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Journal Cover Acta Medica Academica
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 1840-1848 - ISSN (Online) 1840-2879
   Published by Academy of Sciences and Arts of Bosnia and Herzegovina Homepage  [1 journal]
  • Who monitors the mentors?

    • Authors: Mladen M Kuftinec
      First page: 97
      Abstract: No abstract available.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Trends of inflammatory markers and cytokines after one month of
           phototherapy in patients with rheumatoid arthritis

    • First page: 102
      Abstract: Objective. To evaluate changes in the expression of tumor necrosis  factor-α in patients with rheumatoid arthritis submitted to phototherapy. Materials and methods. This was an open label study, enrolling ten patients. The phototherapy scheme within a range of 425 to 650 nm, 11.33 Joules/cm2, 30 cm above the chest was as follows: a) 45-min daily sessions from Monday to Friday for 2 to 3 months; b) three, 45-min weekly sessions for 1 to 2 months; c) twice weekly 45-min sessions for 1 to 2 months, and d) one weekly session for 1 to 2 months until completion. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were measured in peripheral blood and tumor necrosis factor-α, interleukin-1β, and interleukin-10 in leukocytes by quantitative real-time Reverse transcriptase-Polymerase chain reaction. In all the patients the next indexes: Karnofsky scale, Rheumatoid Arthritis-specific quality of life instrument, Steinbrocker Functional Capacity Rating and the Visual Analog Scale were evaluated. Results. Erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor declined notoriously after the indicated sessions. In gene expression, there was a tendency in tumor necrosis factor-α to decrease after 1 month, from 24.5±11.4 to 18±9.2 relative units, without reaching a significant statistical difference. The four tested indexes showed improvement. Conclusion. Phototherapy appears to be a plausible complementary option to reduce the inflammatory component in  rheumatoid arthritis.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Pre-hospital use of inhaled corticosteroids and inhaled beta agonists and
           incidence of ARDS: A population-based study

    • Authors: M.A. Mangi, V. Bansal, G. Li, M.S. Pieper, O. Gajic, E. Festic
      First page: 109
      Abstract: Objective. Inhaled corticosteroids and inhaled beta agonists were shown to decrease the lung injury in animal models. We investigated the association of pre-hospital use of inhaled corticosteroids and inhaled beta agonists with the incidence of Acute Respiratory Distress Syndrome (ARDS) in a population based cohort of hospitalized patients. Material and methods. Retrospective cohort study of adult patients from Olmsted County, Minnesota admitted to the hospital with at least one predisposing condition for ARDS from 2001-2008. The association with pre-hospital use of inhaled corticosteroids and inhaled beta agonists was evaluated using univariate and multivariate analyses. Primary outcome was ARDS and secondary outcome was hospital mortality. Results. Out of 2429 hospitalized adult patients with at least one risk factor for ARDS, 10.5% of those taking and 14% of those not taking inhaled corticosteroids developed ARDS (OR 0.72; 0.53-0.97; p<0.03). Inhaled beta agonists showed similar unadjusted protective effect; 9.7% of users and 14.4% of non-users developed ARDS (OR 0.64; 0.48-0.86; p=0.003). After adjusting for risk factors, comorbidities and severity of illness in the multiple logistic regression model, use of inhaled beta agonists, but not inhaled corticosteroids, remained independently associated with decreased risk of ARDS (OR 0.48; 0.31-0.72; p<0.001 versus 0.87; 0.57-1.29; p=0.49). The estimated protective effects were more pronounced among patients with pneumonia compared to those without pneumonia. Conclusion. Prehospital use of inhaled beta agonists but not inhaled corticosteroids was significantly associated with decreased incidence of ARDS among hospitalized patients at risk, once adjusted for baseline characteristics, predisposing and comorbid conditions, as well as severity of illness.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Neonatal bacterial meningitis: Results from a cross-sectional hospital
           based study

