Background: The COVID-19 pandemic is likely to have unprecedented and unforeseeable consequences, from those on a worldwide/global level to those at the local level–at the level of local communities and families, and individuals (and not just humans, but all other living beings), of which the future will testify in various ways. Objective: This work presents principles of treatment health care protection of people who has consequences of the colaps of helatcare sytem in Bosnia and Herzegovina (BiH) during Corona pandemic time and proposals how to make it better, with a focus on indications and restrictions for use different methods of education medical staff and how to improve therapeutic modalities by professional staff by education with new ICTs. Methods: System analysis of Public health sector in BiH which has felt down as consequences of great influence of rough political system generaly and at Cantonal and Community levels need to be meta analized by publich health care experts and by most influential health managers who can help to improve distroid current Health Care System at all levels, from Primary to Terciray level of ih heakth care protection. Results: The health system in BiH was unprepared for the COVID-19 pandemic. The unpreparedness of the health system varied in individual areas. The reasons for the unpreparedness of the health system in responding to the pandemic are the organization of the state of BiH by the Dayton Peace Agreement, according to which the health system is fragmented and regulated by law, without the possibility of its harmonization, coordination and interconnection. This pandemic period has clearly shown that “public health” as a medical discipline has been and remains a peripheral concern of society, that is, it has always been put on the back burner. The reason for this is the constant favoring of clinical disciplines, which is not disputed as a need, but this situation has shownhow much public health is needed and called upon when solving such pandemics, which have become a planetary problem. Proof of the previous statement is the very small number of epidemiologists and social medicine specialists in BiH. Conclusion: The response of the health system of BiH as a whole to the outbreak of the Covid-19 pandemic was inadequate, untimely, unprepared, unprofessional, chaotic, misinformed and with a lot of politicking, quasi-leadership and, in the end, it will turn out to be influenced by crime. This led to a high rate of illness and death, led to a great burden on the unprepared health system and setbacks in economic and social terms.

Background: SARS-CoV-2, though primarily a respiratory pathogen, exhibits multi-organ tropism, with the liver among the commonly affected organs. Elevations in liver enzymes are frequent in hospitalized COVID-19 patients, yet acute and pronounced hepatocellular injury in young, clinically stable individuals is uncommon. The underlying mechanisms may include direct viral cytopathic effects mediated by ACE2 receptors, immune-mediated injury, systemic inflammation, and metabolic stress. Notably, hepatic involvement can develop independently of respiratory compromise. Objective: The aim of this case report was to describe three adult patients with serologically confirmed SARS-CoV-2 infection and mild respiratory symptoms who presented with acute liver injury in the absence of other identifiable causes. Case report: During a confirmed COVID-19 wave in Bosnia and Herzegovina, a targeted outpatient study was performed in a family medicine setting. Routine liver testing was conducted for all suspected COVID-19 cases. Laboratory evaluation included liver enzymes, hepatitis serology, autoimmune markers, and inflammatory parameters, with imaging (ultrasound or MRI) to exclude structural pathology. Three previously healthy male patients (aged 25–45) developed acute liver injury during mild febrile illness, all with serologically confirmed SARS-CoV-2 infection (positive IgM and IgG). Retrospective assessment revealed unrecognized metabolic dysfunction-associated steatotic liver disease (MASLD) in all cases. Initial symptoms were fatigue and myalgia without respiratory distress. Laboratory findings demonstrated marked elevations of AST and ALT (>1000 U/L), GGT (>900 U/L), and raised ferritin and D-dimer, while bilirubin remained normal. This biochemical profile - disproportionately elevated transaminases and GGT with preserved bilirubin - was consistent across cases, suggesting SARS-CoV-2–related hepatocellular injury. All patients recovered rapidly with supportive outpatient care, without progression to liver failure. Conclusion: Clinically stable COVID-19 patients may experience acute hepatocellular injury, particularly those with underlying metabolic dysfunction such as MASLD. The recurring biochemical pattern of significantly elevated AST, ALT, GGT, and ferritin with normal bilirubin suggests a distinctive SARS-CoV-2–associated liver injury phenotype. Recognition of this presentation is essential for appropriate evaluation and management. Routine liver function monitoring should be considered in COVID-19 patients, regardless of respiratory symptom severity, especially in those with metabolic risk factors.

