1Family medicine education center at Health Center Tuzla, Bosnia and Herzegovina 1University of Tuzla Faculty of medicine, Department of family medicine, Bosnia and Herzegovina 2Family medicine education center at Health Center Zenica, Bosnia and Herzegovina 3Family medicine education center at Health Center Mostar, Bosnia and Herzegovina Selective serotonin reuptake inhibitors and risk for gastrointestinal bleeding Едукативни чланци / Educational Articles

ABSTRACT Objectives: The aim of this study was to evaluate a frequency and clinical presentation of hypertension crises due to age, gender, duration and seriousness at Emergency Medical Service Department of the “Dr Mustafa Šehovic” Health Care Center Tuzla. Methods: The research was conducted in the period between November 2009 and April 2010 and involved 180 examinees of both genders, aging between 30 and 80 years of age with the diagnosis of arterial hypertension. The examinees were divided into two groups: control group consisting of examinees without hypertension crisis (95 examinees) and experimental group consisting of examinees with hypertensive crisis (85 examinees). Descriptive statistical methods were used in the statistical data processing. Results: The research results showed that there had been significantly more female examinees than the male ones (60% vs. 40%; p=0.007). The average age of male examinees was 55.83±11.06 years of age, and the average age of female examinees was 59.41±11.97 years of age. The hypertension crisis frequency was 47.22%, where the hypertensive urgencies were statistically significantly more present than the hypertensive emergencies (16.47%vs.83.53%; p<0.0001). The largest number of experimental group examinees (28.23%) belonged to the age group of 60 to 69 years of age; urgency 26.76% and emergency 35.71%. The largest number of examinees with hypertensive crisis (49.41%) appeared in the period between 6.00 p.m. and 11.59 p.m. The largest number of emergency group examinees (69.01%) had been treated for arterial hypertension for ten years, and the examinees from the emergency group (42.86%) had been treated for 10, 11 and 20 years. The average blood pressure value at the hypertensive crisis examinees was 204.82/126.58 mmHg. Conclusions: The frequency of hypertensive crises in the Emergency Medical Service Department is high and it reaches 47.22%. Hypertensive urgencies were significantly more present in terms of statistics than the hypertensive emergencies (83.53% vs. 16.47%; p<0.0001).

Introduction: Factors of cardiovascular risk (CVR) are often grouped in cases with diabetes mellitus (DM) with significant increasment of risk for CV disease . The aim of this research is to determine the frequency of CVR and and total CVR in cases with DM and to investigate connection of CRP of other factors of CVR in total cardiovascular risks. Material and methods: In 92 cases with DM weist values were taken as well as body mass index (BMI), blood pressure, sugar in blood, cholesterol, triglycerides, C reactive protein (CRP) and according to SCORE system the 10 year period of CVR were determined. Results: Out of 92 tested cases with age 55,22± 8,3 years, 63,05% were males and 36,95% were women, 81,5% were with values of sugar in blood >7mmol/l, 44,6% were with values of HbA1C>7% and 63,0% >6,5%. The value of cholesterol were >4,5mmol/l in 87%, triglycerides >1,7mmol/l in 78.3% of tested cases. 81,5% of tested cases were overweight and 49% with larger weight values. Average cardiovascular factor according to SCORE system was 3, 92± 3,7% with significant difference among sexes (M-4,86; W-2,32, p3mg/l) 52% of tested cases were with high cardiovascular risk. There is significant positive correlation between CRP and cholesterol level (p<0, 01), triglycerides, blood in sugar, HbA1c and upper values of blood pressure (p<0, 05). Significant correlation between CRP and total cardiovascular risk (p=0, 63) was not evident. Conclusion: Cases with diabetes mellitus have high level of non regulated cardiovascular risk factors. Even though there is significant correlation between CRP and and pressure values, sugar in blood, HbA1c, cholesterol, triglycerides, significant correlation between CRP and total cardiovascular risk in cases with diabetes mellitus is not evident.

Background. Transfusion therapy represents a rational model of therapy which is frequently used in neonatal period. Aim.to investigate predictive role of blood group, Rh factor and gestational age in transfusions reaction in neonates. Patients and methods. we evaluated 95 neonates gestational age between 28 and 42 weeks treated with blood components. All neonates were treated in the Unit of Neonatology at Department of Gynecology and Obstetrics at University Clinical Center Tuzla in the period of 01.01.2006.-31.12.2008. Results. During the period of investigation there were 12 526 born neonates gestational age from 28 to 42 weeks. Incidence of transfusion reaction was 0, 37%. The median of gestational age in the complete sample was 38 weeks, with interquartile range from 35 to 39 weeks, with 28 weeks minimum and 40 weeks maximum. The incidence of transfusion reaction in relation with the blood group was most evident in recipients in blood group type A, but there were no statistically significant differences in incidence of transfusion reactions between four blood groups (X2=6.352; df=3; p=0.097). There was no statistically significant difference in incidence of transfusion reaction according to the Rh factor (X2=0.755; df=1; p=0.385). Investigation of transfusion reaction according to the blood group and Rh factor showed no statistically significant difference (X2=8.063; df=7; p=0.327). The logistic regressional analyses showed that the gestational age is significant predictor of appearance of transfusion reaction (OR=0.867; %95 CI=0.756 do 0.993; p=0.04). Conclusion. Transfusion reactions in neonates are not rare. The blood group and Rh factor are not valid in prediction of transfusion reaction while the gestational age is good predictor in appearance of transfusion reaction.

