Introduction: Gastric MALT lymphoma accounts aproximately 7% of all gastric tumors. Women are mostly affected by this disease (mean age 60 years). The aim of this study was to determine the incidence of gastric MALT lymphoma in the Endoscopy Unit of the Department of Gastroenterology Of University Clinical Center Tuzla, the degree of histological malignancy and correlation with the Helycobacter pylori infection and then to evaluate the effectiveness of triple-antibiotic therapy (protonic pump inhibitors and antacides) in treatment of these cases. Patients and methods: All the patiens in the study were performed with gastroscopy and mucosal tissue biopsy in the Endoscopy Unit of the Department of Gastroenterology of UKC Tuzla. PHD and IHH analysis of the given material were performed in the Patology Department of UKC Tuzla. The blood analyses on H. Pylori were done in the Department of Microbiology of UKC Tuzla. Results: 112 patients with gastric tumors were involved in this study, 91 of whom suffered from malignant tumors, six of them had MALT lymphoma (five of them had confirmed H. pylori infection, four had histologically confirmed low-grade tumors and two was categorised as high grade malignancies). Histological lesions were classified according to the actual Ann Arbor classification. Patients with high malignancy risk underwent the operative procedures, and then were treated by polychemiotherapy (CHOP protocole, VI-VIII cikluses). All the patients with confirmed H. pylori infection were treated with antibiotics for 2-4 months, after which complete eradication was accomplished in all cases. Patients histologicaly diagnosed with low grade malignancy showed complete histological regression. In addition to that, after triple antibiotic therapy none of the patients presented with the disease transformation into another histological form. Discussion and Conclusion: The results of this study prooved high incidence in use of triple antibiotic therapy in treatment of patients who suffer from MALT lymphoma with confirmed H. pylori infection. Besides, it is very important to emphasise the fact that patients had no side-effects during polychemiotherapy which was used to treat all the patients regardless of their histological type and malignancy degree of MALT lymphoma.

AIM Prospective vertical cross-section study has been conducted with an aim to determine the prevalence for the consumption of the psycho-active substances and correlation between consumption and quality of life of sixteen year old adolescents in Tuzla Canton. METHODS Cluster sample is used with a class as the main sample unit. Information were collected through anonymous questionnaires consisted of social-demographic questions, then questions related to the use and consumption of psycho-active substances, as well as of questions related to the quality of life of adolescents (content with family, friends, financial status, health status and personal self-content). RESULTS 356 students are included in this survey. Almost half of examinees smoked cigarettes at least once in a life, and about 80% use alcoholic beverages. Marihuana is used by 7% of students. Boys lead in consumption of alcohol and marihuana in relation to girls (alcohol; P=0.001; marihuana; P=0.001). 10.9% of students used tranquilizers without the prescription of the relevant doctor and 2.2% students used tranquillizers with proper doctor's prescription. Common thing, related to the consumption and use of all three substances, was the fact that friends use it as well (tobacco p=0.31; alcohol p=0.36; marihuana p=0.44; P=0.001). There is also significant correlation between alcohol consumption of the parents and their children (father use alcohol p=0.22; mother use alcohol p=0.21; P=0.001). Discontent with family financial situation expressed 23% students. Low self-respect of the examinees is statistically significantly connected with the use of all three substances (marihuana p=0.17; p=0.001; alcohol p=0.13; P=0.05; tobacco p=0.11; P=0.05). CONCLUSION Important and significant factors for the prevention of this public and health problem are: good communication with parents, selection of friends, prevention of the psycho-active substances use by the parents, improvement of social and financial condition in the family.