Background: The prevalence of obesity and obesity-related clinical conditions, including metabolic-associated steatotic liver disease (MASLD), sarcopenia, and a wide spectrum of pathological manifestations, is rising globally. According to WHO, BMI is the only anthropometric measure currently used to classify obesity, overweight, and underweight. However, emerging research suggests that obesity is a complex pathological state influenced by multiple etiological factors. Given the limitations of BMI, there is a growing need for a more comprehensive assessment of body composition, particularly fat mass quantity and distribution. Bioelectrical impedance analysis (BIA) provides valuable anthropometric data that can help differentiate obesity phenotypes and guide improved therapeutic approaches. Objective: This study aims to analyze body composition using BIA in a randomly selected sample of adults from primary healthcare settings in Bosnia and Herzegovina. The primary goal is to assess total body weight, fat mass quantity, fat distribution, and obesity types prevalent in this population. Additionally, the study seeks to establish reference values for further diagnostic, preventive, and therapeutic strategies to improve public health outcomes. Methods: A cross-sectional study was conducted on adults (≥18 years) in Gračanica, Bosnia & Herzegovina (B6H), from January 2021 to January 2025. Inclusion criteria required participants to provide signed informed consent, while exclusion criteria included acute systemic diseases, severe dehydration, and fasting for more than 24 hours. Anthropometric parameters measured included age, height, weight, BMI, body fat mass (BFM), fat-free mass (FFM), percent body fat (PBF), waist-hip ratio (WHR), and bone mineral content (BMC). Data were analyzed using SPSS (version 18), with results presented as medians, interquartile ranges, and percentiles (5th, 25th, 50th, 75th, and 95th). Results: A total of 4,628 adults participated in the study, of whom 2,824 (61.0%) were female and 1,804 (39.0%) were male. The median age was 45 years (IQR: 29 years). The findings revealed that over one-quarter of the B&H population is obese, with abdominal obesity being the predominant type. This phenotype is associated with the highest risk for metabolic syndrome and MASLD. Conclusion: Our study highlights a high prevalence of obesity among the examined individuals in primary care settings in B&H, with abdominal obesity being the most common type. This phenotype is strongly associated with metabolic complications. BIA-derived parameters of fat distribution and visceral fat mass may serve as valuable tools for improving obesity classification and developing more effective preventive and therapeutic strategies.

Background: Antibodies are key elements in the fight against diseases, including Covid-19. The pandemic is still ongoing, and Long Covid is a challenge due to the unclear chronic course of the disease. Objective: To analyze the antibody profile and coagulation status in patients who recovered from Covid-19 and developed symptoms of Long Covid, with a focus on D-dimer as an indicator of thromboembolic complications. Methods: The subjects are patients of the family medicine clinic who had an acute form of Covid-19 and after 3 months developed symptoms of Long Covid. The level of IgG and IgM antibodies to SARS-CoV-2 was regularly monitored during the acute form of the pandemic, and then also when symptoms of the chronic course appeared. The control group consists of patients who have recovered from the acute form of the disease without symptoms of Long Covid. Antibody analysis will provide insight into the diagnostic, prognostic and therapeutic value of antibody titer determination. Results: The occurrence of elevated levels of IGM and D-dimer were significantly increased in patients with various symptoms of Long Covid. Monitoring of IgG and IgM antibodies can be of key importance in the diagnosis, prognosis and therapy of Long Covid, and D-dimer for the diagnosis of vascular disorders and the detection of patients at risk for thromboembolic complications. In the practice of family medicine, but also in many specialist protocols, the importance of assessing the immune response when symptoms of Long Covid appear is neglected. Conclusion: Given the complex clinical picture of Long Covid, most doctors, regardless of specialty, must acquire knowledge and skills for diagnosis and treatment of Long Covid symptoms. It is necessary to create guides that can be supplemented with new discoveries, especially in the field of human immune defense against new virus variants and new forms of Long Covid.

Background. Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential procedure for diagnosing and treating biliary and pancreatic disorders but carries the risk of significant complications, particularly in patients with pre-existing conditions. The most critical complications include acute pancreatitis, bleeding, perforation, and cholangitis. Early detection and comprehensive therapeutic interventions are key factors in patient recovery and require seamless communication among healthcare professionals at all levels of care. Close collaboration between medical staff ensures a well-coordinated treatment strategy, even at the primary care level. Objective: This article aims to present a case of a patient who developed multiple severe complications following ERCP, including ulcer perforation with pneumoperitoneum, acute pancreatitis, cholangitis, and cardiac decompensation, all of which were successfully managed within an outpatient and family medicine setting. Methods and Design: The patient’s clinical history, laboratory findings, radiological imaging, and endoscopic evaluations were carefully analyzed and described to outline the approach to diagnosis and management. Case Presentation: An 86-year-old male with a known history of peptic ulcer disease opted for outpatient treatment after undergoing an ERCP procedure. The patient subsequently developed a series of severe complications, including ulcer perforation, pneumoperitoneum, acute pancreatitis, and cholangitis, along with cardiac decompensation. However, through meticulous outpatient management and primary care follow-up, the patient achieved a favorable recovery. Conclusion: This case report highlights that comprehensive outpatient management can effectively address complex complications following ERCP, even in patients with pre-existing conditions. Coordinated care at the primary healthcare level plays a vital role in ensuring positive outcomes.

