BIMA
- FIMA INTERNATIONAL CONVENTION
June 2001
Bosnia and Herzegovina
ABSTRACTS
MATERNAL
AND CHILD HEALTH
ABSTRACTS:
SEXUAL ATTITUDES, UNWANTED PREGNANCY AND UNSAVE ABORTION
Jurnalis Uddin, Research Institute, Yarsi University, Indonesia
The
sexual attitudes of the contemporary Asian people as depicted
by TIME magazine in its March 19, 2001 edition are prone to be
similar to that of the western people. The work of Saifuddin and
Hidayana (1999) depicts the sexual attitudes of the contemporaryIndonesian
Muslim youth. By taking 2 big cities and 2 villages that lie in
2 different Indonesian big islands as their place of study,they
come to a solid conclusion that the sexual attitudes of the Indonesian
youth is already get caught with that has been achieved by their
peer in Asia. One of the consequences of this trend is unwanted
pregnancy. But the change of the sexual attitudes is not the only
reason of the continuous rising numbers of unwanted pregnancy.
Physical and mental health, contraception failure, rape, incest,
fetus is diagnosed to have untreatable genetic disease are compelling
reasons why they seek save abortion. But in most developing countries,
including Indonesia, induced abortion is regarded as a criminal
act and deserved to be jailed. In facing an unmarried teenage
girl who has been forcedly conceived by a rapist or a crook, the
Indonesian ulamas heartlessly advise the girl to marry the rapist
and wait until the baby is borne. The ulamas totally ignore the
mental, psychological, social and cultural impact of a marriage
that should be faced by the girl and her family. An induced abortion
is only open to those whose pregnancy will threaten the life of
the women. In some Islamic countries such as Turkey, Kuwait, Sudan
and Iraq their law allow their people to have induced abortion
not only if the life of pregnant women is threaten of the existence
of the fetus, but also if the women have physical and mental ailment,
the pregnancy is due to rape of incest or if the fetus has untreatable
genetic diseases. Up to date there is no sign that the Criminal
Law and the view of ulamas in Indonesia are going to be reviewed.
To overcome this dead alley, it is now left one solution that
is to socialize the use of secondary or emergency contraception
that effective if used sex within 72 hours of unprotected sex.
CAUSES OF THE MORTALITY IN THE LOW BIRTH WEIGHT INFANT
Maksić
H1 , Heljić S1 , Begić K2, Beganović
N2, Maksić S3
1Pediatric
Hospital, University Clinical Centre Sarajevo, Bosnia and Herzegovina
2Gynecology-Obstetric Hospital, University Clinical Centre
Sarajevo, Bosnia
and Herzegovina
3Bone Surgery Hospital, University Clinical Centre Sarajevo,
Bosnia and Herzegovina
All newborns with birth weight less than 2500 gramms regardless
to gestational age are considered as the group of “Low Birth Weight
Infants” due to many similar attributes, like: difficulties with
adaptation on extrauterine life, needs for special neonatal care,
specific morbidity, and risks for long-term outcome. The aim of
this study is the estimation of the mortality rate and mortality
causes according to clinical feature and laboratory findings by
retrospective study in two-years lasting period, from 1.1.1999.
to 31.12.2000., in the Gynecology-Obstetric Clinic and Neonatal
Intensive Care Unit of the Pediatric Clinic, Sarajevo. Extremely
Low Birth Infants (birth weight lower than 1000g) and extremely
premature infants (less than 28 gestational weeks) were excluded
from the study. During this period, 43 Low Birth Weight infants
(Birth Weight 1000-2500 g) died, or 10,3% related to total number
(n=416) of the same population of live births. Group of dead infants
was analyzed by birth weight and by gestational age: more than
half, that is 53,5% (23/43) belonged to the group of Very Low
Birth Weight (1000/1500 g), 76,6% (33/43) were with gestational
age 28-32 weeks. The
main cause of mortality was sepsis and its complications in 41,9%
(18/43), RDS 25,6% (11/43), lung complications of mechanical ventilations
20,9% (9/43) and 11,6% (5/43) death was caused by the other, less
common reasons.
ESTABLISHING OF SUCCESSFUL BREAST-FEEDING
Beganović
N1, Dizdarević J1, Heljić S2,
Maksić H2:
1Gynecology-Obstetric Hospital, University Clinical Centre
Sarajevo,
2Pediatric Hospital, University Clinical Centre Sarajevo,
Bosnia&Herzegovina
Mother’s milk is biologically superior substance with practical
and physiological advantages. It makes possible for child to grow
and to develop normally, protects child from infections and atopic
skin disorders and helps to foster emotional mother-child interaction.
95% of mothers are physically capable to breast-feed their babies.