INTRODUCTION The clinical and epidemiological data show that proper nutrition plays an important role in maintaining health and combating the danger of developing some chronic diseases in the elderly population. Nutrition is an important factor in many physiological and pathological changes that accompany the aging process. More than 50% of elderly patients are suffering from malnutrition which is information that concerns. Due to various factors, older people are potentially vulnerable groups at risk of malnutrition. Loneliness, isolation from society and neglect of parents by children is a big problem to many people in old age. OBJECTIVE To determine differences in nutritional status of elderly people living alone compared to those who live in family surroundings. SUBJECT AND METHODS The study was conducted in the municipality of Tuzla in 2009-2010, in outpatient family medicine Simin Han. The survey covered a total of 200 elderly subjects (age >65 years). Subject group consisted of 45% of people living alone, and 55% control group consisted of elderly patients who live in traditional family surroundings. Questionnaires used in this study are General geriatric assessment questionnaire and Mini nutritional status. RESULTS The average age (+/- SD) was 75.4 +/- 6.2 years in subject group, while the same in the control group was 74.9 +/- 5.6 years. In subject group significantly more patients are on the verge of poverty. There are significant differences in the classification of financial status, according to the groups (p = 0.043). Members of subject groups have significantly lower BMI categories (p = 0.03) compared with the control group. In our study, people who live alone are at increased risk of malnutrition (p = 0030), have reduced the number of daily meals, significantly lower daily intake of protein, fruits and vegetables in the diet in relation to persons living in a family environment. Significantly more patients with loss of appetite live alone. According to the existence of self-reported food problems significantly more people are in subject group. There is a difference value score "Small assessment of nutrition" between the two groups (p = 0.001). About 22% of the total number of respondents said they have not so good health status compared to others. CONCLUSIONS Loneliness is a significant predictor of anorexia nervosa, the risk of malnutrition and malnutrition. Results indicate that it is necessary to work on improving the status and protection of elderly.

1 Kljucne rijeci: stres, mobing, žrtve mobinga, privremena sprijecenost za rad SAŽETAK: Mobing ili psiholosko zlostavljanje usmjereno je prema jednom pojedincu koji je stavljen u poziciju u kojoj je bespomocan i u nemogucnosti da se zastiti od stalnih maltretirajucih aktivnosti. Mobing ima negativne posljedice na zdravlje zaposlenih, sto povecava stopu izostanka s posla zbog bolovanja. Cilj rada je procijeniti ucinke mobinga na privremenu sprijecenost za rad (apsentizam) u medicinskih tehnicara. Prospektivnom studijom poprecnog presjeka analizirali smo stopu prevalencije mobinga i njegove ucinke na apsentizam u medicinskih tehnicara u primarnoj njezi. U istraživanju smo se koristili validnim upitnikom samoodgovorom među 274 (239 žena i 35 muskaraca) medicinskih tehnicara. Za analizu rezultata primjenjivao se standardni Statisticki paket za drustvena istraživanja (SPSS) verzija 10.0. Statisticke hipoteze testirane su na razini od α = 0.05. Među ispitanicima 87% bile su žene. Oko 54% ispitanika imalo je iskustvo mobinga u prethodnoj godini, a 24% (36/147) bilo je perzistentno izloženo mobing ponasanju (žrtve mobinga). Ispitanici s iskustvom mobinga statisticki cesce su imali sve simptome vezane za stres i mobing, izuzev depresije i nesanice. Oko 22% ispitanika se izjasnilo da se koristilo privremenom sprijecenoscu za rad (bolovanjem). Srednja vrijednost izgubljenih radnih dana po ispitaniku je M±SD= 6,76±22,00 (rang: 1-180) dana. Bolovanje kao i dužina bolovanja su statisticki znacajno udruženi s ocjenom trenutne radne sposobnosti, ocjenom odnosa zdravlja i radnih zadataka (WAI) i mobingom (P=0,001). Mobing je rasirena pojava među zdravstvenim radnicima. Vise od pola medicinskih sestaratehnicara je bilo izloženo mobingu u prethodnoj godini. Osobe koje su prijavile mobing dva su puta cesce bile na bolovanju.

Deep venous thrombosis (DVT) is common condition, which principally affects the veins in the lower leg and thigh. It is the most common in adults over 60 years of age, but it can occur in any age group. More than 200,000 new cases of deep venous thrombosis occur annually. Of these, 30 percent of patients die within 30 days from onset, one fifth of the patients suffer sudden death due to pulmonary embolism, and about 30 percent of patients develop recurrent DVT within 10 years. The most common risk factors for developing the deep venous thrombosis are recent surgery or hospitalization. Other risk factors, which include advanced age, obesity, infection, immobilization, fractures, childbirth within the last 6 months, use of combined (estrogen-containing) forms of hormonal contraception, smoking and air travel ('economy class syndrome'), are some of the better-known causes of DVT. Over the last 10 years, new strategies for diagnosing suspected DVT have been introduced. One of them is use of clinical criteria that takes into account signs, symptoms and risk factor for developing DVT and which can be accurately applied to categorize probability of DVT. These clinical criteria are also useful to identify patients that can have benefit from prolonged anticoagulant therapy. Pulmonary embolism, which is the worst complication of DVT, can be life threatening, so the establishing of accurate diagnosis and rapid treatment of DVT help to prevent this problem and to save patient's life.