Background. The novel SARS-CoV-2 virus initiated one of humanity’s biggest pandemics, swiftly spreading worldwide and inducing significant health issues. This virus prompted widespread changes, with initial inadequate immune response and a lack of effective drug therapies. Consequently, every organ, particularly the respiratory and nervous systems, was susceptible to infection. The Covid-19 pandemic ended in 2023, but ongoing symptoms led to the term Long Covid and chronic manifestations. Objective: The aim of this article was to describe the important role of health professionals, especially family physicians and their teams when and how to identify common neurological symptoms and clinical conditions during pandemic and post-pandemic period. Methods. A systematic review gathered data on neurological symptoms and complications in Covid-19 patients, ranging from mild, like headache, to severe, such as encephalitis and stroke. Results and Discussion. Analysis revealed a significant proportion of Covid-19 patients experiencing neurological manifestations, with about one-third exhibiting symptoms. Epidemiological data showed ongoing Long Covid symptoms alongside acute manifestations. Many of cases with Long Covid related neurological complications were presented. Common neurological manifestations included chronic fatigue, changes in smell and taste, brain fog, headaches, fibromyalgia, cognitive impairment, and mood disorders. Severe Covid-19 cases were more likely to exhibit neurological complications, such as ischemic brain vasculitis and thromboembolic events, associated with higher mortality rates. Neurological complications of Covid-19 are frequent and diverse, necessitating a multidisciplinary approach in diagnosis and treatment, coordinated by primary care physicians. In practice, it is necessary to monitor the patient’s immune status over a longer period, and coagulation disorders (D-dimer) for adequate therapy and rehabilitation. Very important is to recognize the immune response after an acute infection. Due to the epidemic occurrence of Long Covid, it is necessary to introduce the above-mentioned procedures also in case of clinical signs of Long Covid. There are several hypotheses for the causes of Long COVID symptoms, including immune disorders, persistence of the virus in various organs, and microvascular coagulation changes. Within primary healthcare as the first line of defense it is necessary to address stress caused by COVID-19, try to recognize the affected other organ systems. Conclusion: The family doctor with his communication skills can make connection with the secondary and tertiary levels and the consulting services of immunologists, microbiologists, nutritionists, pharmacist, physiatrist and infectiologist. The family medicine team plays a key role in prevention, random detection and adequate medical procedures. The main interventions at the primary level should include education, emotional support, specific nutrition interventions and lifestyle modifications.

Background: COVID-19 affects all organ systems, including the visual organs. Clinical manifestations encompass all segments of the eye. Neuro-ophthalmic manifestations are rare and can occur during the acute phase of the illness, during recovery, or in the course of Long COVID. These clinical manifestations include optic neuritis and various forms of encephalomyelitis. Optic neuritis more commonly occurs during the recovery phase from the acute form or during Long COVID. Family physicians are in a position to first diagnose optic neuritis in the early stages. Objective: The aim of this paper is to present a case of optic neuritis occurring in the early stages of the disease, diagnosed in the prehospital period in a family medicine practice with consultations from ophthalmologists, infectologists, and neurologists. Such close collaboration enabled the early administration of corticosteroid therapy. Case report: A case of a 28-year-old woman is presented, who exhibited symptoms of COVID-19 with a confirmed positive antigen for the SARS-CoV-2 virus (PCR nasopharyngeal swab). On the fourth day of illness, sudden loss of vision in the right eye occurred along with headache. Early diagnosis and early administration of corticosteroid therapy led to significant improvement in vision. Conclusion: Clinical manifestations of eye diseases can occur in the early stages of COVID-19 as a direct consequence of viral infection. Ophthalmologist and neurologist examinations are necessary in the early stages of the disease for timely diagnosis of various ophthalmologic and neurologic disorders and adequate therapy.