Material and
methods: We retrospectively analyzed a sample of 150 mothers/term
infant pairs: a hundred after spontaneous vaginal delivery and
fifty after Cesarean section. Infants were brought to their mothers
for breast-feeding after first half an hour of life, with giving
to the mothers’ sufficient encouragement and support. The advantages
of breast-feeding and breast-feeding techniques are explained
to mother by physicians and by video techniques. After initial
nursing, infants were brought to the mother for the further feeding
“on demand”. The mothers delivered by Cesarean section are received
their babies for initial breast-feeding 12 hours after delivery.
Results:
At the first controll, one and half month later, we found that
55% (55) of mothers after spontaneous delivery exclusively breast-fed,
30 % (30) use breast-feeding together with formula feeding, 15%
(15) did not breast-feed at all, and mothers delivered by Cesarean
section in 40%(20) ceases exclusively breast fed, et 50% (25)
use breast-feeding together with formula feeding and 10% (5) did
not breast feed at all.
Conclusion:
This result can be estimated as a very successful in both of groups,
generally 85% in infants born by spontaneous delivery and 90%
in infants born by cesarean section. Good results are caused by
stuff activities in promotion of breast-feeding.
Recommendation.
All Maternity wards should have written instructions, which lead
to the successful breast-feeding with additional education of
health workers.
ATTITUDES AND KNOWLEDGE ABOUT EPILEPSIES AMONG TEACHERS OF PRIMARY
SCHOOLS IN SARAJEVO
Zubčevic
S., Gavranović M.*, Alečković M., Buljina A.;
Pediatric Hospital, Clinical Center University of Sarajevo, Bolnička
25, Sarajevo, Bosnia and Herzegovina
*Neurology
Hospital, Clinical Center University of Sarajevo, Bolnička 25,
Sarajevo, Bosnia and Herzegovina
Epilepsies are state of primarily cerebral origin, characterized
by recurrent episodes of disturbed consciousness, movement, senses
or behavior. They often start early in the childhood,and last
throughout adolescence and on, that means period in which child
gets most of its education. Social attitudes regarding these patients
actively influence treatment of child, and in certain degree determines
its outcome and future of patient. Progress in social and human
attitudes is accompanying development of medicine in last decades.
Preserving of personal integrity is becoming benchmark of successful
treatment. Patient is fully recognized in normal society. Unfortunately,
throughout the world, and in our country, there are lot of superstitions
and ignorance in dealing with epilepsies. Lack of understandingof
the essence of disease leads to fear, that leads to prejudice.
One of the most critical parts of society that do not get enough
of health information is a teacher.
They do not get appropriate data for dealing with chronically
ill child. One
hundred of primary school teachers in 5 public primary schools
in Sarajevo were randomly assigned to fulfill the questionnaire
with 15 questions that reflected their attitudes and knowledge
about epilepsies. On the basis of results and comparing them to
results of other authors it is concluded that: ·The
knowledge of primary school teachers in Sarajevo about epilepsies
is in between the one that we find in developed countries of Western
Hemisphere and the one that we find in developing countries of
the Third world. ·Influence
of prejudice that are
accompanying persons with epilepsies, which are part of traditional
comprehension of the disease, on attitudes of primary school teachers
is still significant.
THE
EFFICACY OF CHLORAL HYDRATE FOR SEDATION IN CHILDREN
Hadžagić-Ćatibušić
F1, Krehić J2, Zubčević S1, Maksić
H1, Džinović A1
1Pediatric Hospital, University Clinical Center Sarajevo
2Department of Clinical Pharmacology, University Clinical
Center Sarajevo, Bosnia & Herzegovina
Chloral hydrate is one of the drugs the most frequently used forsedation
of the children, undergoing radiological imaging studies, and
medical and dental procedures. The increasing use of neuroimaging
techniques in pediatric neurodiagnosis has made the problem of
sedation for pediatric brain and spine examinations very actual.
The main principles
of sedation are safety and efficacy.
Goal:
The goal of the study was to determine the adequate protocol for
sedation with chloral hydrate and its efficient and safe dose.
Patients
and Methods: The study has included 60 children, who have been
given chloral hydrate rectally prior to electroencephalography
(EEG), computed tomography of the brain (CT) or magnetic resonance
imaging of the brain (MR). Each
child has been sleep deprived before chloral hydrate administration.
Results: The age range of the patients was between 2 months
and 5 years, with mean age 19.5 months. 54 children (90%) have
been successfully sedated and 6 sedation failures have happened
(10%). 32 patients have been sedated for EEG recording, 21 for
CT of the brain and 7 for MR of the brain. The average dose
of chloral hydrate for EEG recording has been 69.5 mg /kg body
weight, with the highest dose in the age group 24-36 months,
which was 74.15 mg/kg body weight. The average dose of chloral
hydrate for computed tomography of the brain has been 83.2mg/kg
body weight, with the highest dose in the age group 6-12 months,
which was 103.42mg/kg body weight. The average dose of chloral
hydrate for MRI of the brain has been 62.38mg/kg body weight,
with the highest dose in the age group 0-6 months, which was
94.25mg/kg body weight. The mean time of sleep deprivation before
the administration of chloral hydrate has been 2 hours 55 minutes.
