Introduction: Mental function has a physiological basis and is clearly associated with somatic and social functioning as well as the state of total health. Early childhood is an extremely important period and a special opportunity for an adequate promotion of mental health and the prevention of mental disorders. Most of the mental disorders that are registered with adults start at age 14. The aim of the paper: The aim of the paper was to point out the importance of promoting healthy life-

Introduction: Metabolic syndrome (METS) represent a simultaneous presence of multiple metabolic disorders in one person. Prevalence is increasing worldwide, which is probably related to increased obesity and sedentary lifestyle. Non-alcoholic steatosis or “fatty liver” is a metabolic disease caused by fat dysfunction. It can be a sign of some other disease, and can often be found in patients with metabolic disorders. Ultrasound is an acceptable method for the identification of fatty steatosis. There is evidence that when turmeric is used as a herbal diet, with its active metabolite of curcumin, can repair fatty acidosis and thus prevent progression of fatty steatosis complications such as cirrhosis and liver cancer. Goal. The aim of the study was to determine the effects of 400 mg curcuminaddition to the nutrition on ultrasound morphological characteristics of the liver in METS patients. Methodology: A prospective cohort study was conducted on 100 subjects with METS, treated in the family medicine practice of the Tuzla Canton, aged 35-70 years. The therapeutic effects of 400 mg curcumin on ultrasound-morphological characteristics of the liver were followed, validated by ultrasound in 50 respondents of experimental groups with METS. The data were processed by the IBM SPSS Statistics 21 statistical analysis program using parametric techniques andStudent’s t-test for paired samples. Results: There were 65% of women in the study. There were no statistically significant differences in the age of respondents within the analyzed groups. The use of 400 mg curcumin per day was statistically significantly improved ultrasound morphological characteristics of the liver in subjects with METS. Conclusion: All respondents with METS who used curcumin had beneficial effects on the morphological characteristics of the liver. Curcumin had stronger effects on subjects with METS and DM type 2 than others.

Introduction: It is known that phacoemulsification of cataracts after penetrating keratoplasty there are always some difficulties and of course a higher rate of different intraoperative complications. Phacoemulsification after PK may cause significant endothelial injury and affect long term graft survival. Aim: The aim of this report is to describe one of these cases and the possible ways to manage them. Case report: We report a case o of a 31-year-old female patient, with a cataract on her left eye. She reported that when she was 10 years old, she was admitted to regional hospital in Bosnia and Herzegovina due perforative corneal war injury. At the age of 11 years at Germany on her left eye corneal transplantation was performed. She reported that she wasn’t ever seeing quite good, due high myopia. Twenty years after war injury she was admitted to hospital. At that moment patient has been ophthalmologicaly examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found occlusion of pupil and complicated cataract. Her only wish was to get operated due cosmetic reasons. Before surgery her visual acuity on her left eye was light perception. Thirty days after surgery her visual acuity was 0,1 without correction. Conclusion: It is concluded that cataract surgery in patients after keratoplasty is more complicated. Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

Introduction: The prevalence of dyspepsia in the general population worldwide is very high (20-40%). Upper abdominal complaints are one of the most common cause of patients’ visits to primary care settings. Making an accurate etiological diagnosis of dyspepsia is difficult, but is an important challenge and goal for every doctor in primary care practice. Clinical guidelines have standards for gastroesophageal reflux disease, management of Helicobacter infection and indications for the use of endoscopy (empiric treatment, prompt endoscopy, “test and treat”). In spite of the application of those standards, many patients experience no improvement in their symptoms or often the recurrence of disease. Aim: This study presents a new approach to the diagnostic and therapeutic management of uninvestigated dyspepsia in primary care settings to provide long-term effective control of symptoms for family doctors. Material and methods: 3000 unselected consecutive dyspeptic patients underwent abdominal ultrasound, and 1000 dyspeptic patients from the same group upper endoscopy.. In this approach diagnostic evaluation of dyspepsia includes: abdominal ultrasonography as a first line obligatory routine method and the exact estimation of nutritional condition. Results: Abdominal ultrasound, physical examination and BMI control have significant value in the diagnostic evaluation of dyspepsia. The therapeutic approach includes, besides general standards (acid suppressive drugs, eradication of H. pylori, prokinetic and antidepressant agents), life style modification and nutritional interventions as first-line treatments. In this approach the use of new drugs such as ursodeoxycholic acid (UDCA), pre and probiotics, and digestive enzymes supplements is recommended. Conclusion: Throug the combination of different diagnostic procedures as first line methods, including abdominal ultrasound and nutritional condition (BMI), a family doctor can manage successfully uninvestigated dyspepsia at the primary care level.

Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.

Introduction: High blood pressure is the cause of almost 13 % of all deaths in the world. DASH (Dietary Approaches to Stop Hypertension) is “gold standard” in diet recommended by American Society of Hypertension, American Heart Association and Dietary Guidelines for Americans 2010 for reduction many CV risk factors including hypertension. Non-pharmacological treatment of hypertension through DASH dietary program with reduction of salt intake can significantly reduce high values of blood pressure and decrease general cardiovascular risks. Goal: The aim of this research is to determine the prevalence of hypertension among miners in Banovici coal mine and amount of salt taken in meals during work time. Material and methods: We inspected the medical documentation and registers for all employees in coal mine Banovici in order to provide calculation of hypertension prevalence. Based on reports and company standards on grocery usage and average amount of salt used in preparation of one meal in coal mine kitchen, we have calculated the average consumption of salt of one employee per meal. Results: There are 2700 of employees in coal mine Banovici with average life age of 46 years. From them 694 (25.7%) miners have arterial hypertension. Also 707023 kg of salt is being spent for preparation of meals in coal mine kitchen on yearly basis. Employees take between 4-9 grams of salt per one meal excluding the salt contained in bread. Conclusion: the amount of salt intake per one meal in the coal mine kitchen is larger from daily doses recommended by ACC/AHA.

Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine.

UNLABELLED Trichobezoar of gastrointestinal tract is an uncommon clinical condition and can present diagnostic and therapeutic challenge in practice. Clinical manifestations vary from no symptoms to serious complications. Delay in diagnosis may lead to an acute abdominal syndrome with lethal consequences, because of perforation, bleeding and obstruction of gastrointestinal tract. The most useful diagnostic procedure is gastroscopy. Large trichobezoars are difficult to remove endoscopically, so majority of cases require surgery. CASE REPORT We report a unique case of large gastric trichobezoar in young female with nonspecific symptomatology but with palpable huge epigastric mass and rare complications: multiply gastric ulcers and antral polyposis. CONCLUSION After operative removal of the bezoars ulcers healed completely, but antral polyposis persists.

INTRODUCTION Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. GOAL Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. METHODS Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. RESULTS There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice. CONCLUSION The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

BACKGROUND Pain in the lower abdomen is one of the leading reasons that lead the patient in surgery. Although appendicitis is the most common cause in about two thirds of patients the other causes must be taken into account. OBJECTIVES To determine the probabilities which could determine what is an etiological cause of pain. MATERIALS AND METHODS comprised 102 patients hospitalized in general hospital Tesanj because the clinical symptoms dominated by acute pain in the lower abdomen. The study was retrospective prospective clinical study. All data were collected in a special database and statistically analyzed. RESULTS Of all the causes of abdominal pain in the lower abdomen the most common is appendicitis with a total of 62 patients, of which slightly more male patients (36) compared to female patients (26) or (57% male and 43% female patients). If we analyze the time elapsed from pain onset to patient visit of physician we can say that patient with more intense pain will visit physician sooner. Colic and intense pain is a characteristic of colon cancer (15 patients) and Crohn's disease. Dull pain is characteristic of omentum cyst, diverticulitis, and intestinal obstruction and was seen in one fifth of patients with colorectal cancer and one third of patients with acute appendicitis. Palpatory positive pain in Mc Burney's point distinguishes appendicitis from other causes in most cases. DISCUSSION The decision-making in the treatment of abdominal pain is depending of nature of pain, intensity, spreading, and sensitivity to palpation and localization of pain that usually indicates the place where the sick organ transmits the inflammatory process to the parietal peritoneum. Other symptoms that accompany pain and laboratory tests can be of crucial importance.

Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.

Acute appendicitis is one of the most common causes of acute lower abdominal pain. However, there are other diseases that can cause pain and mimic acute appendicitis. Some of these conditions are treated surgically; however, some of them should be treated conservatively. Therefore, the treatment of diseases associated with a number of decisions made by doctors and patients. The decision making is divided into three levels. At the first level, the patient and his family are to decide that patient should go to visit physician. At the second level is a physician in primary health care, who decides whether a patient deserves conservative or operative treatment. If he think that it is necessary to forward patient to the hospital, the other specialist: surgeons, urologists and gastroenterologists are involved in the decision making process. At the third level are decisions about the future treatment of the patient. The patient can be sent to home treatment, control exam could be appointed, patient cold be operated or observed. For decision making process physicians use information collected from patient’s history, physical examination of patients, laboratory tests and radiological examinations.

The second half of twentieth century is characterized by development of many digital methods in medical diagnostics, such as ultrasound. Each one of them (US, CT, MRI, DSA, termovision, nuclear medicine) has its advantages and limits, which resulted with their multidependencies. Continuous technical advancements improved diagnostically quality of methods mentioned above. Since 1950th many innovations resulted in diagnostical improvements of ultrasound: B-mode, Doppler and 3D modality, harmonic imagining and contrast. In last couple of years, big improvement was brought by introduction of sonoelastography, which is used for precise identification of character of pathoanatomical changes, as well as their stages.

One of the most common causes of acute pain in the lower abdomen is appendicitis and covers almost two thirds of the total number of hospitalized patients. The survey included all patients who have pain in lower abdomen and came to the review at the Polyclinic Doboj-South and General Hospital Tesanj during 24 working hours. The sample consisted of 101 patients hospitalized at the General Hospital Tesanj with the clinical picture dominated by acute pain in the lower abdomen. Taken into account are all relevant clinical parameters necessary for establishing rapid etiological diagnosis of acute lower abdominal pain. So we can say that appendicitis has the following characteristics: pain is gradual, increasing in duration from 8 to 16 h, localized in the lower right quadrant, or begins in the epigastrium and is descending into the lower right quadrant and spreading in a large percentage of proximal dorsal and then the inner part of the thigh. Accompanied by nausea, vomiting, with a statistically significant increase in leukocyte levels over 10000 and pathological findings in urine. The difference between rectal and axillary temperature was statistically significant. Palpatory positive painful in Mc Burney spot. Patients are usually younger than 30 years.