Aim To develop and validate a screening questionnaire for migraine without aura with sufficient diagnostic accuracy to be used in primary care settings. Methods The study was designed as cross-sectional, multicentric, diagnostic accuracy trial of new questionnaire for screening patients who visit general practitioners, with an aim to reveal migraine without aura. The instrument was constructed for the purpose of this study, and validated on the sample of 429 primary care outpatients. The gold standard of diagnosing migraine without aura was clinical estimate by a neurologist based on the International Classification of Headache Disorders 3rd edition (ICHD-III) criteria. Diagnostic accuracy of the instrument was tested through construction of the Receiver Operator Curve. Results The Balkan Migraine Screening Questionnaire (BMSQ) instrument showed good diagnostic accuracy (sensitivity 83.4% and specificity 79.9%) for migraine without aura, with significant screening yield among previously undiagnosed patients of 75.9%. The study also confirmed a high percentage of patients with hidden migraine without aura (MWA) (52.9%) revealed by the BMSQ and the ICHD-III criteria that would otherwise remain undiagnosed. Conclusion The BMSQ is a valid and reliable clinical instrument for revealing migraine without aura, which could be easily selfadministered by patients. It has high screening yield, discovering majority of patients with previously undiagnosed migraine without aura, whose definite diagnosis should later on be confirmed by the attending physicians using the ICHD-III criteria.

Introduction: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). Aim: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. Methods: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). Results: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). Conclusion: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.

Objectives: The aim of the study was to test the efficiency, compliance of patients and tolerance to the lisinopril and hydrochlorothiazide treatment. Methods: We conducted an observational, nonintervention multicentric study in 19 centers in Bosnia and Herzegovina. The study included 147 patients of both sexes diagnosed with essential hypertension who were already ordinated by antihypertensive therapy. The patients were monitored for 12 weeks, i.e. one initial and four control examinations. Results: The fixed combination of lisinopril and hydrochlorothiazide lowered the values of systolic and diastolic blood pressure for an average of 31/15 mmHg in patients aged 30 to 59 and for an average of 30/10 mmHg in patients over 60 years. The aimed blood pressure values were achieved in 82.31% of patients. The patients’ compliance was evaluated as very good for 87.07% of patients, good for 10.88% of patients and unsatisfactory for 2.04% of patients. Conclusion: Fixed combination of lisinopril and hydrochlorothiazide is efficient and well tolerable with very good compliance of patients. Keywords: Lisinopril, hydrochlorothiazide, fixed combination, efficiency, compliance

Background: Sarajevo has had the destiny of a place where different civilizations collided. This reflected on all aspects of life in Sarajevo. The development of pharmacy in Sarajevo began a long time ago. This article presents the development of private Sarajevo pharmacies in the 19th and 20th centuries. Objective: The article aims to introduce the reader to a chronological overview of the opening of pharmacies, their owners and the addresses where they were located. Results and Discussion: The article deals with prominent doctors who were also pharmacists, as well as attars and attar shops which are considered the forerunners of modern pharmacies. During the Austro-Hungarian period, pharmacies and pharmacy activities flourished. They introduce reforms and organize the pharmacy business as we know it today. Conclusion: At that time, the owners of the pharmacies were foreigners, mostly Czechs and Poles. During the old Yugoslavia, additional pharmacies were opened. After the Second World War, all private pharmacies in this area became state property.

The time interval from the 9th to the 13th century remained known as the “Golden period of the Arab science”, and a significant place among the taught sciences are occupied by Medicine and Pharmacy. In the history of medicine, Islamic medicine, also known as Arabic medicine, refers to the science of medicine developed in the Islamic Golden Age, and written in Arabic Arabs were able to use their cultural and natural resources and trade links to contribute to the strong development of pharmacy. After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period slowed down due to numerous unfavorable political-economic and other circumstances, thanks to the Turks, Arab culture and useful Islamic principles expanded to the territory of our homeland of Bosnia and Herzegovina. Significant role in the transfer of Arabic medical and pharmaceutical knowledge was also attributed to the Sephardic Jews who, with their arrival, continued to perform their attar activities, which were largely based on Arab achievements. However, insufficiently elaborated, rich funds of oriental medical and pharmaceutical handwriting testify that Oriental science has nurtured in these areas as well, and that the Arab component in a specific way was intertwined with other cultures and traditions of Bosnia and Herzegovina.