Conclusions: It is necessary to establish a written protocol
about chloral hydrate sedation. Preparation of the patient and
family is
essential for successful sedation.
Printed literature and specially prepared video presentation
are both helpful for parents and children. Sleep
deprivation is an important component of the chloral hydrate
sedation efficacy. Properly sleep deprived child could be sedated
efficiently with lower dose of chloral hydrate EEG
recording could be successfully done with lower dose of chloral
hydrate in comparison to CT and MRI of the brain.
THE FREQUENCY
OF CHILDREN TRAUMATISM AND ITS IMPORTANCE THROUGH THE ORGANIZED
SYSTEM OF EMERGENCY CENTRE (CUM)
G.
Halilbegović-Dedović, Z. Hadžiahmetović: Clinical Centre of
University Sarajevo, Sarajevo, Bosnia and Herzegovina
Emergency Centre was founded in 1994. in “extraordinary” circumstances
as the result of need for union of Admission Units in Traumatology,
Orthopedic and Surgical Departments, into Central Unit for Triage
and Admission. This Central Unit includes the medical team composed
of surgeon, orthopedist, traumatologist, and anesthesiologist,
who are responsible for patients triage. After war ceasion the
organisation has changed and the medical staff of Emergency Centre
(CUM) takes over more and more patients care. Reviewing
the present materials we made evaluation:
-
Frequency of children trauma -
Injuries localisation regarding organ systems -
Distribution according to other surgical subjects -
Possibilities in definite treatment of these injuries by CUM
This study comprised injuries of children age from 0-18 years
in the 4years period from January 1995.-December 1998.
The analysis
was retrospective, and data was collected from Admission register.
The total number of injured children in that period was 7157.
The distribution of injured people according to year reporting
was carried out (the greatest number was in 1998.), as well as
according to gender (60% males), age (the most frequently in the
age of 10-15 years) and injuries sites according to organ systems
(locomotoric system 58%). The most common accepted pathologic
material in closed injuries was contusion (40%); in wounds, it
was lacerocontusion wound (18%). The
isolated trauma was present in 84% injured children;
multiple trauma in 15,5%, and polytrauma in 0,5%. After patients
care in Emergency Centre (in this 4-year period), the majority
of children (41%) was referred to Bone Surgery Clinic, and 37%
to home care. Primar
surgical wound care was done in the small operating theatre of
Emergency Centre in 15% children. We
analysed our possibilities in definite care of injured people
and made conclusion: The
universal algorythms of patients care, greater coordination of
medical teams with single responsibilities of each member of the
team in ABCD care system, as well as CT diagnostic and Unit for
putting plaster cast in CUM, should improve the union of Admission
Units and also enable medical staff improvement as well as independent
and more qualitative medical care in Emergency Centre.
POSTTRAUMATIC STRESS DISORDERS
ABSTRACTS:
SEXUAL VIOLENCE DURING THE WOMEN PSYCHOLOGICAL PROGRESS AND RAPE
IN WOMEN MATURE AGE
Salčić-Dizdarević
D.: Clinic of Psychiatry – Clinical Center of Sarajevo University,
Bolnička 25, Sarajevo, Bosnia and Herzegovina
As a result of clinical experience (clinical psychiatric diagnostic
and psychotherapeutic treatment), it is pointed out at psychodynamic
and psychopathologic features depending on women age in which
the sexual violence happened, and in which form. Sexual
violence in the early stage of psychological progress have as
result the psychopathology and psychodynamic in wide range, from
severe personality disorder, over borderline reactions to different
features of non-psychotic disorders, but always with severe disturbances
of feminine identification. Rape in these early stages, according
to literature review, are always in greater correlation with severe
psychic disorders. Repeated erotic long-lasting violence is in
greater correlation with non-psychotic disorders. Etiopathogenetic
factors of rape, i.e. violence, including a lot of unconscious
resistances, were considered in this group (in the beginning in
fragments). In
the group where women are raped in mature age, psychopathology
is characterised by predominantly developed clinical feature of
posttraumatic stress disorder with unrare mobilisation of comorbidity
in the range from depressive conditions to posttraumatic personality
disorders . They reflect to women
functioning change in the family, in women attitudes to own sexualities,
as well as in their disorders in functioning in the social aspect.
All of that is more present and more intensive, if other kinds
of violence, besides rape, were present, such as it was in the
war. Overcoming
of these mentioned features requires the application of composed
rehabilitation process (adequate form of psychotherapy, social
and eventually legal aid, as well as general medical aid).