Background: Prior to 2012, the mesentery was perceived as a fragmented structure, lacking distinct functional and anatomical characteristics, and was merely considered part of other digestive organs. Dr. J. Calvin Coffey's in 2012 in his study redefined the mesentery as a distinct organ with a clearly defined anatomical and histological structure, although its specific function remains under investigation. The continuous structure and unique tissue properties of the mesentery classify it as the 78th independent organ in the human body. Insights into mesenteric adipose tissue have enhanced our understanding of normal metabolic processes and disease etiology, impacting health significantly. Experimental and clinical research highlights the vital roles of visceral adipose tissue, influencing neighboring organ function. The interaction within the brain-gut-liver axis is illuminated by the newfound functions of mesenteric adipose tissue, emphasizing its independent organ status. Objective: This study aims to evaluate the latest findings on the structure and function of the mesentery, focusing on visceral-mesenteric adipose tissue, and assess its role as a new organ in the brain-gut-liver axis. Methods: A comprehensive analysis of clinical and experimental studies on the mesentery's structure and function was conducted, focusing on recent discoveries regarding mesenteric adipose tissue and its role in the brain-gut-liver axis. Results and Discussion: Recent research has revealed the mesentery's unique functions, particularly in mesenteric adipose tissue. Mesenteric adipose tissue plays a crucial role in metabolic functions and influences disease onset. It acts as a vital link in the brain-gut-liver axis, directly influencing hepatic metabolism and disorders such as metabolic syndrome. Conclusion: Scientific evidence confirms the mesentery's anatomical and functional specificities, solidifying its status as the 78th independent organ in the human body. It serves as a crucial link in the brain-mesentery-small intestine-liver axis, impacting health and disease. Ongoing research holds promise for advancing our understanding of pathophysiological mechanisms and treatment approaches for metabolic syndrome and other chronic diseases.

Background: In December of 2019, SARS-CoV-2, a new type of coronavirus, appeared, and it turned into an international epidemic. The consequences of the pandemic, especially the isolation measures, fear of infection and bad economic trends, as a result of the crisis, threaten people's basic psychological needs. Objective: The objective of this research was to assess the impact of the COVID-19 pandemic on mental health and perceived social support of persons with disabilities in Bosnia and Herzegovina. Methods: The research included a total sample of 232 respondents with different types of disabilities. The Symptom Checklist (SCL-90) was used to verify the research objective, which assessed three dimensions: somatization, depression and anxiety. Also, in order to verify the research objective, the Multidimensional Scale of Perceived Social Support was applied, which consists of 12 statements that measure the perceived social support of family, friends and other people. The research data was processed with descriptive and inferential statistics. The basic statistical parameters were calculated, while the t-test was used for an independent sample of respondents to verify the set objective. Results: The results of the research showed that persons with disabilities, who were infected with the SARS-Cov-2 virus, had a significantly higher level of somatization, anxiety and depression compared to those who were not infected with the virus. The results in relation to social support did not prove to be statistically significant. Conclusion: The obtained results lead to the conclusion that, in the future, interventions by experts of various profiles must be planned to preserve the mental health of persons with disabilities, which is why it is important to invest in the emotional, psychological, social, physical and spiritual well-being of the individual.

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Background: Thromboembolic complications are a frequent occurrence during COVID-19. This report presents a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery. Pathological occlusive changes, such as thrombosis, are four times more common on the left subclavian. Thrombosis of the subclavian artery occurs in about 1% of the population, but atherosclerotic changes are common and usually asymptomatic. Objective: The aim of this report is to present a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery associated with symptoms of COVID-19. Case report: A 56-year-old female patient presented with tremor, numbness and prickling in the right hand, tinnitus, blurred vision, vertigo, syncope, trismus and headaches. The formation of a thrombus caused neurological symptoms in the right hand with a stronger pronounced tremor, headache and syncopal episodes. Routine CT with angiography did not reveal significant subocclusions of the neck arteries or significant ischemic changes in the brain. The patient was treated as Parkinsonismus (disease) with syncopal and collapsing episodes. Due to worsening subjective complaints, CT angiography of the neck and head blood vessels was repeated with iterative 3D reconstruction. The examination, as mentioned above, revealed atherosclerotic changes with thrombosis and stronger subocclusion of the right subclavian artery (RSA) proximal to the origin of the arteria vertebralis. Both vertebral arteries, as well as arteria basilaris, had a normal appearance. During physical exertion of the right arm doppler examination of neck blood vessels revealed the presence of reverse blood flow in the right vertebral artery. Haematological tests and high D-dimer also confirmed the diagnosis. After anticoagulant therapy, the thrombotic mass on the mural calcified RSA plaque disappeared. With the reduced physical strain on the right hand and a lifestyle change, syncopal conditions and headaches stopped. There was a reduction in tremors and tingling in the right hand as well. Conclusion: We reported a case of subclavian steal syndrome caused by thrombosis associated with OVID-19. Thromboembolic complications are common in the course of this disease. The diagnosis was confirmed with advanced diagnostic tools (CTA with 3D reconstruction), laboratory tests (D-dimer) and doppler ultrasound. When routine CT angiography is not completely clear, 3D reconstruction is necessary.