Introduction: This research was to follow characteristics of breakthrough pain caused by cancer (BTcP) and other most common sympthoms (ESAS) at patients in advanced stage of cancer disease in palliative care. Patients and methods: Prospective study included 433 patients which were treated in Palliative Care Centre in UKC Tuzla, Bosnia and Herzegovina. Group 1 was consisted of 353 patients whose basal cancer pain of intensity 4-7 NRS was treated weak opiates (basal analgetic- fixed combination of tramadol/paracetamol (37.5 mg/325 mg) in initial dose 3x1tbl for pain intensity 4, to 4x2tbl (for pain intensity 7). In Group 2 (80 patients) basal pain of intensity 8-10 was treated strong opiates as basal analgetic (oral morphine and transdermal fentanil). If the previous day were 2 or more breakthrough pain that required ‘’rescue dose’’ of analgetics (tramadol 50-100 mg orally in group 1 ie. Oral morphine 8-12 mg in the group 2), the dose of basal analgetic was increased. Results: The total number of reported breakthrough pain in all 433 patients for 10 days of treatment was 3 369 (0.78 BTcP /per patient/day), where at Group 1 patients showed significantly lower BTcP (0.56 BTcP/patient/day). The average intensity of BTcP was 5.91 where in the Group1 was 4.51 while in the Group 2 8.04. 582 (17.28%) was rated grade 7, of which 539 were successfully coupled by strong and 43 (7.39%) successfully coupled by weak opiates. From 556 BTcP who were rated with 8, 540 of them were coupled strong and only 16 successfully coupled by weak opiates. 1967 (58.39 %) of breakthrough pain has occured in the evening hours (18-06 h), while 1402 (41.62%) BTCP occured during day hours (06-18h). Most (1290 or 38.29%) of breakthrough pain lasted less than 10 minutes, 882 (26.18%) between 16 and 20 minutes, 752 (22.32%) between 11 and 15 minutes, 407 (12.8%) between 21 and 30 minutes and 38 (1.13%) lasted longer than 20 minutes. Conclusion: Duriong our study, we noted a relatively large number of breakthrough pain with lower intensity (3-6) in patients treated with weak opiates, which are also adversely affected patients satisfaction with pain treatment and required additional doses of analgetics. In the small percentage is possible the breakthrough pain of stronger intensity (7-8) treat by maximum doses of weak opiates.

Introduction: Paper is written on the basis of data collected in collaboration with family doctors in several cities in Bosnia and Herzegovina. Material and methods: In this retrospective, randomized study was carried out processing of data collected by special design questionnaire from the field through studies and analyzes carried out in 5 health care institutions in the territory of Bosnia and Herzegovina. The study included 270 patients who underwent three consecutive medical examinations. Results: Total reduction in blood pressure in average was 32.8 mmHg for systolic and 17.1 mmHg for diastolic, which is consistent with previously published results. Lisinopril/Hydrochlorothiazide is therefore a valuable therapy in the field of internal medicine. Study of this medication confirmed its efficacy in the treatment of hypertension. Conclusion: Control of high blood pressure in our patients according to data was very low, so it is necessary to intensify measures of prevention and treatment.

Introduction: Fluoride is natural element that strengthens teeth and prevents their decay. Experts believe that the best way to prevent cavities is the use of fluoride from multiple sources. Studies even show that in some cases, fluoride can stop already started damage of the teeth. In children younger than 6 years fluoride is incorporated into the enamel of permanent teeth, making the teeth more resistant to the action of bacterial and acids in food. Goal: The aim of this study is to determine the effects of improving the health status of teeth after six months treatment with the use of topical fluoridation 0.5% NaF, and the level and quality of the impact of treatment with chemical 0.5% NaF on the dental health of children at age from 8 to 15 years, in relation to gender and chronological age. This study included school children aged 8 to 15 years who visited health and dental services dependent in Mostar. Results: It is obvious that after the implementation of treatment with 5% NaF by the method of topical fluoridation, health status of subjects from the experimental group significantly improved, so that at the final review 89.71% or 61 subjects of the experimental group had healthy (cured teeth), tooth with dental caries only 5.88% or 4 respondents tooth with dental caries and filling 4.41% or 3 respondents, extracted baby tooth 14.71% or 10 respondents, while for 13.24% of respondents was identified state with still unerupted teeth. Our findings are indirectly confirmed that the six-month treatment of fluoridation with 5% NaF, contributed to statistically significant improvement in overall oral health of the experimental group compared to the control group which was not treated by any dental treatment. Conclusion: It can be concluded that there is a statistically significant difference in the evaluated parameters of oral health of children in the control group compared to the studied parameters of oral health the experimental group of children at the final dental examination.

