Background: Previous pandemic and catastrophic events significantly changed the life of every human being, bringing him/her into a state of stress and the need to quickly adapt to new ways of daily activity. COVID-19 has a negative impact on all elements of health: social, physical and mental. Pharmacotherapy, as well as protective measures (isolation, wearing masks and maintaining physical distance) did not give the expected results. Vaccination has not yet led to herd immunity, so it is still jeopardizing every aspect of human health (1, 2). Non-pharmacological methods, such as stress and sleep control, physical activity and contact with nature are of great importance since they can significantly contribute to staying healthy during a pandemic. Objectives: The aim of this paper is to evaluate the impact of non-pharmacological measures such as stress and sleep control (with different measures against the negative effects of anxiety and depression on mental state) and the possible positive impact of “forest bathing” on improving the immune response to the virus and its consequences. Methods: Available evidence-based studies on ways to com- bat stress and the effect of the proposed measures on human mental health and the im- mune system were analyzed. From the mentioned studies, recommended measures have been registered, which refer to stress and sleep control, diet and eating habits, contact with nature (“forest bathing”, gardening), virtual communication and meditation (mindfulness practice). Results and Discussion: The combined results of these studies indicate that COVID-19 has a chronic course and complications that significantly affect the physical, mental and emotional state of the patient. Proven positive effects of non-pharmacological measures can be applied in the daily practice of primary health care in the comprehensive fight against the COVID-19 pandemic. Conclusion: Non-pharmacological measures such as stress and sleep control, spending time in nature, healthy diet, and physical activity may improve the immune response to COVID-19. These measures, with their positive effects on all aspects of health, can make a major contribution to controlling and improving the quality of life during the COVID-19 pandemic.

Background: Haematochesia (Lower Gastrointestinal Bleeding (LGIB) is the most common reason for endoscopic examination. Generaly it is caused by hemorrhoids and diverticular disease, but other anorectal conditions can also lead to LGIB. Recurrent bleeding may result in secondary iron deficiency anemia. Colonoscopy is the primary diagnostic option for establishing a diagnosis of colonic bleeding. Objective: This study aimed to analyze symptoms and endoscopic finding (specialy hemorrhoids) who may be sources of LGIB.Second goal of this study is to estimate time from onset of symptoms to performance of a colonoscopy. Methods: A retrospective study included 603 adult patients who underwent colonoscopy in General Hospital “Sv. Apostol Luka“, Doboj, Bosnia and Herzegovina, between 1.1.2020 and 31.12.2020. Results: Average age of the examined population was 62±13,3years. According to the gender they were mostly men. To be exact,by percentage it was 53.7% of men and 46,3% of women, or by number: 324 men and 279 women. The most common indications for colonoscopy were LGIB (48,8%), abdominal pain and irregular stool. Most frequent endoscopic findings were hemorrhoids 42%. Normal findings had almost one third of all examinated patients. Combined findings-presence of more clinical entities in one patient were presented in 95 cases. In the group with hemorrhoids were almost two thirds of males, but there was no gender difference noted in between group with LGIB and without LGIB. More than half patients were older than 61 years. Anemia was presented in almost 20% of cases. Significantly it is higher frequency of abdominal pain, irregular stool and weight loss observed on the group without LGIB. Also, significantly more frequently patients with LGIB underwent colonoscopy in 0-30 days when compared with patients without LGIB (p=0,016). Conclusion: In patients with haematochezia, taking a careful medical history is mandatory. Hemorrhoids, diverticular disease and colorectal cancers are the most common causes of bleeding. Patients with LGIB and abdominal pain were previously examined with colonoscopy. Completely colonoscopy is advocated to detect probable proximal lesions.

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.

Background: From 2013 the World Medical Association’s Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. Objective: The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. Methods: After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. Results: Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. Conclusion: The AMSBH’s decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

Background: Accurate human body composition assessment is becoming very important in clinical practice due to the possibility of early diagnosis and preventive interventions of metabolic disorders. Fats are one of the most important elements in maintaining normal body structure and different methods are used to determine its total amount and distribution. The amount and distribution of abdominal white adipose tissue, and especially the visceral type, provides important parameters in the development assessment of central obesity, insulin resistance, diabetes and other chronic non-infectious diseases. Objective: The aim of the study was to determine the amount of visceral adipose tissue in adults who are overweight and then estimate the probability of developing insulin resistance (IR) in those with higher amounts of visceral adipose tissue. Based on a comparison of the amount of visceral adipose tissue and the frequency of IR, evaluate the clinical significance of a routine procedure for body structure assessment in relation to the amount of visceral adipose tissue. Methods: Subjects were adults of both sexes aged 20 to 77 years, who were patients in two family medicine clinics. Including criteria for the study were: increased body weight (BMI≥25) and normal blood glucose values (4.0 – 5.4 mmol/L). All subjects underwent anthropometric measurements (BMI, waist circumference, waist-hip ratio) and body structure assessment with bioelectrical impedance. According to the values for the amount of visceral adipose tissue (below and above 110 cm2), the subjects were divided into two groups. All subjects underwent an IR test. We used the HOMA 1 value of 2 as a cut off for the risk of chronic non- infectious diseases in non-diabetic population. Results: The study included 80 patients. 14 patients did not complete the study, so the total number of subjects was 66 (39 women and 27 men). 36 subjects had elevated values of visceral adipose tissue (over 110 cm2). In this group, the presence of IR was registered in 30 patients or 81%. In the control group with a normal amount of visceral adipose tissue, IR was registered in 10 subjects or 33%, which is a statistically significant difference. Conclusion: Increased amount of visceral adipose tissue in overweight patients significantly affects the occurrence of IR. For the patients with an increased amount of visceral adipose tissue, it is necessary to introduce intensive preventive measures to stop the development of diabetes and other complications as a result of IR presence.

