Background: History of pharmaceutical industry in Bosnia and Herzegovina (B&H) has its roots from 1951. Importance of domestic industry not just from economical aspect but also from public health perspective and as scientific base has not been evaluated previously. Objective: The aim of this article was to provide the review of the pharmaceutical industry developments in Bosnia and Herzegovina, its roots, current position and future perspectives.. Methods: Research of published scientific papers as well other documents and archives of pharmaceutical manufacturers has been conducted. We have also analysed market trends focusing on domestic producers. Results and Discussion: Over more than seventy years of B&H pharmaceutical industry has been developing. During Yugoslavia only two companies existed of which one, Bosnalijek is still present, while Sanofarm has been closed. After 1996, expansion of domestic manufacturers started and today six companies are present. They are mainly oriented to generic drugs production in different forms. Total market share of domestic producers in B&H is 20-25% which is relatively low comparing to other countries. Many of domestic manufacturers are exporting their products to some of the most demanding markets in Europe and Middle East. Conclusion: Long history of domestic drug manufacturers in B&H gives solid legacy for future developments. Importance of local producers has been confirmed during war in B&H and COVID-19 pandemic as a crisis situation, mainly from public health perspective and sustainable supply of essential medicines. Higher support by state and collaboration with academia in order to expand portfolio, especially in area of biologic medicines is required in future.

Background: The economic burden induced by all types of Diabetes mellitus (DM) and their complications has reached 1.8% of gross domestic product (GDP) globally. The economic burden of diabetes mellitus in Bosnia & Herzegovina (B&H) is still unknown. Objective: To investigate the economic burden of diabetes in Bosnia and Herzegovina, including the costs of diagnosing and treating diabetes and its complications. Methods: The study was designed as a top-down cost of illness study, based on prevalence, analyzing both direct and indirect costs of DM and complications caused by DM. All types of DM were taken into account, and estimates were based on total B&H population. Costs of services per patient were calculated by multiplication of share of treated population, service utilization data and unit costs. Results: Annual economic burden associated with DM in B&H is around 189 million euro (739 euro per patient), which makes 1.11% of gross domestic product (GDP) of B&H in 2020 (16,993,101,523 euro, according to the World Bank data). The largest part of this burden was created by DM medication and costs of managing complications (heart failure and stable angina being major cost drivers among the complications), followed by laboratory tests and physician visits. Conclusion: Total costs of DM per patient in B&H are within the range of costs in other Central-Eastern European (CEE) countries, reflecting significant economic burden, but also determination of healthcare payers in B&H to provide optimal management of DM in congruence with contemporary clinical guidelines

Background: Studies suggest that applying probiotic skincare products may have beneficial effects on the skin due to bacteria competitiveness and specific metabolites produced by probiotics. The cream CLS02021 is a postbiotic blend of metabolites, including organic acids, enzymes, and peptides that are a result of the co-fermentation of three proprietary probiotic strains and is specific for its high concentration of the enzyme Sphingomyelinase which plays a significant role in cell signaling pathways and ceramide production. Objective: The aim of this study is to evaluate the cosmetic effects of probiotic-derived Ingredient CLS02021 and its safety in healthy volunteers. Methods: Fifty healthy volunteers between 18 and 69 years old were recruited to participate in this multicentric, randomized, intra-individual, double-blind group study. Following a face-split design, volunteers applied both face cream containing CLS02021 on one side of their face and a placebo cream on the other side of their face for a total duration of four weeks, two times a day. Evaluation of the cosmetic effects included instrument measurements of moisturizing, elasticity, wrinkle depth, sebum production, pore size, melanin production, sensitivity, and side effects. Results: A significant difference of CLS02021 over the placebo group was observed for moisture and elasticity increase (both p<0.001), pore size (p<0.01), and a wrinkle depth decrease (p<0.05). No significant differences were noted in sebum production, melanin level, skin cleanliness, and sensitivity between groups. Conclusion: CLS02021, as a probiotic-derived ingredient, showed strong beneficial effects on skin moisture and elasticity increase, wrinkle depth, and pore size reduction. Face cream containing CLS02021 is well tolerated and could be an organic choice for cosmetic hydrating and antiaging skincare treatment.

