy bought in pharmacies. There were 297 patients of different age.26 %. their attitudes on the way of feding.89 %.19 %).18 % .60 %. 235 Graphic 1. minerals and vitamins by the patients treated in UKC Sarajevo Journal of Society for development of teaching and business processes in new net environment in B&H . According to educationanal level.26 % ). Graphic 3. by method of random cause. 15. The reasons why the patients don’t use artificial preparats of vitamins and minerals or use them rarely are in the largest percentage (22. in suburban area live 26. out of which 162 males and 135 females in different age group.56%). Feeding additions of vitamins and minerals in feeding of qustioned patients.and there are those who don’t use them at all. Multivitamin additions. retired 22. 61. only in extreme situations.10 %).

light and storage and the way of food preparation.18 % .53 %. 88.7 % of questioned patients.40 %) consumes fruits and vegetables only several times a week what leaves the organism without important nutritiens.92 % of questioned patients.05 % of users take it. thinks that they do give enough attention to healthy lifestile. gular intake of fruit and vegetables while 46. Obviously. 49 % of questioned patients. Out of total number of questioned patients 85. More than a half of questioned patients consider that it is neccessary to take additions with re236 Journal of Society for development of teaching and business processes in new net environment in B&H . Various feeding is one of the main marks of helthy feeding and most of our patients. mark 3-41. Graphic 4. mark 4-20.75 % disagrees . one third of them partialy agrees 8.Volume 2 / Number 4 / 2008 About medical action of these suplements. With attitude that bought groceries lose the necessary vitamins and minerals by modern processing. thinks that taking of additional vitamins and minerals as supplements.47%). mark 2-18. on health improvement of patients evaluation n1-5 has given the following results: mark 1 gave 3. most of them think that vitamins are instabile connections sensitive on heat. Fruits and vegetables are irreplaceble part of quality and balanced feeding becouse provide many important vitamins and minerals and it important to overlook the intake of fruit and vegetables what can be seen in the following graphic (graphic 5. and 10. Interesting information would be that very small number 13.). There are those who try to have 4-5 meals but the average is 3 meals per day in 53. 5.HealthMED . the largest number of users recieved the information from the media (47. eats fruits and vegetables which they have produced themselves.52 %.77% cases from the pharmacist. Graphic 6.18 %. others dissagree with this. Attitude on consuming of ruits and vegetables apart from using feeding additions. The source of information about feeding additions of minerals and vitamins by the patients treated in UKC Sarajevo Graphic 5.53 % and mark 5-16. Others claim that their feeding isn’t as it should be ant they are consuming 2 and less meals a day.12 % of them dissagree. Evaluation of influence of vitamins and minerals.21 % remarks that their feeding is as such.07 %. In recomendations of SZO in daily intake of fruits and vegetables. the same number questioned patients 57. Confirmative answer on claim that inappropriate preparation of grocerries decreases the content of vitamins has given 92. while others fully agree. doctora (22. while most of them provides it on the market what is shown in thwe folowing graphic. doesn’t have good effect on organism without intake of fruits and vegetables. Fruits and vegetables in feeding The great number of questioned patients (40.89 %). regardless their origin. Approximately. 91 % .

which is 23. More than a half live in urban area. In Slovenia. The largest usage of multivitamin additions.60 %.55 % live in the country. and others 22..26 %). Many of them are affraid of sideeffects and most of them didn’t answered at all. Fruits and vegetables are irreplacable part of quality and balanced feeding.55 %). Journal of Society for development of teaching and business processes in new net environment in B&H 237 . Multivitamin additions in 35. As leading risk-factor in creation of illness. the most important meal is certainly breakfast (56. after this. the lack of body activity and alcohol consuming. retired 22. mostly use multivitamin additions (26. increasing of immunity.36 %. and those who don’t use them at all (15.9 % take artificcial additions of vitamins and minerals. Interesting information would be that very small number13. they answered in first place (36. which includes daily multivitamin and mineral addition to feeding as usefull prevention of potential feeding gaps. For most of them. stress exposure at home and at work. 27. the questioned persons consider smoking. while others are with finished primary school. while others are unemployed. (3).26 %. in suburban area live 26.18 % . Todays’ lifestile brings high changes for creation of subclinical lack of vitamins and minerals and expert advise is implementation of optimal feeding after which comes selection of quality addition to food. Research conducted in USA 2000 had shown that 33.40 % consumes fruit and vegetables only several times a week what excludes important nutrities to organism.89 %) are becouse of the attitude that during food taking such addittions aren’ t neccessary. zhey are ‘wrapped’ in their natural complexes which are best apsorbed and used in the organism. the most of them are with finished high school (65. the largest number of questioned eats homemade fruits and vegetables ( 6).90 %). only 5. There are those who thimk that the main meal is lunch and supper all in one. who are in this questionaire processing. overcomming of pyisical weakness. eats fruits and vegetables which they have produced themselves. Popularisation of food additions has grown so much that redesigned oiramid of proper feeding.(7).30 % patients – for ex. university and two-year higher educational level 18.Volume 2 / Number 4 / 2008 Discusion There are totaly 297 patients. during the meal. In question ‘why do they use vitamin and mineral additions’?. More than a half live in urban area. becouse they secure many of important vitamins and minerals. out of which 162 males and 135 females in different age group.05 % follow this recomendation. increased blood preasure and than in the same number of opinions overweight. while others are with finished primary school. In case of illness). in suburban area live 26. where similar research was taken. Unfortunately. the large number of them 40.55 % live in the country.09 % patients. 54% of them use vitamin and mineral additions to food what is significantly lower than in other authors’ research. university and two-year higher educational level 18. Vitamine and mineral food addititives use several times a day. In recomendations of SZO about daily intake of fruits and vegetables .01 % are consumed after meal . If we exclude those who use them only in exceptional cases (30. the most of them are employed (44. Patients hospitalised in KC University of Sarajevo.10 %). preventing of cardiovascular illnesses. than improvement of apetite. Such attitude san be be evaluated as excellent becouse nuritients from food are the best selection. while mot of them provides it on the market.22 %.71 %.48 %). the second place belongs to A + C + E. students 4.HealthMED . Speaking in terms of education.55 %). the most of them are with finished high school (65. out of which 162 males and 135 females in different age group. The reasons why some don’t use mineral and vitamin additions in ther food or use them rarely are (22. According to educationanal level.18 %. There are totaly 297 patients. 9. and others 22.18 % . According to educationanal level.2 % higher than in 1987. disorganised feedeing. (8). and the least taken are multimineral additions 3. and the number of those who take before meal is even.26 %.48 %). according to research is in America (5).

Use of Vitamin. Beograd. 943944.334-339 3. Subar A. Nonvitamin.M..W.. Feeding aditions are taken randomly. L.Volume 2 / Number 4 / 2008 Conclusions  Participation of feeding aditions vitamins and minerals in feeding of patient is significant (54%).. Bosnia and Herzegovina e-mail: fatimajusupovic@yahoo.. najboljša je pestra prehrana. 228: 31. Diplomska naloga.54-55 5. broj 7/2004.Higijena. Shaw GM. 6. 104.etal.F. 1-7 8. M. Millen A. Anonimous. Dodd K.  The great role in popularisation of feeding additions have the media with constant advertising  Vegetables and fruits on the menu. Moore K. Zavod za udžbenike i nastavna sredstva. Saddam A.Curr Opin Clin Nutr Metab Care 8.2000.Challenges to rebuilding the US food pyramid.E.Kinney. Univerza v Ljubljani. 2. Literature 1. Journal of the American Dietetic Association: 1999 Corresponding author: Fatima Jusupovic Faculty of Health. 2005. Consuming of fruits and vegetables several times a week (40. Dietary suplement use among undergraduate college students. Kocijančić R. 4.Journal of the American Medical Assotiation. Pecelj-Gec M. 1992. Zdravje 1999. Službene Novine Federacije.. XX. Erjavec M .2002. Vitaminski i mineralni pripravki u prehrani Slovencev. Mineral.com 238 Journal of Society for development of teaching and business processes in new net environment in B&H . Značaj ishrane.HealthMED . as natural source of vitamins and minerals in feeding of questioned patients isn’t sattisfying. and Nonmineral Supplements in the United States: The 1987. 6-28. without previous evaluation of nutritive status by the experts in this area of expertise and the most used are multivitamin preparts (26. and 2000 National Health Interview Survey Results: Jurnal of The American Dietetic Association 2004. University of Sarajevo. 40%) is a habit that needs to be changed in future  Education level of our population about healthy and balanced feeding is minimal becouse there is no quality source of information.  The area of nutricionism is still without a place that is deserved in a sense of promotion of healthy way of life. J.. 2005.26%). 7.

with clinically diagnosed probable Alzheimer’s disease by NINCDS-ADRDA criteria. aged 65 and over. systolic and diastolic blood pressure did not differ significantly between the two groups. Known risk factors for the development of AD include: age. Results of numerous studies conducted with the purpose to elucidate the role of CRP in AD are conflicting. Bosnia and Herzegovina Summary Background: Alzheimer’s disease (AD) represents a progressive dementia. Amina Valjevac1. Orhan Lepara1. Subjects included in the study underwent history. genetic susceptibility. University of Sarajevo. All patients had mini mental state examination (MMSE) score < 23 and a Hachinski ischemic score 4 or bellow. Fifteen community dwelling. dyslipidemia.HealthMED . Systolic and diastolic blood pressure was measured with the use of mercury sphygmomanometer on the right arm after at least a 5-min rest. hypertension and inflammation are considered to be possible vascular risk factors for AD. clinical examination and mini mental state examination. subjects without dementia served as the control group. Azra Alajbegovic2 1 2 The Institute of Physiology and Biochemistry. Atherosclerosis. Association of CRP and systolic and diastolic blood pressure in AD patients has not been extensively investigated. Clinical Centre University of Sarajevo. In AD group we found negative correlation between serum CRP concentration and systolic 239 Journal of Society for development of teaching and business processes in new net environment in B&H . family history of dementia and female gender.Volume 2 / Number 4 / 2008 Does serum C-reactive protein concentration correlate with blood pressure values in patients with probable Alzheimer’s disease? DA LI KONCENTRACIJA C-REAKTIVNOG PROTEINA U SERUMU KORELIRA SA VRIJEDNOSTIMA KRVNOG PRITISKA KOD PACIJENATA SA MOGUĆOM ALZHEIMEROVOM BOLESTI? Asija Zaciragic1*. C-reactive protein (CRP) is an important marker and mediator of low-grade inflammation. Serum CRP concentration was measured by means of particle enhanced immunonephelometry. age-matched. Its possible role in the development and the progression of AD is still not fully understood. Bosnia and Herzegovina Clinic of Neurology. Methodology: AD group consisted of fifteen institutionalized patients. Results: Age. apparently healthy. All subjects in this group had a MMSE score > 28.

diagnosis of AD can be definite. Ispitanici uključeni u istraživanje bili su podvrgnuti uzimanju anamneze. C-reaktivni protein (CRP) je važan marker i medijator inflamacije niskog stepena. Obtained results do support the notion that low-grade inflammation has no impact on blood pressure values in patients with AD. Njegova moguća uloga u nastanku i progresiji AB još uvijek nije u potpunosti rasvjetljena. with changes in personality. Ključne riječi: Alzheimerova bolest. Dobijeni rezultati ukazuju da inflamacija niskog stepena nema uticaja na vrijednosti krvnog pritiska kod pacijenta sa AB. Conclusions: Our results have shown that negative correlation between serum CRP concentration and systolic and diastolic blood pressure exists in patients with AD but this correlation is not statistically significant. The etiology and pathophysiology of AD is still not fully understood. C-reactive protein. Rezultati brojnih studija sprovedenih sa ciljem pojašnjenja uloge CRP kod AB su oprečna. porodični istoriju demencije i ženski spol. U AB grupi utvrdili smo negativnu korelaciju između koncentracije CRP u serumu i sistolnog krvnog pritiska (r=-0. The diagnosis Journal of Society for development of teaching and business processes in new net environment in B&H .Volume 2 / Number 4 / 2008 blood pressure (r=-0. Poznati riziko faktori za nastanak AB uključuju: dob. sa klinički dijagnosticiranom mogućom Alzheimerovom bolesti prema NINCDS-ADRDA kriterijima. development of neurofibrillary tangles in brain tissue and neuronal loss.43) but this correlation was not statistically significant. Također.35) in AD group. genetsku predodređenost. Key words: Alzheimer’s disease. Zaključci: Naši rezultati su pokazali da postoji negativna korelacija između koncentracije CRP u serumu i sistolnog i dijastolnog krvnog pritiska kod pacijenata sa AB ali ova korelacija nije statistički signifikantna. Koncentracija CRP u serumu određena 240 je laser nefelometrijom. dobno odgovarajućih. sistolni krvni pritisak. Svi pacijenti su imali mini mental state examination (MMSE) skor < 23 i Hachinskijev ishemični skor 4 ili manje. systolic blood pressure. These changes can be one of the first symptoms of the disease. Ateroskleroza. zdravih pacijenata bez demecije služili su kao kontrolna grupa. Rezultati: Dob.HealthMED . Metodologija: AB grupa se sastojala od petnaest institucionaliziranih pacijenata.43) ali ova korelacija nije bila statistički signifikantna. diastolic blood pressure Sažetak Uvod: Alzheimerova bolest (AB) predstavlja progresivnu demenciju. Povezanost CRP i sistolnog i dijastolnog krvnog pritiska kod pacijenata oboljelih od AB nije opsežno istraživana. hallucinations and agitation. hipertenzija i inflamacija se smatraju mogućim vaskularnim riziko faktorima za AB. Petnaest. Larger prospective studies are required to investigate these findings further. negativna mada ne i signifikantna korelacija utvrđena je između koncentracije CRP u serumu i dijastolnog krvnog pritiska (r=-0. negative although not significant correlation was found between serum CRP concentration and diastolic blood pressure (r=-0. starijih od 65 godina. C-reaktivni protein. Veće prospektivne studije su potrebne da bi se ovi nalazi opsežnije istražili. kliničkom pregledu i ispitivanju kognitivne funkcije primjenom mini mental state examination testa. Svi ispitanici u ovoj grupi imali su MMSE skor > 28. dijastolni krvni pritisak Introduction Alzheimer’s disease (AD) represents a progressive dementia neuropathologically characterized by widespread ß amyloid deposits (plaques) in cerebral arterial walls. sistolni i dijastolni krvni pritisak nisu signifikantno bili različiti između dvije grupe. followed with behavioral impairment including delusions. All of the above symptoms ultimately lead to impaired daily functioning and patients with AD in later and more sever stages of disease require total care (1). probable and possible. dislipidemija.35) u AD grupi. Likewise. Sistolni i dijastolni krvni pritisak izmjeren je upotrebom živinog sfingomanometra na desnoj ruci nakon najmanje 5 minuta odmora. Based on these criteria. Primary symptom of AD is decline in cognition and memory. In diagnostics of AD standard clinical diagnostic criteria designed by National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer’s disease are used.

Possible role of CRP in the development and the progression of AD is still not fully understood.Volume 2 / Number 4 / 2008 of definite AD requires histopathological confirmation by postmortem examination (2). Since the neurodegenerative processes in AD may begin in midlife it is important to identify early risk factors for the development of AD.HealthMED . the exclusion criteria were positive history of cardiovascular or thyroid disease. All procedures on human subjects were performed in the accord with Helsinki Declaration of 1975. with clinically diagnosed probable Alzheimer`s disease by NINCDS-ADRDA criteria. It is related to arterial stiffness and as such represents a measure of atherosclerosis (12) 241 Journal of Society for development of teaching and business processes in new net environment in B&H . age-matched. Results of numerous studies conducted with the purpose to elucidate the role of CRP in AD are conflicting. Thus. chronic inflammatory disease (asthma and rheumatoid arthritis). Patients had a Hachinski ischemic score 4 or bellow (11). with the patient in sitting position after five minutes of rest. For both groups of subject. C-reactive protein (CRP) is an acute phase protein and is thought to be a link between innate and acquired immune system. Hypertension was defined as a systolic blood pressure of >140 mm Hg or a diastolic blood pressure of >90 mm Hg or both. All patients had mini mental state examination (MMSE) score < 23 (10). Dik et al. The aim of the present study was to examine the association between blood pressure values and serum C-reactive protein concentration in patients with probable AD. Values were based on a single measurement. Based on experimental and neuropathologic studies. We have previously reported that serum CRP concentration was significantly higher in patients with probable AD compared to age-matched controls (6). On the other hand. apparently healthy. Pulse pressure was calculated as the difference between systolic and diastolic blood pressure. Bosnia and Herzegovina.9). clinical examination and mini mental state examination. According to these findings controlling CRP production at tissue level could be significant factor in reducing inflammatory damage in AD. Fifteen community dwelling. aged 65 and over. asymptomatic subjects without dementia served as the controls. All subjects in this group had a MMSE score > 28. We included all patients currently institutionalized at specialized unit for patients with dementia within Health-Care Hospice for persons with disabilities and other persons in Sarajevo. Important role in blood pressure regulation has the brain but it still remains to be elucidated whether neuronal degeneration that occurs with aging contributes to the decline in blood pressure in elderly (7). but they can also directly induce neurodegeneration of Alzheimer’s disease. Subjects underwent history. Blood pressure was measured manually in a standardized manner using a sphyngomanometer. Subjects with self-reported common cold were also not included in the study. Informed consent was obtained from all subjects and/or their caregivers. hepatic or renal insufficiency and cancer. Studies have shown that mean systolic and diastolic blood pressure has a tendency for an increase up to the age of 75 but that it decreases afterwards. inflammation is postulated to play a central role in processes leading to neurodegeneration as well as vascular injury (3). with or without the use of blood pressure lowering medications. Study conducted by Yasojima and al. (5) have demonstrated that serum concentration of CRP is not associated with cognitive decline in older persons. Evidences suggest that hypertension and hypercholesterolaemia may increase the risk of dementia by inducing atherosclerosis and impairing blood flow. (4) has demonstrated that CRP is concentrated in pyramidal neurons and is upregulated in affected areas of AD brain. the influence of dementia process on blood pressure remains inconclusive. The relationship between blood pressure and dementia is complicated because it has been reported that hypertension in midlife is a risk factor for Alzheimer’s disease but on the other hand there are studies that have shown that low blood pres- sure predisposes the development of Alzheimer’s disease (8. Neuroinflammation includes an innate immune system reaction which results in an attack on host neurons. CRP is not only extremely sensitive marker but as well a mediator of inflammation and tissue damage. Materials and methods Two groups of subjects were enrolled in the present study: Fifteen patients.

Figure 1. CardioPhase hsCRP consists of a suspension of polystyrene particles coated with mouse monoclonal antibodies to CRP. Associations between continuous variables were tested with Spearman`s rank correlation analysis.05 were considered statistically significant. Serum CRP concentration was determined by means of particle enhanced immunonephelometry with the use of BN II analyzer at the Institute of Clinical Chemistry and Biochemistry.68 0.57 p< NS p<0. no statistically significant difference was observed in systolic and diastolic blood pressure between control group and patients with probable Alzheimer’s disease.34 25. Clinical Centre of the University of Sarajevo.00 AD group (n=15) 73.03 56. for 10 minutes to separate serum and were immediately used for the measurement of serum CRP concentration.05). Alzheimer’s disease (AD) group As shown in Figure 1. Results The baseline characteristics of the two groups enrolled in the study are reported in Table 1.98 0.p. Baseline characteristics of control subjects and patients with probable Alzheimer’s disease. Data are presented as mean ±SEM. No difference emerged in age.07±1. WHR: waist/hip ratio. Reference interval for CRP with the use of this method is from 0 to 5 mg/l.97±0. As presented in Table 2.05 242 Journal of Society for development of teaching and business processes in new net environment in B&H . Samples were centrifuged at 4000 r.93±2.HealthMED .0001). there was a negative cor- Table 1. Variables Age (year) MMSE score BMI (kg/m2) WHR PP (mmHg) Control group (n=15) 69.05 49. data were analysed with Mann-Whitney U Test which is the nonparametric alternative for the unpaired t test.46±2. Data are reported as mean ± SEM.Volume 2 / Number 4 / 2008 Non-fasting blood samples were drawn from antecubital vein into siliconized tubes. body mass index and waist/hip ratio between the groups. Likewise. Since CRP is highly skewed and the study sample is small.62±1. Subjects with AD had statistically significantly higher pulse pressure values compared to the control group (p<0.33±2. negative although not significant correlation between systolic blood pressure and CRP in patients with AD was observed (r =-0.m.43). Mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the control group and Alzheimer’s disease (AD) group. BMI: Body Mass Index. MMSE score was significantly lower in subjects with AD compared to controls (p<0. Two-tailed p values <0.4±0.0 statistical software system.0001 NS NS p<0.17 27. Statistical analyses were performed using SPSS 12.86±0.90±0. PP: Pulse Pressure. MMSE score: Mini Mental State Examination score.57 9.67±3. CardioPhase high-sensitivity CRP (DADE BEHRING) was used as a diagnostic reagent.57 28.

057 Discussion Numerous findings from clinical. gender.58* DBP r =. Interestingly. Some authors speculate that blood pressure decrease might be an early manifestation of the dementing process. sex. Spearman correlation analysis (unadjusted) of systolic and diastolic blood pressure with C-reactive protein and Mini mental state examination (MMSE) score in patients with probable Alzheimer disease. Among persons with high blood pressure decreased cognitive performance has been reported as well as greater cognitive decline with age (16). SBP C-reactive protein MMSE score r =. the possibility that low blood pressure causes brain damage should not be excluded. Hypoperfusion is thought to have important role in the development of AD by triggering mitochondrial dysfunction and increased oxidative stress. It has been shown that disruption of cerebral blood vessels and reduced blood flow can have severe consequences on neural activity.HealthMED . and level of education. Zhu and al. In a large epidemiologic study. findings of Skoog et al.35). it is possible that clinically unrecognized vascular lesions in the brain or atherosclerosis may be responsible for both blood pressure decrease and cognitive decline in patients with AD (22). (17) have shown that high blood pressure was not associated with an increased risk of AD in logistic regression models adjusted for age. Even thought it is believed that the low blood pressure in subjects with dementia and neuronal degeneration are secondary to the brain lesions. low diastolic blood pressure (≤65 mm Hg) was also associated with the increased risk of AD (19).0.50). Patients with the most severe impairment in dementia at baseline had largest decrease in blood pressure. In our study there was no statistically significant difference in mean systolic and diastolic blood pressure between patients with probable AD and apparently healthy controls. BMI and antihypertensive therapy.05 ‡p=0. Morris and al. It seems possible that low blood pressure may accelerate the process of dementia by lowering cerebral blood flow. Razay et al.05). which may play a causative role in the development of dementia. p< 0. It has been proposed that high blood pressure may increase risk of Alzheimer disease (15).43 r = 0. (20) found that elevated systolic blood pressure and high cholesterol. Statistically positive correlation was observed between systolic blood pressure and MMSE score in AD group (r=0. On the contrary. (21) found a significant decrease of blood pressure in patients with Alzheimer’s disease after one year of follow up which was independent of age. Conversely. increases the risk of AD in later life. According to numerous reports blood pressure declines in the years preceding dementia onset and further declines during the course of AD.0. (14) have demonstrated that oxidative stress represents one of the earliest changes in AD affected brain and plays a vital role in the vascular abnormalities underlying metabolic defects in AD. whereas diastolic blood pressure in midlife has no significant effect on the risk of AD. (18) have identified high blood pressure as a risk factor for AD. (8) suggest that before disease onset in subjects with dementia blood pressure begins to decline which might implicate that disease process may decrease blood pressure values. Still. and the degree of reduction generally correlates with the severity of dementia. the mechanisms linking vascular risk factors to AD remain unclear. A study by Kivipelto et al. A study conducted by Hanon et al.50‡ *p< 0. Table 2. However. Clinical observations have shown that episodes of hypotension may result in cerebral hypoperfusion. and in particular combination of these risks in midlife. On the other hand. Decreased cerebral blood flow is known to occur in AD. Positive correlation between diastolic blood pressure and MMSE score was determined but it was not statistically significant (r=0. Wu et al. (23) found lower mean systolic blood 243 Journal of Society for development of teaching and business processes in new net environment in B&H . epidemiological and pharmacological studies suggest that vascular factors play fundamental role in the pathogenesis of AD (13).Volume 2 / Number 4 / 2008 relation between diastolic blood pressure and CRP in patients with AD but it was not statistically significant (r =-0.58.35 r = 0.