Background: Enormous number of medical journals published around the globe requires standardization of editing practice. Objective: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). Methods: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. Results: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal’s web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. Conclusions: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals’ quality.

Introduction: Pseudo journals, hijacked journals, fraudulent journals, fake journals, and predatory journals waste valuable research when authors publish their studies in them. Aim: This article described novel suggested features for the identification of fraudulent journals and aimed to explain this issue to help inexperienced scientists avoid publishing in predatory journals. Methods: The articles related to this topic in were retrieved from PubMed and trustable Internet sources. Results: Unfortunately, some fake journals have made their way into reputable databases, such as PubMed, PubMed Central, MEDLINE, SCOPUS, and Web of Science; thus, the serious question has been raised regarding how we should address this problematic phenomenon. We recommended 28 suggested characteristics of predatory journals for readers to take into consideration. Conclusion: Unaware of the detrimental effects associated with publishing in disreputable journals, inexperienced researchers can fall victim to them. Together, as both readers and writers, we should completely boycott predatory journals.

Introduction: COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease. World Health Organization (WHO) declared the official name as COVID-19 in February 2020 and in 11th March 2020 declared COVID-19 as Global Pandemic. In June 6th 2020, over 7 million cases registered in the world, recovered 3.4 million and death over 402.000. Aim: The aim of this study is to retreive published papers about COVID-19 infection deposited in PubMed data base and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection and opinions of experts about treatment of afected patients with COVID-19 who have Cardiovascular diseases (CVDs). Methods: It’s used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVDs. Results: After searching current scientific literature (on PubMed till today is deposited more than 1.000 papers about COVID-19 with consequences in almost every medical disciplines), we have acknowledged that till today not any Evidence Based Medicine (EBM) study in the world. Also, there are no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19, including patients with CVDs. Vaccine against COVID-19 is already produced and being in phases of testing in praxis in treatment of COVID-19 at affected patients, but the opinions of experts and common people whole over the world about vaccination are full of controversis. Conclusion: Frequent hand washing, avoiding crowds and contact with sick people, and cleaning and disinfecting frequently touched surfaces can help prevent coronavirus infections are the main proposal of WHO experts in current Guidelines, artefacts stored on a web site. Those preventive measures at least can help to everybody, including also the patients who have evidenced CVDs in their histories of illness. Authors analyzed most important dilemmas about all aspects of CVDs, including etipathogenesis, treatment with current drugs and use of potential discovered vaccines against COVID-19 infection, described in scientific papers deposited in PubMed data base.

Introduction: COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China’s Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020. Aim: The aim of this study is to search scientific literature in the biomedicine and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection of Cardiovascular diseases (CVD), and other most common chronic diseases which are on the top mortality and morbidity rates in almost all countries in the world. Also, to propose most useful measures how to prevent patients to keep themselves against COVID-19 infection. Methods: We used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVD, and, also, Guidelines proposed by World Health Organization (WHO) and European Society of Cardiology (ESC), and some other international associations which are included in global fighting against COVID-19 infection. Results: After searching current scientific literature we have acknowledged that not any Evidence Based Medicine (EBM) study in the world during last 5 months from the time when first cases of COVID-10 infection was detected. Also, there is no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19. Expectations that vaccine against COVID-19 will be produced optimal during at least 10 months to 2 years, and in all current Guidelines most important proposed preventive measures are the same like which one described in Strategic documents of WHO, in statements of Declaration of Primary Health Care in Alma Ata in 1978. Conclusion: WHO proposed preventive measures can be helpful to everybody. Physicians who work at every level of Health Care Systems, but especially at primary health care level, must follow those recommendations and teach their patients about it. But, the fact is that current focus of COVID-19 epidemic has targeted on protection of physical health of population in global, however, the influence on mental health which will be one of the important consequences of COVID-19 pandemic in the future, and which could be declared as «Post-coronavirus Stress Syndrome„ (PCSS) could be bigger challenge for Global Public Health.