Background: For many years, pharmacy and medicine were inseparable sciences, so everything that was done in the field of medicine, that is, treatment, can be related to pharmacy. The history of pharmacy therefore also includes the history of medicine, at least until the 13th century, when pharmacy was officially separated from medicine. Objective: The aim of this study was: to describe the books and monographs that are available on the Internet, which deal with the study of the history of Pharmacy; and to show pharmaceutical history museums around the world and their unique collections of pharmaceutical artifacts. Methods: During the preparation of this paper, a descriptive method of analysis from the available literature was used. The analysis of available literature included professional books, monographs, articles and other literature available on online browsers. Results and Discussion: Today there are a large number of societies, academies, associations and foundations dealing with the history of pharmacy. Also, a lot of books, monographs and scientific papers published in on-line databases. The goal of each organization is the research of historical facts in the field of pharmacy and medicine that will be shared with professionals, but also persons who are not from the profession (doctors, librarians, archaeologists, archivists). A large number of museums have been opened for the history of pharmacy, and almost every developed country has such a museum. Such museums represent a national treasure, because they preserve the valuables of pharmacy from the territory of the country, as well as the world.

Background: Alternative The topic of this article is the development of pharmacy in the Middle Ages. Objective: The aim of this paper is to bring readers closer to the development and importance of pharmacy and health activities in general of this century. Methods: This is sistematic review of the published papers about historical facts about development pharmacy in Bosnia and Herzegovina in the past. Results and Discusion: There are few documents that speak and testify about health and hygiene data and opportunities in Bosnia and Herzegovina from the Middle Ages and the time of the independent Bosnian state, because very little was written and mostly knowledge was transmitted by narrative. Bosnia, as an independent state, was first mentioned in the Charter of Kulin Ban in the 12th century. The Charter was sent to the Republic of Dubrovnik and provided safe passage for merchants through Bosnia and tax exemption. The Republic of Dubrovnik also had many influences on the development of all social conditions, including medicine and pharmacy. Doctors and pharmacists were able to come to Bosnia unhindered and engage in treatment and the sale of medicines, without having to fear whether they would pay taxes to the state or be robbed. Conclusion: Until Bosnia came under Ottoman influence, treatment in Bosnia was rather primitive, the number of pharmacies and health facilities was minimal, and hygienic conditions were rather poor. Folk medicine and spells were mainly practiced, which were passed down from generation to generation, by narrative tradition. Only with the arrival of the Ottomans, hospitals and pharmacies began to open, and the health care system was better regulated.

Background: The rich history of pharmacy in Bosnia and Herzegovina has been sporadically dealt with systematically, except by enthusiasts and researchers. The only book on this topic was published in 1958, and after the aggression against Bosnia and Herzegovina, the history of pharmacy was treated mainly as part of the history of medicine. The lack of a culture of memory and a systematic approach to historical heritage brought together a group of experts who deal with this topic in more detail and collect available historical relevant material. Pharmacy as a highly regulated health discipline also in Bosnia and Herzegovina is a legacy of legal acts and documents that depict different periods and the development of pharmacy itself under the influence of circumstances and legislation. Objective: The aim of this paper is to show the development of legislation related to the pharmaceutical sector in Bosnia and Herzegovina through the historical periods of its development. Methods: This is retrospective research based on internet sources, archives and publications available in libraries. Results and Discussion: The available legal regulations and documents through five periods of pharmaceutical development were analysed, from which it can be concluded that the organization of the pharmaceutical industry and its development over time remained stricter. Legal regulations depict the role of pharmacy in the health system, but they also represent sources for further research in this area, and constitute important historiographical material. The analysis of legal regulations speaks volumes about the way pharmaceutical activity is organized, so it is possible to follow the appearance of the first pharmacies, pharmacists, requirements for the quality of medicines, production and the modern role of pharmacists in the health system. Pharmaceutical legislation will certainly be the subject of future negotiations on the accession of Bosnia and Herzegovina to the European Union, and harmonization with the acquis of the EU is expected in the coming period.