Jonker C. Launer LJ. Eikelenboom P. Brain Res. Elevated serum C-reactive protein concentration in Bosnian patients with probable Alzheimer’s disease. Mehmedika-Suljic E. Havlik RJ. MedArch. Patterson C. Coric G. 15-year longitudinal study of blood pressure and dementia. Garcia A. Inflammation and dementia: epidemiologic evidence. Likewise. McGeer EG. Mehmedika-Suljic E. Evidences have shown that there is a local upregulation of inflammatory cytokines. Serum inflammatory proteins and cognitive decline in older persons. Scoog I. Yasojima K. Palmertz B. Comijs HC. 2005. Arslanagic S. Neurobiol Aging. White LR. According to these authors it still remains unclear whether low systolic blood pressure predisposes the development of AD and contributes to its etiology or is the result of neurodegeneration.HealthMED . Fajkic A. Hsiung R. 244 Conclusions Our results have shown that negative correlation between serum CRP concentration and systolic and diastolic blood pressure exists in patients with AD but this correlation is not statistically significant. We found a statistically significant association between systolic blood pressure and MMSE score in patients with probable AD. 2007. 7. Avdagic N. Andreasson L.21(1):49-55. Fischer et al. Even though we failed to find significant association between blood pressure values and serum C-reactive protein concentration in patients with probable AD further investigations. Ross GW. Landhal S. Dik MG. Human neurons generate C-reactive protein and amyloid P: upregulation in Alzheimer’s disease. Lernfelt B. Literature 1. Lepara O. Feightner JW. (27) found no correlation between blood pressure values and cognitive performance in the elderly. On the other hand. Journal of Society for development of teaching and business processes in new net environment in B&H . 3. 8. Hadzovic-Dzuvo A.Volume 2 / Number 4 / 2008 pressure in patients with probable AD compared with controls. Obtained results do support the notion that low-grade inflammation has no impact on blood pressure values in patients with AD. 2. Kucukalic A. 5. 2006.347:1141-1145. are necessary to explore these findings more profoundly. Zaciragic A. Conversely. acute phase proteins such as CRP. 59:106-109. 2005. 6. Svanbory A. (25) evaluated numerous vascular risk factors including blood pressure and CRP and correlated these risk factors with overall cognition in a community-based cohort of 75-year-old individuals. Sadovnick AD. especially large population studies. Journal of Alzheimer’s Disease. Alajbegovic A. Hack CE. 178(5):548-56. Recent studies suggest that specific inflammatory mechanisms contribute to neurodegeneration. Our results have shown that there is a negative although not significant correlation between systolic blood pressure and CRP in patients with AD. 4. McGeer PL. Valjevac A. Loncarevic N. Launer LJ. in the same group of patients correlation between diastolic blood pressure and MMSE score was also observed but it was not statistically significant. Petrovich H. Multidisciplinary studies are needed to clarify possible causal relation between blood pressure and cognitive function in elderly population. activation of the complement cascade and accumulation of microglia in damaged areas of AD brain (24). (26) who have reported that both systolic and diastolic blood pressure were positively and significantly related to baseline MMSE score in the very old individuals. risk assessment and primary prevention of Alzheimer disease. Peila R. Authors did not find an association between Mini-Mental State Examination score and blood pressure or CRP. Oden A. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Smit JH. Masaki K. 887:80-89. Scherr et al. Neurology. Our results are partly in the accordance with those of Guo et al. a negative correlation between diastolic blood pressure and CRP in patients with AD was determined but it was not statistically significant. The neurologist role in diagnostics and therapy of Alzheimer’s disease. Nilsson L.12:151-156. Persson G. 2000. Alajbegovic A. CMAJ 2008. 185:102-106. Foley D. Diagnosis and treatment of dementia: 1. MacKnight C. Schwab C. Acta Neurol Scand Suppl. 1996. 2000.64:1371-1377. Lancet. Larger prospective studies are required to investigate these findings further.

49:37-43. Zhu X. Arch Neurol. Stroke 2002. de la Torre JC. Verghese J. The association between midlife blood pressure levels and late-life cognitive function: the Honolulu-Asia Aging Study. Fischer P. 2000. J Neurol Sci. Blood pressure and performance on the Mini-Mental State Examination in the very old. Association of incident Alzheimer disease and blood pressure measured from 13 years before to 2 years after diagnosis in a large community study. Fratiglioni L. JAMA. Havlik RJ. The role of inflammatory reaction in Alzheimer’s disease and neurodegenerative processes. Nissien A. Cerebral blood flow in dementia. Skoog I. Katzman R.34:939-944. Hebert Le. Lenoir H. Hachinski VC. Masaki K.net Journal of Society for development of teaching and business processes in new net environment in B&H 245 . 2003. Asmar R. Laakso MP. Vascular oxidative stress in Alzheimer disease. Hebert LE. The metabolic syndrome and Alzheimer disease. Zhou D. 2006. von Strauss E. China. Launer LJ. Manganaro D. Scherr PA. A 6-year followup study. Stadlan EM. 17. Marshall J. Folstein M. Vreugdenhil A. 60:223-228. Risk factors for vascular dementia: hypotension as a key point. 19. Perry G. Caadesus G. Latour F. 15. 25. Symon L. Stroke 2001. 274:1846-1851. J Neural Transm Suppl.FR). Neurology. J Nutr Health Aging. 2001. Iliff LD. 22. Helkala EL.32:632-637. Glynn RJ. 21. University of Sarajevo. Antonello RM. Zilhka E. Midlife vascular risk factors and Alzheimer’s disease in later life: longitudinal. Bosnia and Herzegovina e-mail: zarias@lsinter. Fratiglioni L. Relation of blood pressure to cognitive function in the elderly. Acta Neurol Scand. Corresponding author: Asija Zaciragic Institute of Physiology and Biochemistry. 14. 10. Honda K. Kurkowska-Jastrzebska I. Fastbom J. 1984. Katz M. Qiao Y. Rigaud AS. Drachman D.36(1):15-23.145(12):1106-1113. BMJ 2001. Hall CB. Relationship between blood pressure and Alzheimer’s disease in Linyian County. Guo Z. Zehetmayer S. Bennett DA. 20. Reneman RS. 9(2):106-111. Harris PLR.72(10):1125-1123. Kuslansky G. Evans DA. Scherr PA. Du Boulay GH. Evolution of blood pressure in patients with Alzheimer’s disease: a one year survey of a French Cohort (REAL. Smith LA. 1995. van der Knip DA. Razay G. 33: 1152-1162. 13. Russell RW. 26. 24. van Popele NM.Volume 2 / Number 4 / 2008 9. Winblad B. Siedlak SL.32:454-60. 2002. Toponchian J. Zhang L. Alzheimer disease as a vascular disorder: nosological evidence. 11.61:16671672.4(2):395-402. 1991. Como P. 27. Neurol Neurochir Pol. Low blood pressure and risk of dementia in the Kungsholmen Project. Low blood pressure and the risk of dementia in very old individuals. HanninenT. Bots ML. Witteman JC. Wen C. 12. Association between arterial stiffness and atherosclerosis: the Rotterdam study. Clinical diagnosis of Alzheimer`s disease: report of the NINCDS-ADRDA work-group under the auspices of the Department of Health and Human Services Task Force on Alzheimer`s disease. Grobbee De. Wilcock G. McAllister VL. Czlonkowska A. Hallikainen M. 23. Nunomura a. Vasc Health Risk Manag. Smith MA. Hanon O.64:93-96. 1997. Vilotti C. Pizzolato G. 1975. Qiu C. Jungwirth S. Tuomilehto J. Price D. Arch Neurol. Alhainen K.114(2):84-90. Tragl KH. 2007. Neurology. Morris MC. Hoeks AP. Petrovitch H. Am J Epidemiol. Viitanen M. 322:1147-1451. Forette F. Torre P. Winblad B.134:1303-1315. Realation between vascular risk factors and cognition at age 75. 257(1-2):240246. Bauer K. Kivipelto M. 2005. 2007. Aliev G. 58: 1640-1646. Huber K. Vascular aspects in Alzheimer’s disease. Lipton RB. 18. Am J Epidemiol. Moretti R. Arch Neurol. population based study. 2008. Hofman A. Foley D. Arch Neurol 2003. Wu C. Seux ML. McKhann G. Life Sci 2003. 16. Soininen H.HealthMED . Moreira PI.

68 mmol/L) versus control group (X=56±1. Esad Cosovic2.Volume 2 / Number 4 / 2008 The effects of spirulina platensis on biohumoral markers of renal function in gentamicin-induced acute tubular necrosis in rats EFEKTI SPIRULINE PLATENSIS NA BIOHUMORALNE MARKERE BUBREŽNE FUNKCIJE KOD GENTAMICINOM-UZROKOVANE AKUTNE TUBULARNE NEKROZE KOD ŠTAKORA Nesina Avdagic1*.33±20. intraperitoneally for 7 consecutive days.09mmol/L) and creatinine: gentamicin group (X=192.026) and attenuated the gentamicin induced acute tubular necrosis. gentamicin+spirulina group (X=107. Zakira Mornjakovic2. control group. was treated with 0.47±2. First. University of Sarajevo. Almira Hadzovic-Dzuvo1 1 2 Institute of Physiology and Biochemistry.15mmol/ L).47±2.5±23.14mmol/L) versus gentamicin group (X=192.53±1. The most significant increase of serum biohumoral markers of renal function was in gentamicin group (urea. Faculty of Medicine. Asija Zaciragic1. gentamicin+spirulina group (X=11.68 mmol/L) (p=0. Key words: spirulina platensis. gentamicin.15mmol/L) versus control group (X=7. Our results indicate that Spirulina platensis diminished toxic renal effects of gentamicin and preserve renal function in gentamicin induced acute tubular necrosis in rats. Second. nephrotoxicity Journal of Society for development of teaching and business processes in new net environment in B&H . Spirulina platensis decreased the serum level of biohumoral markers of renal function (urea. acute tubular necrosis. Emina Nakas-Icindic1. gentamicin group was treated with gentamicin (80 mg/kg per day). Next 7 days was treated concomitantly with Spirulina platensis per os and gentamicin intraperitoneally in the same volume as animals in previous groups. Adult Wistar rats (n=18).002) and creatinine.08±0. both sexes. urea.24 mmol/L) (p=0. University of Sarajevo. Renal function was assessed by measuring serum urea and creatinine concentrations. intraperitoneally also for 7days.(p=0. gentamicin+spirulina group was pretreated for two days with water solution of Spirulina platensis (1000mg/kg in 2 ml of water) per os. Third. Bosnia and Herzegovina Institute of Histology and Embryology. gentamicin group (X=27.HealthMED . creatinine.66mmol/ L) versus gentamicin group (X=27. The light microscopic histological analysis confirmed the acute tubular necrosis in gentamicin and gentamicin+spirilina group.9% sodium chloride. Faculty of Medicine. Gentamicin induced renal failure due to acute tubular 246 necrosis in both experimental groups.002). were divided into three equal groups. Bosnia and Herzegovina Summary The aim of this study was to assess possible protective effects of Spirulina platensis on gentamicin-induced renal dysfunction in rats.5±23.

intraperitonealno također 7 dana. Gentamicin may also cause mitochondrial damage or direct inhibition of mitochondrial oxidative phosphorylation (4). Gentamicin je uzrokovao renalno zatajenje zbog akutne tubularne nekroze u obje eksperimentalne grupe. antidiabetic effects (16) and prevents lead toxicity (13. Histološkom analizom koja je rađena svjetlosnim mikroskopom potvrđena je akutna tubularna nekroza kod gentamicin i gentamicin+spirilina grupe. Spirulina platensis has immunomodulatory (10). Materials and methods Animals The experiment was performed in adult Wistar rats (n=18) weighing 200 to 300g in accordance with the approval of local Ethic Committee. kontrolna grupa. Renalna funkcija je procjenjivana mjerenjem koncentracije uree i kreatinina u serumu. especially vitamin B12 and provitamin A (β-carotene).Volume 2 / Number 4 / 2008 Sažetak Cilj ove studije je bio da procjeni moguće protektivne efekte Spiruline platensis kod gentamicinom-uzrokovane renalne disfunkcije kod štakora.5±23. je primala gentamicin (80 mg/kg dnevno). In previous studies some synthetic and natural antioxidants have been used to attenuate gentamicininduced oxidative stress and renal dysfunctions (6. podjeljeni su u tri jednake grupe. antioxidant (13. The aim of the present study was to assess whether treatment with Spirulina platensis may prevent or ameliorate renal dysfunction and injury in gentamicin-induced acute tubular necrosis in rats.HealthMED . intraperitonealno 7 uzastopnih dana.68 mmol/L) versus kontrolna grupa (X=56±1. Unfortunately. These include binding of gentamicin to phospholipids and inhibiting the activity of phospholipase A and C which alters the function and structure of cellular and intracellular membrane (2.47±2. Naši rezultati ukazuju da Spirulina platensis umanjuje renalne toksične efekte gentamicina i štiti renalnu funkciju kod gentamicinom uzrokovane akutne tubularne nekroze kod štakora. Before the experiments all animals were housed under 247 Journal of Society for development of teaching and business processes in new net environment in B&H . gentamicin+spirulina grupa (X=107.17).15mmol/L) versus kontrolna grupa (X=7. Several mechanisms could be involved in gentamicin induced renal dysfunction. Reactive oxygen species (ROS) may participate in the pathogenesis of gentamicin-induced renal dysfunctions (5). Spirulina platensis je smanjila serumski nivo biohumoralnih markera bubrežne funkcije (urea. blue green algae. gentamicin grupa (X=27.9).(p=0.12).24 mmol/L) (p=0. Spirulina platensis.15mmol/L). Prva. gentamicin grupa.47±2.026 ) i umanjila efekte gentamicinom uzrokovane akutne tubularne nekroze. akutna tubularna nekroza. It is rich of proteins.5±23.002) i kreatinin. vitamins. kreatinin. gentamicin+spirulina grupa (X=11.53±1. Sljedećih 7 dana je istovremeno tretirana sa Spirulinom platensis per os i gentamicinom intraperitonealno u jednakoj količini kao i životinje iz prethodne grupe. nefrotoksičnost Introduction Aminoglycoside antibiotics (gentamicin) are widely used in clinical medicine because of their favorable antimicrobial efficacy against Gram-negative infections.14mmol/L) versus gentamicin grupa (X=192.3). urea.002).33±20. Druga. magnesium. selenium (8.7). the clinical use of aminoglycoside is limited by their potential ototoxicity and nephrotoxicity (1). je dva dana prije tretirana sa vodenim rastvorom Spiruline platensis (1000mg/kg u 2 ml vode) per os. Treća. has a long history of use as food supplement. Ključne riječi: Spirulina platensis. and some vital elements like zinc. anticancer (11.68 mmol/L) (p=0.9% natrium hlorid. Odrasli Wistar štakori (n=18). je primala 0.14). essential amino and fatty acids. The pathophysiology of aminoglycoside nephrotoxicity has not been completely elucidated. oba pola. Najsignifikantnije povećanje serumskih biohumoralnih markera bubrežne funkcije je bilo u gentamicin grupi (urea. gentamicin.09mmol/L) i kreatinin: gentamicin grupa (X=192.66mmol/L) versus gentamicin grupa (X=27.08±0. antihyperlipidemic (15). gentamicin+spirulina grupa.

Mann-Whitney test was used to test the significance of mean values differences between the two groups. gentamicin+spirulina and normal saline injection.30 a. Drugs Gentamicin was purchased.D. consisting of six rats each: control. Tissue sections of 5μm were stained with hematoxylin-eosin (HE) and Periodic acid-Schiff (PAS). Gentamicin+spirulina group was pretreated for two days with water solution of Spirulina platensis (1000mg/kg in 2 mL of water) per os. Results were expressed as mean ± SEM. gentamicin and gentamicin+spirulina group. 248 Journal of Society for development of teaching and business processes in new net environment in B&H . Statistical analysis Statistical analyses were performed using SPSS software. injection solute (under the trade name Bosnalijek). At the end of the experiment.m. Animals were divided into three groups.00 and 9. Histology For microscopic evaluation kidneys were fixed in 10% formalin and then embedded in paraffin wax.05. vertically divided into two sections and fixed in 10% formalin and then embedded in paraffin wax for histological analyisis.Volume 2 / Number 4 / 2008 standard laboratory conditions and were allowed one week of adaptation period. The injections were given between 9. Kidneys were immediately removed. Afterwards. Spirulina platensis was obtained commercially as a dark bluegreen dry powder (from Nutrex Hawaii M. The results were expressed as mmol/L. The same test was used to investigate association between serum creatinine concentrations and histological injury score in total experimental sample. intraperitoneally also for 7 days. Absorbance was measured at 500-520 nm. (17). The results were expressed as mmol/L. 24 hours after the last gentamicin. Gentamicin group was treated with gentamicin (80 mg/kg per day). Absorbance was measured at 340 nm.HealthMED . Association between serum urea concentrations and histological injury score was tested with Spearman’s rank correlation analysis. to minimize the circadian variation seen in gentamicin-induced nephrotoxicity (18). followed by administration of Spirulina (1000mg/ kg in 2 mL of water) per os. Experimental protocol Control group was treated with 0. Blood was drawn from the abdominal aorta for the measurement of serum urea and creatinine concentrations. version 12. Creatinin Jaffe’s reaction was used for determination of serum creatinine concentration. intraperitoneally for 7 consecutive days. The statistical significance was considered at p<0. The difference in values of tested parameters was assessed by Kruskal-Wallis test. and rats were sacrificed under deep ether anesthesia and the front wall of the abdominal cavity was opened. and gentamicin (80 mg/kg per day) intraperitoneally for 7 days. A minimum of 10 fields by light microscopy for each kidney sections were examined and assigned for severity of changes according to Houghton et al.9% sodium chloride. Standard rat chow and tap water were given ad libitum. Biohumoral markers of renal functions Urea Serum urea concentration was determined by enzymatic method. Formulas™ ).

In gentamicin+spirulina group value was higher (X=11.002). Creatinine Gentamicin markedly increased the serum creatinine concentrations. Serum urea concentrations (mmol/L) in control. The highest value was in gentamicin group (X=192.24 mmol/L) (p=0. The renal tissue of rats treated with gentamicin showed necrotic areas in the superficial cortex. Values are expressed mean ± SEM *p= 0.002) than in control group(X=7. but it was still higher than in the control group(X=56±1. (Figure 2). Figure 2.002).47±2. **p= 0.66 mmol/L.001). In the control group there were no any changes in structure of renal tissue. The standard light microscopy has been used for histological analysis. (Figure 1) border membranes of almost all cells were disrupted. gentamicin+spirulina and gentamicin group of rats.14 mmol/L) (p=0. gentamicin+spirulina and gentamicin group of rats.68 mmol/L).002 compared with control.08± 0. p<0.09 mmol/L) but significantely lower than in gentamicin group (p=0.002). Values are expressed mean ± SEM. The highest value was in gentamicin group (X=27.15mmol/L).026).HealthMED . Brush- Figure 3. Spirulina platensis partially reduced these changes. statistically significant.53±1. desquamated epithelial cells debris in the lumen of proximal tubules and interstitial edema. Spirulina platensis significantly decreased the serum creatinine concentration (X=107. p=0.5±23. Figure 1. correlation was found between histopathological injury score and serum urea concentration in total experiment sample (r= 0.74.026 compared with control and gentamicin. Renal histology Using Spearman’s rank correlation analysis a positive. Mean serum urea concentration (mmol/ L) and kidney histological injury score within control and experimental groups 249 Journal of Society for development of teaching and business processes in new net environment in B&H . **p= 0.002 compared with control. and the difference between groups was statistically significant (p=0.Volume 2 / Number 4 / 2008 Results Biohumoral markers Urea The significant differences in serum urea concentrations were observed between the groups (p<0.01) (Figure 3). *p= 0. Serum creatinine concentrations (mmol/L) in control.002 compared with control and gentamicin.33 ±20.

interstitial edema and tubular brush border loss were observed. correlation between histological injury score and serum creatinine concentration also was found (r= 0. (24) and Mohan et al. (26) also tested protective effects of Spirulina in ATN caused by ciclosporin. These results. Figure 4. where as Khan M. The renal dysfunction due to gentamicin induced acute tubular necrosis (ATN) has been conformed by increased of biohumoral markers of renal function. In this study use of Spirulina platensis also decreased level of kidney damage. et al. 1500mg/kg). In the gentamicin group marked necrosis of cortical tubules.62. radiological contrasts. The renoprotective effects of Spirulina have been confirmed in experiments in which ATN was caused by mercury chloride (HgCl2) (27). serum urea and creatinine concentration were significantly lower in animals that concomitantly with mercury chloride received Spirulina.Volume 2 / Number 4 / 2008 In total experimental sample a positive. Spirulina diminished this increase. but it can be also caused by cisplatin. (9) who also investigate protective effects of Spirulina in gentamicin-induced acute tubular necrosis in rats. Gentamicin and other aminoglycoside antibiotics caused acute tubular necrosis and renal dysfunction in rats (22. indicate that Spirulina platensis can ameliorate gentamicin-induced renal dysfunction in rats.HealthMED . The protective effects of Spirulina platensis were investigated in present study in animal model of ATN caused by gentamicin.01) (Figure 4). 1000. 23). Results of these studies confirmed that Spirulina platensis has renoprotective effect and decreased the serum urea and creatinine concentration and significantly prevents nephrotoxicity due to its antioxidant actions. p<0. (27) who induced ATN with mercury chloride. These results are in accordance with the results of Kuhad et al. as well as other compounds of lesser importance (20. Desquamated epithelial cells debris in the proximal tubular lumen was also observed widely in these necrotic areas. Their results have showed that use of Spirulina lowers serum 250 urea and creatinine concentration in ATN caused by gentamicin. 21). Kuhad et al. Results of our study are also in the accordance with results of Sharma et al. Morphological changes in kidney specimens in our study were similar to those observed by Kuhad et al. Mean serum creatinine concentration (mmol/L) and kidney histological injury score within control and experimental groups Discussion Acute tubular necrosis (ATN) is most frequently caused by constriction of blood vessels. statistically significant. Treatment with Spirulina platensis reduced these changes. as well as the results of our study. heavy metals. Results of light microscopic analysis in our study showed various level of reanl injury (ATN) in animals both treated with gentamicin and gentamicin+spirulina concomitantly. Journal of Society for development of teaching and business processes in new net environment in B&H . (25) tested protective effects of Spirulina in ATN caused by cisplastin. (9) who used higher dose of gentamicin (100mg/kg) and three different doses of Spirulina (500. Humoral markers of renal function. serum urea and creatinine concentration especially in animals treated only with gentamicin. The results from their study suggest that Spirulina can significantly modify the renal damage in mercury chloride induced toxicity.

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Transplant.. Nephrol. Rasic S.. The effects of inducible nitric oxide synthase inhibitor L-N6(1-iminoethyl) lysine in gentamicn-induced acute tubular necrosis in rats. Khan M.. Tirkey N. Cancer Chemother.com 252 Journal of Society for development of teaching and business processes in new net environment in B&H . et al. Kumar A.C. Sharma M. Shobha JC.. Avdagic N. Renoprotective effect of Spirulina fusiformis on cisplatin-induced oxidative stress and renal dysfunction in rats. Pharmacol. Spirulina attenuates cyclosporine.induced nephrotoxicity in rats. 28(3):247-254.. 2006. Fail. Hadzovic-Dzuvo A.. 2007.Toxicol.. 25. avdagicn@yahoo. Dial.HealthMED . Kumar M. 27. Shobha J. Chem.. 2006. Chopra K. Nakas-Icindic E. Sharma A. 26. Bosnian Journal of Basic Med. Corresponding author: Nesina Avdagic Institute of Physiology and Biochemistry School of Medicine. 24. 58(6): 802-808. Food. 2007. University of Sarajevo Bosnia and Herzegovina e-mail. Mohan IK. Pilkhwal S. Protection against cisplatin-induced nephrotoxicity by Spirulina in rats. Valjevac A. 7(4): 322-327.Volume 2 / Number 4 / 2008 ameliorates gentamicin-induced renal injury in rats.. Journal of Applied Toxicol. 26 (5): 444-451. Mohan I. Khan M. 2002. Kuhad A. 45(6): 879-887.K. 17: 21222131 23.. Evaluation of protective efficacy of Spirulina fusiformis against mercury induced nephrotoxicity in Swiss albino mice. Zaciragic A. 2006.K.. Ren.. Sci. et al.

Mensura Kudumovic³ ¹ KCU Sarajevo. and that on the basis of certain anthropometric dimensions directs athletes towards sport disciplines in which one can expect optimal success. Anthropometric investigations are direct indexes of the morphological structure of the body. ³ Faculty of Medicine. Bosnia and Herzegovina. and it has touching points with all other branches of medicine.Volume 2 / Number 4 / 2008 Anthropometric values for boys aged 14 – 15 years who actively train basketball in comparing to boys of same age who do not train any sports ANTROPOMETRIJSKE VRIJEDNOSTI KOD DJEČAKA UZRASTA 14 – 15 GODINA KOJI AKTIVNO TRENIRAJU KOŠARKU U ODNOSU NA DJEČAKE ISTE DOBI KOJI NEMAJU SPORTSKIH AKTIVNOSTI Dijana Avdic¹. school. The aims of this investigation are to investigate the anthropometric values of boys on a sample of 100 tested people. Bosnia and Herzegovina Summary Humane anthropometry (man-measure. military and industrial medicine. scope of the body and skin wrinkles. Bosnia and Herzegovina. from which 253 Journal of Society for development of teaching and business processes in new net environment in B&H . Fatima Jusupovic². Body Mass Index. height. Canton Sarajevo. the distribution of fat tissue and compare the anthropometric measurings. so the results can be compared. The research was performed on a chosen sample of 100 boys aged 14 to 15 years. In sport medicine it serves to objectively establish the development of the body. The investigations are performed with certain methods and according to the standard conditions in the whole world. It finds a wide application in sport. ² Faculty of Health. Anthropometric investigations serve to follow the growth and development of the human organism. 50 who actively train basketball and 50 who do not train any sports at all. they encompass the measuring of weight. the processing and studying of the gained measures. that with the comparison of consecutive measurements notices the progress or stagnation in development. and indirect indexes of the exchange of energy and the caloric balance of the organism.HealthMED . Greek) is a science which deals with the comparative measurings of the human body.