    • First page: 117
      Abstract: Objective. The aim of the study was to determine the epidemiological characteristics of bacterial meningitis observed in neonates born in the Department of Gynaecology and Obstetrics, University Clinical Centre Tuzla, Bosnia and Herzegovina, admitted to Intensive care unit (NICU) or readmitted, because of suspected infection, after discharge from the nursery. Subjects and methods. This study was carried out from July 1, 2012 to June 30, 2013. During this period 4136 neonates were born. All neonates admitted to the Intensive care unit with signs and symptoms of systemic infections, and neonates readmitted to the Intensive care unit, after discharge from the nursery for sepsis work up were included in the study. Results. Eighteen of 200 neonates (9%) admitted or readmitted to the NICU developed meningitis. 61% cases were late onset meningitis. The overall incidence was 4.4/1000 live births. The mortality rate was 11.1%. The mean age of symptom presentation was 8.7 days. The most common clinical features were: fever, respiratory distress and jaundice. Significant risk factors for acquiring meningitis were: male gender, Caesarean delivery, stained amniotic fluid. Positive CSF finding were detected in 6/18 (33.3%) of cases. Gram-positive bacteria were more frequently responsible for confirmed meningitis. In all neonates with meningitis blood culture was examined and 5 (50%) yielded Gram-negative bacteria. Conclusion. The high rates of neonatal meningitis with predominant late onset may suggest nosocomial origin. Measures to improve antenatal, intrapartum and delivery care and measures during NICU hospitalisation are necessary to lower the risk of nosocomial infections.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Effect of family disintegration on age at menarche

    • First page: 124
      Abstract: Objective. The aim of this study was to determine the effect of psychosocial factors on the age at menarche of girls in Federation of Bosnia and Herzegovina (FBH). Subjects and methods. A cross-sectional study was conducted from September 2002 to May 2003 in all Cantons of the FBH. The random stratified sample included 19.803 girls aged 9.0 to 17.5 years. Data were collected using the status quo method. Probit analysis was used to estimate median age at menarche and 95% confidence intervals. Results. The present study shows that menarche occurred significantly earlier (p<0.05) in girls from dysfunctional families (median: 12.99 years, 95% confidence interval: 12.93-13.05) than in girls who grew up in intact families (median: 13.04 years, 95% confidence interval: 13.01-13.07). Analyzing separately the impact of each of family stressors on age at menarche, we found that menarcheal age was significantly lower in girls from single-mother families, whose parents are divorced, whose one parent is died and where alcoholism in family is present than in girls from intact families. Maturation was found to be earlier in girls from dysfunctional families then in those from intact families after the influence of place of residence and sibship size was eliminated. Conclusion. From our research we can conclude that the girls from dysfunctional families reached earlier age at menarche than their peers who grew up in normal families, and that this effect did not disappeared after controlling for socioeconomic
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Inhaled corticosteroids and incident pneumonia in patients with asthma:
           Systematic review and meta-analysis

    • Authors: Vikas Bansal, Muhammad A. Mangi, Margaret M. Johnson, Emir Festic
      First page: 135
      Abstract: Objectives. To systematically review all available studies on inhaled corticosteroid use and incident pneumonia in asthma patients. Methods. We performed a literature search from January 1, 1993, through August 15, 2015, using PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers’ web clinical trial registries with multiple search terms. We included studies that compared the risk of incident pneumonia among patients utilizing and not utilizing inhaled corticosteroids. We then summarized risk estimates into two random-effect meta-analyses; one including randomized controlled trials and another one including observational studies. Results. Fourteen studies were estimable; ten randomized controlled trials included 19,098 participants and four observational studies included 44,016 participants. There was no heterogeneity in randomized trials and summed risk ratio demonstrated the use of inhaled corticosteroids was protective of pneumonia; risk ratio 0.74, 95% CI 0.57to 0.95, p=0.02. On the contrary, observational studies showed summed odds ratio of 1.97; 95% CI 1.87to 2.07, p<0.0001, I²=0%, suggesting increased risk of pneumonia with use of inhaled corticosteroids in asthma patients. Conclusions: Inhaled corticosteroids
      are associated with decreased risk of incident pneumonia in patients with asthma based on meta-analysis of available randomized trials. Although observational studies in similar patients suggested higher risk of pneumonia, the inherent methodological limitations confer lower grade of confidence in these studies.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Medication in the elderly - considerations and therapy prescription

