Introduction: Obesity, insulin resistance (IR) and fatty liver (FL) related to modern lifestyle are getting epidemic characteristics and present the most important world public health problem. Obesity, FL and IR are basic parts of metabolic syndrome. Metabolic syndrome is caused by excessive consumption of high-calorie food, chronic stress and unhealthy eating behavior. Current research shows that the digestive system with close realationship with brain has central role for keeping entire health and plays a fundamental role in pathogenesis of insulin resistance and fatty liver, but and many other diseases. Aim of the work: The aim of the paper is to evaluate and summarize new knowledge about relationship between the digestive system and the brain and how disregulation of interaction among them and eating behavior can influence on development IR and FL. Next aim of the work is to find evidence of positive effect of implementation new recommendations for healthy eating behavior, the current dietary and physical activity guidelines on prevention insulin resistence and fatty liver. Results: Current science has shown that food, eating habits and digestive system-brain relationship have a strong and decisive influence on patogenesis insulin resistance and fatty liver. Choosing healthy personal diet and healthy eating habits with a healthy lifestyle gives the opportunity to prevent insulin resistence and fatty liver, cardiovascular diseases, diabetes mellitus and many other diseases Conclusion: Better understanding of new key mechanisms of development insulin resistance and fatty liver lead to the development new therapeutic dietary and nutritional approaches. IR an FL have asymptomatic clinical course, so primary prevention and screening in early childhood are the best way to prevent the beginning and expansion of diseases. Current treatment needs to be based on the principles of personal medicine and focused on healthy lifestyles including nutrition and physical activity.

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-

Objective: Timely recognition and optimal management of atherogenic dyslipidemia (AD) and residual vascular risk (RVR) in family medicine. Background: The global increase of the incidence of obesity is accompanied by an increase in the incidence of many metabolic and lipoprotein disorders, in particular AD, as an typical feature of obesity, metabolic syndrome, insulin resistance and diabetes type 2. AD is an important factor in cardio metabolic risk, and is characterized by a lipoprotein profile with low levels of high-density lipoprotein (HDL), high levels of triglycerides (TG) and high levels of low-density lipoprotein (LDL) cholesterol. Standard cardiometabolic risk assessment using the Framingham risk score and standard treatment with statins is usually sufficient, but not always that effective, because it does not reduce RVR that is attributed to elevated TG and reduced HDL cholesterol. RVR is subject to reduction through lifestyle changes or by pharmacological interventions. In some studies it was concluded that dietary interventions should aim to reduce the intake of calories, simple carbohydrates and saturated fats, with the goal of reaching cardiometabolic suitability, rather than weight reduction. Other studies have found that the reduction of carbohydrates in the diet or weight loss can alleviate AD changes, while changes in intake of total or saturated fat had no significant influence. In our presented case, a lifestyle change was advised as a suitable diet with reduced intake of carbohydrates and a moderate physical activity of walking for at least 180 minutes per week, with an recommendation for daily intake of calories alignment with the total daily (24-hour) energy expenditure (24-EE), depending on the degree of physical activity, type of food and the current health condition. Such lifestyle changes together with combined medical therapy with Statins, Fibrates and Omega-3 fatty acids, resulted in significant improvement in atherogenic lipid parameters. Conclusion: Unsuitable atherogenic nutrition and insufficient physical activity are the new risk factors characteristic for AD. Nutritional interventions such as diet with reduced intake of carbohydrates and calories, moderate physical activity, combined with pharmacotherapy can improve atherogenic dyslipidemic profile and lead to loss of weight. Although one gram of fat release twice more kilo calories compared to carbohydrates, carbohydrates seems to have a greater atherogenic potential, which should be explored in future.