We established an average body weight of 96% for basketball players. obima tijela i kožnih nabora. An average BMI was established for 100% of boys who do not train any sports.) je nauka koja se bavi komparativnim mjerenjima ljudskog tijela. Standardi kojima smo se služili prikazani su u percentilnim krivuljama. Journal of Society for development of teaching and business processes in new net environment in B&H . Body Mass Index. Antropometrijska ispitivanja su direktni pokazatelji morfološke građe tijela. Djeca sportisti nisu: gojazni.HealthMED . Body Mass Indeks. Our results have shown an above average height for even 76% of basketball players. od kojih 50 aktivno trenira košarku u košarkaškom klubu “Željezničar”. ne puše. ne drogiraju se. Prosječan BMI ustanovljen je kod 100% košarkaša. they do not consume alcohol. and 50 boys who do not train any sports. Prosječnu tjelesnu visinu ustanovili smo kod 90% dječaka bez sportskih aktivnosti. Nalazi široku primjenu u sportskoj. grč. te da na bazi pojedinih antropometrijskih dimenzija usmjerava sportaše prema sportskim disciplinama u kojim se može očekivati optimalan uspjeh. Prosječnu tjelesnu težinu ustanovili smo kod 94% dječaka bez sportskih aktivnosti. školskoj. Prosječnu vrijednost DMT ustanovili smo kod 56% dječaka bez sportskih aktivnosti. te indirektni pokazatelji izmjene energije i kalorijskog bilansa orga254 nizma. te se rezultati mogu upoređivati. they do not take any narcotics. Ključne riječi: sportska medicina antropometrijske vrijednosti. We established an average body height of 24% for basketball players. U sportskoj medicini služi da objektivno ustanovi razvoj tijela. ne piju. Ispitivanja se vrše određenim metodama i pod standardnim uslovima u cijelom svijetu.Volume 2 / Number 4 / 2008 50 actively train basketball in the basketball club “Željezničar”. da poređenjem uzastopnih mjerenja uoči napredak ili stagnaciju u razvoju. and elementary school “Vladislav Skaric” and on boys who attend the same school and train basketball in the basketball club “Željezničar”. distribuciju masnog tkiva i uporediti antropometrijska mjerenja Istraživanje je rađeno na odabranom uzorku od 100 dječaka starosti 14 – 15 godina. The standards which we used are displayed on the percentage curves.Š “Vladislav Skarić” i kod učenika koji pohađaju istu školu a košarku treniraju u košarkaškom klubu “Željezničar”.Š. visine. Antropometrijska ispitivanjaj služe za praćenje rasta i razvoja čovječijih organizama. they have less chances of becoming ill from chronic diseases. imaju manje rizika od obolijevanja od hroničnih bolesti. “Isak Samokovlija”i O. Kod košarkaša prosječnu tjelesnu težinu ustanovili smo kod 96%. Mjerenja su izvršena kod dječaka koji pohađaju osnovne škole: O. a ima dodirne tačke i sa svim drugim granama medicine. We established an average body weight for 94% of boys who do not train any sports. Ciljevi ovog istraživanja su ispitati: antropometrijske vrijednosti dječaka na uzorku 100 ispitanika. Naši rezultati su pokazali nadprosječnu visinu kod čak 76% košarkaša. pa se postavlja pitanje da li intenzivno treniranje košarke ima uticaja na tjelesnu visinu ili se dječaci sa nadprosječnom visinom češće odlučuju na treniranje košarke. obradom i proučavanjem dobivenih mjera. manje čak izostaju sa nastave. uzrasne kategorije kadeta. Sažetak Humana antropometrija (čovjek–mjera. Key words: the sport medicine of anthropometric values. Children who train sports are not: obese. The measurings were performed on boys who attend the following elementary schools: Elementary school “Isak Samokovlija”. Kod košarkaša prosječnu tjelesnu visinu ustanovili smo kod 24%. they are less absent from their lessons. 50 koji se bave aktivno košarkom i 50 koji se ne bave sportskim aktivnostima. so one sets the question whether intensive basketball training has any effect on the body height or do boys with an above average height more often decide to train basketball. Body Mass Indeks. the height category of a cadet. they do not smoke. i 50 dječaka koji se ne bave sportom. vojnoj i industrijskoj medicini. Prosječan BMI ustanovljen je kod 100% dječaka bez sportskih aktivnosti. An average BMI was established for 100% for basketball players. obuhvataju mjerenje težine. We established an average body height for 90% of boys who do not train any sports. We established an average value of DMT for 56% of boys who do not train any sports. Kanton Sarajevo.

The indexes of the muscular and the body mass. Anthropometric measurings are performed because of scientific research or for practical aims. Factors which have an effect on the growth and development: Genetic potential A finally reached height and development of the child depend on the genetic potential of the parents and there is also a good corelation between the height of brothers and sisters. The speed of the growth varies during the phases of growth and development so that it is fast in the pre-natal. desirably in the morning hours. Populations which suffer from chronic malnutrition do not only have less body weight but they also have less than average height. the heels together and the tops of the feet apart. Sex Male children are longer and heavier at birth than female children. The body height is the vertical distance from the base to the highest point on the top of the head. The measured person stands on an even base barefoot. 255 Journal of Society for development of teaching and business processes in new net environment in B&H . The body scopes are measured on clearly defined points. without an effect on the height of the child. If a period od malnutrition did not last long the remnants can be substituted for in height with an accelerated growth. In medicine the most often used are the anthropologic characteristics which in a certain period give an idea of the health condition. One of the most important morphological characteristics is the body height. Introduction Anthropometric measurings are reliable and precise. and a highly caloric and unhealthy diet leads children to physical problems and illnesses. mutually connected processes.HealthMED . and the scope of the hips on the widest part of the flanks. The scopes of the body are measured with a metal or plastic centimetre strip and never with a linen one because of the impreciseness which arises during the stretching. A chronic malnutrition disables the child from reaching the height predicted by the genetic potential. Seasonal variations The speed of the growth in height is the fastest in spring and it can be twice as fast from the speed of growth in autumn. straightens up. The best possible growth and development require an optimal health. the hands are spread along the body. The development is an advancement of skills and complex functions. Late in puberty distinct differences appear in height. The control of the measurings should be performed by the same person who performed the first measuring if possible. the functional condition and the physical development of the organism are the body scopes. The growth and the development are independent. which shows the growth. contrary to that the speed of the increase of body mass is the fastest in autumn. weight and the proportions of the body. The body height is measured in the morning. The body mass is measured in the morning hours. Growth is the increase of certain dimensions or the total body mass. and they are applied as well on an individual as on certain population groups. The scope of the waist is measured in the middle between the rib arc and the crest of the bone.Volume 2 / Number 4 / 2008 1. The growth usually lasts during the first twenty years of life and the development continues even after that. health condition and indirectly the living conditions of that person. considering that the height decreases during the day. but the differences fade out with the reaching of the first year of life. An anthropometer is the most precise instrument for the measuring of height. the feet straightened up to the knees. The body mass is measured with a medicinal decimal scale with an additional weight. after the emptying of the bladder and the digestive tract. because of the flattening of the intervertebral discusses. The main rules and principles during the anthropometric measurings are to always measure at the same time and if possible to measure with the same equipment and the same technique. and to the second year one half of the height which it will have as an adult. Shorter periods of malnutrition result only in the losing of weight. Diet A regular and healthy diet provides a physically healthy growth and development. during the first year of life and in adolescence. physical development and the connection between the morphological and the phisiological characteristics of the person. The length of a newly-born during birth totals to almost one third of his or her adult weight. The body mass displays the health condition. development. on an empty stomach if possible without or with a minimum of underwear.

that is. It is considered that stimuli which cause systematic physical activity urge the young organism to correct growth and development which is especially tumultuous in adolescence. organised. working habits and moral responsibility through a respectful relationship towards the teammate and opponent. endurance and skills. The majority of sports and especially collective sports have an effect on the creativity of the child. raises the level of some psychomotoric abilities: speed. the culmination is reached with the reaching of the 25th year of life. Programmed physical activity – training.Volume 2 / Number 4 / 2008 Health condition Chronic diseases lead to a decrease of growth while brief infections do not have an effect on the speed of growth. organs which play a part in the metabolic processes and the autonomic nervous system. The centimeter curve of height (boys) Journal of Society for development of teaching and business processes in new net environment in B&H . strength. Besides all the positive aspects sport has on the growth and the development of the organism there is a significant influence on the normal mental development. Psychomotoric abilities represent a complex readiness for the carrying out of certain movements. time scheduled (6 to 8 hours weekly). above 97 in a considerable measure step away from the biggest number of children of that same age. The percentages on those graphs represent average child height. Children with the parameters below 3. The centimeter curves are in a span of P = 3 – 97. Basketball is a sport which is played and trained in the whole world and also one of the most trained sports between boys and girls. especially the cardiovascular system.HealthMED . Physical activity is a basic human need from his or her birth to old age. The curves of the growth of height. Programmed physical activity positively stimulates the function of the inner organs. as on their growth and especially on the growth of bones. Socio-economic state of the family Socioeconomic state of the family has an effect on the speed of the growth and development as on an utmost reached body height and weight. weight and the BMI are made on the basis of statistically processed data of a big number of healthy children in the coordinate system in which the abscissa tells the age of the child and on the ordinate the reached weight. Functions of the individual endocrine glands The function of individual endocrine glands has an effect on the increase of cells. weight and BMI. Physical activity of the child-sports Sport exercise is a mean of sport education and its effect on children is important. weight and the BMI of a certain child we compare with the corresponding measures of a group of healthy children. Active training of basketball contributes to: • Physical development of the player • The development of cognitive functions 256 • The development of healthy and the adoption of new positive habits • The development of personal and social values which are very important in the upbringing of children • The accepting of obligations towards others • Individual and team responsibilities • Self-respect. the respecting of others and the respecting of rules • A development of persistence. Body height. the respiratory system. The growth of body height. performed by a professionalist. weight and the BMI of the centimeter curve In everyday praxis for the evaluation of physical progress of the infant first of all serves the body weight. Picture 1. height or BMI for that age. and after the first year of life for the long-term supervision the body height. planned. and in its development have a similar curve like other human characteristics. For the physical activity to have a positive influence on the development of a young organism it has to be: programmed.

50 who actively train basketball and 50 who do not train any sports. Men are under a risk if the relationship of the scope of the waist/hips is bigger than 0. and 50 boys who do not train any sports. 3. • The calculation of the relationship of the body mass and the height show the measure of the level of nutrition. but not the constitution.2 Methods of research In this research the following anthropometric methods were used which include the measuring of: . 3.95cm and women if it is bigger than 0. The aims of research 2.85cm. The anthropometric measurings were carried out according to standard methods by which the anthropometric protocol was respected with the instructions on the procedure of measuring. from which 50 actively train basketball in the basketball club “Realway”. 2.3. • The risk of developing obesity exists for children if their BMI is above the 85th percentage. they develop differences characteristic for the male or female sex. • The measurings were performed on boys who attend the following elementary schools: Elementary school “Isak Samokovlija” and elementary school “Vladislav Skaric” and on students who attend the same school but train basketball in the basketball club “Realway”. The examiners and the methods of work 3. Only in puberty as a consequence of the producing of sex hormones. • BMI changes for children with age and it is highly dependent on the BMI of the biological parents.Volume 2 / Number 4 / 2008 Body Mass Index – BMI The most frequent method for the establishing of nutrition which is used today in epidemiologic research but more and more often in daily practice is the establishing of the index of body mass (BMI).scope of the hips • The data was incorporated in the appropriate form (example 1). which can be presented as: • BMI = Body weight/body height (m)².body height . The BMI is calculated on the basis os the relationship between the body mass and the body height squared. The distribution of fat tissue – DMT Beside the level of obesity one needs to pay attention to the distribution of fat tissue.HealthMED .scope of the waist . Anthropometric measurings • During the measurings the boys had on them only the underwear and they were measured in the morning hours.4. Compare the anthropometric measurings. becoming category of cadets. Through the relationship of the scope of the waist and hips one determines the distribution of fat tissue (DMT). because the central distribution with the accumulation of fat on the trunk and abdomen are united with a big number of breakdowns.1 Examiners • The research was performed on a chosen model of 100 boys aged 14 – 15 years. 2. For children up to puberty there is no difference in the distribution of fat tissue according to the sexes.2 Examine the Body Mass Index 2.1.body weight . To examine the anthropometric values for boys on a model of a 100 tested people. Canton Sarajevo. and they are obese if the BMI is bigger than the 95th percentage. before breakfast and after the carrying out of the physiological needs. Examine the distribution of fat tisssue 2. • A person who follows the growth and development of a certain child is compared to the BMI with the values on the percentage curve and can early notice the threats to developing obesity or malnutrition. 257 Journal of Society for development of teaching and business processes in new net environment in B&H .

Volume 2 / Number 4 / 2008 • Before the measurings the instruments were checked in order for the measurings to be as precise as possible and mutually comparable. the calculating of certain proportions. such as Bosnia and Herzegovina.2 cm 184.5 cm Body weight (kg) 45-90kg 52-86kg. For international comparings and for countries which do not have such curves. Body height (cm) • The body height was measured with an anthropometer which consists of one vertical metal rod with a scale. The display of the tested people according to age and sport activities Age 14 .K. • For the comparison of the somatic growth of children many countries have set their standards.HealthMED . and the hips circumference on the widest part of the flanks.15 Number of boys 50 50 % 100% 100% Body height (cm) 158-187 cm 165-196cm X 167. the so-called curves of growth and development of children. • The tested people were measured by standing on an even base barefoot with their heels together and a little separated toes. they do not move during the measuring and the noting down of the body weight. Anthropometric indexes • Anthropometric indexes represent certain relations of the anthropometric measurings mutually. between the rib arc and the crest bone. body weight and their middle values of the total sample Age Body height and weight Sport inactive boys Basketball players K. The results of research Table 1.15 Total % Sport inactive boys Number of boys 50 100 100 % % 50 % Basketball players K.2 kg 71 kg 258 . 5.K. With the mobile leg of the anthropometer we touch the top of the head and we note down the height. “Željezničar” Number of boys 50 % 50 % Table 2. on which there is a mobile horizontal leg. with the same apparatus and method at the same time. • The tested people were measured by standing on the scale. • The waist circumference is measured in the level of the umbilicus. their body and the top of their head resting on the measuring scale. Body circumference (cm) • Body circumference is measured with a plastic centimeter strip. they were carried out by the same team. curves of growth are applied which have been accepted by the World Health Organisation. X 59. Body weight (kg) • The body weight was measured with a medicinal decimal scale with a supporting weight. “Željezničar” Total % 100 100% Journal of Society for development of teaching and business processes in new net environment in B&H 14 . Body height. that is.

the middle value for weight is 71 kg.67 – 0.2 cm.9 X 17.89 X 0.K.25 150-162cm 12% 0 26 -75 163-177cm 26 5 52% 10% 14 . BMI. from which 50 boys do not train sports and 50 boys who actively train basketball in the basketball club “Željezničar”.9 and the middle value of the DMT is 0.9-25. Body weight shown in percentages Age Percentages Body height (cm) Sport inactive boys Basketball players K. “Željezničar” Total % Body height Span (cm) 158-187 165-196 100 100% X 167.15 Body weight Span (kg) 45 .4 15.2 kg. DMT and their middle values 14 .85 cm. the distribution of fat tissue and their middle values Age BMI and DMT Sport inactive boys Basketball players K.4 – 21. For basketball players the middle value of body height is 184.89 X 0.9 X 17.9 18. In the totally expressed sample the middle value of the body height of boys without sport activities amounts to 167.88 cm.86 X 59. weight.94 0.85 In the table there is a display of the tested peopl aged 14 – 15 years devided according to the sport activities.15 76 .4-21. while the BMI and the DMT are also standard.79 – 0.9 – 25.85 Table 5.88 0.79-0. For basketball players the middle value of the body height deviates from the standard one for this age concerning the above average. In the representative sample the measuring of body height was performed and the gained results show distinct differences in body height for these two groups of tested people.2 71 BMI Span (cm) 13. and the middle value of the DMT amounts to 0. Body mass index. Table 4. “Željezničar” Total % 6 0 100 % 3 .K.2 184. “Željezničar” Total % 100 100% Number of boys 50 50 % 100 100 14 . the middle value for weight is 59.90 52 .HealthMED .97 174-181cm 13 7 26% 14% 5 38 >97 >182cm 10% 76% Number of boys 50 50 % 100% 100% Journal of Society for development of teaching and business processes in new net environment in B&H 259 .67-0.Volume 2 / Number 4 / 2008 Table 3.15 BMI 13. and all are students of two elementary schools in the Municipality center.9 18.4 15.5 cm. The middle values for body height.94 0. Age Anthropometric measurings Anthropometric values Sport inactive boys Basketball players K.88 0.K.8.7 DMT Span (cm) 0. weight.5 For basketball players the middle value of the BMI is 18.8 DMT 0. Body height. The middle value of the BMI for boys who do not train sports is 17. BMI and DMT for boys who are sport inactive show the standard values.

K. Body height shown in percentages Age Centimeters Body weight (kg) Sport inactive boys Basketball players K.5 12 31 24% 62% 76 . that is. between 3-97 P we have 90% and while the above average body height of > 97 P or >182 cm is present in 10% of boys.18 33 15 100 100% Journal of Society for development of teaching and business processes in new net environment in B&H 14 . while an above average body weight of >82 kg is present in 4% of basketball players. “Željezničar” Total % 3 . The standard weight of 39 – 81 kg.75 18. from 3-97 P is present in 94% and an above average weight of >82kg. 3-97 P we have 24% while distinctly high > 97 P. of >97 P is present in 6% of sport inactive boys. that is. Body weight In the total sample the standard body weight between 39-81 kg. The BMI of boys presented in percentages Age Percentages BMI Sport inactive boys Basketball players K.15 26 . >182 cm there is present in 76% of basketball players. that is.97 21. from 3-97 P is present in 96% of basketball players.Volume 2 / Number 4 / 2008 Graph 1. Table 6.1 – 21. Basketball players with a standard body height of 150 – 181 cm. In the body weight of these two groups there are distinct differences but not the same ones as for the body height.97 64 – 81 kg 13 35 26% 70% 3 2 >97 >82 kg 6% 4% Number of boys 50 50 % 100% 100% Graph 2. Body height Sport inactive boys with the standard body height of 150-181cm. that is. Table 7. “Željezničar” Total % 7 0 100 100% 3 .6 .25 39 – 49 kg 14% 0 26 .15 76 .27 5 4 10% 8% >97 >27 Number of boys 50 50 % 100% 100% 66% 30% 260 .25 16 .K.75 50 – 63 kg 27 13 54% 26% 14 . that is. that is.HealthMED .

on is present in 24% of sport inactive and 62% of basketball players.K. BMI The values of the BMI on the graph show a meek malnutrition in 66% of sport inactive boys and 30% of basketball players.15 0.80 – 0.Volume 2 / Number 4 / 2008 Malnutrition and obesity have significant hereditary predispositions. while there are no obese people in either of the groups. Graph 3. The DMT is a measure for the determining of the type of obesity.94 36% 6% 4 >0. The relations of the tested values: body height. For boys in adolescence there is an increase in the number of muscular cells. proportions and the shape. so that the weight for boys increases on account of the muscular tissue.K. That leads to an increase of the total mass and to a change of body dimensions. it is believed that the genes for nutrition operate on the level of the hormonal regulation. a moderate pre-obesity is present in 10% of sport inactive and 8% of basketball players. “Željezničar” Total % Body height <3 3-97 45 12 57 57 >97 5 38 43 43 Body weight <3 3-97 47 48 95 95 >97 3 2 5 5 <3 14 . weight.70 – 0.89 26 42 52% 84% 18 3 14 .90 – 0. “Željezničar” Total % 0. so that some people from the same “raw material” produce more fats than others. BMI and DMT Age Anthropometric measurings Percentages Sport inactive boys Basketball players K. and if they are even sport active they can have the ideal anthropometric measures. and the amount of fats slowly decreases. and an important indicator of the risks for health. DTM Table 8. the normal nutriti- Graph number 4. The DMT of boys of the total sample displayed in the following table Age DMT (cm) Sport inactive boys Basketball players K.79 2 5 100 100% 4% 10% 0.HealthMED .15 BMI 3-97 50 50 100 100 >97 <3 DMT 3-97 46 50 96 96 >97 4 4 4 Journal of Society for development of teaching and business processes in new net environment in B&H 261 .95 8% Number of boys 50 50 % 100% 100% Table 9.

BMI and DMT for both of them. but also frequent enough.2 cm and for basketball players it is 184. the others were in the framework of the standard. For the sport activity to give its positive stimuli to growth and development. In our research the boys from the sample belong to a group of tall boys because the average body height of sport inactive boys amounts to 167. Sports as movement in general. Discussion A right growth and development are one of the fundamental conditions for a later harmonious and healthy way of living. waist circumference and hips and the recalculating of the BMI and the DMT. In our research an increased BMI was present in 10% of sport inactive boys and 8% of basketball players.5 cm. 10% of basketball players with a decreased value of the DMT. The average body weight for sport inactive boys amounts to 59. After that the analysis was performed and the tabeling of the data and after that the comparison of the gained results. Canton Sarajevo. it is not enough for it to be just exhaustive. The BMI of the total sample is between 3 – 97 percentages (16 – 27). The DMT of 3 – 97 percentages there is present in 100% of basketball players. that is. while over 97 percentages (>182 cm) there is present in 10% of boys who are sport inactive and 76% of basketball players.HealthMED . The body height and weight are factors which tell us about growth and development. The body weight between 3 – 97 percentages (39 – 81kg) there is present in 94% of boys who are sport inactive and 96% of basketball players. The results of the analysis of the fout most important physical indicators (body height and weight. systematic and so used that it makes up for the rest and insufficient movement to which children and youth are forced to during the day. The body height of 3 – 97 percentages (150 – 181 cm) is present in 90% of sport inactive boys and 24% of basketball players. the maximum values are present in 36% of sport inactive boys and 6% of basketball players. represents a stimulans to growth and development of the organism. waist circumference and the hips) together with the recalculated BMI and DMT enable the defining of the right growth and development as well as the following of the effect of sports on the same. and there are no basketball players in this group. while for sport inactive boys 92% is between the 3 – 97 percentages and 8% have an increased DMT. and compare the anthropometric measurings. The DMT is a useful indicator of the type of the type of obesity. The DMT for 100% of basketball players was in the framework of the standard. we have 4% of boys who are sport inactive. 52% of sport inactive boys and 84% of basketball players with the ideal values of the DMT. Also to examine the Body Mass Index. 5. Standards which we used are displa- Journal of Society for development of teaching and business processes in new net environment in B&H . the distribution of fat tissue. The BMI is the most precious indicator of the nutritive condition. in a big measure physical activity can have an effect or inactivity. weight.Volume 2 / Number 4 / 2008 Compared to the normal values.2 kg and for basketball players it is 71 kg. To the deviations in growth and development which arise during puberty. The maximum DMT was present in even 36% of sport inactive boys and 8% of an increased DMT. The narrow aim of the research was to examine the average body height and weight of boys in the Sarajevo Canton and the deviations from the standard values. risky. over 97 percentages (> 81 kg) there is present in 6% of boys who are sport inactive and 4% of basketball players. 6. The measuring of the anthropometric parameters was performed with the standard 262 methods and that of height. Conclusion and recommendations This research had the aim of examining the anthropometric values for boys who actively train basketball and those who do not train any sports on a sample of Canton Sarajevo. and 8% of sport inactive boys have the abdominal type of obesity. The research was conducted on a sample of 100 tested people of the male sex aged 14-15 years in the municipality Center. considering that in comparison to height the weight is a vague indicator and criterium for the evaluation of physical development. The gained results show that we have distinct deviations in body height for sport inactive boys and basketball players and the standard values for body weight.

There is only one more distinct indicator in the deviations and that is the DMT for boys without sport activities. The average body weight was established for 94% of boys without sport activities. Recommend special sport activities to children encompassed in the sport clubs.Volume 2 / Number 4 / 2008 yed in the percentage curves. The deviations in body height was established for 10% of boys without sport activities. they do not consume alcohol. The average values of the DMT was established for 56% of boys without sport activities. the acquiring of working habits. and deviations in body weight were established for 4% of basketball players. Children athletes are not: obese. and deviations in body height was established for 76% of basketball players. The average body height was established for 90% of boys without sport activities. A positive effect on the psychic functions especially on the reduction of stress. Recommendations To promote natural diet of newly-borns and healthy ways of living in the family. Our results have shown an above average height for even 76% of basketball players. Perform systematic and especially periodic check-ups if school children and youth because of an early detection and prevention in the deviations of growth and development. they do not smoke. For the DMT we are sure that basketball has a positive effect because the majority of basketball players had an ideal relation of waist and hips. and deviations in relation to the DMT were established for 44% of boys without sport activities. For basketball players the average DMT was present in 94% of them. they do not take drugs. they have fewer risks of falling ill from chronic diseases. they are even less absent from their lessons. Journal of Society for development of teaching and business processes in new net environment in B&H 263 . For basketball players the average body height was established for 24%. professors and educators and parents. In the group of boys without sport activities we had 10% of an above average height. Children in pre-school age should be introduced to organized programs of sports (children playhouses). The deviations in relation to the BMI are neither present in boys without sport activities nor in basketball players. Advantages and use from training sports for children A haromonious growth and development of all organic systems and especially the cardiovascular system. The deviations in body weight was established for 6% of boys without sport activities. one learns persistence. The average BMI was established for 100% of basketball players. 44% of them has an increased or risky DMT. moral responsibility is developed through a respectful and correct relationship towards the teammate and opponent. The deviations in relation to the DMT were established for 6% of basketball players. the strengthening of self-confidence. Perform health enlightenment of school children and youth. so one sets the question whether intensive training of basketball has an effect on the body height or do the boys with an above average height more often decide to train basketball. For basketball players the average body height was established for 96%. the respiratory system and the muscular – bone system.HealthMED . which enables an individual development of intelligence and physical abilities with play and socialising.

Jannssen I. 2005 Dec 9. Fett W Fabbro A. 7. Codrington CA. 2. 288 (14): 1728-32. 9.82:377-82. Acta Paediatr 1993. e-mail: dijana2007@gmail. Body mass index measurements and prevalence of overweight and obesity in school-children living in the province of Belgian Limburg.44(2):157-63. B: Blood pressure. Nutrition and diet for healthy lifestyles in Europe. Kolacek S.2:45-53. Luzar V. J Int Soc Sports Nutr. Early determinants of cardiovascular risk factors in adults. 12. Exercise Program. Dietary Reeducation. Pokorn D. waist circumference and health risk. J Sports Med Phys Fitness. Fett C. Flegal K.European Commission. Massa G. Br J Sports Med. Hunt PH. Carroll M. 2008 Jan. Apostolidis N.161(6):343-6.1-5. Ross R. Obes Res 2003. 5.42(1):25-30. Epub 2007 May 25. 8. “Eurodiet”. Eur J Pediatr 2002.11(5):668-73. International Obesity Task Force. Evidence in support of current National Institutes of Health Guidelines. Arch Intern Med 2002. Kafatas A. Physiological and technical characteristics of elite young basketball players. JAMA 2002. Hopkins WG. Obes Res 2003.46:491-5. 3. Willms JD. Kudumovic M. 10. Geladas ND. McKenna MJ. Bolatoglou T. Frelut ML. Kudumovi A. Modelling age and secular differences in fitness between basketball players: a 10year-period investigation. Performance and Body Indexes Associated with Risk Factors in Overweight/Obese Women. 11. Nassis GP.9-12 Corresponding author: Dijana Avdic KCU Sarajevo. Marchini J. HealthMED 20071(1):. Skin folds under the chin for scholage children. Childhood Obesity. Pyne DB. 2004 Jun. Prevalence of overweight among children in Europe. 2001.Volume 2 / Number 4 / 2008 Literature 1. Cnattingius S. Ogden C. 13. Kapetanovic T.4(4):195-200. Report 2004.com 264 Journal of Society for development of teaching and business processes in new net environment in B&H . Ped Res 1999. Tremblay MS. Jusupovic F. Hadzihalilovic J. Katzmaryzk PT. Tuvemo T. Johnson C.162:2074-9. 1999-2000. Lobstein T. Drinkwater EJ. Body mass index. Geographic and demographic variation in the prevalence of overweight Canadian children. 4. Bosnia and Herzegovina.HealthMED . Jonsson B. Katzmaryzk PT. Stoisavljevic D. Prediction of male adult stature using anthropometric data at birth: a nationwide population-based study. 6. Prevalence and trends in overweights among US children and adolescents.

