Aim: Comparison of accuracy rate in prediction of cardiovascular disease using Naive Bayes with Logistic Regression. Materials and Methods: The Naive Bayes (N=10) and Logistic Regression Algorithm (N=10) these two algorithms are calculated by using 2 Groups and taken 20 samples for both algorithm and accuracy in this work. The sample size is determined using the G power Calculator and it’s found to be 10. Results: Based on the Results Accuracy obtained in terms of accuracy is identified by Naive Bayes (87.02%) over the Logistic Regression algorithm (92.18%). Statistical significance difference between novel Naive Bayes algorithm and Logistic Regression Algorithm was found to be p=0.001 (2 tailed) (p<0.05). Conclusion: Prediction of cardiovascular disease using Logistic Regression is significantly better than the Naive Bayes.

Introduction: Multiple sclerosis (MS) is a chronic, autoimmune and progressive multifocal demyelinating disease of the central nervous system. The aim of this study was to evaluate rehabilitation of patients with multiple sclerosis using BI (Barthel index) and EDDS (Expanded Disability Status Scale).Methods: A clinical observational study was made at the clinic for physical medicine and rehabilitation in Sarajevo. We analyzed 49 patients with MS in relation of gender, age and level of disability at admission and discharge, patient disability were estimated using EDDS scale. The ability of patients in their activities of daily living were also analyzed according to the BI at admission and discharge.Results: Of the total number of patients (n=49) there were 15 men and 34 women. The average age of female patient was 42.38±13.48 and male patient 46.06±9.56. EDDS values were significantly different at the beginning and at the end of the therapy (p=0.001) as was the value of BI (p=0.001).Conclusion: MS patients, after the rehabilitation in hospital conditions show significant recovery and a reduced level of disability; they show higher independence in activities but rehabilitation demands individual approach and adjustment with what patients are currently capable of achieving.

AIM To establish a value of D-dimer and compare findings of elevated and normal values with the golden standard, computed tomography (CT) of lungs in patients who had symptoms indicating pulmonary thromboembolism (PTE) at admission. METHODS This retrospective/prospective study was conducted at the Department of Internal Diseases of the Cantonal Hospital Zenica, Bosnia and Herzegovina. A sample included 80 patients with symptoms indicating PTE at the time of admission, D-dimers and CT scan of thoracic organs were performed. The patients were divided into two groups: 40 examinees with PTE confirmed by CT scan and 40 patients (control group) whose PTE was not confirmed by the CT scan. RESULTS Sensitivity of D-dimer according to statistical calculation was 87.5%. Specificity of D-dimer was 57.5%. The chance of a patient to have PTE in case of elevated values of D-dimer was 3.58 higher than in patients with normal D-dimer values. The positive predicative value of D-dimer was 0.54, the negative predicative value was 0.75. Test accuracy was 57.5%. Values of D-dimer >0.83 using a ROC curve and present clinical symptoms of the disease have indicated further diagnostic examination according algorithm and a need for CT scan (of thoracic organs ) CONCLUSION D-dimer is important in the diagnostics of PTE, high sensitivity and low specificity have been proven. A positive D-dimer test indicates the presence of PTE. However, the test is not reliable. In order to set a diagnosis it is necessary to visualize a blood clot by computed tomography of lungs.

Executive summary. National mental health policy: SASOP extends its support for the process of formalising a national mental health policy as well as for the principles and content of the current draft policy. Psychiatry and mental health: psychiatrists should play a central role, along with the other mental health disciplines, in the strategic and operational planning of mental health services at local, provincial and national level. Infrastructure and human resources: it is essential that the state takes up its responsibility to provide adequate structures, systems and funds for the specified services and facilities on national, provincial and facility level, as a matter of urgency. Standard treatment guidelines (STGs) and essential drug lists (EDLs) : close collaboration and co-ordination should occur between the processes of establishing SASOP and national treatment guidelines, as well as the related decisions on EDLs for different levels. HIV/AIDS in children: national HIV programmes have to promote awareness of the neurocognitive problems and psychiatric morbidity associated with HIV in children. HIV/AIDS in adults: the need for routine screening of all HIV-positive individuals for mental health and cognitive impairments should also be emphasised as many adult patients have a mental illness, either before or as a consequence of HIV infection, constituting a ‘special needs’ group. Substance abuse and addiction: the adequate diagnosis and management of related substance abuse and addiction problems should fall within the domain of the health sector and, in particular, that of mental health and psychiatry. Community psychiatry and referral levels: the rendering of ambulatory specialist psychiatric services on a community-centred basis should be regarded as a key strategy to make these services more accessible to users closer to where they live. Recovery and re-integration: a recovery framework such that personal recovery outcomes, among others, become the universal goals by which we measure service provision, should be adopted as soon as possible. Culture, mental health and psychiatry: culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline. Forensic psychiatry: an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners), each with specific needs, problems and possible solutions. Security in psychiatric hospitals and units: it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.