INTRODUCTION Diabetes currently affects more than 170 million people world-wide, but the World Health Organization (WHO) expects that the number of patients will double within the next 20 years. Diabetic nephropathy (DN) is the leading cause of kidney disease in patients who need renal replacement therapy. It is defined by increased urinary albumin excretion in the absence of other renal diseases. The goal of the study is evaluation of DN in older patients with diabetes mellitus (DM) type 2. PATIENTS AND METHODS Prospective study has been used to analyze 182 patients of old age with DM type 2 according to the criteria of WHO. According to the concentration of albumin in urine the patients were divided in 2 groups: the patients who have confirmed type 2 DM with DN and patients who have confirmed type 2 DM without DN. The following parameters were determined and compared in both groups of patients: age, sex, duration of diabetes, concentration of glucose in blood, microalbuminuria, blood pressure, smoking, obesity, and family history with kidney disease. Albumin/ creatinine ratio was calculated and concentration of albumin in urine was tested by specified albumin straps. RESULTS The prevalence of type 2 DM in the health care center is 3.64% and prevalence of DN is 24.72%. Results show that duration of DM type 2 is significantly longer in patients with DN (p<0.0001) and concentration of albumin in urine is inreased (p<0.0001), and that significantly higher concentration of HbA1c (p=0.005) and increased creatinine in serum (p=0.04) is present when compared with patients without DN. This study did not find evidence of age, sex, blood pressure, smoking, obesity and family history with kidney disease as risk factors in genesis of DN. CONCLUSION Duration of DM type 2, increased concentration of glycosyllated HbA1c, and increased creatinine in blood are the risk factors in genesis of DN in older patients with DM type 2.

SUMMARY Acute mesenteric ischemia is one of the most important urgent states in internal medicine. Diagnosis set on time is the key to success in treatment of this disease. In practice, setting adequate diagnosis is usually lat, because the first symptoms and physical findings were not proportioned to pathogenic changes. When a complete clinical picture of illness develops with signs of ileus and septic shock it is usually too late for adequate treatment. Early diagnosis can be set, if during the occurrence of acute abdominal pain in patients who have status with precipitating factors for the formation of emboli, thrombosis and mesenteric vasospasm, in the early evaluation of disease thought to the possibility of acute mesenteric ischemia, and undertake specific diagnostic procedures. In the first place we must distinguish urgent situations of mesenteric vascular diseases that are made by embolism and thrombosis of superior mesenteric artery (AMS) from chronic states such as chronic mesenteric ischemia or intestinal angina, celiac compression, ischemic colitis and chronic mesenteric venous thrombosis. This article shows the case of patient with acute mesenteric ischemia – arterial thrombosis, which had predisposing factors and has developed an image of vascular ileus. Color Doppler and standard abdominal ultrasound can detect the disease at an early stage, and set the indication for arteriography procedures and surgical procedures.

Ultrasound (US) has been recognized as a powerful tool for use in the diagnosis and evaluation of many diseases in clinical practice. The possibility of immediate bedside US examinations in the evaluation of specific emergent complaints makes it an ideal tool for the emergency specialist. Correct diagnosis of potential life-threatening emergencies such as hematoperitoneum following blunt trauma, abdominal emergencies, ectopic pregnancy, pericardial tamponade, and aortic aneurysms with US evaluation can be easily made. Emergency physicians now view screening ultrasonography as highly focused and limited to answer on select set of questions. These questions include: Is there a pericardial effusion present? Are there gallstones present? Is there hydronephrosis evident? Is there free peritoneal fluid? Is there intrauterine pregnancy? Is there an abdominal aortic aneurysm (AAA) present? Is there a foreign body? It is clear that emergency screening ultrasound is now accepted tool for the rapid evaluation of the emergency patient. Using this effective diagnostic and therapeutic tool in emergency units our patients will have efficient, safe, and accurate health care.