Results: Research have shown that in three the biggest Clinical centers in area of Federation of Bosnia and Herzegovina. it is necessary. first of all. Methodology: Sample includes Clinical centers in Sarajevo.Volume 2 / Number 4 / 2008 Methods of removing infectious and laboratorys’ waste in clinic centers METODE UKLANJANJA INFEKTIVNOG I LABORATORIJSKOG OTPADA U KLINIČKIM CENTRIMA Aida Vilic-Svraka1. structure. this sort of waste presents big epidemiologic risk. transportation. big part of this waste is taking away in deponia with communal waste. That way danger of spreading infectious illness is increasing and it is necessary to respect strict criteria of evidence and supervision from place of approving this material waste to place it is finally carrying. Journal of Society for development of teaching and business processes in new net environment in B&H 265 . That way. carrying and control of infectious and laboratorys’ material waste in three the biggest clinical centers in area of Federation of Bosnia and Herzegovina. hurting and poisoning. and Tuzla. Aida Filipovic-Hadziomeragic1. Canton and health facilities. Federation. Zlatko Vucina1.HealthMED . to create regulative law and regulations which would regulate system of institutions correctly for command of medical waste. its sort. collection. Research questionnaire is sketched on the base of directives which is recommended by CDC from Atlanta. Target: Research had aim to interrogate the way of storaging. we used questionnaire as instrument of research. It is necessary to create three or five year plan of carrying infectious and the other medical waste and also to create detail instructions about principles of operate this sort of waste in all levels of health protection. in fact. In order to get informations about producer of infectious and laboratorys’ material waste. For treatment and review of information’s we used descriptions statistics (percentual perception) in analysis of correlations of some variations and calculating hi-square of test for comparable some variations. transportation and carrying. For establishing of complete of infectious waste system in Bosnia and Herzegovina. Mirsada Mulaomerovic1 1 Institute for public-health of Federation of Bosnia and Herzegovina Summary Introduction: Health facilities are big producers of infectious and laboratory’s material waste which present the most dangerous sorts of medical waste because of high degree of infectious. 60% of infectious and laboratory’s waste is taking away together with communal waste. and Clinical hospital in Mostar. Carrying of this material waste becomes big problem for all health facilities and it declares in increasing its quantity. Conclusion: Results of research have shown that methods of taking away infectious and laboratory’s waste from three the biggest Clinical centers in area of Federation Bosnia and Herzegovina are not safe.

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Sažetak Uvod: Zdravstvene ustanove su veliki proizvođači infektivnog i laboratorijskog otpada, koji zbog visokog stepena rizika od infekcija, ranjavanja i trovanja predstavljaju najopasnije vrste medicinskog otpada. Zbrinjavanje ovog otpada postaje veliki problem svih zdravstvenih ustanova, a očituje se u povećavanju njegove količine. Na taj način se povećava i opasnost od širenja infektivnih bolesti, pa je neophodno poštovati stroge kriterije evidencije i nadzora, od mjesta nastanka ovog otpada, do mjesta njegovog konačnog zbrinjavanja. Cilj: Istraživanje je imalo za cilj da ispita način skladištenja, transporta, zbrinjavanja i kontrole infektivnog i laboratorijskog otpada u tri najveća klinička centra na području Federacije Bosne i Hercegovine. Metodologija: Uzorak je obuhvatio Kliničke centre u Sarajevu i Tuzli, te Kliničku bolnicu u Mostaru. Da bi se dobili podaci o proizvođaču infektivnog i laboratorijskog otpada, njegovoj vrsti, strukturi, sakupljanju, prevozu i zbrinjavanju, služilo se anketnim upitnikom, kao instrumentom istraživanja. Istraživački anketni upitnik je koncipiran na osnovu smijernica koje preporučuje CDC iz Atlante. Za obradu i prikaz podataka koristila se deskriptivna statistika (procentualno učešće) u analizi korelacija pojedinih varijabli, kao i izračunavanje hi-kvadrat testa za uporedni prikaz pojedinih varijabli. Rezultati: Istraživanje je pokazalo da se u tri najveća klinička centra na području Federacije Bosne i Hercegovine 60% infektivnog i laboratorijskog otpada odlaže zajedno sa komunalnim. Najveći problemi su vezani za skladištenje i tretman ove vrste medicinskog otpada. Potvrđeno je postojanje statističkih razlika između pojedinih kliničkih centara. Najnepovoljnija situacija jeu Kliničkoj bolnici u Mostaru, jer se kompletan čvrsti infektivni i laboratorijski otpad odlaže zajedno sa komunalnim. Postrojenja za obradu infektivnog otpada u Kliničkom centru u Sarajevu, prerađuju 1/3 nastalog infektivnog otpada, a situacija je najpovoljnija u Kliničkom centru u Tuzli, gdje se svega 13,33% neobrađenog infektivnog i laboratorijskog otpada odlaže zajedno sa komunalnim. Zaključak: Rezultati istraživanja su pokazali da metode odlaganja infektivnog i laboratorijskog 266

otpada iz u tri najveća klinička centra na području Federacije Bosne i Hercegovine nisu sigurne, tačnije, veliki dio ovog otpada se odlaže na deponije zajedno sa komunalnim otpadom. Na taj način ova vrsta otpada predstavlja veliki epidemiološki rizik. Za uspostavljanje cjelovitog sistema upravljanja medicinskim otpadom na nivou BiH, Federacije, Kantona i samih zdravstvenih ustanova, potrebno je najprije stvoriti zakonsku regulativu i propise koji bi tačno regulisali sistem upravljanja medicinskim otpadom. Neophodna je izrada tro- ili petogodišnjeg plana zbrinjavanja infektivnog i ostalog medicinskog otpada, kao i izrada i primjena detaljnih uputa o principima rukovanja ovom vrstom otpada na svim nivoima zdravstvene zaštite. 1. Introduction During giving health services (diagnosis, treatment of patient) there are huge amount of infectious and laboratory’s waste left, which can endanger health of people and environment. In total pollution this sort of waste has a big part (5-12%), but it consists of waste matters which were created to protect health of people and animals’ health and/or similar research, it is necessary to care it according to fast requests. Infectious waste often contains pathogen biological agens which make illness in people who are under that influence because of its type, concentration and number, and means: culture and tools from microbiology laboratory, parts of equipment, material and tools which come in touch with blood or secrets of illness people or it is used for surgical operations (needle, lancets, syringes, scalpels) bandage a wounds (bandages, tampons) and abductions and waste materials from department for isolation patients and department for dialysis, systems for infusions and transfusion, gloves and other tools for one way use, clothes of staff, and material which is in contact with experimental animals which are injected with of infectious material. Pathological waste – parts of human body, amputated parts, tissues, organs which are removed during surgical interventions, tissues taken in diagnostic purpose, lancets, and fetuses and so on, are special sort of potential infectious waste. Pathological waste has ethic meaning. (1,2,3)

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In clinical-chemistry laboratory and X-ray laboratories ussualy appears medical chemistry liquid waste. It contains of chemicals which have dangerous substances (laboratory reagenses liquides for disinfection based on phenol or perohloretilen, waste with great concentration of hard metal, different chemicals and radioactive waste material). Denatured alcohol, calciumcarbid, halogen organ, dissolvers, radio-active and other dangerous waste matters mustn’t be in canalization system. Nonmedical chemical liquid waste consists of means for cleaning of rooms and sanitary equipment for example different sorts of detergent and other means for washing, salt acid, hydrogen and different disinfects. This sort of chemical liquid waste is mainly removed by releasing it in sewage system, but type and quantity of that material must be limited. In clinical laboratory either hard chemistry waste appears (which can consist a lot of toxic and infectious substances) and radioactive waste. Waste which consists of hard metals is presented under category of dangerous waste which is very toxic. For example, waste of mercury appears dropping during break of medical equipment but waste of sodium appears of expending battery. Special category is radioactive waste which has specific way of elimination and carrying. (4,5) Waste water from hospitals contains many pathogenic bacteria that cause intestinal diseases. This water often contains Koch’s bacilli, enteroviruses (include Coxsackie viruses, rhinoviruses, polioviruses) and Hepatitis A viruses. Pollution by drinking water with hospital waste may cause epidemics. As viruses are more resistant to physical and chemical inactivation than bacteria, proper treatment of waste water is necessary. Discharge of liquid medical waste out of sewage system is allowed only if proper treatment has been applied.(6) When we talk about solid infectious waste, the main problem is taking away of sharp objects: scalpels, needles, lancets, used in interventions. On city depo, it is often possible to see needles, bandages and other material waste which is potential source of infection. Pipettes, lancets and blood needles for hematology research, are often transmitters of virus hepatitis B (VHB) and virus hepatitis C (VHC). Causes of infection are staying longer in needles, so if someone accidentally comes

in touch with it, one can be infected easily. Risk from scalpel, lancet or some other sharp object is less than risk from needle bit, probably because there is more blood left in needle. Virus hepatitis B is really resisted and can live one week or even longer out of body. On 30 °C this virus can keep infection till 6 months, and on 60 °C – four hours. It is similar with virus hepatitis C. Virus of human immunodeficiency (HIV), is also transmitting with infected blood, blood products, contaminated needles, sprayers and other instruments. However, this virus is less resisted (it can live 3-7 days on room temperature). (7, 8, 9) Chemicals used in hospitals are potential source of pollution, mostly through water, by sewage system. Small amounts of dangerous chemical waste can cause poisoning and chemical burns. Taking care of infectious and laboratory waste is becoming great problem of health institutions. Proper handling with infectious material waste is important measure in preventing hospital infections. One of the general measures is environmental protection and classifying, collecting, storaging and treatment, in fact disinfection of infectious material waste. Interesting information is that rich countries are not necessarily had to take care of material waste. It is necessary to set aside 0, 5% of bruto national income per inhabitant. That means that countries with low bruto national income should set aside between 0,18 and 6 dollars per inhabitant per year.(10,11,12). 2. Methodology of research Sample encircled tertiary level of health protection – three the biggest Clinical centers on the area of Federation Bosnia and Herzegovina (hospital departments and laboratories). Research has been done due to protocol of research, by standard phases: 1. Production of situation analyze based on existing data and research: 2. Production of suggestions of research; 3. Production of action and financially plan; 4. Implementation of research (preparement of research questionnaire, data collecting, entering data base, statistic processing of data); 5. Evaluation and producing the report; 267

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Research encircled next variable: 1. Sharp objects (needles with syrers, lancets, scalpels, and tweezers) 2. Bandage materials (tampons, bandages, gazes, absorbent cotton) 3. Systems for infusion and transfusion of blood 4. Supplies for one way use (gloves …) 5. Other infectious material waste 6. Cultures and supplies from laboratory 7. Chemicals containing other dangerous substances (laboratory reagents, means for disinfection based on phenol or perochloretilen, acids, bases, waste with great concentration of hard metals…) 8. Other chemicals In process of data treatment SZO and CDC, EPI info 2000 with SAAS/SUDAN software packet has been used, with aim to calculate the sample, values of factors in data base, to calculate standard mistakes and coefficient of variation. Statistical differences in range from 95% interval of correctness’s were defined. For showing data, we used descriptive statistics (percent inclusion) in analysis of correlation of some variables, as well as getting hi-square test for compare view of some variables, where according to analyze of data some hypotheses were seen important for statistic differences in relation on acting of some variables. 3. Results Clinical center in Sarajevo doesn’t have three year or five year plan for taking care of medical material waste, while 60% of analyzed units have documentation about this sort of waste. Person in charge for organization and indoor supervision don’t have 40% of analyzed units, and person in charge for taking care of data base about medical waste, making and delivering monthly report to person in charge for organization and indoor supervision don’t have 86, 67% of analyzed units. Partly selection of infectious and laboratory’s waste on place where they happened make 80% of analyzed units. For packaging infectious material waste, plastic bags are being used in 40% of ana268

lyzed units, in 40% is intended plastic wrapping material, and in 20% carton boxes are being used. For packaging of laboratory’s waste in 46,67% of analyzed units, plastic wrapping material is being used, in 26,67% plastic bags are being used, and in 20% carton boxes are being used. One third of analyzed units (33,33%) keep sharp objects in intended, solid covered dishes which are safe from penetration and opening. Wrapping material for infectious and laboratory waste, which is waterproofed and insured from spilling of the content, have 40% of analyzed units, while 33,33% of analyzed units have wrapping material marked with proper color (red or orange for infectious, yellow for chemical waste). In 66,67% of analyzed units wrapping material with infectious and laboratory’s waste can not be open without authority. Special storage for infectious and laboratory waste, which is covered, marked and intended only for that purpose have 33,33% of analyzed units. Storaging of untilled infectious laboratory waste lasts till 24 hours, and longer than 24 hours for laboratory waste which is being collected for taking away with authorized companies with whom the contract has been signed. Treatment of infectious material waste with disinfection and sterilization, in fact, taking it away with authorized companies, is being done in 33,33% of analyzed units. Untilled infectious and laboratory waste is being taken away together with communal waste in 66,67% of analyzed units. In all analyzed units, human tissues are being burried on cemetery. Liquid infectious and laboratory waste is not processing before releasing it into sewege system in 60% of analyzed units. Other liquid infectious and laboratory waste is being treated with disinfection, in fact it is being taken away with authorized companies. In Clinical center in Sarajevo, 46,67% of staff working on classifying and processing of infectious and laboratory waste material, is educated for that kind of job, 73,33% of staff have full protective clothes. In most of analyzed units, final treatment of infectious and laboratory waste is huge problem. Next problem is storaging, classifying and transporting infectious and laboratory waste materials. Clinical center in Mostar doesn’t have 3 year or 5 year plan for taking care of medical material waste, as well as documentation about this sort of

Journal of Society for development of teaching and business processes in new net environment in B&H

and in those units there is time planed for transportation of this sort of waste material. Other liquid infectious and laboratory waste is processed by disinfection. marked and predicted only for that purpose.67% of staff that works on classifying and processing of infectious and laboratory waste.67% of staff have full protective clothes. only human tissues are being burried in cemetery. in fact it has been put aside together with communal waste. None of the analyzed units don’t have wrapping material for waste which is waterproofed and marked with proper color.HealthMED . In 13. in fact taking laboratory waste away is part of 86. Solid infectious and laboratory waste treatment is not part of any analyzed unit. solid and covered dishes which are insured from penetration and opening. Intended plastic bags are being used for packaging infectious and laboratory waste in 40% of analyzed units. yellow for chemical waste). with residence in Tuzla). Storaging of untilled infectious waste in most of analyzed units lasts from 1 to 12 hours. Storaging of human tissues lasts from 3 to 12 hours. There is no specific storehouse for infectious and laboratory waste which is covered. Storaging of untilled laboratory waste last 24 hours. liquid infectious and laboratory waste are not processed before releasing into a sewerage system. 26.33% of analyzed units. All analyzed units with human tissues as infectious waste are using freezers for their storaging. In all analyzed units. Infectious and laboratory waste treatment with disinfection and sterilization. Transportation of infectious and laboratory waste is exclusively done by communal service vehicles without any time planning. 269 Journal of Society for development of teaching and business processes in new net environment in B&H . Clinical center in Tuzla has 5 year plan for keeping of medical waste and all analyzed units have documentation about this sort of waste. sharp objects are being stored in intended. Next problem is storaging.Volume 2 / Number 4 / 2008 material waste. storaging of untilled laboratory waste lasts 3-12 hours. human tissues are being burried in cemetery. In most of the analyzed units. closed dishes which are insured from penetration and opening. In Clinical hospital in Mostar. In most of analyzed units. This wrapping material couldn’t be opened without authority. as well as person in charge for organization and indoor supervision who makes and deliver monthly report to person in charge for indoor supervision. In all of analyzed units. There is storehouse for infectious and laboratory waste which is covered marked and predicted only for that purpose. plastic wrapping material is being used. All analyzed units have wrapping material for infectious and laboratory waste which is waterproofed and insured from dropping or spilling the content and which is marked with proper color (red or orange for infectious. classifying and transportation of infectious and laboratory waste. solid. All analyzed units make full selection of infectious and laboratory waste on place where they happened.67% of analyzed units. In 13. and 66. is educated for that kind of job. All analyzed units are doing partial selection of infectious and laboratory waste on place where they happened. Simple plastic bags and carton boxes are being used for packaging infectious and laboratory waste.33% of analyzed units. All analyzed units keep sharp objects in intended.33% of analyzed units. and releases into a sewerage system without previous processing. and vehicles are easy to clean and disinfect. Liquid infectious and laboratory waste is processed before releasing into a sewerage system in 6. Storaging of untilled laboratory waste lasts up to 12 hours (it is collecting for taking it away by authorized company with whom the contract has been signed. final treatment of infectious and laboratory waste is a huge problem. Wrapping material with infectious and laboratory material waste can not be open without authority. and in 60% of them. Intended plastic wrapping material is being used for laboratory waste in 20% of analyzed units. Other liquid infectious and laboratory waste releases into a sewerage system without previous processing. as well as person in charge for taking care of data about medical waste who makes monthly report and deliver it to person in charge for organization and indoor supervision. communal and untilled infectious and laboratory waste are being taken away by 13.67% of analyzed units. For 86.67% of analyzed unites transportation of infectious and laboratory waste is done with vehicles made only for that purpose. Both. in fact it is taken away by authorized companies. None of the analyzed units don’t have person in charge for organization and indoor control for medical material waste.

Mostar. In most of analyzed units.33% of staff working on classifying and processing infectious and laboratory waste. and health of patients and all people.05 = that means that difference in average appraisal is very important.22 270 Journal of Society for development of teaching and business processes in new net environment in B&H . According to removing method of infectious and laboratory waste Average 9.33 3552. variance analyze have been done (ANOVA) and the results are in table 1.) Observing full sample with average appraisal of 10. The best evidenced situation is in Clinical center in Tuzla. Mostar.21 24.00 Theoretical 3.10 20. in relation with method insurance.74 df 2.89 Fempirical 52. Since F empirical > F theoretical. there is appraisal created for each unit from the sample according to answers on relevant questions from question mark.41 1016.45 2.00 44. is educated for that kind of job and 93. in fact p value is less then 0.67% of this waste is being burned in places predicted for that. The biggest possible appraisal is 23. the results are: Graph 1: Average appraisal of insure method of infectious and laboratory waste in clinical centers (comparison according to clinical centers) In order to check if there is statistical important difference according to average appraisal between clinical centers in Sarajevo. where specialists for hygiene and epidemiology are taking seriously this issue.26 2. and Tuzla.86 MS 1268.41 p-value 0. without filters and without control of outlet gas emission).91 (maximum appraisal is 23).33% of them have full protective clothes – those who are working with infectious and laboratory material waste. and also to compare those appraisals. since 86.00 Count 15 15 15 Sum 140 46. According to statistical processing of those given appraisals for three clinical centers. It is a great risk for medical staff health. and the lowest is 0.Volume 2 / Number 4 / 2008 In Clinical center in Tuzla 99.5 318 In order to give appraisal in clinical centers in Sarajevo.00 42. Mostar and Tuzla. final treatment of infectious and laboratory waste is huge problem.HealthMED . and Tuzla.20 Variance 67. This research has shown that there is statistical important difference between clinical centers in Sarajevo. and the worst evidenced situation is in Mostar (high average appraisal of methods which are being used in Clinical center in Tuzla. and it is not due to hygiene standards (connected to a boiler room chimney. conclusion is that methods for removing infectious and laboratory waste in clinical centers in the area of Federation of Bosnia and Herzegovina are not insured because 60% of this sort of waste is taking away together with communal. exists of epidemiology-hygiene Sector for supervision. Table 1 Anova: Single Factor SUMMARY Groups KC Sarajevo KC Mostar KC Tuzla ANOVA Source of Variation Between Groups Within Groups Total SS 2536.33 3.

It is a long-term process.17). as well as risk for patients and all people’s health. There is no supervision of air pollution emission what represents risk for medical staff health as well as for patients and all people’s health. obligations and responsibilities for law and physic subjects should be defined. handling.91. High average appraisal for Clinical center in Tuzla can be explained by existing hygiene-epidemiology Sector for supervision. transportation. lack of material and human resources. It is connected to a chimney of existing boiler room. Based on legislative regulations. Open container for keeping infectious 271 Journal of Society for development of teaching and business processes in new net environment in B&H . education about risks connected with infectious waste and taking care of it safely. . and bad control for taking care of. However. Sarajevo and Mostar. methods for taking care of infectious and laboratory waste do not completely satisfy hygiene principles. so people could be protected from danger during collecting. 67% of infectious and laboratory waste is destroying. treatment or final taking care of infectious and other medical material waste (16.HealthMED . Most economic measures for treatment of infectious/medical waste in transitional period are sterilization with high temperatures. It is a method that gives complete sterilized material.System establishing for handling with infectious and other medical waste.Choosing safe environmental solutions. with chemical means. should be obligated to take care of waste on ecology accepted way. In Europe and in the world. it is necessary to make legislative regulative and regulations for exact handling with this sort of waste. even a health institutions – producers of this dangerous waste. and sharp objects are crushing with special crushers. So. This is ecological completely safe and good method for destroying infectious waste material. When we talk about taking care of infectious and laboratory waste in clinical centers. (13. . 33. classifying. Discussion and conclusions Infectious and laboratory waste is the most dangerous and the biggest part of medical waste and it should be treated due to management principles which are part of EU and developed countries of the world. . Clinical center in Sarajevo. and the worst is in Clinical hospital in Mostar. are the most common problems connected with this sort of waste materials. ionization radiation (gamma and UV rays) and nonionizational radiation (new technology – micro and radio waves) which is most acceptable method. Since average appraisal for complete sample is 10.Volume 2 / Number 4 / 2008 in Clinical centers in Tuzla. Institutions for health commit themselves to take care of their infectious waste on ecological accepted way. there are clearly defined regulations for taking away medical waste and according to them there are obligations and responsibilities for law and physical subjects how to treat material waste. because what’s given from the method can be taken away together with communal waste material. it is relative small share (less than 50%). the best evidenced situation is in Clinical center in Tuzla. the best evidenced situation is in Clinical center in Tuzla. The most important is to clearly define responsibilities for correct handling with this waste and it is finally provided: . Incinerator. where 86. which presents risk for medical staff health. 4. and the worst is in Clinical hospital in Mostar.Rising up level of consciousness in public. lack of information about health risks. In that way. Results of this research have shown that three of the biggest clinical centers in Federation Bosnia and Herzegovina. and the maximum appraisal is 23.33% of infectious waste refine in special instruments for sterilization through the microwaves. At the same time.14) Legislative-regulatory frame existing in our region is not in conformity with EU countries which has influence on quality of medical interventions and appearing epidemiology risks (15). 60% of untilled infectious and laboratory waste take it away together with communal waste. Non existing systems for taking care of infectious and laboratory waste. conclusion is that removing methods of infectious and laboratory waste in clinical centers are not insured.Development of system for handling and final taking care of waste which includes defining responsibilities and providing means for using it. where employed doctors – hygiene and epidemiology specialists are seriously do their job. is old-fashioned method and partly satisfy hygiene standards.

Medicinska naklada. Farmaceutski fakultet. Marković. Beograd. S. i sur. Department of Health and Human Services. K.. should be given to organization or company authorized for handling with dangerous waste. Kuala Lumpur: World Health Organization. Final report. Univerzitet u Bihaću. Bašić. Australia 19. 8. E. Š. 1996. Fred Hutchinson Research Center. WHO Regional guidelines for health care waste management in developing countries (draft). because whole emission in the air is water steam and carbon dioxide. Kapić. Gržetić. M.: Životna sredina i o.. impenetrable covered dishes. Office for solid waste. Đukanović. WHO/HIV/ 2004.. Guidance for evaluating Medical Waste treatment Technologies. Š. 6. 1983. br. Literature 1. C. Other possibility for taking away dangerous chemical waste materials includes its return to producer. Portland. Executive Summary. 2006. Osnovi upravljanja čvrstim otpadom. Elit. Upravljanje i minimizacija zdravstvenog otpada. 18. 4. Ilić. Oregon Health and Science University. Victoria 3181. Chou. E. Western Pacific Regional Environmental Centre. I. F:A:. Leder.. 3. 20. ISBN 0 12.. W... Deliveries like this should satisfy international agreements such as Basel convention. Kendić. Zbornik radova. D.. R.: Virologija. 4. 2002. IWM.com 272 Journal of Society for development of teaching and business processes in new net environment in B&H . 9.. Medicinski fakultet. Đarmati. UK. Beograd. 7. because energy produced by combustion of waste is using for heating the apartments..03. Službene novine Federacije Bosne i Hercegovine. Bihać. Department of Epidemiology and Preventive Medicine. 10. 19. M. Mikrobiologija sa parazitologijom – dijagnostika i terapija. Ćatović. Ilić. S. Department of Laboratory Medicine. Sarrubi.. Beograd 14. Univerzitet u Sarajevu. Mikrobiologija – Morfološki aspekti sa dijagnostikom. They are constructed due to ecology principles.. 11. The best solution would be construction of Regional factory – modern incinerator for destroying of this waste which is case in EU. Zagreb.. S. Epidemiologija. Agency for Toxic Substances and Medical Waste: A Report to Congress. Puvačić Z. Seattle.. University of Washington Program in Infectious Diseases.. and to increase number of depos which will satisfy minimum of sanitary conditions. Construction of factory like this is very expensive. Miletić.HealthMED . (18. EPA. 2. Beograd. 5. ISBN 86-82081-11-3 17.A. 1819. 1996. Division of infectious diseases. in Vienna). 198-203. It is necessary to reduce number of disorganized depo-places. Univerzitet u Sarajevu. Sarajevo. A. Fizičko-hemijski osnovi zaštite životne sredine. Institut za ispitivanje materijala. M. Rutala.. Bešlagić. Priručnik o “Sigurnom upravljanju otpadom od aktivnosti zdravstvene zaštite”. 2004. Higijena. 2000. WA 98109. Katedra za mikrobiologiju. Presečki V. and cleaning city waste water before releasing it into a water current (mechanical and chemical treatment). They have great capacity and medical waste from all regions can be processed in them.. treat it chemically or storage it on places for dangerous chemicals. Corresponding author: Aida Vilic-Svraka Institute for public-health Bosnia and Herzegovina e-mail: aidavilicsvraka@yahoo. Sarajevo. F. Miletić. Zvizdić. 1998. 1993. 20). Sarajevo.. D. II knjiga. Infect. 15. Incineration large amount of halogen solvents (which contains chloral or flour) shouldn’t been done if machines don’t have proper equipment for cleaning gases. so we can think about it only in future period.. Zakon o upravljanju otpadom. Veselinović. Management of infectious waste from hospitals. Upravljanje zaštitom životne sredine prema Evropskom zakonodavstvu. XX kongres JUDIMK. 1994. 1998. K. Monash University.01-335/03 16. Those incinerators are placed in centers of big towns (for example. This waste can be exported to countries which have staff and machines for safe treatment of this dangerous waste. Ćatović. Bešlagić. and transportation should be done with intended vehicles. Infectious Diseases Epidemiology Unit.. Control. Those organizations can eliminate waste in rotation furnace.Jerome. E. Any waste material that couldn’t been efficiently burned. 1997. S. OR 97239. (1999). WHO 1990 ISBN 92 4 154525 13. 245-250.Volume 2 / Number 4 / 2008 waste materials must be replaced with solid. novembar. World Health Organization (2004): Policy Brief: Provision of sterile injecting Equipment to reduce HIV transmission.

