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Journal Cover Acta Medica Academica
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   ISSN (Print) 1840-1848 - ISSN (Online) 1840-2879
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  • Predictive value of SAPS II and APACHE II scoring systems for patient
           outcome in medical intensive care unit

    • Authors: Amina Godinjak, Amer Iglica, Admir Rama, Ira Tančica, Selma Jusufović, Anes Ajanović, Adis Kukuljac
      First page: 89
      Abstract: Objective. The aim is to determine SAPS II and APACHE II scores in medical intensive care unit (MICU) patients, to compare them for prediction of patient outcome, and to compare with actual hospital mortality rates for different subgroups of patients. Methods. One hundred and seventy-four patients were included in this analysis over a oneyear period in the MICU, Clinical Center, University of Sarajevo. The following patient data were obtained: demographics, admission diagnosis, SAPS II, APACHE II scores and final outcome. Results. Out of 174 patients, 70 patients (40.2%) died. Mean SAPS II and APACHE II scores in all patients were 48.4±17.0 and 21.6±10.3 respectively, and they were significantly different between survivors and non-survivors. SAPS II >50.5 and APACHE II >27.5 can predict the risk of mortality in these patients. There was no statistically significant difference in the clinical values of SAPS II vs APACHE II (p=0.501). A statistically significant positive correlation was established between the values of SAPS II and APACHE II (r=0.708; p=0.001). Patients with an admission diagnosis of  sepsis/septic shock had the highest values of both SAPS II and APACHE II scores, and also the highest hospital mortality rate of 55.1%. Conclusion. Both APACHE II and SAPS II had an excellent ability to discriminate between survivors and non-survivors. There was no significant difference in the clinical values of SAPS II and APACHE II. A positive correlation was established between them. Sepsis/septic shock patients had the highest predicted and observed hospital mortality rate.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Factors influencing pain therapy for metastatic cancer patients in Bosnia
           and Herzegovina

    • Authors: Ivana Tica Sedlar, Sanda Cale, Ana Paric, Marija Peric, Jasna Jurcic, Eduard Vrdoljak
      First page: 96
      Abstract: Objective. To investigate cancer pain management and evaluate factors that could be addressed and lead to potential improvement of pain therapy. Materials and methods. Two hundred patients with metastatic cancer pain at the Department of Oncology, University Hospital Mostar, completed questionnaires about cancer pain treatment. Thirty oncologists from the Cancer Institute, University of Sarajevo and the Department of Oncology, Clinical Hospital, Mostar were asked to complete the questionnaire about cancer pain management. Results. Compliance for analgesics was statistically better (p=0.013) for patients who were regularly asked about pain than for those patients who were asked periodically. Nearly twice as many patients, whom the doctor always asked about pain, regularly took medication (65.5% versus 32.8%). There was a statistically significant, positive relationship between regular use of analgesics and the interest of the doctor about pain reduction after initiation of analgesic therapy (p=0.008). Almost half of the patients, 47%, stated that their doctor did not devote enough time to their pain problems during the interview. Statistically significantly more patients took analgesic medication regularly if they were not afraid of narcotics (p=0.006). Numerical or VAS scales in description of cancer pain were used by only 30% of interviewed oncologists. The vast majority of doctors, 86.7%, used opiates for the terminal phase of the illness. Conclusion. Assessment and the treatment of cancer pain in Bosnia and Herzegovina remains inadequate, emphasizing the need for changes to cancer pain patient care.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Risk factors for post-colectomy adhesive small bowel obstruction

    • Authors: Edin Husarić, Šefik Hasukić, Nešad Hotić, Amir Halilbašić, Senada Husarić, Ismar Hasuki
      First page: 113
      Abstract: Objective. The purpose of this study was to assess the risk factors for adhesive small bowel obstruction (SBO) following colectomy for colorectal cancer. Patients and methods. In this retrospective study we analyzed 284 patients who underwent surgery for colorectal cancer at the Department of Surgery University Clinical Center Tuzla in the period from 1st January 2009 until 31st December 2014. All patients underwent open colectomy. The length of follow up was from 6 months to 6 years (median follow up 3 years and 6 months). The study included all patients who underwent surgery due to colon cancer. The study excluded patients with postoperative small bowel obstruction after colon cancer surgery with different comorbidities. Results. In the analyzed sample of 284 patients, a small bowel obstruction occurred in 13.7% patients after surgery for colon cancer. The highest correlation of risk factors and the occurrence of postoperative small bowel obstruction after colectomy for colorectal cancer in multivariate regression analysis was found to be for Tumor-Node-Metastasis ≥3 (or =3.680), and postoperative
      complications (or =30.683). Conclusions. Postoperative SBO have many causes, but in this study the highest risk factors were the Tumor-Node-Metastasis ≥3, and postoperative complications.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Skeletal maturity assessment using mandibular canine calcification stages