Emergency medicine is a clinical and academic discipline that does not deal with certain specific diseases or organic systems. This discipline is characterized with a comprehensive approach to the patients which is in a state of vital threat regardless of the nature and etiology of the disease which leads to such state. In the institutions of emergency medicine all patients arrives at any time of the days regardless of age and a range of symptoms so that emergency medicine applies clinical diagnostic and therapeutic methods of all other clinical disciplines in order that in the short period of time discover the cause of vital functions disturbance and apply emergency therapeutic procedures. All emergency states from all clinical disciplines belongs to the emergency medicine which leads practical management based on specific principles and approach to this kind of patients. Development of technology and application of new diagnostic procedures enabled doctors in emergency medicine to introduce effective diagnostic management during the first contact with the patient and to avoid costly and long hospital procedures. Ultrasonography examination is already for a long time important methods in all clinical disciplines, so it is inevitably applied in emergency medicine. Ultrasonography diagnosis has a high sensitiveness and specificity of most frequent illnesses at the departments and emergency wards, so the mobile ultrasonic device as an integral part of the equipment of family doctors may constitute “visual stethoscope “, especially important and indispensable in emergencies. This method applies the ideal technology achievement for nearly all the emergency sates and which is proven based on the needs in practice, on the basis of scientific facts based medicine and the recommendations of the World Health Organization (WHO) for the obligatory of application of this method in centers for emergency medicine. Additional benefits are simple handling of the machine and the possibility of repeated examination and monitoring of the dynamic pathological changes. Necessary practical and theoretical knowledge can be gained during under and post-graduate education within the framework of existing programs.

Objective To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. Methods A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Results Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9–5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (ρs=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother–children relationship with index case (13/31; 41.9%) than among those with father–children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88–65.21; P<0.05). Conclusion In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.

Colorectal cancer occurs in the familial cancer syndromes in about 2 to 4 percent. The major genetic syndromes are Familial adenomatous polyposis (FAP) and Hereditary nonpolyposis colorectal cancer (HNPCC). FAP is caused by germline mutation of APC gene, and HNPCC is caused by germline mutation in one of five MMR genes. The identification of patients with inherited disease is very important in the management of colorectal cancer. But, it is impractical to test every patient with the disease for these mutations. The clinical and genetical screening programme should be advised for family members at risk and colectomy in affected individuals in purpose to reduce the frequency of colorectal cancer.

UNLABELLED The gallbladder cancer is the most common primary cancer of the hepatobiliary system, and ranks fifth of the cancers of the gastrointestinal system. It is accidentaly found in 1-3 % of patients with gallstone disease, and in 0,5-2,4% on postmortem exam. GOAL Show the incidence, clinical state, and suplement the diagnostic procedure of the patients with the risk factors for gallbladder cancer. Find proper surgical treatment in every stage of the disease according to Nevin-Moran system and the hystological type of the cancer. METHODS Retrospectively we evaluated all cholecystectomies in our hospital in a three year period. We established the incidence of gallbladder cancer and we tried to discover the common characteristics of this group of patients. We analized the histological type of the cancer, and the stage of the disease in correlation with clinical presentation, results of the surgical treatment , and the survival and the quality of life. RESULTS In three years we performed 2553 cholecystectomies, and in 1,7 % of patients -43 patient we discovered the cancer of gallbladder. It is 5 times more common in females. The mean age of the patients with gallbladder cancer is 65 years (55 - 82 years). The etiology of this disease is unknown. In 5 (11,6 %) patients cancer is discovered preoperatively. In 38 (88,4 %) patients it was adenocarcinoma of the gallbladder. Other morphologic types are analplastic cancer, carcinosarcoma, and "squamous cell carcinoma". In 30 patients (69,8 %) we performed cholecystectomy, and in 8 (18,6%) patients extended cholecystectomy with its components. Radical resective procedures on liver were performed in 5 (11,6%) patients. According to the localisation in 60% of cases the cancer was located in fundus, in 30% of cases in corpus,and 10% of cases in the neck of the gallbladder. No patient with stage V survived 1 year after the procedure. CONCLUSION The incidence of the gallbladder cancer in our series is in the slight increase. The quality of life and the survival are inversely correlated with the depth of the invasion and the extent of the spread of the cancer. The extensive surgical procedures in advanced stage of the disease, because of the grim prognosis, does not justify the risk of the operative treatment.