Posebnu opasnost predstavljaju 273 Journal of Society for development of teaching and business processes in new net environment in B&H . Sam naziv deratizacija dolazi od riječi de-rat što zapravo znači «osloboditi od štakora». Repulsing of harmful rodent species was carried out inside pharmaceutical company in city of Zagreb in area which size is 80. it would be wise to detect which rodent species live in the area that we want to get rid of of the rodents. Sažetak U praksi deratizacijom se nazivaju sve mjere i postupci koji se provode s ciljem suzbijanja odnosno smanjenja populacije štetnih glodavaca (miševi.. The rodents are important pests for humans because they carry out a quite number of contagious diseases. Za deratizaciju su korišteni Brodilion parafinski blokovi od 30. but during summer and winter population estimate is about 100-500 individuals. The most important pests to humans are Rattus norvegicusgray rat.voles. poljski i šumski miševi). they represent a great danger when their population is increasing rapidly in the areas of the factories that produce food and medical supplies for humans.000 individuals during the spring and autumn months. For the hunting of a couple of rodents we used so called “sticky decoys“. Sandra Mramor-Muzevic1. Especially. Also. and brucellosis) and rickettsial and viral diseases (typhus. field mice and wood mice).Volume 2 / Number 4 / 2008 Repulsing of harmful rodents in specific environmental conditions of pharmaceutical factory SUZBIJANJE ŠTETNIH GLODAVACA U SPECIFIČNIM UVJETIMA NA PODRUČJU FARMACEUTSKE TVRTKE Suad Habes1. the term deratization is used to describe all types of measures and actions that are undertaken to repulse populations of harmful rodent species (mice. Sefkija Muzaferovic2 1 2 Fakultet zdravstvenih studija Sarajevo Prirodno-matematicki fakultet Sarajevo Summary In practice. The term deratization comes from word de-rat which means “get rid of rats”. precaution has been taken that a percentage of abundance of each species should be known beforehand. Glodavci predstavljaju velike štetočine i prenosioce zaraznih bolesti. bite and with their ectoparasytes. Before performing every act of deratization. Also. For the implementation of deratization. The act of deratization was prefor- med four times during 2006. 000m2. Rattus rattus-black rat. These species contaminate groceries. The assessment has shown that rodent population is rapidly increasing up to 500-1.HealthMED . feces. plague. encephalitis). 100 and 200g as well as Brodifakum paraffin blocks from 25 to 210g were used. štakori. they are the carriers of many harmful diseases like bacterial diseases (salmonella. mišoliki glodavci – voluharice. mouse like rodents. rats. te Brodifakum parafinski blokovi od 25 i 210g. 100 i 200g. saliva. the rodenticides Brodilion paraffin blocks from 30. and Mus musculus-house mouse. Suzbijanje štetnih glodavaca je vršeno unutar jedne farmaceutske tvrtke u Zagrebu čija je povrsina 80. water and surfaces with their urine. 000m2.

30 million tons of food annually and devour or damage approx. voće i povrće. god. becoming the most prevalent 274 mammal on the planet. the Dubrovnik Senate Council has become the first city in the world to introduce mandatory 40-day quarantine for all travelers and goods in order to prevent the spreading of plague. It is almost impossible to quantify the amount of financial loss caused by rodent infestation. fecesom. dok je tokom zimskih i ljetnih mjeseci populacija glodavaca procjenjena na 100-500 jedinki. Rattus rattus-crni štakor te vrsta Mus musculus-kućni miš. with as many as 2. In 1805. The World Health Organization (WHO) estimates that rodents destroy approx. slinom. salmoneloza) i virusna oboljenja (tifus. There are approx. Rattus norvegicus-sivi štakor. te preko ektoparazita. prenose brojna bakterijska (kuga. 20 dana nakon deratizacije napravljena je procjena infestacije koja je pokazala da glodavci više nisu prisutni unutar kompanije. Oba otrova su probavni otrovi koji se mješaju sa hranom koju glodari rado konzumiraju. šap. This is the first written document concerning the mandatory destruction of rats (3). Svi blokovi su fiksirani žicom da ih kojim slučajem glodavci nebi prenijeli na druga mjesta. Ove vrste onečišćuju namirnice. roughly sufficient for 130 million pe- Journal of Society for development of teaching and business processes in new net environment in B&H . having survived to this day primarily thanks to their phenomenal ability to adapt and their fast breeding capabilities. meso. raw goods and other items used by humans. slinavka). the humans have come to realize that rodents are a serious enemy and have taken more care in their containment (2).000 species of mammals on Earth. dok je tokom proljeća i jeseni na otvorima šahtova stavljana dva Brodilion parafinska bloka ili Brodifakum parafinska bloka. It is also estimated that they cause a 5% damage in consumer goods production. ugrizom. It is estimated that rodents damage 10 times more food than they need and that they consume up to a third of their body volume daily. including Croatia. sir. while causing significant damage and causing a serious health problem since they are a natural carriers of many infectious and parasite diseases of both humans and livestock. The named procedure mainly indicates the eradication of rats and mice that cause significant health and economical damage. Prije svake deratizacije treba prvo pristupiti identifikaciji vrsta glodavaca koji obitavaju na području koje treba biti deratizirano. Introduction Rodents can be found in every corner of the world. 5. Za izlov uzoraka upotrebljavani su tzv. Tokom zime i ljeta na otvorima šahtova i na revizionim otvorima se stavljao po jedan Brodilion parafinski blok ili Brodifakum parafinski blok. 5 billion dollars worth of goods. It is not without reason that rodents are claimed to be the most intelligent and destructive mammals on the planet. (7) At the end of the 19th century. the rodents have evolved and easily adapted to the climatic changes conditions. Najveće štetočine predstavljene su sljedećim vrstama. the most important species are commensal rodents. In 1397. was discovered. when the function of the rats in the spreading of diseases. ljepljivi mamci u koje se uhvatilo nekoliko primjeraka od svake vrste. Takođe. black rat (Rattus rattus) and the household mouse (Mus musculus).000 rodent types (1). dok je na revizionim otvorima stavljan po jedan blok. Deratizacija je vršena u četiri navrata tokom 2006. vodu i površine urinom . damaging or spoiling large quantities of food. bjesnilo. are the gray rat (Rattus norvegicus). riba. Također proveden je i stupanj infestacije kojim je konstatovano da je u proljeće i jesen populacija glodavaca procjenjena na 5001000 jedinki. bruceloza. Posebno velika konzumacija hrane zabilježena je u proljeće i jesen kada nastupa i sezona razmnožavanja. namely the plague. They have followed mankind in its historical development. Economical damage stems from rodents consuming. (8) The most important commensal rodents in the world.Volume 2 / Number 4 / 2008 kada se namnože unutar postrojenja koje prave hranu i lijekove za potrebe čovjeka. For us. Otrovi su mješani sa sljedečom hranom.HealthMED . For the last 50 million years. which live in the vicinity of the humans and feed on human food. Deratizacijom su obuhvaćena 54 slivna šahta i 16 revizionih otvora. the same Council ruled that all ships entering the Gruz port of Dubrovnik must exterminate rats by burning coal. Ovi otrovi su biološki veoma učinkoviti i glodavci ugibaju nakon samo jedne uzete doze (single doze).

secretion from the smell gland (near tail). resulting in shortcuts and fires (4). namely the biological conditions. Rickettsial and viral . The aesthetic aspect of the rodent extermination must also be taken into account. field mice and forest mice) although the root of the word deratization means de-rat. created by mixing 40-45% paraffin (melting point 80ºC) with rat food. typhus. ticks.Leptospirosis. Humidity plays an important part when performing deratization since not all rodenticides can be used in humid conditions. rabies. Protozoal – Toxoplasmosis. and telephone and electric cables are damaged. Chemical measures include the use of pesticides that will cause poisoning or sterilization of the rodents. leishmaniasis. mucus.Trichinellosis. i. gas lines. is based on solid paraffin baits. Parasitic . The above practice includes all methods that result in the reduction of the population of rodents (mice. cacao. physical. They also attack sugarcane. mouse like rodents like voles. which is at the number of units that will ensure the survival of the species while being acceptable to the humans (10). plague. since they cause fear. rodents are one the primary carriers of infectious diseases for both humans and livestock. fruit. namely the po275 Journal of Society for development of teaching and business processes in new net environment in B&H . is not suitable for humid environment due to degradation of said baits. which often carry them to their dens. The deployment of scattered baits. Rodents usually spread diseases in the following manners: . like cellars. and by biting (mucus. To achieve this. rye.HealthMED . mostly chemical measures are used today.mouth disease. rodents destroy 15% of rice growths (food for 12 million people) during the vegetative period. feces. whether it is in the form of grains or pellets. Unfortunately. it is not uncommon to encounter cases of physical attack against children and household pets (3). mosquitoes) Diseases that rodents can transmit can be divided into several categories: Bacterial . Modern methods of extermination in wet conditions. causing infected food to be declared unusable for humans. In European warehouses. teeth) . Concerning health aspects. Throughout a year. where the very presence of rodents may cause economical damage. The choice of the combination. mold often forms on the baits. and root vegetables. coconut. a single gray rat can deposit up to 7 liters of urine (droplets) and 18 kg of feces (turds). It is almost impossible to overemphasize the importance of rodent suppression. Due to their resistance to environment conditions (because of paraffin).2) According to estimates by experts in South East Asia. sewers or brooks. amebiasis. measures of sustained extermination need to be enforced in all spaces occupied by humans. they remain active for a longer period. sesame. These pesticides are known by a collective name of raticides or rodenticides and can be used in different combinations.Foot . The successful extermination requires the use of biological. house infrastructure.Pollution of water sources. tularemia. ‘to be free off rats”.Via ecto-parasites (lice. salmonellosis. making them inadequate for the use. brucellosis.and .Volume 2 / Number 4 / 2008 ople (1. Rodents also damage art works and documents in libraries. the size of the population and location of certain construction (11). In Congo. revulsion and even panic. It is for these reasons that the number of rodents should be reduced. rodents destroy up to 40% of tapioca plants. Additionally. mechanical. Such baits are very attractive to rats. goods and surfaces by urine. the active ingredient is also important. like camps. they damage wheat. Much of the damage is also caused by ‘nibbling for the sake of nibbling’. In humid conditions. In addition to the composition of the bait. and chemical measures followed by the sanitization of the environment. beans. the chance for transmission is very high. Since they are always present in the vicinity of humans. causing the extermination to be treated merely as setting up poisoned traps. e. hotels and similar sites. This way. sewer lines. kept at the biological minimum. Fungal – Dermatomycoses. and potato plantations. which is incorrect. the method and the application of precautionary measures are dependent on the type of the rodent against which they are used. hemorrhagic fever. This is of particular importance for tourism sites. fleas. heating lines. rats. corn. museums and archives. viral encephalitis.

To estimate effectiveness of executed measures Material and Methods The eradication of harmful rodents (deratization) in wet environment conditions has been done within the property area of a pharmaceutical company in Zagreb. the channel-like watercourse. Today. passes through the area and both the pedestrian and traffic bridge span over it. . . second generation anticoagulant rodenticide.If the rodents are regularly seen during the night as well as occasionally on the daytime. the size of rodent population is between 1 and 100. 005%. two brodifakum blocks should be applied.If the rodents can occasionally be seen at the sunset and during the night. b) Brodifakum paraffin blocks contain 0. population size is between 500 and 1. population size is estimated to be between 1. 400 m in length. have about 20 000 m² in size. The size of entire area is 80 000 m² whereas the green and traffic areas. and 200 g) as well as Brodifakum paraffin blocks (25 g and 210 g) were used. 005 % brodifacoum as the active compound which belongs to group II poisons. For the purpose of investigation which included an estimation of the size of rodents’ population occupying the area of a pharmaceutical company in Zagreb. The brodifakum paraffin blocks of 210 g weight connected to the wire are also available and they can be hanged for the use in the drainage system apertures. The length of the system pipe network is about 8 000 m in conjunction with the network of 16 metallic control channels (revision apertures) and 54 drain manholes which are covered with iron bars for collecting precipitations. The embankments on both stream sides are arranged and well maintained.To describe the suppression of rodents in specific conditions in the area of a pharmaceutical company in 2006 .To show results of suppression after deployment of suppression measures .000.Volume 2 / Number 4 / 2008 ison that will kill the rodent. When the rats are targeted for the eradication. For the deratization of external areas Brodilon paraffin blocks (30 g. the rodents will not notice it and will not indigest it. Aims of the Study . The horizontal sewerage system which serves for the drainage of the part of the industrial water as well as precipitations has its drainpipe connected to filtering system. the assessment of the level of infestation of investigated area is based on information obtained by quizzical of the company working Journal of Society for development of teaching and business processes in new net environment in B&H . It must be mixed well into the bait. . Accordingly.HealthMED . the method of Gunderson was used and the following criteria were applied: . Brodifakum paraffin blocks weighing 25 g are suitable for the use in open areas. population size is between 100 and 500. because otherwise. on which an external eradication linked to wet conditions was performed. 100 g. Also. the following chemical compounds were used during eradication procedure: a) Brodilon paraffin blocks contain hydroxy coumarin derivative bromadiolone. Brodilon rodenticide paraffin block is a very efficacious tool for the eradication of gray and black rats and household mice in the communal hygiene and public health setting. In addition.000 and 5. According to the law regulating the poisonous substances (NN 27/1999) and the register of permissible poisons (NN 7/2001) bromadiolone is listed the group III poison at concentration of 0.000. Both 276 the bait block traps and pellets contain bromadiolone.If the rodents are regularly seen both during the night and in broad daylight. one block is applied in the case of mice eradication. Conversely.If the rodents cannot be seen but the damage attributed to their presence is observable. most used rodenticides are anticoagulants (1).

When put properly. and deratization are carried out. a) Deratization within the area of pharmaceutical company Having in mind specific and sensitive nature of the working activities within the pharmaceutical corporation. desinsection. The deratization procedure was done during 2006 and was repeated four times within three month time intervals. Eradication procedure The eradication procedure was performed in the accordance with the Guidelines describing the exact means by which obligatory disinfection. 47 x 0.The drainage network is unlimited source of constant food supply to rodents. include finding rodent feces and other trails. Additionally. Additionally. Accordingly. The assessment of infestation was done prior to and after performing deratization procedure and the efficacy of eradication procedure in wet conditions was evaluated accordingly.The drainage network is simplest but yet the best way for rats to communicate. damages done by their presence and by the discovery of systems of tunnels and active holes which the rodents built on the certain locality. it is particularly important to perform a proper deratization within the structures and spaces of sewerage system due to following reasons: . 25 g Brodifakum paraffin blocks were put in different quantities which were depending on the assessment of the level of infestation. Along these lines. control checking was done and the damaged and consumed lures were replenished. . wire noose has been shown a reliable tool in the fixing paraffin block within a specific control place of the drain system which thus prevents paraffin blocks to be carried away by water stream. 47 m in the diameter which are covered with iron bars for collecting precipitations. one paraffin block equipped with wire noose was placed into each shaft and was fixed to the metal frame of the control channel in a way that the paraffin block was put down to the level of the branching of the drainage network tubes. 65 m x 0.HealthMED . Given that our investigation was focused on performing deratization procedure in wet conditions. Afterward. there are also 54 manhole shafts 0. For deratization of the channel-like watercourse in its entire length (400 m) and the green areas (20. Five days after performing external deratization. 000 m2) Brodilon paraffin blocks of 30 g mass were used. we shall describe those deratization activities which were done on the external green and traffic areas of the pharmaceutical company and its drainage system. For deratization purpose. .Volume 2 / Number 4 / 2008 staff and by our direct observations throughout period of the research conduct in the designated area which. Also. wire noose increasingly prevents rats of taking away and relocating paraffin blocks to more convenient place for them. amongst other. an enormous emphasize is given to proper sanitation of all the factory buildings and structures and their environs. The network of metallic corrective control channels of the sewerage system consists of 16 shafts on designated area.The drainage network and its microclimate offer favorable conditions for rodent growth and reproduction. Previous to setting of any bait within the shafts. it is necessary to carefully check after opening of shaft for the presence of explosive gases such as methane or hydrogen sulfide (H2S) or any other potentially explosive gas by using Dräger’s detector which is equipped with special tubes for detection of explosive gases. covered by plastics. 65m dimension. the lure is hanging in the air above the embankment which serves as a place of rest for the rats and thus presents an ideal place for luring tired rats to stop and have a rest and frequently consume the bait. in each collecting shaft at least one light-green 100 g Brodilon wire noose-equipped paraffin block (5 x 5 x 4 cm) was inserted as described previously. Journal of Society for development of teaching and business processes in new net environment in B&H 277 . deratization was done by using Brodilon 200 g paraffin blocks as well as 210 g Brodifacum paraffin blocks equipped with wire noose which improves the accessibility to certain places. As mentioned before. Each shaft has 0.

400 g 32. we have found that the level of infestation was lower during summer and winter and that population size was between 100 and 500 rodents. 000 g 930 g 13. the deratization was done by placing alternately two Brodilon and one Brodifakum block at 10m distance intervals (2:1 ratio) on designated areas whereas during the summer and winter periods. 730 g 8. whereas 3. re- spectively. 400 g 10. 500 g 800 g 6. 680 g 3. Time of deratization Spring Summer Autumn Winter Total Brodilon paraffin block 100 g 10. 600 g Total 8.880 g of different blocks was consumed in four sessions during 2006. during spring and autumn sessions of deratization total of 8.500 g Brodifakum 25 g blocks. 200 g blocks in the amount of 1. 400 g Brodifakum paraffin block 210 g 3.400g. 460 g 278 Journal of Society for development of teaching and business processes in new net environment in B&H . 600 g 1. 000 m2 big green surface area and streams (canals) at their entire 400 m length. presents a summary data for the paraffin blocks consumption during the execution of four acts of deratization of the sewerage system (drain manholes and revision apertures) performed in 2006.600g. The consumption of paraffin blocks has increased during spring and autumn due to increase in rodent population. Table 1.500 g of paraffin blocks was consumed in each period and included the consumption of 6. 880 g Table 2.Volume 2 / Number 4 / 2008 Results and Discussion First step in our approach was to determine the level of infestation of investigated area by using the method of Gunderson. 500 g 1. 760 g 8.360 g of Brodifakum 210 g blocks were consumed concomitantly. By using the method criteria. 680 g 48. 600 g 1. Consumption of the 100 g and 200 g Brodilon and Brodifakum paraffin 210 g blocks used for deratization of the sewerage system (drain manholes and revision apertures). when infestation was higher. 680 g 15. Table 1.HealthMED . an increased amount of paraffin blocks of different weight (100 g. 800 g 5. Since the level of infestation was lower during summer and winter sessions. 360 g 1. 760 g 8.000 g Brodilon 30 g blocks and 2.680 g of different blocks were consumed during summer and winter actions. On the other hand. As expected. overall consumption of paraffin blocks was in accordance with the level of infestation. Table 2. 000 g 930 g 6.000 during spring and autumn. the baits were put at 20 m intervals and at 1:1 ratio. 200 g. respectively.600 g of Brodilon 200 g and 3. 48. during spring and autumn periods. Time of deratization Spring Summer Autumn Winter Total Brodilon paraffin block 30 g 6. 400 g Brodilon paraffin block 200 g 1. 080 g Total 15. 8. 360 g 1. Consequently. 600 g 6. 860 g Brodifakum Paraffin block 25 g 2. and 210 g) was applied. 730 g 20. Conversely. 360 g Brodifakum 210 g blocks were used. Overall. 600 g 1. respectively. when infestation decreased.800 g of Brodilon 100 g blocks as well as 1. It can be seen from the table that the consumption of a paraffin blocks stand at 15. 500 g 1. 500 g 800 g 2. Consumption of the Brodilion 30 g and Brodifakum 25 g paraffin blocks used for deratization of outdoor green surface areas and streams (canals). Brodilon 100 g blocks were consumed in the amount of 5. 680 g 10. An overall paraffin blocks consumption during summer and winter period was 1. Accordingly. 800 g 5. we have found that the population size was between 500 and 1. illustrates a summary data for the Brodilon paraffin 30 g and Brodifakum 25 g blocks respective consumptions during the execution of four acts of deratization in 2006 which was performed on the outdoor 20. one Brodilon and Brodifakum paraffin block each were used in that period.730 g of blocks in each period and included consuming 930 g Brodilon and 800 g Brodifakum paraffin blocks.760 during spring as well as autumn actions and that 10.

Time of deratization Spring Summer Autumn Winter Total Brodilon paraffin block 30 g 990 g 300 g 1.490 g) of paraffin blocks was consumed after spring session of deratization. 860 g 2. The biggest quantity of paraffin blocks was consumed after autumn session (1. Table 3.Volume 2 / Number 4 / 2008 Overall. 880 g 20.600g whereas Brodifakum paraffin blocks were used at 18. 950 g 750 g 4. 080 g 6. 480 g Total 48. 940 g 55. It has previously been stated that rodenticides are digestive poisons and thus they should be ingested to get in touch with rodent organism. 490 g 550 g 1.HealthMED . In addition. 600 g 1. the protective gloves were used during the placing of baits which prevented the possibility that human sweat could come in contact with the baits and repulse rats of taking it. 940 g Brodifakum paraffin block 25 g 500 g 250 g 750 g 300 g 1. the baits were placed into the rodent active holes and hidden places and rodent paths. 740 g Table 4. 800 g 13.950 g) whereas somewhat lesser amount (1. Since the poison active compound is not attracting Table 3. The use of Brodilon paraffin blocks amounted to 55. The review of total consumption of Brodiion and Braodifakum paraffin blocks utilized for deratization of sewerage system and outdoor surface in pharmaceutical factory area during 2006. Overall.740 g of paraffin blocks were consumed during four sessions of external deratization in 2006. reviews total consumption of Brodilon and Brodifakum paraffin blocks that were spent on deratization of the sewerage system and outdoor surface areas of pharmaceutical factory area during four sessions of deratization in 2006. Additionally. we would like to emphasize that we have created ‘eradication map’ before performing act of deratization. Also. 740 g 74. 600 g Brodifakum Paraffin blocks 10. The map was showing all the places at which the baits were to be located. 20. summarizes the consumption of Brodilon and Brodifakum paraffin blocks during time of the inspection and the replenishment of decoys which was done five days after deratization of external areas. It was reasonable to expect the difference between data having in mind higher level of infestation during spring and autumn periods. Thus. The consumption of the blocks during summer and winter acts of deratization was similar and averaged 650 g of consumed blocks in each of two periods. Table 4.480 g quantity. 800 g Total 1. total yearly consumption of both Brodilon and Brodifakum baits used for the deratization in wet conditions was 74. This finding testifies that both types of decoys were equally attractive and well prepared. 200 g 450 g 2.460 g of different paraffin blocks was consumed in four sessions of deratization of green area and water stream systems during 2006. 080 g Journal of Society for development of teaching and business processes in new net environment in B&H 279 .080 g. Location Sewerage system Outdoor green areas Decoy supplement Total Brodilon paraffin blocks 38. were afterward carefully masked and covered by the layers of earth to prevent any accidental exposure of humans and animals to these poisonous traps. we have verified throughout inspection and decoy replenishment that 4. 800 g 18. carried out five days after deratization of the outdoor surface area. Also. 460 g 4. Consumption of the Brodilon 30 g and Brodifakum 25 g paraffin blocks during the inspection and supplementation of the decoys. we have observed that the rodents did not discriminate between Brodilon and Brodifakum blocks and they consumed both types of baits equally well.