Background: The world was struck with a pandemic accompanied by maybe one of the most popular words out there right now, which is COVID-19. It has affected every aspect of life imaginable, especially in the medical sector particularly in our case dental care. Objective: This study goes on to analyse and assess the impact of COVID-19 on dental care in Bosnia and Herzegovina, varying from the staff, patients, supplies/equipment, and finances. Methods: An online survey and over-the-phone surveys were conducted, bringing in raw information to help with this study. Results: In total there were 10 different dental offices that information was obtained from. About 90% say that the pandemic has affected their patient flow, obviously due to some restrictions and regulations. And 60% say that the cost of PPE has increased since the pandemic started, while 40% said otherwise. Other data can be found in the rest of the study. Conclusion: Entering into the pandemic, dental practices quickly started to realize the seriousness of this situation, changing the way they do normal everyday work to accustom to this “new norm”. During such a problem, both sides have to participate to act upon accordingly to bring health and safety for everyone.

Background: Mobile pharmacies are special organizational units or infrastructures that serve to supply medicines to remote communities or are stationed on ships or as such exist during war conflicts on the battlefields to provide first aid to the wounded and to provide the necessary medicines. The establishment of mobile pharmacies is regulated by the law of each state and only preparations approved by law can be found in it. There are also regulations for the good storage and warehousing of these drugs. Objective: The aim of this article was to provide an overview of the available literature on the topic “Mobile pharmacies through history”, which shows the development and progress in the structure and function of mobile pharmacies throughout history. Methods: This is an descriptive study based on the searched available literature from the on-line databases regarding to present a historical overview of mobile pharmacies during the most significant war events in Europe and the USA. Results and Discussion: Mobile pharmacies were first mentioned in Egypt and the Roman Empire, but it was not until 1500 that military and ship’s doctors began using them, and wealthy nobles had their own boxes of medicines, which they carried on long voyages. Mobile pharmacies became more and more popular, so in the 18th century, practical manuals on the use of the contents of the box began to be published. The importance of a mobile pharmacy was shown in the wars, where people, before their appearance, died due to the impossibility of providing first aid on the battlefield. The advanced medicine and pharmacy that developed on land, greatly affected the health care at the sea. The constant incidence of infectious diseases, poverty and inadequate nutrition, insecurity of navigation and long voyages are the main reasons why sailors often fell ill and were exposed to injuries at work. A situation like that required that the problem of health protection on ships gets solved in accordance with the then principles of medicine and pharmacy. Conclusion: Authors demonstrated the importance of mobile pharmacies in treating and providing medical protection on boat trips. Regarding the ship’s pharmacies, pharmacists have the role of supplying ships with medicines, conducting training for captains and ship staff, advising shipping companies and captains on equipping ship pharmacies and advising on the preparation of national regulations and national ship pharmacy supply policy.

Background: Information and communication technologies (ICT) are widely used in a health care as a result of pharmaceutical informatics and technology developments. There is a huge potential for pharmaceutical practice of technologies utilization in a different practice settings especial community pharmacy and patient counseling. Objective: To evaluate Bosnia and Herzegovina (BH) pharmacists` knowledge and attitudes towards informational and communication technologies and extend of its utilization. Methods: Online survey conducted among pharmacists from different practice settings. Results: Pharmacists in BH are familiar and well known regarding importance of informational technologies. 93% are using special pharmaceutical information systems, and majority use technologies and software for prescription processing (47%), calculations (24%) communication (22%) and 9% for Internet search. 90% of pharmacists have profiles on social media mainly Facebook, followed by Instagram and LinekdIn mainly used for networking and communication with peers but less with patients. They have positive attitude regarding potential benefits of using social media for communication with patients and treatment outcomes improvement. Conclusion: Pharmacists in Bosnia and Herzegovina have satisfactory level of information and communication technologies understanding and knowledge. It is of high importance that education of future pharmacist in this field is in line with nature of pharmaceutical informatics in light of its clinical application rather than technical so future pharmacists can contribute to improvements in social media medicines-related information, learn from consumers’ online activities, and design new ways of delivering care to communities and individuals.