Background: We could say that traditional healing is a way of healing that has been common since ancient times. It has been passed down from generation to generation for many centuries. Magic medicine, although not approved by any of the monotheistic religions present in Bosnia and Herzegovina, and strictly prohibited by Islam, in the form of various magical acts and spells, exists among the people. Some of these magical practices have their roots in the pre-Christian Slavic period and earlier. Objective: The aim of this article was to provide the review of the traditional medicine during the history and today in Bosnia and Herzegovina. Methods: Review of the available literature, personal contacts and personal experience in contact with the traditional medcine. Discussion: Some of these magical practices have their roots in the pre-Christian Slavic period and earlier. Since the cause of the disease was usually associated with evil beings of supernatural powers, a deity or God’s will or punishment, it is understandable that priests have long been engaged in healing. Especially in the mentally ill, there seemed to be a certain divine or demonic origin of the disease. Muslim folk medicine divides diseases into two groups; in fevers and obsessions with unclean spirits. Folk medicine knows the healing properties of herbs and other substances of animal or mineral origin. The medicinal properties of simple foods that can be found in every home are also widely used, such as: milk, honey, vinegar, oil, onion, and garlic. Prescription books, known as “ljekaruše”, were created by collecting and writing down folk remedies. They were written mostly by Catholic priests. “Witch doctors” or “healers” have been preserved in Orthodox monasteries. Conclusion: Traditional medicine is important for history of medicine, ethnology, anthropology, and abounds in folklore elements. It is an area that leads to knowing, understanding or feeling the very nucleus of a nation.

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Background: The new coronavirus SARS-CoV-2 caused a pandemic that threatened all aspects of life and health while worsening the socio-economic situation of the entire population. COVID-19 affects all organs and organ systems. The symptoms of the affected organs can last for a long time after the acute infection. About 1/3 of patients develop neuropsychiatric signs in the clinical course of the disease. The most common symptoms are mental fog, headache, cognitive changes, behavior changes, muscle weakness, anosmia and ageusia. These symptoms may develop due to a direct effect of the virus on the neurons or hyper reactive immune response. Objective: The aim of this article is to describe 2 young adults who developed neuropsychiatric symptoms in the course of Long COVID-19 syndrome. Ischemic vasculitis was proved using CT imaging. Case report: We collected data of two younger females who had previously recovered from the acute form of COVID-19 without respiratory complications. They developed in the next 1-2 months a clinical picture of a brain disorder. In both cases, CT and angiography scans of the brain showed signs of ischemic vasculitis. Neurological therapy has led to an improvement of the neuropsychiatric symptoms. Conclusion: Neuropsychiatric disorders in Long Covid syndrome are common and diverse. Two cases of young adults who developed signs of neurological disorder in the post COVID-19 period were presented, and CT scans of the brain showed signs of ischemic vasculitis.

Background: The corona virus is transmitted in three ways: by direct contact with an infected person, by droplets, and by air. Transmission control according to official guidelines can be prevented by keeping a distance, wearing a mask and washing hands. Sharing a space with several members of the immediate or extended family increases the risk of transmission in all three ways. In Traditional Bosnian families two or three generations live in one household. The family doctor is informed with living conditions of the residents and has the opportunity to monitor the rate of secondary transmission from the index case, and then recommend additional preventative and treatment measures. Objective: The aim of the study was to determine the first occurrence of the symptoms and to monitor possible intrafamilial transmission of the disease through clinical examinations and microbiological-serological tests. Methods: The study was conducted in a family medicine clinic in the region of northeastern Bosnia and Herzegovina from March to December 2020. Patients with symptoms that could indicate the presence of COVID-19 disease were registered. If COVID-19 was proven, the patient became an index case. The other members of the family would be monitored for the secondary transmission via laboratory (PCA SARS-CoV-2 and IgM and IgG antibodies) and clinical parameters. Results: Characteristics of 25 index cases were analyzed. All 25 of them were middle-aged men that worked outside the home. In 25 households, there was a total of 123 members that shared a home with the index patient. Secondary transmission developed in 76 out of 123 family members (61.8%). Only one patient had a severe form of the disease and was hospitalized. 2 patients died. Conclusion: Intrafamiliar transmission of Covid-19 in households of Bosnia and Herzegovina is high. The secondary attack rate of SARS- CoV-2 in households is 61,8%. In the surveyed households, family members use common rooms with an infected patient, and the customs of family gatherings are maintained, without the implementation of protective measures. The family medicine team has the opportunity to apply appropriate preventive action, education and early prehospital treatment as well as adequate selection for the hospital admission.