Antikoagulants first generation Kumatetralil Difacinon Warfarin Pival Klorfacinon LD50 mg/kg brown rat 16. LD50 values of anticoagulant rodenticides of the first and second generation for the brown rat. On the other hand. it should be mixed with a kind of food which rodents prefer. cheese. 5 Antikoagulants second generation Brodifakum Flokumafen Bromadiolon Difenakum LD50 mg/kg brown rat 0. Today. 3 0. Also. fruits and vegetables. cooking oil is added to ensure better mixing of the poison and food compound. are seldom used. Total consumption of all types of Brodilon and Brodifakum paraffin blocks used for deratization of the sewerage system and outdoor surface area in pharmaceutical company during 2006. In addition. fish. However. as well as different types of grains. etc. irrespective of its way of manufacturing. it is generally recognized that rodenticides of choice for the eradication of rodents in wet conditions are solid forms of the second generation anticoagulants whose active compound is based on bromadiolon and brodifakum. should be of highest quality because overdosing it may deter rodents of taking it whilst the sub dosing of the poison may result in the development of resistance to the poison. smoked meat. Graph 1. The main characteristic of the second generation of anticoagulants is that they are highly efficacious at single dose. Mamak. solid paraffin decoys are only forms of decoys which are stable in wet conditions. 0 58. sugar. cheese. 0 20. In order to attract rodents the decoys also contain a moderate amount of different smelly and tasty attractants such as anis. In addition. liquid rodenticides. mamak’s organoleptic features should be well manufactured to attract rodents. Table 5. illustrates the overall consumption of all types of Brodilon and Brodifakum paraffin block rodenticides that were used for deratization of sewerage system and outdoor surface in pharmaceutical company area during 2006. which dissolve in water. decoy powdered forms are used to cover active holes and rodent communication paths. 5 3. fresh decoys should be prepared just prior to use to prevent spoil of the ingredients. 3 1. On the other hand. Such mixture of the poison and attractive food is called ‘mamak’. They use different types of attractive food stuff such as meat.Volume 2 / Number 4 / 2008 rodents. Graph 1. salt.HealthMED . 6 280 Journal of Society for development of teaching and business processes in new net environment in B&H . there are different decoy nourishment preparations present on the market called the carriers. first generation of the anticoagulant rodenticieds is efficacious only after five to six days of constant consumption by rodent. presented are the LD50 values for the first and second generation of anticoagulant rodenticides obtained on brown rat. On the other hand. In Table 5. Currently. 4 1. 0 50.

Poljak V. particularly the determining the most efficacious formulation and suitable form of decoys which will be used. . Zagreb: Zavod za javno zdravstvo grada Zagreba. The degree of infestation was assessed by using method of Gunderson. Efficacious eradication of rodents is based on the comprehension of their biological. Zbornik predavanja. . it has been concluded that population size has been reduced bellow 100 rodents. 5. Krajcar D. full amount of spent paraffin blocks which were chosen for deratization in wet conditions in 2006 was 74. Zagreb. Poreč.080 g. 2004: 11-23 8. Based on overall data. dezinsekcije. : Javnozdravstvena važnost deratizacije. deratizacije i zaštite uskladištenih poljoprivrednih proizvoda. Generally. dezinsekcije. 2005 : 3 3. Zidar R. DDD i ZUPP 2001. etiological. Poreč. Korunić Z. dezinsekcija i deratizacija u HACCP sustavu. 2. 2001: 216 Journal of Society for development of teaching and business processes in new net environment in B&H 281 . : Analiza rizičnih kontrolnih mjesta za sprovođenje djelotvorne deratizacije (HACCP). 2002: 43 7. Glodavci i ptice. : HACCP-teorija i praksa s posebnim osvrtom na kontrolu štetočina. 2001:226 9. the manufactured paraffin blocks of different weight and dimensions containing anticoagulants of the second generations (Brodilon and Brodifakum). 4.480 g Brodifakum was spend.Volume 2 / Number 4 / 2008 Conclusions 1. 2002: 1 2. 6. DDD i ZUPP 2001. Molek K. uskladištenih poljoprivrednih proizvoda i predmeta opće uporabe te muzejski štetnici. Zbornik predavanja. Capak K. Štetnici hrane. Milinković Lj. specifically the deratizations of the open green areas and sewerage system of the pharmaceutical factory. : Dezinfekcija. 8. Bakić J. : Praktična provedba deratizacije. 167-198 4.600 g Brodilon paraffin blocks as well as 18. Dezinfekcija. it has been concluded that the measures which have been undertaken during 2006 were successful and that the choice of paraffin decoys was appropriate for the act of deratization in wet conditions in the open green areas and sewerage system of the pharmaceutical factory in Zagreb. and ecological distinctiveness. Zbornik predavanja. were used. Novine u djelatnosti dezinfekcije.000 during spring and autumn whereas population size was estimated to be between 100 and 500 during the summer and winter time. dezinsekcija. dezinsekcije i deratizacije (NN 38/98) 6. The act of deratization is a complex and responsible action requesting methodical preparatory and organizational activities and requests skilled staff to execute it properly. Glodavci i ptice. 2002: 1 5. Literature 1. During four sessions of deratization in 2006 the amount of 55. Pravilnik o načinu obavljanja obvezatne dezinfekcije. : Suzbijanje glodavaca. 7. The level of infestation and the size of rodent population in designated area was calculated to be between 500 and 1. Zbornik predavanja. Glodavci i ptice. deratizacije i zaštite uskladištenih poljoprivrednih proizvoda. 2001. Novine u djelatnosti dezinfekcije. Capak K.HealthMED . 3. Krajcar D. : Naši sinantropni mišoliki glodavci. deratizacija. : Javnozdravstvena i gospodarska važnost štetnika uskladištenih poljoprivrednih proizvoda i hrane. For the purpose of the eradication of rodents in wet environments. Zagreb. Three weeks after performing of deratization additional evaluation of the level of infestation was done. Deratization in wet conditions is a unique activity which asks for additional organizational efforts. Zagreb. Zagreb. Zagreb. Zbornik predavanja.

2004: 380 11. : Način provedbe obvezatne dezinsekcije i deratizacije. . : Preventivna sustavna deratizacija kanalizacijske mreže-nova saznanja . Zbornik predavanja.32 12. Pouzdan put do zdravlja životinja. Mali Lošinj. Oživotvorenje Pravilnika o uvjetima i načinu provođenja obvezatnih DDD mjera-provedba u praksi. : Prednosti krutih raticidnih meka s djelatnim sastavcima I i II generacije antikoagulanata u sustavnoj deratizaciji razorenih naselja. Bakić J. J. 5. znanstveno stručni skup iz DDD-a s međunarodnim sudjelovanjem. 1995: 267-273 Corresponding author: Suad Habes Fakultet zdravstvenih studija Sarajevo Bosna i Hercegovina e-mail: hsuad@hotmail.HealthMED . Veledar H. Zbornik 2.com 282 Journal of Society for development of teaching and business processes in new net environment in B&H .Volume 2 / Number 4 / 2008 10. Umag. znanstveno stručnog skupa s međunarodnim sudjelovanjem DDD u zaštiti zdravlja životnja i očuvanju okoliša. 2006: 31. ljudi i njihova okoliša. Bakić. Lukić I. Zagreb.

University of Sarajevo. Studija je obuhvatila 80 pacijenata sa okluzijom najmanje jedne veće koronarne arterije. School of Medicine. U prvoj grupi smo ustanovili postojanje vijabilnog miokarda u perfuzionom području infarktom zahvaćene arterije. dok je druga grupa (n =35) obuhvatila pacijente sa neadekvatnom kolateralnom cirkulacijom. Ključne riječi: miokardna vijabilnost.patients with well-developed coronary collaterals to the infarct-related coronary artery. coronary occlusion Sažetak Studija evaluira odnos postojeće vijabilnosti miokarda i razvoja kolateralne cirkulacije u infarciranom području kod pacijenata sa totalnom koronarnom okluzijom. In the first group we established the presence of viabile myocardium in the perfusion territory of the infarct-related artery. Bosnia and Herzegovina Summary The present study evaluated the relationship between the presence of viable myocardium and the develompment of collateral circulation to the infarct area in patients with total coronary occlusion. The perfusion defects in the group with good collateras were predominantly reversible.HealthMED . što ukazuje da koronarne kolaterale štite mikardnu vijabilnost u području sa totalnom koronarnom okluzijom. Perfuzioni defekti u grupi sa dobrom kolateralnom cirkulacijom su bili pretežno reverzibilni. Pacijenti su kategorizirani u dvije grupe na osnovu veličine kolateralne cirkulacije: grupu 1 (n=45) su činili pacijenti sa dobro razvijenom kolateralnom cirkulacijom.Volume 2 / Number 4 / 2008 The relationship between myocardial viability and collateral circulation ODNOS VIJABILNOSTI MIOKARDA I KOLATERALNE CIRKULACIJE Aida Hasanovic Institute of Anatomy. Ovi rezultati ukazuju da dobro razvijena kolateralna cirkulacija može dovesti do smanjenja infarciranog područja i da predviđa postojanje vijabilnog miokarda. A significant correlation between good collaterals with complete protection and poor collaterals with no protection was noted. These results suggest that the existance of welldeveloped coronary collaterals may contribute to minimizing the infarct area and to prediction of the presence of viable myocardium. collateral circulation.patients with poor coronary collateral development or without significant collateral circulation. The study group consisted of 80 patients with occlusion of at least one major coronary artery. group 2 (n =35) . Key words: myocardial viability. koronarna okluzija Journal of Society for development of teaching and business processes in new net environment in B&H 283 . suggesting that coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. kolateralna cirkulacija. The patients were categorized in two groups depending on the extent of their collateral circulation: group 1 (n =45) . Uočena je signifikantna korelacija između dobrih kolaterala i kompletne zaštite i loših kolaterala bez zaštite miokardne vijabilnosti.

and circumflex artery –Cx) and the existence. All patients selected for myocardial imaging had severe stenosis or total occlusion of at least one major coronary artery. Angiography is used for measuring coronary artery lumen norrowing. The most widely available method for identification of viable myocardium is single photon emission computed tomographic (SPECT) imaging with thallium-201 (Tl-201). is unable to retain Tl-201. Using 201Tl imaging. 3. 4). shortly after coronary artery disease had been demonstrated by contrast arteriography. 2. and note was made of the site and number of complete coronary occlusions and severe coronary stenoses together with any associated coronary collateral channels. Patients with hypertension. Regions of ischemia caused by severe coronary disease appear as functional defects of tracer accumulation in the myocardial scintigram (9. a tendency toward equilibrium of Tl-201 concentration in viable myocardium. Myocardial imaging using thallium-201 (201Tl) is a non–invasive technique which is valuable in the analysis of regional myocardial perfusion. Tl-201 is continuously exchanged between the myocardium and the blood stream. Coronary Angiography Selective coronary angiography was performed in multiple projection using the Judkins technique. Therefore. origin and the direction of collateras. Patients and methods Eighty patients with angiographically documented coronary artery disease at the Department of Nuclear Medicine were investigated by (201Tl) myocardial scintigraphy. Although coronary arteriography provides clear definition of significant coronary artery disease it is less satisfactory in the delineation of coronary collateral vessels for it reveals only epicardial anastomoses of a size no smaller than 100-200 ų and not the deeper connections which exist within the myocardium (5. with the rate of exchange in proportion to the difference in Tl-201 concentration between the myocardium and the blood stream.6.0 mm) and “inadequate” (average calibar -1mm and less). The majority of patients had complete occlusion of at least one vessel. the myocardium concentration is greatest in those areas of myocardium with the highest blood flow. All coronary arteriograms were reviewed independently by two observes in ignorance of the scintigraphic analysis. For all patients we applied left ventriculography for the evaluation of its function. without an intact cell membrane.7).Volume 2 / Number 4 / 2008 Introduction The relationship between the presence of viable myocardium and the extent of coronary collateral circulation to the infarct area during occlusion of coronary arteries was evaluated by authors (1. Over time. left anterior descending artery-LAD. however. we have analysed the influence of well-developed coronary collateral cir284 culation angiographically documented on myocardial viability in patients with coronary occlusion. extraction and clearance.HealthMED . In viable myocardium. which means that regional myocardial concentration of Tl-201 is dependent on regional blood flow. a Tl-201 perfusion defect that is reversible is considered indicative of ischemic but viable myocardium (11). Necrotic myocardium. This phenomenon is termed „redistribution“. after the administration of Tl-201. or primary myocardial disease were excluded from this study.10). A significant coronary stenosis was defined as reduction of the coronary lumen by more than 50 per cent. On the angiograms we analyzed collaterals as “adequate” (average calibar greater than 1. valvular heart disease. ejective fra- Journal of Society for development of teaching and business processes in new net environment in B&H . The study was approved by the local ethical commitee and conducted in accordance with the Helsinki declaration. We determinated a maximal lumen constriction of the coronary artery (right coronary artery-RCA. it is not the ideal method for determining its physiologic significance (8). Thallium 201 enters myocytes primarily by active transport. and severe stenosis as a reduction in diametar greater than 80 per cent. Therefore.

left anterior oblique 45º and 70º were routinely acquired in every patients (each position-five minuts) after exercise and redistribution after 3 hours. the differences between the groups were significant (P<0. In the group with poor collaterals in the vast majority cases demonstrated akinesia or dyskinesia of the corresponding myocardial segment. Thallium-201 Myocardial Scintigraphy Studies of regional myocardial perfusion were performed at rest and during pressure (a maximal exercise test on a bicycle ergometer).Volume 2 / Number 4 / 2008 ction and kinetics. During the exercise test each patients received 1. In the group with poor coronary collateral development the perfusion defects were predominantly ireversible. Our patients with chronic total occlusion had severe and extensive stress-induced myocardial perfusion defects regardless of the grade of angiographic coronary collaterals. Left ventriculography was performed in the right anterior oblique projectin. The exercise end-point was maintained for one and a half to two minutes so that there was maximal myocardial uptake of circulating tracer in the presence of symptoms. Anterior. and an electrocardiogram recorded during a maximal exercise test on a Monark bicycle ergometer with lead V5 monitoring. resting 12 lead electrocardiogram. suggesting that well-developed coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion.001). All patients had a complite physical examination. Using Chi-square test.001 level. An ejection fraction in the group with well-developed coronary collateral vessels and good left ventricular function was > 50%. Defects located in the anterior wall and septal region were allocated to the left anterior descending artery.HealthMED . n =35) of viable myocardium in the perfusion territory of the infarct-related artery. The result was considered “positive“ when a reversible defect was allocated to the perfusion territory of the coronary artery of interest. Localisation of perfusion defects in relation with corresponding blood vessel determinated visual on each image divided into five segments. defects in the lateral wall were allocated to the left circumflex coronary artery. A 20 % symmetric energy window centered on the 72 keV peak was used. The viability of myocardial tissue was assessed by exercise thallium-201 myocardial scintigraphy. Journal of Society for development of teaching and business processes in new net environment in B&H 285 . Statistical comparison of data was perfomed using the Chi-square test. and defects in the inferior wall were allocated to the right coronary artery. After a 10–minute recovery period. In the first group we established well-development coronary collateral vessels and predominantly normal or hypokinetic left ventricular function.5 mCi of 201Tl through an indwelling intravenous canila at the onset of angina pectoris or limiting dispnoea. The difference between the two groups was significant at the 0. in the group with inadequate collateral circulation was 35%. n =45) or absence (group 2. The digital images were displayed on a TV monitoring. The perfusion defects in the group with good collateras were predominantly reversible (Figure 1). myocardial imagining was performed with subjects in the supine positions using a gamma camera and a highsensitivity parallel-holed collimator. Results The study included 80 patients with chronic total occlusion who underwent rest-stress myocardial perfusion scintigraphy and coronary angiography. All projections images were stored on magneto-optic disks in a 64x64 matrix. After computer treatment a digital scintigraphic images were described by one interpreter. Patients were divided into two groups according to the presence (group 1. Each defect was further classified as moderate or severe according to the degree of tracer deficit seen in that region.

10). In contrast. Our study showed that the perfusion defects in the group with good collateras were predominantly reversible.3. Similary. Thus. Analysis of perfusion scintigrams in patients with angiographically documented collaterals reference to reversible defect of infero-lateral segment. several studies with planar 201 scintigraphy suggested that coronary collaterals also prevent stressinduced ischemia (1. poor or absent coronary collateral development was usually associated with severe deficit of tracer in corresponding regions of the scintigram.5). it is possible that even Journal of Society for development of teaching and business processes in new net environment in B&H . In this group the absence of viable myocardium in the perfusion territory of the infarct-related artery was established.11). In the group with poor coronary collateral development the perfusion defects were predominantly ireversible.2. Similary. particulary during diastole in an ischaemic left ventricle. however. Angiographically invisible collaterals were never associated with complete scintigraphic protection and usually conferred no protective benefit. suggesting that well-developed coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. Bridging collaterals also offered inadequate protection from myocadial ischemia during exercise.HealthMED . The relation between the degree of coronary collateral development assessed angiographicaly and the severity of 201 Tl uptake defects seen in the myocardial scintigram in our patients showed a association between well-developed coronary collateral vessels and accompanying preservation of myocardial 201 Tl uptake. Patients with left anterior descending disease. and ischemia of this region The relation between the degree of coronary collateral development assessed angiographicaly and the severity of 201 Tl uptake defects seen in the myocardial scintigram showed a highly significant association between well-developed coronary collateral vessels and accompanying preservation of myocardial 201 Tl uptake. Although the mechanism for this protection is not clear the normal pressure gradient that exists between left and right ventricles may be increased during dynamic exercise. However. Using 201Tl myocardial scintigraphy many patients with total occlusive disease of a dominant right coronary artery are seen to have adequate collateral vessels providing complete protection from ischemia in the distribution of this artery during dynamic exercise.7). Single-photon emission tomography of the heart with 201tallium was performed according to standard stress (planar projection -45 º). 8. This effect probably accounts for the preservation of tracer uptake in the inferior wall of the left ventricle as seen in 201Tl scintigrams (9. were not protected from the appearance of ischaemic uptake defects (4. so that collateral flow is maintained or increased in the direction of the low pressure right ventricular myocardium.Volume 2 / Number 4 / 2008 Figure 1. vessel ghosting was always accompanied by severe scintigraphic uptake defects. Patients with chronic total occlusion had severe and extensive stress-induced myocar286 dial perfusion defects regardless of the grade of angiographic coronary collaterals. Discussion In patients with a chronic total occlusion. Several studies have suggested that coronary collaterals preserve resting myocardial flow but are inadequate to protect againist reduced blood flow during hyperemic stress (6. our study investigated the relationship between the angiographic development of collateral circulation and myocardial viability in patients with coronary occlusion. one relevant limitation of 201TI imaging is that relative regional myocardial ischaemia is reflected in the scintigram rather than in terms of absolute perfusion.

Werner GS.Medic. Sand NP. 2007. Ohno A. Hoshiga M. Kojima S. Odavić M. Hayes SW. Žurn. Ferrari M. Fukai M. Tajfl D. Circulation. 3(1): 89-93.122(2):409-14. Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion. Influence of angiographic collateral circulation on myocardial perfusion in patients with chronic total occlusion of a single coronary artery and no prior myocardial infarction. Makkar R. Reversible perfusion defects on stress thallium imaging in the group with adequate collateral circulation suggesting that welldeveloped coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. 2. Sciammarella M.35:624-632. Hasanović A. Kamenica S. Literature 1. Miwa K. Šišić F. and the existence of well-developed collateral channels predicts the presence of viable myocardium in the infarct area. Ishihara T. 3. 3. University of Sarajevo. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction: a regional metabolic study. 8 (1):12-17. Fazlibegović E. Figulla HR. Kawakatsu M. 8. Radionuclide techniques for the assessment of myocardial viability. 2006. 5. HealthMED.45(6):950-5. The clear correlation between the angiographic grade of collaterals and corresponding areas of protection seen in the scintigram gives the angiographer reasonable reassurance that there is functional relevance in a detail description of these important channels. Bagger JP. Hasanović A. 7. Nakakoji T. Yokota N. Negoro N. 2004. Am Heart J. E Skoufis. Collateral circulation as a marker of the presence of viable myocardium in patients with recent myocardial infarction. Nariyama J. J Nucl Med. Yamanishi K. Abidov A. Maisey MN. Kulenović A. Sasayama S. Li M. Jurić I.2001.6(4):29-31.104:2784-90. 25 (4): 272-279. Functional significance of collateral circulation during dynamic exercise evaluated by thallium-201 myocardial scintigraphy. 11.com Journal of Society for development of teaching and business processes in new net environment in B&H 287 . Edwards AC. AI McGhie. These findings indicate that the presence of ischemic but viable myocardium is intimately related to the development of collateral circulation in patients with myocardial infarction.Br Heart J 1980:47-55. Fujita M. Gastmann O. 1991. Functional significance of recruitable collaterals during temporary coronary occlusion evaluated by 99mTc-sestamibi single-photon emission computerized tomography. Vojnosanit Pregled. Conclusions 1. Kar S. Bosnia and Herzegovina. Spaić R. 4. School of Medicine. 2000. Hasanović A. 1987 44 (2): 128-131. J Am Coll Cardiol. Tex Heart Inst J. Friedman JD et all. Nielsen TT. Corresponding author: Aida Hasanovic Institute of Anatomy. Aboul-Enein F. Nozawa T. email: ahasanovic69@yahoo.J Cardiol. 6.2000. Wada O. Perfuziona scintigrafija miokarda i ehokardiografija kod pacijenata sa koronarnim kolateralama. Angiogenesis of ischemic myocardium. Wainwright RJ. though better perfused than the left coronary artery. Ohkubo T. Sowton E. 2002. Uticaj kolateralnog srčanog krvotoka na rezultate scintigrafije srčanog mišića u bolesnika sa ishemijskom bolešću srca.Volume 2 / Number 4 / 2008 the right coronary artery territory is ischemic during exercise. Bosn J Basic Med Sci. Thuesen L.35(2):103-11. Richartz BM. 1998. 2. Nakajima O. Milošević A. 9.HealthMED . 10. Rehling M. Betge S. Flo C. The role of collateral circulation in preserving myocardial function.

Police officers are exposed on daily basis to stressful and traumatic events.HealthMED .The subjects who had completed the program were significantly more likely than the subjects from control group to request medical advice in crisis situations. Once the reaction to traumatic experience. anxiety. that is. behavior changes. . One group received structured stress management program and another did not. All members of both groups completed BAI and ASI tests ahead and after the treatment. Another objective was to evaluate the effects of structured stress management program on police officers by measuring their anxiety levels before and after the treatment. serious threat to one’s life and body integrity. Materials and methods: The subjects were police officers.The group of police officers who had received the structured stress management program registered statistically significant anxiety sensitivity reduction compared to the test group. the events outside usual human experience (e. Consequences and symptoms of stress include physical and psychosomatic illnesses. emotional and cognitive problems. divided 288 into two groups. as well as three months after the treatment. Conclusions: . Outcomes: Statistical data analyzes revealed that the subjects who had received stress management program displayed a statistically significant anxiety sensitivity reduction.Volume 2 / Number 4 / 2008 Application of cognitive behavior therapeutic techniques for prevention of psychological disorders in police officers PRIMJENA KOGNITIVNO-BIHEVIORALNIH PSIHOTERAPIJSKIH TEHNIKA U PREVENCIJI PSIHIČKIH POREMEĆAJA KOD POLICAJACA Sibila Sijaric-Voloder1. The subjects were also significantly more likely to request medical advice after completing psychotherapeutic program. Key words: cognitive-behavior psychotherapy.g. help and consulting ‘’DOMINO’’ Summary Introduction: Police work has been recognized as high risk for stress. stress management. judged by its intensity and duration. developed more active and planned coping strategies for stressful situations. had less somatic reactions to stress and have thus also achieved improved performance at work and in private life. Objectives: Objective of our work was to develop a structured stress management program based on cognitive behavior therapy principles for persons in high risk professions such as police officers. aged from 30 to 45 years. each consisting of 20 persons. exceeds one’s “subjective coping threshold” we talk about pathologic reaction to trauma which can cause various psychological disorders. witnessing violent acts or severe physical harm or death of another). Journal of Society for development of teaching and business processes in new net environment in B&H . Dzejna Capin1 1 Association for psychological assessment.

po obimu i trajanju govorimo o tzv. Jacobi (1) studied health-related workers’ compensation claims to discover that police officers were seven times more likely than other professionals to submit such claims.). ozbiljna prijetnja životu ili tjelesnom integritetu. alcohol.Spremnost da se obrate za stručnu pomoć u kriznim situacijama je kod ispitanika značajno porasla dok kod kontrolne grupe nije došlo do promjena. Richard and Fell (2) conducted a research on the sample of 23 976 workers from Tennessee including 168 police officers. odnosno nasilnom činu te prisustvo takvim događajima). Nakon završenog psihoterapijskog programa njihova spremnost da se obrate za stručnu pomoć se izrazito povečala. the events outside usual human experience (e. asthma. They discovered that police officers experienced many more health problems than other professionals.Volume 2 / Number 4 / 2008 Sažetak Uvod: Posao policajca spada u grupu visokorizičnih zanimanja po pitanju stresa. nakon završenog tretmana i tri mjeseca nakon toga. Svi su tri puta popunili BAI i IOA. smanjenja somatizacijskih reakcija a samim tim i do poboljšanja njihovog funkcionisanja u radnoj i privatnoj sredini. rage. guilt. .HealthMED . inability to concentrate. sadness) and cognitive problems (memory problems. short temper). Introduction Police work has been recognized as high risk for stress. restlessness. Blackmore (1) has ranked police work among the top 17 occupations (out of 130) related to increased risk of health problems. Rezultati rada: Statistička obrada podataka je pokazala da je kod grupe koja je prošla strukturirani stres menađment došlo do statistički značajnog sniženja anksiozne osjetljivosti. trouble thinking clearly. irritability. As a result of his research. Ključne riječi: kognitivno-bihevioralna psihoterapija. Materijal i metode: Ispitanici su policajci. promjene u ponašanju. excessive tobacco smoking. starosne dobi od 30-45 godina života podjeljeni u dvije grupe od po 20 članova. patološkom obliku reakcije na traumu koje može biti uzrok razvoja različitih psihijatrijskih poremećaja. emocionalne posljedice te kognitivne smetnje. povečanja načina za aktivno i plansko suočavanje sa stresnim situacijama. anksioznost. serious threat to one’s life and body integrity. Svakodnevna je izloženost policajaca stresnim i traumatskim događajima. dermatologic diseases. Kada reakcije na traumatsko iskustvo pređu određenu mjeru po „subjektivnoj nepodnošljivosti“. exceeds one’s “subjective coping threshold” we talk about pathologic reaction to trauma which can cause various psychological disorders. particularly digestive and blood circulation problems. digestive problems. Consequences and symptoms of stress include physical and psychosomatic illnesses (hart and coronary artery diseases. that is. indecisiveness. judged by its intensity and duration.Grupa policajaca koji su bili uključeni u strukturirani stres menađment je imala statistički značajno smanjenje anksiozne osjetljivosti u odnosu na kontrolnu grupu. behavior changes (abuse of alcohol and some medicines – anxiolitics or social withdrawal. na početku tretmana. food. as well as that 30% of police officers’ claims were related to back pain and another 50% to hypertension. fearful anticipation…). increased consumption of coffee. Zaključci: . mood swings. Once the reaction to traumatic experience. stres menađment. Cilj rada: Cilj rada je bio strukturirati stres menadžment po principima kognitivno-bihevioralne psihoterapije za lica koja obavljaju visoko rizične poslove kao što su policajci. emotional problems (anxiety. 289 Journal of Society for development of teaching and business processes in new net environment in B&H . cilj rada je bio evaluirati efekte strukturiranog stres menađmenta za pripadnike policijskih snaga utvrđivanjem stepena anksioznosti prije i nakon tretmana. changing opinions. witnessing violent acts or severe physical harm or death of another). pogled na drugu osobu koja je ozbiljno povrijeđena ili ubijena u nesreći. odnosno događajima koji su izvan granica uobičajenog ljudskog iskustva (npr. Također. Posljedice ili simptomi stresa su tjelesni-psihosomatske bolesti. spinal problems etc. sleeping disorders.g. Police officers are exposed on daily basis to stressful and traumatic events. Jedna grupa je prošle strukturirani stres menađment dok druga nije.