    • First page: 159
      Abstract: The aim of this study was to integrate and present pertinent findings from the literature dealing with the treatment of the elderly within a primary care setting. Medical care for the elderly is an integral part of a general practitioner’s (GPs) everyday work and is challenging for concurrently (comorbidity, multimorbidity) and they often have deteriorated organ function and decreased physiological reserves due to the natural aging process. The choice of appropriate medication for each particular disease is a complex process and can cause “therapeutic confusion”, especially among younger GPs in the field. Elderly people are prone to develop adverse side-effects to usual dosages of medications and the side-effects are even 7 times more frequent in elderly than in younger patients. Moreover, in therapy for elder patients, a responsible clinician always needs to think about potential drug to drug interactions and possible compromised pharmacokinetic dynamics in the aging body. Professional geriatric societies in many countries (USA, Germany, UK) have developed lists of potentially inappropriate medications for the elderly, and they update them systematically. Lists such as The Beers Criteria list and STOPP/START criteria should always be consulted when administering therapy to elderly patients. In this paper we emphasized the importance of medication lists as an important practical support in a GP’s everyday work. Implementation of such therapeutic aids reduces the possibility of medical error and minimizes the chance of an inappropriate prescription for this vulnerable population stratum. Conclusion. When prescribing drugs for the elderly, GPs should take into account the specificities of the elderly, their biological and chronological framework and should always apply the principles of rational, conservative and evidence-based pharmacotherapy.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Dr. Stanko Sielski (1891–1958): Physician, scientist, humanist

    • First page: 169
      Abstract: This work presents the results of research into the life and work of Dr. Stanko Sielski, related to his professional, scientific and humanitarian work. He was born in Gračanica, Bosnia and Herzegovina
      (BH) in1891, to a family of Polish origins. He attended high school in Travnik and completed his studies of medicine in Vienna in 1919. During the First World War he served on the frontlines with the Austro-Hungarian army. He began his service as a doctor in Konjic, Prozor and Glamoč, and then worked in Varcar Vakuf, Zenica, Travnik, Bihać, Banja Luka, Sarajevo and Tuzla. At that time in BH living conditions were very bad, the level of education of the people insufficient, there were many epidemics of infectious diseases, and the mortality of the population was high. Dr. Stanko Sielski made a significant contribution to treating the sick, preventing various diseases and the health education of the people. In the realm of the history of medicine in BA, he researched the life and work of doctors from previous generations, the work of medical institutions, old medical manuscripts written in Arabic, Persian and Turkish, folk beliefs about the origins and treatment of a variety of illnesses, and the role of herbal medicine and amulets in treating the sick. In addition, he undertook research in the fields of archaeology, ethnology and sociology. He published the results of his research in scholarly journals. In the Second World War he saved the lives of many Jewish doctors and their families from persecution in concentration camps, and as a result in 2014 he was posthumously declared “Righteous Among the Nations”. Conclusion. Dr. Stanko Sielski, alongside his work as a doctor, was also involved in a variety of scientific research and publication work, which contributed to the preservation and a better understanding of the material and spiritual heritage of BH.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Brain abscess due to Aggregatibacter aphrophilus and Bacteroides uniformis