Introduction: Cardiovascular diseases (CVD) are the leading death cause in modern world and are the most public health problem. WHO program for CVD contains: prevention, command and follow up of CVD in global level. Aim: Investigate CVD frequency in family medicine team in 2012.year (one year period of time) and qualitative management prevention and clinical services management quality of CVD together with recommended standards. Patients and methods: clinical revision of clinical standard practice patients with CVD was provided in Family medicine team in Public Health Centre Tuzla for the period of time from January 01 2012 - December 31 2012. For quality of realized services, AKAZ standards were based for: chapter 2. Health promotion and diseases prevention 2.5. preventive clinical services; chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke. From CVD register next parameters had been used: age, gender, disease diagnose, therapy, blood pressure values, total cholesterol values, ß blockers therapy, anticoagulant therapy prescription, smoker status, stop smoking recommendation and influenza vaccination recommendation. Statistical approach: All results were taken in Excel program and statistically analyzed. Descriptive standard tests were taken with measurement of central tendency and dispersion. For significant differentials achieved with χ² chances relation was taken (Odds Ratio-OR) with 95% relevant security. All tests were leveled in statistical significant from 95% (p<0,05). Results: Considering total registered habitants number 1448 (males 624 females 824) total diseases of usually CVD in Team 1 family medicine 531 (36,67%). The most frequent disease was hypertension which was presented in 30,31% of registered patients but in total CVD illness was present in 82,67%. In relation with total patients number (531), female prevalence from CVD 345:186 males vs. 65%:35%; P=0,001 and was statistically significantly higher. Almost patients were in age from ≥65 years. Nearly all the standards for chapter 2. Health promotion and diseases prevention and chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke are met in larger percentages than the minimum, however, bad quality signs we have found in total cholesterol control were values of total cholesterol were ≤ 5mmol/l achieved only in 27.58% patients with CVD. Stop smoking recommendation in smokers with TIA and Stroke (total 10 smokers) was registered in 20,00% patients. Indicator was not achieved,(min level 25%). Conclusion: Role of family medicine team is extremely important in patient care who suffer from chronically noncontagious diseases such as CVD, as one of them. Considering that in our country preventive programs for CVD are at small level, results of this study are acceptable. Our plans for personal continuous educations and patient educations about healthy life style are pointed for higher or average of achieved standards and of course everything what have to be done should be written in personal dates of patients.

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.

Objective: The aim of this study is to confirm the effect of one month dietary treatment on the level serum lipids (cholesterol and tryglicerides) and aminotransferases in overweight patients aged over 50 years. Methods: In agreement with the respondents we requested that they immediately only reduce consumption and that in the reporting period use only food without the use of pharmacotherapy (fat lowering agents and lipid lowering medications). The reason for this assumption is that there is physiological variation for biochemical and hematological examinations by number of internal and external influences determine the size of physiological changes, as well as the necessity of the necessary concentration of certain nutrients for basal metabolism, and function of the body–cells or metabolites. These same subjects, we monitored the frequency of the results, the results of blood glucose, cholesterol, triglycerides, aminotransferase, acidum uricum creatinine after 1 month. The study was carried out on a targeted sample of 10 respondents in the Primary health care center in Gracanica for a period of 30 days. The tests on this sample were conducted survey on health status and nutrition, HIV treatment and diagnosis. Findings: Thee results show that there is an increased number of obese subjects. The paper analyzes the results of biochemical tests in subjects aged over 50 years. On the target medical and biochemical laboratory diagnostic examinations in 10 subjects of both sexes were observed: elevated results of blood glucose, cholesterol, triglycerides, aminotransferase, uric acid and creatinine. It was also observed the fact that most patients was with increased body mass (BMI = and> 25). It has been observed continuous decline or normalization of laboratory test results after one month. Conclusion: There is a growing number of people who are overweight (BMI 25-30) and obese (BMI> 30) due to poor habits, which is dominated by excessive calorie intake. Due to the increased supply of food nutrients: glucose and/or triglyceride, cholesterol, protein in the body, there is increase in the metabolism of carbohydrates, proteins, nonprotein compounds, purine and lipid, with an intense oxidative processes in the mitochondria in particular fat cells and liver disorder utilization of glucose, lipids, purine. As a consequence, the pathological results: higher levels of glucose in the blood, cholesterol, triglycerides, uric acid, creatinine and aminotransferase were observed.

Introduction: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. Aim: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health. Results: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.

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.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and

AIM To analyse the difference in documentation of standard parameters for monitoring DM type 2 between Family Medicine Teams (FMT) and Teams on Program Additional Training (PAT). METHODS Study was conducted as 20 medical chart audits of diabetic type 2 patients randomly selected per 3 FMT from Zenica and 3 PAT from Kakanj. According to the chart, we assess sex, age, glucose in blood-GB, blood pressure-BP, total cholesterol-TC, body mass index-BMI, HbA1c, foot exam, eye exam and urinoanalisis and have any of the tests been done in the past year. RESULTS 60 medical chart from FMT and 60 medical charts from PAT teams were reviewed. FMT vs. PAT teams recorded: BG 58% vs. 30% (X2 = 8.651, p = 0.003); BP 70% vs.33% (X2 = 14.716, p = 0.0001); TC 35% vs.22% (X2 = 2.011, p = 0.156); BMI 48% vs.28% (X2 = 4.266, p = 0.038); HbA1c 41% vs.75% (X2 = 12.377, p = 0.0004); foot exam 26% vs. 78% (X2 = 28.158, p < 0.0001); eye exam 48% vs. 65% (X2 = 2.749, p = 0.097) and urinoanalisis 38% vs.88% (X2 = 30.179, p < 0.0001). CONCLUSION FMT recorded a higher number of metabolic parameters for macrovascular risk factors (BG, BP and BMI) than microvascular risk factors (HbA1c, foot exam and urinoanalisis) which are were better controlling by PAT teams.