Introduction: Diabetes as lifelong chronic disease requires pharmacological treatment using plastic pens and needles. Proper disposal of used pens and needles have impact not just on health but environment as well. In 2020 there will be 3.2 million pens used and disposed in Bosnia and Herzegovina resulting in over 600 tons of this waste. Worldwide problem is related to proper disposal of used insulin pens and sharps. Aim: To investigate and evaluate what are the attitudes, knowledge and practices on insulin pens and needles disposal among diabetes patients in Bosnia and Herzegovina. Methods: The research was conducted in five cities in Bosnia and Herzegovina in period December 2019–January 2020 using questionnaire consisted of 28 questions distributed among patients with diabetes through their local patient associations. Results: Total 250 diabetes patients participated. 40.4% inject medicines for 2 times per day and 37.6% for three and more times a day. Patients have not been instructed on proper disposal of used pens or needles in 67.6% and 66% respectively. The most appropriate place to dispose used pens is pharmacies and 90% of respondents would participate in program of collecting used pens if one exists. 75.6% of respondents consider improper disposal of pens and needles as healthcare problem, 18.8% see this as ecological problem and for 4% of them this is not a problem at all. Conclusion: Current practice of disposing used insulin pens and sharps is improper. Patients are aware of health and environmental risk. There is a huge opportunity for pharmacists and other healthcare provides to provide better information and counseling diabetes patients on this topic.

BACKGROUND Multiple sclerosis (MS) as chronic neurodegenerative disease significantly impact patients' quality of life (QoL). QoL instruments can be generic (EQ-5D, SF-36) and disease-specific like MSQoL-54. Use of disease-specific instruments is preferred since it captures broader symptoms related to MS than generic instruments. Mental health is impacted by MS and different psychiatric conditions significantly impact QoL. We have conducted prospective non-interventional study among MS patients. Aim was to measure and compare MS patients QoL by generic and disease-specific instrument at baseline and after one year and to identify potential correlation between these two types of measurements and to assess mental health scores among MS patients in Bosnia and Herzegovina (B&H) and other countries. SUBJECTS AND METHODS Study included 62 patients diagnosed with MS and treated at Neurology clinic in Sarajevo from April 2016 to May 2017. Study was approved by Ethical Committee. QoL has been measured by EQ-5D and MSQoL-54. Measurement has been performed at baseline and after 12 months. RESULTS Average utility score measured by EQ-5D at the baseline and end of the study were 0.688 and 0.639 respectively with no significant difference (p=0.850). EQ-5D utility and MSQoL-54 score showed high correlation at baseline; rho=0.873 p=0.0001 for physical health and rho=0.711 p=0.0001 for mental health. At the end of the study no significant correlations have been found (p>0.05). High negative correlation found between EDSS and scores measured by EQ-5D and MSQoL-54; at baseline (rho=-0.744 p=0.0001) and at the end of the study (rho=-0.832 p=0.0001). Similar MS impact and loss of QoL found in B&H and other countries. CONCLUSIONS Both instruments can be used in measuring QoL but disease-specific are preferred since they capture broader symptoms impacting MS patient QoL. Using QoL instruments could drive clinician decision and patient-centric care as well as reimbursement and policy decision by recording treatment outcomes.

Introduction: COVID-19 pandemic suddenly affected all countries and health care systems from different perspectives including severe disruption of chronic disease services including diabetes. Diabetes is a serious condition and highly present in Bosnia and Herzegovina population, so provision of diabetes care is a important part of good control. Countries had different responses to adopt diabetes care under new circumstances as well as Bosnia and Herzegovina. Aim: To investigate and evaluate the impact of the COVID-19 pandemic on the provision of diabetology care in Bosnia and Herzegovina from the perspective of patients and diabetologists. Methods: Online survey for diabetologists and patient organizations have been developed with adopted question for different perspectives. The survey has been conducted online early September 2020. Collected data were analyzed in SPSS software for descriptive statistics. Results: 25 diabetologists and 24 diabetes patient organizations responded. 72% of diabetologists believe that pandemic has partially altered work with patients and 56% believe that the organization of diabetes care has successfully responded to the new circumstances but 80% believe that the diabetes care system should change. 75% of patient organizations thought that the organization of diabetes care did not adequately respond and 87.5% believe system should change. Conclusion: No significant differences found between RS and FBiH when it comes to majority of questions. Both diabetologists and patients consider that system of diabetes care in Bosnia and Herzegovina should be improved in future. It has been also found that diabetologists in Bosnia and Herzegovina responded and adopted their practices similar to other countries.