AIM to determine impact of passive and intensive education on values of HbA1c, blood pressure, total cholesterol, triglycerides, mass body index as well as on practicing of recommended physical activity and habit of smoking among patients with type 2 diabetes. METHOD From 130 patients with type 2 diabetes questioned, 91 completed cycles of 3 months of passive and 3 months of intensive education. It took place in 4 family practices on Tuzla Canton from December of 2004 to December of 2005. For this purpose the Michigan Diabetes Knowledge Test was used for assessment about disease knowledge. Disease control was also assessed at the same time of diabetes knowledge testing, at the beginning, after 3 months and after 6 months of education. RESULTS After a passive and intensive education there has been a significant improvement (P < 0.05) on the following parameters of disease control: HbA1c, systolic and diastolic blood pressure and total cholesterol, however the difference in triglycerides, body mass index, smoking habits and practicing of regular recommended physical exercise statistically was not significant after passive and intensive education. CONCLUSION The total effect of passive and intensive education of patients with type 2 diabetes in our research resulted in improved metabolic control of the disease.

The experience in our surrounding throughout many years, based on Europeans and Worlds standards of health care service, gives the advantage to the Primary Health Care Service, with well educated family doctors and nurses who work in a community and give cheaper and quality health service. The paper presents a view of Family Medicine development in B&H during the last thirty years, and the most important projects realized in that period.

Liver abscess is a rare complication of sigmoid diverticulitis and must be considered within the differential diagnosis. We report a case of a male patient, age 71, admitted to our hospital with chief complaints of a dull pain in upper right abdominal quadrant, fever and weakness of approximately 5 months duration. He had a history of a surgery 18 years ago after an episode of diverticulitis. Physical examination and biochemistry on initial work-up revealed tenderness on palpation in upper right abdomen, leukocytosis and a 39 degrees C fever. Ultrasound examination revealed round structure with low echo properties in the right lobe of the liver. Further CT scan examination confirmed an abscess collection. We performed ultrasound guided percutaneous catheter drainage with intravenous administration of broad spectrum antibiotics, resulting in a successful treatment of a liver abscess. Colonoscopy confirmed sigmoid diverticulitis which was the most likely the source of bacterial invasion through portal venous system.

Significant increase in mortality from coronary heart disease (CHD) has been seen in Bosnia and Herzegovina in the past decade. Little is known about current secondary preventive practices and treatments among patients with CHD in primary health care. The aims of this study were to evaluate the components of secondary prevention for CHD and to detect possible gender differences. This trial included 70 patients, aged 40-70 years, with established CHD from Family Medicine Teaching Center Tuzla. We evaluated components of secondary prevention (serum total cholesterol and blood pressure levels, smoking habits, body mass index, using aspirin, ACE inhibitors and lipid lowering drugs) in all participants. Results showed that significantly more men than women had diagnosis of CHD. 26/70 (37.14%) patients had myocardial infarction, with significantly higher number of men than women, but more women had angina only. Mean systolic blood pressure was 148.09+/-20.22 and diastolic 91.62+/-10.17 mmHg; mean total cholesterol level was 6.23+/-1.33 mmol/l; mean BMI was 27.9+/-3.32 kg/m(2). Blood pressure was managed according to guidelines in 19 (27.14%), and lipid concentrations in 11 (15.71%) patients. 55/70 (78.71%) patients took aspirin, only 18/70 (25.71%) patients took lipid lowering therapy, and 20/23 (86.96%) patients with heart failure took ACE inhibitors. 16/70 (22.86%) patients were current smokers, only 19/70 (27.14%) patients had healthy body mass index, while 21/70 (30%) patients were obese. Results of this study show a suboptimal secondary prevention in primary health care, which indicate more effective public health messages and changes in the healthcare system that promotes preventive strategies.

Food is prerequisite for development, growth, retain vigor and progress of one person. Food can be helpful in treatment of one person, but also it can be the cause of disease named "the obesity". The obesity today getting a epidemic form and become the most difficult problem in many countries for health workers. This problem has to be taken very seriously to be solved. This article is about what the obesity is, possible causes of it, which health problems the obesity provokes and how to treat it.