Background The increasing number of older patients (pts) with HIV infection, coupled with the prevalence of cardiovascular disease (CVD) at this age, and the side effects of antiretroviral therapy (ART), mainly related to cholesterol levels, led us to select them as an at-risk population for clinical drug monitoring. Purpose Assessment of cardiovascular risk in older patients infected by HIV treated with antiretrovirals. Materials and methods Retrospective study (2010) of HIV-infected older pts (≥65 years) monitored at the infectious disease unit of the author's hospital. Data were obtained from patient medical records, pharmacy medicines database and laboratory test results. Methods used to evaluate CVD: ▶ Framingham risk score (FRS): those whose 10-year risk of coronary heart disease-absolute risk (AR) is predicted to be >20% should be considered for treatment; ▶ Systematic Coronary Risk Evaluation (SCORE): those whose 10-year absolute risk of a fatal cardiovascular event was directly estimated at AR≥10%, if older, should be considered for treatment. Portugal is considered low risk. For female diabetic pts results are multiplied by five, for male patients by three; ▶ Atherogenic index of plasma (AIP): predictor of cardiovascular risk for pts with index >5. Results Of 63 pts (48 men), mean age 70.4 (65–84), 15 had diabetes, 4 were smokers and 23 pts presented either one or more CVD risk scales or index: FRS=16; SCORE=17; IAP=9; FRS+SCORE=10; IAP+FRS=4; IAP+SCORE=0; FRS+SCORE+IAP=5. These 23 pts were treated with at least one antiretroviral that induces hypercholesterolemia (seven showed elevated laboratory test results) and hyperglycaemia (12 had diabetes). Antiretrovirals most commonly used: tenofovir+emtricitabine (35), lopinavir+ritonavir (13), zidovudine+lamivudine (9), abacavir+lamivudine (8) and efavirenz (18). Diabetic pts, as well as those with elevated total cholesterol, presented a higher AR. Conclusions The older population studied presented an increased risk of CVD, confirmed by three evaluation methods, a fact probably also related to ART, since they all had in their therapeutic regimen, one or more medicines that increases total cholesterol and glucose.

Background Although the wide use of human albumin(HA), the risks and benefits of its use in clinical practice remains not conclusive. Since Surgery is the specialty that most uses HA in our hospital, it is relevant to analyse how it is used and what are the outcomes. Purpose Evaluation of concordance of HA prescription on a surgery department(SD) with hospital general recommendations. Materials and methods Retrospective study of six month prescription of HA from January-June 2010. Review of patient's medical record to collect prescription data from the SD. Evaluated data: number of vials (10g) prescribed and administered; plasma albumin value before treatment (ABT) and after; prescribed daily dose; treatment duration prescribed and administered; daily cost/patient and global costs; percentage of prescriptions with ABT<2.5 g/dl and percentage of prescriptions with ABT≥2.5 g/dl; justification for use. Descriptive statistics (mean±SD). Results During six months 329 prescriptions were made to 226 patients: Number of vials prescribed: 3121 and administered: 2705 with global cost 68.950,45€; Plasma albumin before treatment: 2.4±0.5 g/dl(1.2-5.4) and after: 3.0±0.5 g/dl(1.9-5.2); Prescribed daily dose: 27.7±6.3 g (10-60); Treatment duration- prescribed: 4.0±1.0 days (1-10) and administered: 3.0±1.2 days (1-10); Daily cost/patient: 70.6±16.1€(25.5€-152.9€); Percentage of prescriptions with ABT<2.5g/dl: 56.8%; Percentage of prescriptions with ABT≥2.5 g/dl: 41.3% – 1135 administered vials with a cost of 28.931,15€; Justification for use: hypoalbuminaemia: 57.3%, postoperative hypoalbuminaemia: 12.4%, pathology of gastrointestinal tract: 7.0% and others: 23.3%. A percentage of 13.3 HA are not administered and return to pharmacy department. Conclusions The authors found 41.3% of prescription profile not in accordance with hospital general recommendations – HA administration only if the ABT<2.5g/dl. The results of this pilot study, lead us to conclude that, to better support prescription, plasma albumin ought to be measured before and after treatment, and that, systematic drug utilisation review programs, should be started to assure a better cost/effectiveness ratio.

Background Renal insufficiency may affect up to 10% of HIV patients as a result of HIV-associated nephropathy (HIVAN), a consequence of HIV replication in the kidney, AIDS-related kidney disease or drug treatment. Tenofovir, atazanavir and abacavir are mainly used, and it is important to consider the potential impact of kidney disease on antiretroviral therapy.1 2 The increasing number of older patients with HIV coupled with the prevalence of chronic kidney disease (CKD) in this age group and the side effects of antiretrovirals leads us to select them as an at-risk population for clinical drug monitoring. Purpose Assessment of kidney function in older patients infected by HIV treated with antiretrovirals. Materials and methods Retrospective study (2010) of HIV-infected older patients (≥65 years) followed at the infectious disease unit of the author's hospital to identify those with CKD. Data were obtained from patient clinical files, pharmacy drug database and laboratory test results. CKD is defined as either GFR <60 ml/min/1.73 m2 for ≥3 months or presence of kidney damage (KD) for ≥3 months, with or without decreased GFR, manifest by either pathological abnormalities or markers of KD. Proteinuria (>30 mg/dl) is an early and sensitive marker of KD.3 The Modification of Diet in Renal Disease equation was used to estimate the GFR (eGFR).3 The stages (1–5) of CKD are defined based on the level of kidney function. Results Of 63 patients (48 men) with mean age 70.6 (65–84) and mean serum creatinine 0.99±0.31 mg/dl, 15 were diabetic, 19 had CKD at different levels of kidney function: stage 1=3, stage 2=3, stage 3=11, stage 4=1, stage 5=1. Of this nineteen, 14 were men, mean age 70.9 (65–79), 18 with mean serum creatinine 1.25±0.39 mg/dl and 1 with 10.92 mg/dl on haemodialysis, 12 were being treated with tenofovir, 3 with abacavir and 1 with atazanavir+abacavir. Conclusions A significant number of this population had a decreased eGFR and had CKD probably due to age, HIVAN, but also to the use of tenofovir, abacavir or atazanavir.