because they both include different distinct strategies. Another objective of our work was to evaluate the effects of structured stress management program on police officers by measuring their anxiety levels before and after the treatment. reappraisal. aged from 30 to 45 years. two groups of 10 people were formed. while emotion-based coping styles include denial. However. (4). It cannot be valued as good or bad because it is defined as investing efforts into overcoming specific obstacles. active confrontation. in that. imaginary thinking. most police officers request medical assistance at the point when stress at work had already caused long-term consequences on their health and professional efficiency. Such effects of modern lifestyle are further intensified in transitional. direct action. the above can also jeopardize their professional safety. normal and pathological reaction to stress and traumatic experience. problem solving. There is also the difference between cognitive and behavioral coping strategies. such a broad definition of coping styles was proven to be imprecise. Despite numerous positive consequences of the modern lifestyle. (10) conclude that stress management programs have positive effects. The Journal of Society for development of teaching and business processes in new net environment in B&H . b) Control group Control group consisted of 20 randomly selected police officers serving with the Interior Ministry of the Sarajevo Canton. Most previous studies (9). This sets the basis for the basic classification of stress coping styles as: problem-oriented coping and emotion-oriented coping.Volume 2 / Number 4 / 2008 Unfortunately. Coping with stress is different to simple and automatic adaptive reaction to a new situation because it includes cognitive efforts to adjust to a new situation which exceeds one’s capacities at the point when possibility of automatic adaptation is excluded. In addition to psychological and physical health consequences. despite the above distinction. Results of evaluation of cognitive-behavior stress management used on different groups of clients point to positive outcomes of programs used (3). self-blame. different coping strategies do not exclude one another. wishful thinking. all coping styles have their own function. However. but also fear that they will be judged as incapable of police work. suppression. it also affects human organism in the way of producing various psychological and somatic changes. passivity. turning to religion. negotiation. depending on personality. information seeking etc. Problem-oriented styles include planning actions. suppressing competing activities. post-war countries such as Bosnia and Herzegovina. also known as active and evasive coping. holdingback emotions etc.HealthMED . There are two primary functions of stress coping: regulating emotions resulting from stressful situations and attempting to solve the problem. It is common for a person to use different coping strategies in similar situations. aged from 30 to 45 years. Experimental group consisted of 20 randomly selected police officers serving with the Interior Ministry of the Sarajevo Canton.In cooperation with the Ministry of Interior. They rarely require psychiatric or psychological assistance out of fear of stigmatization. positive thinking. Subjects (material) and research methodology a) Subjects Our subjects are police officers. They are little or not at all educated about the concept of stress and trauma. c) Procedure (organization of research) . while studies of blood parameters are contradictory (7). (8). as well as characteristics and cognitive 290 appraisal of the situation. Behavioral strategies can include visible action taken to reduce the effects of stress. using humor. (5). Research objectives Objective of our work was to develop a structured stress management program based on cognitive behavior therapy principles for persons in high risk professions such as police officers. Several studies show that the use of cognitive-behavior stress management leads to normalization of some physiological parameters such as blood pressure (6). while cognitive coping strategies include attempts to re-interpret the situation.

HealthMED . Members of police experience a different kind of work stress compared to other professions. but at times. normal and pathological reactions to stress 3.The control group completed the same psychological tests at the same time as the experimental group but no member of this group has taken part in the program during that period. progressive muscular relaxation) 6. there is an immediate “burst” from low stress to a high stress state. . Burst stress means there is not always a steady stressor. Beck Anxiety Inventory (BAI). Osman & Wade 1997) 2. . In the therapeutic part of the program we used cognitivebehavior therapeutic techniques. However that is not the case among 291 Journal of Society for development of teaching and business processes in new net environment in B&H . Discussion High risk occupations. such as policing job. Anxiety Sensitivity Index (ASI) Results The following diagrams show mean BAI and ASI scores of the two samples. Problem-solving technique 7. Results of this research show that the subjects continued to use newly-acquired techniques after receiving structured stress management program based on cognitive-behavior therapy. Kooper. . At the start of the treatment all members of therapeutic groups completed objective psychological measurement tests which were also used at the end and three months after the treatment in order to evaluate effects. during specific measurement periods. Post-Traumatic Stress disorder 5. This kind of stress is called burst stress. Results. it was single-factor analyses (participation in stress management program). consequences of stressful events (short-term and long-term) 4. while educational part of the program focused on the issues related to stress and trauma.Stress management was structured in such way to cover the following issues: 1. (Osman. The analyses proved that BAI and ASI scores of the subjects who received stress management program have fallen and that the difference between their and the control group’s scores on the two scales was statistically significant. which has resulted in further decline in the above-mentioned parameters. Concept of Stress 2. Trauma. Communication skills d) Research instruments 1. Statistical data analyses were conducted using ANOVA (variance analyses). Coping strategies. Barrios.Group treatment was organized once a week over a period of one month. In usual stressful situations.Volume 2 / Number 4 / 2008 groups received educational-therapeutic program of structured cognitive-behavior stress management. in that. Relaxation techniques (breathing techniques. most individuals develop their own ways to reduce or adapt to stress and attempt to control their behavior in various ways. place persons at risk of being in situations which are outside usual human experience.

and Responses to Stressful Scenarios in Police Recruits. Jane Sims (1997).HealthMED . Beograd. International Journal of Stress Management. Jansson. Vol. .Burell. The Benefits of Graduated Training Program for Security Officers on Physical Performance in Stressful Situations. 8. 10.1. Neil Schneiderman (2003). help and consulting ‘’DOMINO’’ e-mail: voloder@mef. 2. Policijska akademija. No. Sally Standard. Corresponding author: Sibila Sijarić-Voloder Association for psychological assessment. 20: 579-584. Kathryn A Mannix. cumulative effects of exhaustion and stress negatively impact police officers’ family and social life. Matoš. 260:320-331.H. No1. Frank M.S. Vol. Besides. Due to cumulative effects of exhaustion and stress police officers become prone to making mistakes at work. Milovanović. 2. 63-70. Lj. Asplund and C.ba 292 Journal of Society for development of teaching and business processes in new net environment in B&H . LeBlanc. reduced anxiety sensitivity has lead to their improved psychosocial functioning which had a direct impact on their interpersonal communication. Andrew Braum. Samobor. Results have shown that the stress management has helped persons in a high risk profession to develop new ways for coping with stressful situations and to further improve already existing coping skills.unsa. 15. Cognitive Behavioral Stress Management Effekts on Injury and Illiness Among Competetive Athletes: A Randomized Clinical Trial. Michael H. Conclusions . The Relationship Between Coping Styles. Anne Garland. the experimental group continued to register statistically significant fall in BAI and ASI scores compared to control group. Sara Ingvarsson. International Journal of Behavioral Medicine.4. .After stress management program was completed. Perna. Margit Ockenfels. placing them in an even more difficult situation. R. Increased readiness to seek medical advice when experiencing psychological problems would be of enormous significance. because it would enable taking appropriate measures early after pathological reactions occur. 577-582.No. Blake Jelly and Irene Barath (2008). Police work is reactive and not proactive. It is very difficult for police officers to deal with stress. British Journal of General Practice. M. R (1998). Palliaiative Medicine. Paul Gordon. Jens Granath. Stress Management: A Randomized Study of Cognitive Behavioural Therapy and Yoga. Jannifer Gracie. Shula Raviv. Ivy Marie Blackburn. 70-93.11. Cognitive Behavioural Therapy. 9. like an explosion. K. Jan Scott (2006). Vol. Silja Vocks. The evaluation of stress management strategies in general practice: an evidenceled approach. International Journal of Stress Management. Moro. Mattson (2006). A. 350-369. Effektiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners.G. No.The experimental group also registered a significant fall in the scores on ASI scale compared to control group. 3-10. Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized-controlled trial. Ulrica von Thiele and Ulf Lundberg (2006).Volume 2 / Number 4 / 2008 police officers because their stress does not develop gradually but comes in a burst. Blood Pressure Reactivity Can Reduced by a Cognitive Behavioral Stress Management Program. Birgander. Barbara Reid. Vicki R. Sima Zach. Ann Behav Med. G. Claesson. Journal of Internal Medicine. B. 6. Policijska psihologija. Cheryl Regehr. Performance. Lutz Mussgaz and Heinz Ruddel (2004). Vol 35. 25(1): 66-73 5. Ralf Jurgensen. J. pp. Što su stres i psihotrauma i kako ih prevladati? TIP. Antoni. 7. Lindahl. Stirling Moorey. 4. Literature 1. 14. which is often intolerable and very dangerous. 3. 47.The scores on BAI scale of the subjects who received stress management program have fallen and the difference between their and the control group’s scores was statistically significant. (1994). Also. This paper studied the effects of structured stress management on police officers. L. Reuven Inbar (2007).

Medical colleage of University of Sarajevo. two boys and a girl. Genetic testing by amniocentesis before birth or blood test after birth can confirm the diagnosis. Trisomy 18 affects about 1 : 5000-8000 newborn. A child conceived with such an egg or sperm cell may inherit an incorrect number of chromosomes. while a girl had mosaic type of trisomy 18 – all died within first two months of life. kratak životni vijek Introduction The patient with trisomy 18 was first described by Edwards (1960). Most of the children with trisomy 18 die within the first year of life. 95% die within the first year. mosaic trisomy 18 and as a translocation type (partial trisomy for chromosome 18). 293 Journal of Society for development of teaching and business processes in new net environment in B&H . Girls are affected more often than boys. The extra material disrupts the normal course of development. a genetic error occurs during egg or sperm cell formation. Physical abnormalities may point to Edwards’ syndrome. 11). short life span Sažetak Osobe sa trisomijom 18 imaju višak DNA koji potiče od hromosoma 18 u nekim ili svim njihovim stanicama.Volume 2 / Number 4 / 2008 Trisomy 18 – Edwards’ syndrome TRISOMIJA 18 – EDWARDSOV SINDROM Izeta Aganovic-Musinovic. cytogenetic findings. Ovaj višak materijala dovodi do ometanja normalnog razvoja. there have been registrated three cases of Sy Edwards.HealthMED . It can appear like three forms: complete trisomy 18. citogenetička analiza. Boys had complete trisomy 18. regarding different references. Ključne riječi: trisomija 18 (tipovi). Key words: Trisomy 18 (types). Chromosomes are numbers 1-22. Middle life span is less than two months in 50% of these children. in our Center for human genetics. (3. A person inherits one set of 23 chromosomes from each parent. Većina djece sa trisomijom 18 umre unutar prve godine života. a 95% umre unutar prve godine. Javlja se u tri oblika: kompletna trisomija 18. and the 23rd pair is composed of the sex chromosomes. uzrokujući karakteristične simptome za trisomiju 18. mozaični oblik i translokacijski oblik. Genetičko testiranje koristeći amnocentezu prije rođenja ili citogenetska analiza poslije rođenja može potvrditi dijagnozu. but definitive diagnosis relies on karyotyping – cytogenetic testing. (1) Humans normally have 23 pairs of chromosomes. 4) Clinical report In last ten years. Bosnia and Herzegovina Summary People with trisomy 18 have additional DNA from chromosome 18 in some or all of their cells. X and Y. (1. or 1:3000. Prosječan životni vijek je manji od dva mjeseca za 50% ove djece. causing the characteristic features of trisomy 18. Occasionally. Zimka Seremet Center for human genetics. Mirela Djurovic.

using special stains for standard G-band examination. and physical malformations such as brain defects. epicanthal folds.Volume 2 / Number 4 / 2008 Cytogenetics Definitive diagnosis relies on karyotyping. Head and face – small head (microcephaly). Based upon shown data. (2) 294 Picture 4. 3. which involves cytogenetic microscopic examination of the chromosomes. Typical position of hand fingers (2. Reviles typical pes equinovarus Picture 1. Normal kariotype Basic symptoms of clinical report Trisomy 18 severely affects all organ systems of the body. Picture 3. whereas can be seen the presence of symptoms at complete trisomy 18 and mosaic type of trisomy. Journal of Society for development of teaching and business processes in new net environment in B&H . Low set position and unmodulated ears In table are shown characteristic symptoms of trisomy 18. Symptoms may include: 1. clenched hands with 2nd and 5th fingers on top of the others. 2.) Picture 5. seizures. Malformations of the digestive tract. it can be stated that in both cases are present anomalies incompatible with life.HealthMED . but some symptoms more or less are not present in mosaic type of trisomy 18. Bones – severe growth retardation. small lower jaw. and other defects of the hands and feet. 4. small eyes. and 5. Nervous system and brain – mental retardation and delayed development (100% of individuals). high muscle tone. Heart – congenital heart defects (90% of individuals) such as ventricular heart defect and valve defects. overlaps 4. the urinary tract and genitals. Kariotype of child with trisomy 18 Picture 2. overlaps 3. 5.

finger) Hipoplasic nails Born with Prominent heels Foot thumb in dosoflexy position Syndactily Other: Heart malformations (95%) Malformations of GIS Kidney malformations CNS malformations Chryptorchysam Hypoplastic large labia with hypertrophy of clitoris Short sternum Weakness and fragileness Mental retardation Partial hemi vertebra Patient 1 (Trisomy 18) * * * * * * * * * * * * * * * * * * * * Patient 2 (Trisomy 18) + + + + + + + + + + + + * + + Patient 3 (mosaic type 46 XX/47 xx*18) + + + + + + + Discussion People with trisomy 18 have additional DNA from chromosome 18 in some or all of their cells. Such cases are sometimes called mosaic trisomy 18. A small percentage of cases occur when only some of the body’s cells have an extra copy of chromosome 18.HealthMED . and 5. resulting in a mixed population of cells with a differing number of chromosomes.. (4) Trisomy 18 results when each cell in the body has three copies of chromosome 18 instead of the usual two copies. 295 Journal of Society for development of teaching and business processes in new net environment in B&H .Volume 2 / Number 4 / 2008 Table 1. over 4. over 3. The extra material disrupts the normal course of development. high palate Microghnaty Irregular formed ears Extremities: -Typical position of hand (2. Symptoms Head: Dolichocephalism Microcephaly Hypoplastic orbits Microphtalmy Corneal opacities Insert nose base Small mouth Narrow. causing the characteristic features of trisomy 18.

so is questionable their use. The average lifespan is less than two months for 50% of the children. and learning is limited. a piece of chromosome 18 becomes attached to another chromosome (translocated) before or after conception. population. (5). 296 Journal of Society for development of teaching and business processes in new net environment in B&H .HealthMED . doctors and parents face difficult choices regarding treatment. eugenic and disgenetic discussions. Affected people have two copies of chromosome 18. rather than prolonged life. As a result. If one of these atypical reproductive cells contributes to the genetic makeup of the child. Modern medicine is using several methods to achieve this. fetoscopy or amniscopy and amniocentesis. (7) Genetic testing by amniocentesis before birth or blood testing after birth can confirm the diagnosis. plus extra material from chromosome 18 attached to another chromosome. the child will have an extra chromosome 18 in each cell of the body. An error in cell division called nondisjunction results in reproductive cells with an abnormal number of chromosomes. and other cells have three copies of the chromosome. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. we would conclude that genetic information is equal part of child medical care and protection. ultrasound can detect abnormalities in the fetus. The way of improvement and protection of human health is antenatal reveal of inherited diseases.Volume 2 / Number 4 / 2008 Very rarely. Medical therapy is basically supportive care with the goal of making infant comfortable. but to make possible to all parents. People who carry this type of balanced translocation are at an increased risk of having children with the condition. These methods are: physical (examination of pregnant women. but extreme invasive procedures may not be in the best interests of an infant whose lifespan is measured in days or weeks. Abnormalities can be treated to a certain degree with surgery. especially those from families with risk. (10) They need support to walk. (9) Mosaic trisomy 18 is also not inherited. but they can learn to recognize and interact with others. It occurs as a random error during cell division early in fetal development. ultrasound. Cytogenetic methods have special place and significant importance as a base for genetic consulting and informing in this field. but occur as random events during the formation of reproductive cells (eggs and sperm). Most children born with trisomy 18 die within their first year of life. (2) Before birth. 9) Most cases of trisomy 18 are not inherited. (1. With a translocation. Translocation trisomy 18 can be inherited. the person has a partial trisomy for chromosome 18 and often the physical signs of the syndrome differ from those typically seen in trisomy 18. (3. (10) Conclusion Since trisomy 18 babies frequently have major physical abnormalities. some of the body’s cells have the usual two copies of chromosome 18. Close related to these are physico-chemical methods. Verbal communication is also limited. 8) Without questioning ethical. and 9095% dies before their first birthday. 5% of the children who survive their first year are severely mentally retarded. to have healthy child. The main cause for this kind of information is not just to prevent having the affected child or to prevent having the infant with inherited malformations. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18.

Pediatric cardiac Care Consortium. Ann Genet.com Journal of Society for development of teaching and business processes in new net environment in B&H 297 . Friedman JM. (2004). Bradley SM. PubMed citation. NLM Catalog.HealthMED . Tschernigg M. D’Souza S. 8.39(2):110-2. PubMed citation. 5. Gale Encyclopedia of Medicine.J. Genet Couns.93(6):801-3. A comparation of maternal age. PubMed citation. Moyano D. Hooboken.Volume 2 / Number 4 / 2008 Literature 1. Arch Dis Child Fetal Neonatal Ed. Akkab KD. Atz AM. 7. Wang W. Huether CA. Stoppelman SM. accessed at http://www. Wong LY. Allanson. Prenat Diagn. Corresponding author: Izeta Aganovic-Musinovic Center for human genetics. May KM. sex ratio and associated major anomalies among fetal trisomy 18 cases among different cell divison of error. Suzanne B. 08. PubMed citation. 10. Parental origin of the extra chromosome 18 in Edwards syndrome. Yang Q. Tsai FJ.com/ped/topic 652. 1996. c2005. Martin RL. Mayr J. Lorey F. Hills CB.htm (updated may 2. Kroisel PM. Management of genetic syndromes. Rasmussen SA. Torfs CP. Population-based analyses of mortality in trisomy 13 and trisomy 18. Julia Barrett. Medical colleage of University of Sarajevo. Judit E. Am J Med Genet. PubMed citation.239-44.emedicine. Chen CP.) 2. PubMed citation. Sex ratios in fetuses and liveborn infants with autosomal aneuploidy. PubMed citation. N. 2003. Bauer M. Bosnia and Herzegovina e-mail: semirmusinovic@yahoo. 2004 Mar 15. 6. Huggon IC. Effectiveness of cardiac surgery in trisomies 13 and 18 (from the Pediatric Cardiac Care Consortium). 2005 Apr. 2005 Nov. Verma RS.: John Wiley & Sons. Wagner K. Pertl B. Pediatrics. Characterisation of a 19year old «long-term survivor» with Edwards syndrome. Epub 2005 May 24. Fetal echocardiography in trisomy 18. Ramesh KH. Am J Cardiol. 9. et al. 2004. Petek E. 25 (4):327-30. 2nd ed. (updated 14.111(4 Pt 1):777-84.) 3.63(3):492500. Trisomy 18. H. 2006. 1996 Jun 14. Chen. Cassidy. Bishop JK. Graham EM. Lin YH.. Chern SR. 90(6). Shirali GS. Lin CY. 2003 Apr. December 2002.F520-2. 4. eMedicine.14(2).

Medical Faculty. It can be concluded that patients with malignant disease are completely dependant on care from other persons and require efficient and effective palliative care service which can be helpful in relieving psychological disorders in terminal stage of the disease. This prospective. Maligne neoplazme su u 2004 činile 23. Key words: oncology patients. Onkološki bolesnici u terminalnoj fazi bolesti nisu u mogućnosti da obavljaju umjerene kućne aktivnosti i velika većina onkoloških bolesnika nije pokretna. Least present was malignant neoplasms of bone and articular cartilage. mental health 298 Sažetak Na području Kantona Sarajevo se u posljednjih pet godina bilježi porast hroničnih masovnih nezaraznih oboljenja kao što su hipertenzivna oboljenja. Bosnia and Herzegovina Department of pathophysiology. in terminal stage of a malignant disease.7% svih uzroka smrti stanovništva u Kantonu Sarajevo.7% of all death causes among Canton of Sarajevo population. kao i uticaj malignog oboljenja na tjelesno i duševno zdravlje onkoloških bolesnika u terminalnom stadiju bolesti Studija je prospektivna. Najmanje oboljelih je bilo sa malignim neoplazmama kostiju i zglobne hrskavice. Malignant diseases in 2004 accounted for 23. Aim of the study was to investigate the type and duration of malignant disease and the influence of malignant disease on physical and mental health in patients with malignant disease in terminal stage of the disease. Takvi bolesnici zahtijevaju i njegu palijativne službe koja svojom efektivnošću i efikasnosću uveliko može da ublaži psiho- Journal of Society for development of teaching and business processes in new net environment in B&H . U ovoj studiji je utvrđeno da su najzastupljenije maligne neoplazme respiratornog trakta i digestivnog trakta. Dragana Niksic1. Esad Pepic2. study has been conducted in one population group in Canton of Sarajevo area during the period from 2005-2006. Bosnia and Herzegovina Summary Increased incidence of chronic mass noninfectious diseases such as hypertensive disease. Možemo zaključiti da su onkološki bolesnici u terminalnoj fazi bolesti potpuno ovisni o njezi drugih lica. diabetes mellitus and malignant neoplasms has been observed during the last five years in Canton of Sarajevo. dijabetes i maligne neoplazme. Amna Pleho Kapic2 1 2 Department of social medicine. This study included 400 subjects. This study showed that the most frequent neoplasms are respiratory and intrathoracic organs malignant neoplasms and digestive organs.HealthMED . University of Sarajevo. Medical Faculty. age 18-65. populaciona sa jednom grupom ispitanika. physical health. Cilj rada je bio ispitati vrstu i dužinu trajanja malignog oboljenja. University of Sarajevo.Volume 2 / Number 4 / 2008 Influence of malignant disease on physical and mental health in patients with oncology disease UTICAJ MALIGNOG OBOLJENJA NA TJELESNO I DUŠEVNO ZDRAVLJE ONKOLOŠKIH BOLESNIKA Amela Dzubur1. U studiju je uključeno 400 ispitanika u dobi od 18 do 65 godina koji boluju od maligne neoplazme u terminalnom stadiju bolesti Istraživanje je sprovedeno na području kantona Sarajevo u 2005 i 2006 godini putem anketnog upitnika za ispitivanje palijativne njege. Patients in terminal phase of malignant disease are not able to perform regular activities and most of the patients are not mobile.

14%) belonged to age group older than 65 years (females 65.Volume 2 / Number 4 / 2008 loške potrebe onkoloških bolesnika u terminalnoj fazi bolesti. 4. insomnia. in terminal stage of a malignant disease. fizičko zdravlje.7% of all death causes among Sarajevo Kanton population.HealthMED . Patients with oncology disease. and in the age group 18-24 years there were 0. Aim of the study Aim of the study was to investigate the type and duration of malignant disease and the influence of malignant disease on physical and mental health in patients with malignant disease in terminal stage of the disease.4%).31% of patients belonged to age group 55-65 years (female 25. Physical disorders in patients with malignant disease can be caused by the presence of the tumor. M=800. Most common psychological disorders are worry. irritability and lack of concentration (2.6. while there were 846 deaths caused by malignant disease (1). M=67.05). nervousness.1‰ . males 5%).5%) and 206 males (51. Patients spent in average 337. male 23. There was a decrease in incidence of malignant disease as the age decreased so in the age group 45-54 years belonged 15. population study has been conducted in Canton of Sarajevo area during the period from 2005-2006.7% patients (females 4%.7% of patients (females 13%. diabetes mellitus and malignant neoplasms has been observed during the last five years in Canton of Sarajevo. All patients gave formal consent for participating in the study.9566. Ključne riječi: Onkološki bolesnici. 5).68 KM (SD=704. Average age was 65. male 1)(Graph 1).5%). Most patients (54. Many patients together with their family members are faced with problems of psychological origin. mentalno zdravlje Introduction Increased incidence of chronic mass noninfectious diseases such as hypertensive disease.000). Graph 1.00KM). male 0). age 18-65. in age group 25-34 years there were 0.1 years (SD =11.25% patients (female 0. Subjects were selected randomly with insight in evidence of patients with oncology disease receiving palliative care in ambulance for palliative care “Jablanička” in Canton of Sarajevo. nausea.5%. 299 Journal of Society for development of teaching and business processes in new net environment in B&H . males 53. Incidence of death caused by malignant disease was 2. Malignant diseases in 2004 accounted for 23. 194 females (48.75% of patients (females 3.5. 3. but significant difference was found in age groups incidence (p<0. International questionnaire for palliative care. was used. This study included 400 subjects. among which usually are pain. males 17%). M=312. in age group 35-44 years 4.Average income in a family was 1014. Age structure of oncology patients Investigating the type of malignant disease it was found that 32% of patients had malignant neoplasms of respiratory and intrathoracic organs and 30% of patients had malignancy of digestive organs (Table1). designed in accord with World Health organization methodology. Subjects and work method This prospective.7 KM for the treatment (SD=398. There was no statistically significant difference in sex between the age groups.16%. vomiting and others. usually experience psychological disorders and not just physical disorders related to presence of the tumor. sleep disorders.5).17%). related to the treatment and/or invalidity caused by the tumor and other disorders. Results This study included 400 patients. sadness. while 24. especially in the terminal stage of the disease.