    • Authors: Vildana Džemidžić, Alisa Tiro, Amila Zukanović, Ismeta Redžić, Enita Nakaš
      First page: 120
      Abstract: Objective. The aims of this study were: to investigate the relationship between mandibular canine calcification stages and skeletal maturity; and to evaluate whether the mandibular canine calcification stages may be used as a reliable diagnostic tool for skeletal maturity assessment. Materials and methods. This study included 151 subjects: 81 females and 70 males, with ages ranging from 9 to 16 years (mean age: 12.29±1.86 years). The inclusion criteria for subjects were as follows: age between 9 and 16 years; good general health without any hormonal, nutritional, growth or dental development problems. Subjects who were undergoing or had previously received orthodontic treatment were not included in this study. The calcification stages of the left permanent mandibular canine were assessed according to the method of Demirjian, on panoramic radiographs. Assessment of skeletal maturity was carried out using the cervical vertebral maturation index (CVMI), as proposed by the Hassel-Farman method, on lateral cephalograms. The correlation between the calcification stages of mandibular canine and skeletal maturity was estimated separately for male and female subjects. Results. Correlation coefficients between calcification stages of mandibular canine and skeletal maturity were 0.895 for male
      and 0.701 for female subjects. Conclusions. A significant correlation was found between the calcification stages of the mandibular canine and skeletal maturity. The calcification stages of the mandibular canine show a satisfactory diagnostic performance only for assessment of pre-pubertal growth phase.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Medical futility treatment in intensive care units

    • Authors: Marko Jukić, Lenko Šarić, Ivana Prkić, Livia Puljak
      First page: 127
      Abstract: Objective. To investigate cases of potential medical futility treatment in intensive care unit (ICU). Materials and Methods. Retrospective review of 1567 charts of patients treated during the three-year period (2012 - 2014) in the ICU of the University Hospital Centre Split, Croatia, was conducted. More detailed analysis of the deceased patients’ (n=429) charts was performed to identify cases of potential medical futility treatment. There were 99 patients for which ICU treatment was questionable due to their low Glasgow coma scale (GCS) score. For those patients types and duration of treatment were analyzed. Results. Among patients who were treated during that period, 27% had died. Treatment of 99 patients (6.3% of the deceased) was considered a potential medical futility. Mean age of those 99 patients was 68±14 years and the mean stay in the ICU was 14±11 days. They spent 1302 patient days in the ICU, of which 52% days they had GCS 3 score. They were treated with catecholamines during 40% of the patient days. Minimal therapy was provided during 44% of the patient days. Conclusions. Analysis of the deceased patients’ charts in the ICU indicated that a certain percentage of patients did not need prolonged ICU treatment. Instead, they were supposed to be treated in a palliative care unit. To avoid medical futility treatment in ICUs, palliative care unit needs to be established, as well as protocols for determining medical futility cases and ethical committee that will decide which patients will be
      transferred to palliative care.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Influence of gender and selection procedures on academic performance of
           undergraduate medical students

    • Authors: Jérôme R. Lechien, Chantal Kempenaers, Michèle Dramaix, Paul Linkowski
      First page: 137
      Abstract: Objectives. To determine the impact of gender on success of students studying Medicine in Belgium from the first year (MED1) to the sixth year (MED6) of training, in the context (or not) of a selection process after three years at university. Subjects and method. Data were evaluated from two cohorts of medical students: students of the first group (n=88) were not submitted to a selection process and students of the second group (n=76) were submitted to a selection process after MED3. Students were enrolled in Brussels Medical School. The variables studied were the grades obtained after the first session of exams, and the student’s gender. Variables were put into perspective in relation to the cohort/study year. STATA software was used for statistical analysis. Results. Linear regression showed the significant predictability of the grade obtained in MED2 for the grade obtained in MED6 for males and females only in the context of selection (r=0.51; p<0.001). The impact of grades after three years on those after six years was negative in the first group of students (r=-0.17; p=0.005) and positive in the second group (r=0.54; p<0.001). Conclusion. These results show a moderate link between success in MED1 and success in MED6, as long as the students undergo selection. A selection system after MED1, based on medical courses, inter alia, could speed up the maturation of students. Further studies with a higher number of candidates are necessary to confirm these results.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • The forthcoming era of precision medicine