Introduction: Stroke is a rapid loss of brain function due to disturbance blood flow to the brain. The existence of multiple risk factors, the length of their duration, and severity of each factor individually, is positively correlated with the occurrence of stroke. Stroke is the third cause of disability and premature death for men and women. Aim: The aim of this research is that through clinical and epidemiological studies the origin and development of stroke to inspect the same level of representation in the population of the Herzegovina-Neretva Canton. Material and methods: This survey covers the entire population of residents in the Herzegovina-Neretva Canton, and the number of patients who had a need for primary and secondary treating the symptoms of stroke. The very setting of this model of anthropological research modern human groups and theoretical estimates of the impact of genetic and / or environmental risk factors in the formation of phenotypic expression of complex traits of stroke, at the population level, resulted in the realization of the very methodology of this research. The study was conducted at the Department of Neurology, Regional Medical Center (RMC) “Dr. Safet Mujic” and the Department of Neurology, Clinical Center Mostar. These two health institutions, in addition to primary care are at the disposal for entire population of the Herzegovina-Neretva Canton and beyond. Data were collected by examining the details of the history of the board of hospitalized patients in the period from 1 January 2010–to 31 December 2014. The processed are 10 risk factors–potential causes of stroke. We also as research material, used records of hospital morbidity–the disease-illness statistics form (form number: 03-21-61; 03/02/60; 03/02/61; 09/03/60). Results: In our study, stroke is the second most frequent in the period of investigation, and noted the rapid growth that is in 2010 and 10.21% to 14.52% in 2014. There was a slight statistically significant differences in relation to the number of infected men and women, and the same is in favor of the patients are female. The number of patients with ischemic stroke, 954 of them or 48.38% was male and 1,018 or 51.62% were female. Of the 10 possible risk factors, factor 6 has a statistically significant canonical factor value, of which hypertension–CVI and the level of P = 0009 *, p = secondary hypertension, 0034 *, hypertensive heart disease, p =, * 0021, Diabetes mellitus of P = 0029 *, p = Anemia, 0052 * and C-reactive protein (CRP) of p = 0049 *, respectively, these canonical factors carry the entire amount of information about the relations impact of certain risk factors in the onset and development of the brain shock. Conclusion: We conclude that there is a statistically significant correlation between the studied risk factors in the genesis of the origin and development of different types of stroke.

Goal: The goal of the research was to determine the efficacy of a fixed combination of tramadol and paracetamol (acetaminophen) in the treatment of pain of patients with the advanced stage of cancer. Material and methods: A prospective study was conducted at the Center for Palliative Care, University Clinical Center Tuzla, Bosnia and Herzegovina, from January 1st to December 31st 2013. A total of 353 patients who were treated with a fixed combination of tramadol and acetaminophen (37.5 mg and 325 mg) at the initial dosage 3x1 tablet (112.5 mg tramadol and 975 mg acetaminophen) for pain intensity 4, up to 4x2 tablets (300 mg of tramadol and 2600 mg paracetamol) for pain intensity 7 and 8. If the patient during previous day has two or more pain episodes that required a “rescue dose” of tramadol, increased was the dose of fixed combination tramadol and acetaminophen to a maximum of 8 tablets daily (300 mg of tramadol and 2600 mg paracetamol). Statistical analysis was performed by biomedical software MedCalc for Windows version 9.4.2.0. The difference was considered significant for P<0.05. Results: The average duration of treatment with a fixed combination tramadol and acetaminophen was 57 days (13-330 days). Already after 24 hours of treatment the average pain score was significantly lower (p<0.0001) compared to the admission day [5.00 (4:00 to 8:00) during the first days versus 2.00 (1:00 to 7:00) during the second day of treatment]. The average dose of the fixed combination tramadol and acetaminophen tablets was 4.8 ± 1.8 (180 mg of tramadol and 1560 mg paracetamol). Side effects, in the treatment of pain with a fixed combination tramadol and acetaminophen, were found in 29.18% of patients, with a predominance of nausea and vomiting. Conclusion: Fixed combination of tramadol and acetaminophen can be used as an effective combination in the treatment of chronic cancer pain, with frequent dose evaluation and mild side effects.

Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes.

Introduction: Pedobarography as a new diagnostic tool enables measuring the pressure between the foot and the floor during dynamic loading. Dynamic analysis of the foot shows advantage over static analysis due to its capabilities for detecting high load points in certain diseases and in certain phases of walking. Pedobarography as a new method in the context of rehabilitation include wide range of clinical entities. Goal: To show the advantages of pedobarography as new diagnostic and rehabilitation method in prevention programs. Material and methods: A prospective study included 100 patients with diabetes mellitus type 2. Research was conducted in the Primary Health Care Center of the Sarajevo Canton and the Center for Physical Medicine and Rehabilitation. The test parameters were: Test of balance–symmetric load for the test, the number of comorbidity, clinical examination of foot deformity, test with 10 g monofilament, HbA1c. From the total sample 45 patients (Group I) were selected, aged 50-65 years, which underwent pedobarography (on the appliance Novel Inc., Munich with EMED™ platform) and robotic fabrication of individual orthopedic insoles, followed by control pedobarography. Plantar pressure was determined using standard pedobarography, computer recorded parameters: peak pressure (kPa), force (Ns), area (cm). Results: The average age of the respondents was 59.4±11.38 years; altered results on the balance test were present in 34% of patients; 61% of respondents have ≤2 comorbidity. In the total sample, the average number of foot deformity was 2.84. Flat feet have 66% of respondents, and valgus position 57%. The average HbA1c values were 7.783±1.58% (min.5–max.15.0). All subjects (45) after the first, and after the second measurement of peak pressure, have values above 200 kPa, or are in the designated zone of peak pressure that needs to be corrected. In a study was determined the correlation between the number of deformities and peak pressure, the number of deformities and the area upon which plantar pressure act, test with 10g monofilament and peak pressure. Conclusion: Within the framework of prevention programs early diagnosis, detection of sensitivity disorders, adequate treatment and taking load from the feet with the help of pedobarography, are of great importance for the patient suffering from diabetes

INTRODUCTION Hypertension represents an important public health problem. Effective treatment of hypertension is imperative for primary care. GOAL The goal of this study was to examine the efficacy of Valsartan in the treatment of hypertension with emphasis on the overall efficacy in reduction of systolic and diastolic blood pressure in a sample of 738 patients. MATERIAL AND METHODS The study lasted for 12 months (from January 1, 2012 until December 31, 2012 year) and conducted in 18 public health institutions in B&H. Parallel follow up of Valsartan antihypertensive effect through repeated measurements every three months was conducted. RESULTS AND DISCUSSION Our results indicate that both systolic and diastolic blood pressure decreased significantly after 12 weeks of Valsartan treatment. Analysis of adverse effects did not showed statistical significance of side effects for total sample. Statistical analysis by Yates chi-square did not show the presence of statistically significant differences in adverse effects by gender. CONCLUSION We conclude that Val or Val plus are effective and safe antihypertensive drugs for the treatment of mild to moderate

In this work, effect of Tamsulosin hydrochloride as antagonist of alpha1A and alpha1B- adrenergic receptor in patients with bronchial hyper-reactibility was studied. Parameters of the lung function are determined by Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was also calculated. Tamsulosin was administered in per os way as a preparation in the form of the capsules with a brand name of “Prolosin”, producer: Niche Generics Limited, Hitchin, Herts SG4 OTW, United Kingdom. Results gained by this research shows that blockage of alpha1A and alpha1B- adrenergic receptor with Tamsulosin hydrochloride (0.4 mg in per os way) has not changed significantly (p > 0.1) the bronchomotor tonus of tracheobronchial tree in comparison to the inhalation of Salbutamol (2 inh. x 0.2 mg), (p < 0.01). This suggests that the activity of alpha1A and alpha1B- adrenergic receptor in the smooth musculature is not a primary mechanism which causes reaction in patients with increased bronchial reactibility, in comparison to agonists of beta2 – adrenergic receptor which emphasizes their significant action in the reduction of specific resistance of airways.