Decrease in malignant neoplasm incidence related to older age group has been observed in case of pharynx. secondary and unspecified sites 14.0 2. Malignant neoplasms of ill-defined. Breast malignant neoplasms 8.65 11.58 1.47 29. haematopoietic and related tissue 15.03 6.0 0.47 4. brain and other parts of central nervous system 12.Volume 2 / Number 4 / 2008 Table 1. stated or presumed to be primary.91 0.90 3.69 2.92 32.98 0 2.HealthMED .95 35. Malignant disease type in accord with Interantional malignant disease classification (IMCD) in relationship with the disease duration (No=number of patients) IMDC 1 2 3 4 5 7 8 9 10 11 12 13 14 Σ Up to 6 months No 0 7 17 0 0 1 1 2 2 1 1 1 0 33 % 0 21.71 2.33 10.3 7.97 0 3.5 5 years and more No 0 9 14 0 1 2 5 0 4 7 0 0 1 43 % 0 20.03 0 10.69 28. Increased incidence of other malignancy types was associated Table 2.06 31.3 30. of lymphoid.99 8.03 3.03 3.33 4.56 0.8 6.19 3. Patient with different types of malignant disease grouped by International malignant disease classification No=number of patients International disease classification 1 2 3 4 5 7 8 9 10 11 12 13 14 Σ No 13 120 130 8 4 25 28 11 26 19 7 8 2 400 % 3.21 51.06 3.30 16.32 9. Malignant neoplasms of urinary tract 11.99 2. Malignant neoplasms of thyroid and other endocrine glands 13.03 3.91 4. Malignant neoplasms of respiratory and intrathoracic organs 4.78 10.32 3.06 8.25 5. Malignant neoplasms of female genital organs 9.95 0. Malignant neoplasms.8 1.06 5.5 4. Malignant neoplasms of lip.95 0.78 0 32 1-2 years No 5 36 29 3 0 4 5 1 9 5 1 3 0 101 % 4.0 6.52 0 0 3.0 1.06 6.55 0 2. Malignant neoplasms of mesothelial and soft tissue 7.2 2-5 years No 1 30 31 0 2 5 9 1 5 3 3 3 1 94 % 1. Malignant neoplasms of digestive organs 3. Malignant neoplasms of bone and articular cartilage 5.13 5. Malignant neoplasms of male genital organs 10.63 0 9.0 2.19 3.28 0 0 2. Malignant neoplasms of eye. oral cavity and pharynx 2.7 6-12 months No 7 38 37 5 1 13 8 7 6 3 2 1 0 128 % 5.0 1.93 32.19 1. Malignant neoplasms of independent (primary) multiple sites It was found that incidence of malignant disease is greatest after the age of 45 years.65 28.97 0 25.7 300 Journal of Society for development of teaching and business processes in new net environment in B&H . oral and lymphoid tissue malignancy.16 6.96 4.0 32.34 1.8 2.5 100. Melanomas and other skin neoplsms 6.

angry very often No 215 260 301 56 28 % 52. and 47% of patients reported that the disease disallowed feeding by the patients alone (p<0.2%).7%).05).7%) were not able to go to the bathroom alone (p<0.3 No 71 12 6 72 134 never % 17. and significant number of patients (52. a statistically significant number of patients (80%) reported that malignant disease was restricting them in doing everyday activities such as home chores.2 53 32 61 121 201 seldom No % 13.7 9.05).7 52.05). followed by worry and anxiety reported by 65% of patients. Most common malignant neoplasm in female patients was in digestive organs (36.7 Yes.7 24.01) and 52% of patients reported that the disease enabled them to bath and dress alone (p<0. (p<0.0 sometimes No 65 96 32 151 37 % 16.3 14.0 75. kneeling etc. most common were fear of death and pain found in 75.7 27.7% of patients while least reported psychological disorder was aggressive behavior found in just 7. Malignant disease was cause of psychological disorders in many patients It was found that among numerous psychological disorders.0 2. anxious Fear of pain.0%of patients (Table 4). death Guilt Aggressive. Table 3. sad. and breast (11. Influence of malignant disease on psychological reaction presence in oncology patients.05).2 24.7 41 Not restricting No 9 28 9 67 111 25 % 2.2 Table 4.0 8. Most common malignant neoplasm in male patients was malignant neoplasms of respiratory and intrathoracic organs (41.0 50. Statistically significant number of patients (73%) reported that malignant disease restricted mobility (p<0.7 3.5 52.9%).0 33. partly No 71 81 180 163 99 164 % 17. followed by malignant neoplasm of respiratory and intrathoracic organs (21.5 Journal of Society for development of teaching and business processes in new net environment in B&H 301 .7%).0 15. followed by malignant neoplasm of digestive organs (24.7%).5% of patients reported time span of 2-5 years (Table 2). and only 8.7 20.7%) and malignancies of urinary tract (10.2 16. very restricting No 320 291 211 170 190 211 % 80. blue Worried.5 18. 0 73. (No=number of patients) Psychological reactions Very moody. dressing sitting Self feeding Bathroom habits Yes.2 8.2 30.5 47. Most patients reported that the time span from fist symptoms appearance to the examination day was 6-12 months (32%).0 1.Volume 2 / Number 4 / 2008 with older age group.7 6.0 40.HealthMED . influence of malignant disease on physical health of oncology patients (No=number of patients) Activity Moderate activity (cleaning.05) (Table 3).7 42. depressive mood was found in 52.3 7. Investigating the influence of malignant disease on physical health.2 7.7 65. many (42%) reported on impossibility to sit alone (p<0. vacuumcleaning) mobility around the house bathing.2 45.3% of patients.0 37.

008 0.095 -0.Volume 2 / Number 4 / 2008 Investigating the influence of malignant disease on invalidity it was found although not significant that 35% of patients reported invalidity.014 0.05). Greatest percentage of patients who expressed whish to talk belonged to age group older than 65 years. 46% belonged to age group 4654 years. Regression analysis coefficients between physical needs parameters and symptoms ease in patients with malignant disease Coefficient Pain Breathing difficulties Bad appetite Elimination of feces and urine Maintains of hygiene Sleep difficulties vomiting bleeding restlessness immobility 0. All patients who belonged to age groups 18-24 years and 25-34 years experienced both range and anger and also wish to talk.547 -0. p<0.666 0.311 0.1%).008 -0.007 0.7%) and difficulty in breathing (12.973 Table 6.685 302 Journal of Society for development of teaching and business processes in new net environment in B&H .166 -0. difficulties in breathing. while wish to talk was reported by 177 (44%) patients.002 t 2.HealthMED . Analyzing the association between calls to the palliative care for patients physical disorders and symptoms relive no correlation was found using regression analysis between patients physical needs such as pain.98. Out of patients who expressed anger during the disease.717 -2.169 0. Most common cause of sleep disorder was pain (85. No significant difference was found between the sexes.036 0.893 0.05).135 -1.074 -0.112 -2.379 -0.198 0.367 0.017 -0.585 0.210 -0.263 -1. p<0.042 0. Analyzing psychological reactions.510 0.405 P 0.062 0. Regression analysis coefficient between observed parameters in palliative care service and psychological reaction such as anger and rage in patients with malignant disease Coefficient Waiting for home visit by doctor or nurse Satisfaction with palliative care service Improvement in general state upon palliative care arrival Symptoms relieve 0.005 -0. 64 (16.072 0. Table 5.21. bad appetite and decrease in symptoms of the disease upon the palliative care arrival (Table 6).05).042 0.034 -0.7% reported sleep disorders (p<0.023 t 0.05) (Table 5). Using the regression coefficient it was found a significant positive correlation between psychological reactions such as anger and rage and the time waited for home visit by a nurse or a doctor (r=0. and between psychological reactions such as anger and rage and improvement in general state upon palliative care arrival (r=-1.924 0.034 P 0.166.1%) patients reported experiencing rage or anger during the disease. A significant negative correlation was found between psychological reactions such as anger and rage and satisfaction with palliative care (r=-0.660 0. Significant number of patients 50.742 0. p>0.458 0.793 0.903 0.

Other common symptoms are breathing difficulties. Journal of Society for development of teaching and business processes in new net environment in B&H 303 . 9. Least present was malignant neoplasms of bone and articular cartilage. sleep disturbances in 53%. 4.HealthMED . psychological and social problems. Among leading psychological reactions are fear of pain and death. Our study did not find any association between symptoms relive and physical needs such as pain. Patients in terminal phase of malignant disease are not able to perform regular activities and most of the patients are not mobile. and other researchers. irritability in 47%. breathing difficulties. 8. Family members and fosters usually call for help and support in taking care of the patient and for overcoming anxiety and depression. personal hygiene. depression. Similar results found researchers in Great Britain. in Europe and other developed countries in the world. In this study it was found that the great number of patients (32%) is suffering from malignant neoplasms of respiratory and intrathoracic organs. 5). Conclusion This study showed that the most frequent are respiratory and intrathoracic organs malignant neoplasms and digestive organs. nervousness in 62%. USA and Canada (11. Most attention was dedicated to the need for communication inside the family. and lack of concentration in 40% of patients (2. kneel. There are constantly more persons who die in older age from chronical diseases such as malignant neoplasms. In many patients malignant disease enabled them to do house chores. average life duration has increased. bathing and dressing.12). independent movement. feeding. guilt or aggressiveness. Health care systems need to be able to satisfy the needs of those patients easing the pain and giving the support to their families (7. and less percentage (30%) of patients are having malignant neoplasms of digestive organs. lack of appetite and others for which the palliative care was called. It is observed that the anger and rage were less frequent if the waiting time for nursing is less. causing large array of physical. and the help which health professionals can offer in order to overcome pain. where most common psychological disorder were worry in 72% of patients.Volume 2 / Number 4 / 2008 Discussion According to the data from World Health Organization. anxiety and depression. if the patients are more satisfied with palliative care and if the patient’s general state is improved upon the palliative care arrival. Our study showed that the efficiency of palliative care was associated with psychological reactions such as anger and rage in patients with malignant disease. with more people living longer than 65 years (6). anxiety. Pain is one of the symptoms causing the patients and their family members to call a palliative care service. 3. This study found that the most patients with malignant disease in terminal stage of the disease are experiencing great restriction in physical activities causing psychological disorders. apathy. It can be concluded that patients with malignant disease are completely dependant on care from other persons and require efficient and effective palliative care service which can be helpful in relieving psychological disorders in terminal stage of the disease. depressive moods and sleep disturbances. Similar psychological reactions were found by Wong et al. worry. 10). Previous studies of palliative care have mostly been concentrated on patients with malignant disease. sadness in 67%.

Geriatric Medicine. Sepulveda C et al. 2004. 12. In: Denzin N. Evans M. A comparation of places and policies for terminal care. Lincoln Y. 1994: 485-99.Volume 2 / Number 4 / 2008 Literature 1. eds.Hall JM.the solid facts. Handbook of qualitative research.com 304 Journal of Society for development of teaching and business processes in new net environment in B&H . 7. Higginson IJ. Journal of the Royal College of Physicians. Medical Faculty. Glaser BG. WHO regional Office for Europe. 2005.21(1): 45-55 9. 1967. Strategija razvoja zdravstva na Kantonu Sarajevo 2006-2015. Dying from Cancer disease. Journal of Pain and Symptom Management. 1986. Zavod za javno zdravstvo Kantona Sarajevo. Support Care Cancer 2002. 10. Corresponding author: Amela Dzubur Department of social medicine. Public Health and palliative care.Copenhagen. Bosnia and Herzegovina e-mail: ameladzubr@gmail.HealthMED . 4. 9-10 8. Novembar 2005. 11. 6. What do patients living with advanced cancer and their carers want to know? A needs assessment. 2. Page B. 24:91-96. Journal of Chronic Desease. Sarajevo. New York: Adline Press. Altheide DL.39:1-4. Why paliative care for older people is a public health priority. 5. Evaluation research and public policy: Lessons from the national hospice study. WHO regional Office for Europe. Hinton J. 3.29-32. Guba EG. Addington. et al. 1996. Lincoln YS. 2004. Palliative care: The World Health Organisations global perspective. The discovery of grounded theory: strategies for qualitative research. 2002. Connolly R. Franssen E. Strauss AL. Mc Carthy M. Wong RKS. Johnson JM. 1979. Beverly Hills: Sage. Criterion for assessing interpretive validity in qualitative research. Naturalistic inquiry. Aitken LH. 1985.10: 408-15. London: Sage Publishers.30:325-328. Lay M. Paliative care. Lancet. Szumacher E. University of Sarajevo.

so it is easy to read for everyone. it is a very important to raise a medical and public consciences about significance of Osteophorosis. before fracture happens. Osteophorosis’ treatmants takes a lot of money including expences for fractures treatment. Readers will find informations on a questions given in an ordinary life and in a medical practice. stomatology. Book has been written using a very simple and understandable language. has been wrote in a monography style. They believed that the most important part in all way of procedure of a disease lie in identification of a “risk” group because it helps very much in prevention. KAKO LIJEČITI Dijana Avdic. social and economic consequences. Many clinical. They paid a special attention to measures of prevetion and its treatment. Text has been illustarted by tables and pictures. so we can reduce clinical. There is a good ways of a prevention of Ostephorosis like a good diagnosis and succeeds in treatmant of it. Bosnia and Herzegovina About a book Osteophorosis has been defined as a disease characterized by low bone mass and micro architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. A book. Edin Buljugic KCU Sarajevo. how prevent and how treat it OSTEOPOROZA. Therefore. as well. Modern and adequate diagnosis helps in discovering disease on time. pharmacology as much as to a people who are willing to take care of theirs health by preventing a disease also called “a quite thief of the bones”. The book will take place in a medical library of a domestic authors. which are so clear and original made. This book containes precious informations for the good of the service for doctors from general practitioner and family medicals and others specialists to students of medicine. 305 Journal of Society for development of teaching and business processes in new net environment in B&H . Authors have been choosen for all relevant facts about Osteophorosis including a dia- gnosis. which means make as less as possible of its costs. Besides essence facts. authors are using theirs own experinces in explaining things. KAKO SPRIJEČITI. which is in our country kind of an empty place.HealthMED . With all inclusive detials this book very successfuly presenting Osteophorosis as a disease for a contemporary human and a society in general. social and economic consequence are coming from those facts.Volume 2 / Number 4 / 2008 Book preview Osteophorosis.

Autori su odabrali sve relevantne podatke o osteoporozi. Knjiga. Stoga je važno podići svijest medicinskih profesionalaca i javnosti o značaju ove bolesti kako bi se umanjile njene kliničke. kako opšte i porodične medicine. stomatologije. farmacije. pacijentima koji već imaju ovo oboljenje i drugim zainteresiranima. Troškovi tretmana osteoporoze i osteoporotskih preloma su znatni. studentima medicine. Ova knjiga sadrži dragocjene informacije potrebne ljekarima. Tekst je ilustriran tabelama i slikama koje su vrlo pregledne i originalne. Pri tome se autori služe relevantnim podacima iz literature. dijagnosticirati i uspješno liječiti. a čitaoci će naći u njoj informacije i odgovore na pitanja koja se postavljaju u svakodnevnom životu i medicinskoj praksi. Sva poglavlja su obrađena iscrpno i kompetentno. jer će se na taj način moći poduzeti mjere prevencije.com 306 Journal of Society for development of teaching and business processes in new net environment in B&H . je uspjela da sveobuhvatno prezentira osteoporozu kao bolest značajnu za savremenog čovjeka i društvo u cjelini. osobama koje žele sačuvati svoje zdravlje prevenirajući oboljenje.HealthMED . Bosnia and Herzegovina. e-mail: dijana2007@gmail. u vidu monografije. Osteoporoza je bolest koju je danas moguće prevenirati. a posebno su posvetili pažnju mjerama prevencije i liječenja. Savremena dijagnostika omogućava pravovremeno otkrivanje bolesti. na vrlo jednostavan i razumljiv način. socijalne i ekonomske posljedice. Knjiga će popuniti literaturu o osteoporozi. Najveću nadu polažu u identifikaciji “rizične” grupe. dijagnostici oboljenja. koja je kod nas više nego skromna. a iz čega proizilaze kliničke. Corresponding author: Dijana Avdic KCU Sarajevo. tako da knjigu mogu čitati svi. ali i vlastitim iskustvima. a time i intervenciju koja zahtjeva znatno manje materijalne troškove. tako i onima različitih usmjerenja i specijalnosti. socijalne i ekonomske posljedice osteoporoze. a time direktni i indirektni troškovi nastali tokom zbrinjavanja ovih bolesnika.Volume 2 / Number 4 / 2008 O knjizi Osteoporoza je najčešće metaboličko oboljenje koštanog tkiva karakterizirano poremećenom gustoćom kosti i povećanim rizikom za prelom kosti. prije nastanka preloma.

HealthMED . name of the first author or another person with whom correspondence will be maintained. USE OF ABBREAVIATIONS Use of abbreviations has to be reduced to minimum. whole title of the journal has to be written. used methods (with specific data. etc. ideas and conclusions from text. Every corresponedence will use that number. text references. so one page has no more than 2000 alphanumerical characters (30 lines). In discussion. TABLES AND PICTURES Tables have to be numbered and shown by their order. but usually it consists of a page title. Preferable the pictures format is TIF. Legends next to pictures and photos have to be written on a separate A4 format paper. Drawings need to be enclosed on a white paper or tracing paper. name of the instituion the authors (s) belongs to. results. It is appreciated if author marks the place for table or picture. preferably in footnotes below the table. last and first of the author (s). diagrams) have to be original and on their backs contain illustration number. Conventional units can be used without their definitions. footnote with acknowledgments. Titles of the publications are abbreviated in accordance to Index Medicus. drawings. STATISTICIAL ANALYSIS Tests used for statistical analysis need to be shown in text and in tables or pictures containing statistical analysis. cannot be used in the paper. Not-published observations and personal notifications need to be in text in brackets. if possible) and basic facts. results are interpreted and compared to existing. and their significance proven by statistical analysis. Quoting most recent literature is recommended. Type your paper in MS Word and send if on a diskette or a CD-ROM. but if not listed in the index.Volume 2 / Number 4 / 2008 INSTRUCTIONS FOR THE AUTHORS All papers need to be sent to e-mail: healthmed_bih@yahoo.com Every sent magazine gets its number. quality 300 DPI. abbreviated title of the paper and picture top. References cited in tables or pictures are also numbered according to quoting order. and author(s) will be notified if their paper is accepted and what is the number of paper. in Arabian numbers or symbols. Sent paper needs to be in the form of triplicate. Showing references is as how they appear in text. methods. Results need to be shown clearly and legically. 200 words at the most. All illustrations (pictures. summary. at the beginning of papers reference. the article is named as “unknown”. legends for pictures and pictures. Summary has no quoted references. For key words. Presenting paper depends on its content. abstract with maximum of 45 letters (including space). Summary needs to hold all essential facts of the work-purpose of work. SUMMARY Second page needs to contain paper summary. first author last name. considering that original one enclosure of the material can be photocopied. discussion and conclusion. Citing paper with six or less authors must have cited names of all authors. if seven or more authors’ wrote the paper. the name of the first three authors are cited with a note “et all”. at the most. Pictures also have to be numbered as they appear in text. Footnote-comments.. Ali materials. Conclusions have to give an answer to author’s goal. it is cited (referenced). Summaries must have review of underlined data. leaving left margins to be at least 3 cm. Introduction is brief and clear review of a problem. REFERENCES Quoting references must be in a scale in which they are really used. have to be typed double-spaced. previously published findings in the same field. goal. TITLE PAGE Every article has to have a title page with a title of no more than 10 words: name (s). including tables and references. while black and white photo have to be printed on a radiant paper. Methods are shown so that interested reader is able to repeat described research. need to be placed below the text. Only published articels (or articles accepted for publishing) can be used as references. CENTRAL PART OF THE ARTICLE Authentic papers contain these parts: intro-duction. Journal of Society for development of teaching and business processes in new net environment in B&H 307 . If the author is unknown. Known methods don’ t need to be identified. so they can be understood without having to read the paper. explanations. every measuring unit (SI) has to be clearly marked. Every column needs to have title. The paper has to be typed on a standard size paper (format A4).

te ime i adresa prvog autora ili osobe koja će s Redakcijskim odborom održavati i korespondenciju. Legende uz crteže i slike treba napisati na posebnom papiru formata A4. Ispod teksta treba dodati najviše četiri ključne riječi. Rezultate treba prikazati jasno i logički. ako je u citirani članak uključeno sedam ili više autora. a ako se u njemu ne navode. a njihovu značajnost dokazati odgovarajućim statističkim metodama. Ne treba koristiti u radu. rezultati. Slike također. Rukopis treba otipkati na standardnoj veličini papira (format A4). a (uobičajeno) treba da se sastoji od naslovne stranice. STATISTIČKA ANALIZA Testove koji se koriste u statističkim anaizama treba prikazivati i u tekstu i na tabelama ili slikama koje sadrže statistička poređenja. objašnjenja.HealthMED . prezime prvog autora. NASLOVNA STRANA Svaki rukopis mora imati naslovnu stranicu s naslovom rada ne više od 10 riječi: imena autora. dijagrami) moraju biti originalne i na poleđini sadržavati broj ilustracije. SAŽETAK NA BOSANSKOM JEZIKU Prilog radu je i prošireni struktuirani sažetak (cilj).000 alfanumeričkih karaktera (30 linija). Slike je potrebno dostavljati u TIFF formatu rezolucije 300 DPI. a crno-bijele fotografije na sjajnom papiru. Svoj rad otipkajte u MS Wordu i dostavite na disketi ili kompakt disku Redakcijskom odboru. Kada je autor nepoznat. mora biti otipkan dvostrukim proredom. Poželjno je da u tekstu autor označi mjesto za tabelu ili sliku. zaključak) na bosanskom jeziku od 500 do 600 riječi. čime će te olakšati redakciju vašeg rada. referenci. skraćeni naslov rada i vrh slike. Rad treba slati u triplikatu. One koje se citiraju u tabelama ili uz slike također se numeriraju u skladu s redoslijedom citiranja. Sve ilustracije (slike. uključujući tabele i reference. U sažetku se ne citiraju reference. naslov časopisa treba pisati u cjelini. Poznate metode se ne navode nego se navode izvorni literaturni podaci. treba numerisati po redoslijedu kojim se javljaju u tekstu. metode rada. cilj rada. tako da na jednoj strani nema više od 2. s tim da original jedan prilog materijala može biti i fotokopija. metode. Sažeci trebaju da imaju prikaz istaknutih podataka. Reference se označavaju onim redom kako s pojavljuju u tekstu. legendi za slike i slika. CENTRALNI DIO RUKOPISA Izvorni radovi sadrže ove dijelove: uvod. sažetka. uz naslov rada. treba na početku citiranog članka označiti “Anon”. Fusnote–komentare. sva imena autora treba citirati. Ispod sažetka navode se ključne riječi koje su bitne za brzu identifikaciju i klasifikaciju sadržaja rada. a mjerne jedinice (SI) moraju biti jasno označene. teksta. itd. naziv ustanove ili ustanova kojima autori pripadaju. bitne rezultate (sa specifičnim podacima. najbolje u fusnotama ispod tabela. KORIŠTENJE KRATICA Upotrebu kratica treba svesti na minimum. inicijale imena i prezimena auora te naziv ustanova na engleskom jeziku. Ako se navodi rad sa šest ili manje autora. Neobjavljena zapažanja i lična saopćenja treba navoditi u tekstu u zagradama. rasprava. Samo publicirani radovi (ili radovi koji su prihvaćeni za objavljivanje) mogu se smatrati referencama. ostavljajući s lijeve strane marginu od najmanje 3 cm. rasprava i zaključci. tabela. TABELE I SLIKE Tabele treba numerirati prema redoslijedu i tako ih prikazati da se mogu razumjeti i bez čitanja teksta. ideja i zaključaka iz teksta. Metode se prikazuju tako da čitaoci omoguće ponavljanje opisanog istraživanja. skraćeni naslov rada s najviše 45 slovnih mjesta i praznina. fusnotu u kojoj se izražavaju zahvale i/ili finansijska potpora i pomoć u realizaciji rada. Preporučuje se navođenje novije literature.Volume 2 / Number 4 / 2008 UPUTSTVOe-mail adresu healthmed_bih@yahoo. REFERENCE Reference treba navoditi u onom obimu koliko su stvarno korištene. Taj broj koristit će se u svakoj korespondenciji. SAŽETAK Sažetak treba da sadrži sve bitne činjenice rada-svrhu rada. 308 Journal of Society for development of teaching and business processes in new net environment in B&H . arapskim brojevima ili simbolima. navode se samo prva tri imena autora s dodatkom “et al”. korištene metode. U raspravi se tumače dobiveni rezultati i uspoređuju s postojećim spoznajama na tom području. Konvencionalne SI jedinice mogu se koristiti i bez njihovih definicija. rezultati. Način prezentacije rada ovisi o prirodi materijala. Uvod je kratak i jasan prikaz problema.com ZA AUTORE Sve rukopise treba slati na Svaki upućeni časopis dobija svoj broj i autor(i) se obavještavaju o prijemu rada i njegovom broju. ako je to moguće) i osnovne zaključke. Naslovi časopisa skraćuju se prema Index Medicusu. Zaključci moraju odgovoriti postavljenom cilju rada. Sav materijal. Crteže treba priložiti na bijelom papiru ili paus papiru. cilj sadrži kratak opis svrhe istraživanja. Svaki stubac mora imati svoje zaglavlje. crteži.

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