    • First page: 181
      Abstract: Objective. The aim of this report was to describe the occurrence of a bacterial brain abscess in a healthy individual, without any predisposing condition. Case report. A thirteen-year old boy was admitted to the Department of Neurosurgery after the onset of vomiting, headache and dizziness. A neurological deficit was detected during the physical examination so urgent magnetic resonance imaging of the brain was performed, revealing an intrahemispheric, right positioned solitary expansive mass with ring enhancement. Purulent material was obtained during osteoplastic craniotomy with total extirpation of the brain abscess. Aggregatibacter aphrophilus and Bacteroides uniformis were isolated. The patient’s general condition improved and the neurological deficit subsided as a result of the prompt recognition and treatment of this life threatening condition. Conclusion. To achieve a favourable clinical outcome, prompt recognition and surgical treatment of a brain abscess are of primary importance,followed by administration of appropriate antimicrobial therapy. To our best knowledge, this is the first report of this combination of microorganisms as the cause of a brain abscess.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Pediatric advanced stage nasopharyngeal carcinoma - case report

    • First page: 186
      Abstract: Objective. Nasopharyngeal carcinoma is an extremely rare pediatric malignancy predominantly occurring in adolescent males. Its multifactorial pathogenesis is most strongly associated with the exposure to
      Epstein-Barr virus in genetically susceptible hosts. In younger patients, more aggressive biological behavior has been observed, although the overall survival is better compared to adults. Due to its rarity and nonspecific clinical presentation, the diagnosis in children is often delayed and misinterpreted. Case report. We report a case of a 16-year-old boy with stage IVB nasopharyngeal carcinoma. He presented with a painless palpable neck mass, nasal congestion and a history of occasional epistaxis and headaches. Four years after the completion of a multimodal treatment, the patient is in complete remission. Conclusion. Although exceedingly rare, pediatricians should consider nasopharyngeal carcinoma in the differential diagnosis of palpable neck masses, especially in male adolescents. A multidisciplinary approach in the diagnosis, treatment, supportive care and follow-up is of utmost importance.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Guillain-Barré Syndrome Presenting as Unilateral Hip Pain in a Child

    • Authors: Charalambos Neocleous, Konstandinos Diakolios, Alkistis Adramerina, Evangelos Varveris, Vasiliki Tsioni, Konstandina Machairidou
      First page: 191
      Abstract: Objective. The aim of this report is to highlight the importance of close observation and follow-up in children who present with an acutely irritable hip. This is because hip pain is a symptom of not only benign but also severe conditions. Thus, at the time of the initial presentation, hip pain can be misdiagnosed. This report serves as an example for a wide range of doctors such as orthopaedic surgeons, paediatricians, emergency room physicians or primary care physicians, because these are the first-line doctors who treat patients with a painful hip. Case report. We herein present a three-year-old child who was admitted to our hospital with pain in the right leg and initially diagnosed with
      transient synovitis of the hip. An additional examination two days later, after severe deterioration of the clinical picture, revealed that our patient was actually suffering from Guillain-Barré syndrome. Failure to diagnose Guillain-Barré syndrome and initiating prompt treatment is potentially life-threatening. Conclusion. Clinicians should be aware that hip pain could be the presenting complaint of Guillain-Barré syndrome, a syndrome that has many clinical features. Even when all the clinical and laboratory findings indicate a benign condition, Guillain-Barré syndrome should still be considered. Therefore, close observation and follow-up in children who present with an acutely irritable hip is highly recommended. In this way, the potentially catastrophic consequences of more severe conditions can be avoided.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • Obtaining a PhD: Personal experience of a nurse

    • First page: 198
      Abstract: No abstract available.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • An unusual communication between the trunk of the mandibular nerve and the
           lingual nerve in a female cadaver

    • Authors: Sitthichai Iamsaard, Jeerapat Singsorn, Porntip Boonruangsri
      First page: 201
      Abstract: No abstract available.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
  • International publications of authors from Bosnia and Herzegovina in
           Current Contents indexed publications in the second half of 2013

    • First page: 203
      Abstract: No abstract available.
      PubDate: 2015-12-18
      Issue No: Vol. 44, No. 2 (2015)
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