    • Authors: Stjepan Gamulin
      First page: 144
      Abstract: . The aim of this essay is to present the definition and principles of personalized or precision medicine, the perspective and barriers to its development and clinical application. The implementation of precision medicine in health care requires the coordinated efforts of all health care stakeholders (the biomedical community, government, regulatory bodies, patients’ groups). Particularly, translational research with the integration of genomic and comprehensive data from all levels of the organism (“big data”), development of bioinformatics platforms enabling network analysis of disease etiopathogenesis, development of a legislative framework for handling personal data, and new paradigms of medical education are necessary for successful application of the concept of precision medicine in health care. Conclusion. In the present and future era of precision medicine, the collaboration of all participants in health care is necessary for its realization, resulting in improvement of diagnosis, prevention and therapy, based on a holistic, individually tailored approach.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Successful thrombolytic therapy in a patient with congenital corrected
           transposition of the great arteries

    • Authors: Selcuk Ozturk, Fatma Erdem, Serkan Ozturk, Selim Ayhan
      First page: 150
      Abstract: Objective. The aim of this report is to emphasize the importance of thrombolytic therapy in selected patients, such as those with congenital heart defects in whom a coronary artery anomaly can be observed. Case report. We present here a 63 year-old female patient who was admitted to our emergency department with ST segment elevation myocardial infarction and a history of a congenital heart defect. We treated the patient successfully with thrombolytic therapy instead of primary percutaneous intervention, because of the suspicion of a coronary artery anomaly. On the following day, we performed coronary angiography on the patient, which revealed the anomalous origin of the coronary arteries, with the left and right coronary arteries originating from the right sinus of Valsalva and the circumflex artery originating from the left sinus of Valsalva. This anomaly in this patient group is described for the first time. Conclusion. Coronary artery anomaly may be observed in patients with congenitally corrected transposition of the great arteries, and in the case of requiring emergency reperfusion, thrombolytic treatment can be an alternative strategy in this patient group.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Accessory coracobrachialis muscle with two bellies and abnormal insertion
           - case report

    • Authors: George Paraskevas, Konstantinos Koutsouflianiotis, Kalliopi Iliou, Theodosis Bitsis, Panagiotis Kitsoulis
      First page: 155
      Abstract: Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Twiddler’s Syndrome

    • Authors: Ramesh Dharawat, Mohsen Saadat
      First page: 161
      Abstract: No abstract available.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Postal censorship of Bosnian public health institutions during the Second
           World War: The Independent State of Croatia versus Dr. Stanko Sielski

    • Authors: John A. Papalas, Husref Tahirović
      First page: 163
      Abstract: This study aims to present evidence of censorship during World War II by the Independent State of Croatia of one of its public health officials, Dr. Stanko Sielski who was a physician trained in epidemiology and public health. During World War II, he directed the Institute for Combating
      Endemic Syphilis in the Bosnian town Banja Luka. The staff under his direction consisted solely of Jewish physicians. We analyzed two groups of envelopes either sent by or to Dr. Stanko Sielski during the War and found evidence of censorship only in communications with a Jewish physician dated towards the end of the War. Dr. Stanko Sielski would be posthumously recognized for his efforts to shield his Jewish colleagues. Conclusion. The newly available, but still limited data, which we present indicates efforts to censor Dr. Stanko Sielski’s postal communications towards the War’s end. The censors targeted specifically Dr. Stanko Sielski’s correspondences with the Jewish physicians he was protecting. This material highlights the many challenges his public health service experienced during the time of armed conflict.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • From process management towards dynamic capability

    • Authors: Bo Bergman
      First page: 167
      Abstract: No abstract available
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Benefits of the EduPlan/EX software platform in managing teaching

    • Authors: Gloria Vickov
      First page: 170
      Abstract: No abstract available.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Information retention among attendees at a traditional poster presentation

    • Authors: Adam K. Saperstein, Robert P. Lennon, Cara Olsen, Luke Womble, Aaron Saguil
      First page: 172
      Abstract: No abstract available.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
  • Publications of BH authors in journals indexed in Current Contents

    • Authors: Nerma Tanović
      First page: 174
      Abstract: No abstract available.
      PubDate: 2016-12-05
      Issue No: Vol. 45, No. 2 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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