EXPERIENCE IN THE REHABILITATION PROCESS OF SEXUAL TORTURE VICTIMS
DURING THE AGGRESSION TO BOSNIA AND HERZEGOVINA
Bravo-Mehmedbašić A., Kučukalić A., Hadžić E., Prohić A., Đelilović
J.; Psychiatric Clinic, Clinical Center University of Sarajevo,
Bolnička 25, Sarajevo, Bosnia and Herzegovina
In this paper are discussing physical,psychological and social
consequences of sexual torture women. The rehabilitation process
comprises three aspects of the multidisciplinary approach to treatment
: psychological,somatic and social . Their
family members were included in the rehabilitation process too.
Our objectives
were to approach the survivors, first on the cognitive level ,then
to act of sexual torture which was used which were not primary
sexual motivation act,the purpose of sexual torture was aggression
act which was used as the part of war strategy and ethnic cleansing.During
the psychotherapy
process the clients going into emotional level and working with
emotions which was link for traumatic events.As part of reintegration
the experiences are reframed and seen within a new context because
of insight and understanding .The torture experiences become events
of the past.The experiences are not forgotten ,but the clients
look at them differently both of cognitive and emotional level.They
no longer hinder his or her ability to use potential in the new
life perspectives. We registered increasing Posttraumatic stress
disorder within survivors sexual torture victims. Our
objectives are to present importante rehabilitation process for
sexual torture survivors and their family.The traumatic experiences
have to break in through therapy process and we have to break
pathological mechanisms of defense and conspiracy of silence which
produce transgeneration
transmision of psychotrauma . In
this paper we will present rehabilitation of seven women who developed
Posttraumatic stress disorder and Complex Posttraumatic stress
disorder after sexual torture during 1992. Our
clients reduced pathological disorders ,during rehabilitation
process. The
family members of torture victims included in rehabilitation process
helped in establishing healthy interactions between members of
family. Torture prevention in society by compensation through
/moral, law, economic actions/ are necessary for mental health
in society and for mental health of future generations .
DELAYED REACTIONS TO WAR TRAUMA IN CHILDREN WHO SURVIVED EXPEL
FROM SREBRENICA
Ćatić
R.: Department of Mental Health Care, Public Institution Health
Care Center with Policlinic Zavidovići, Zavidovići, Bosnia and
Herzegovina
There are several psychological studies engaged in war induced
trauma in children: Horowitz (1973), Garbarino (1993), in B&H
Ćatić 1997) etc.
Being directly involved in treatment of children who suffered
war induced trauma (after their parents death and/or close members
of their families, expel from Srebrenica etc). I noticed that
there are behavior and success differences in school between these
and the children who have not been exposed to war trauma. This
inspired me to study these differences more thoroughly.
Aim of the
study: Are there any differences in reactions to trauma – anxiety
and depression between the children who suffered any of war trauma
and those children who have not? Are there any connections between
the loss of a parent and other members of a family with depression
and anxiety? Are there any differences in success in school between
the children who suffered any of war trauma and those children
who have not? In what measure do war traumas influence delayed
reaction of depression and anxiety in children? Studied
persons and method of the study: The sample consists of two eighth
grade classes of elementary school. One class consists of 28 children
who havesuffered one or more war traumas (refugees from Srebrenica),
15 boys and 13 girls. The control class consists of 25 children
who have not suffered war traumas, 13 boys and 11 girls. All the
studied persons have gone through the inquiries for trauma and
anxiety assessment and they have also gone through CDI inquiry
for depression assessment in children. All
data have been worked out by statistical method, assessing statistically
important differences between the studied groups in accordance
with the preset aim. Existing ratio between war trauma and depression,
anxiety in children has been assessed by the method of correlation.
Results: There are an important difference between the two studied
groups regarding reactions to trauma – anxiety and depression.
Children who havesuffered any of war traumas are considerably
more anxious and depressive in relationship to the control-studied
group. There is considerable connection between trauma caused
by the loss of parent and other members of a family with depression
and anxiety. There is also a considerable difference in success
at school between the children who have suffered any war trauma
and those who have not. War traumas at a great extent influence
reaction of depression and anxiety in children.
Conclusions: It is necessary to conduct all-inclusive interdisciplinary
study of war induced trauma in children and it’s consequences
for the further development of children’s population. It
is necessary to make a therapeutic strategy so that traumatized
children can adapt to normal life as much as possible.
THE PROBLEMS IN THE TREATMENT OF PROFESSIONAL SOLDIERS WITH POSTTRAUMATIC
STRES DISORDERS
Hasanović
M., Avdibegović E., Pajević I., Sinanović O.: Deprartment of Psychiatry
University Clinical Centre, Faculty of Medicine, University of
Tuzla, 75000 Tuzla, Bosina and Herzegovina
After finishing the war in Bosnia and Herzegovina (B&H), meaningful
number of soldiers of Bosnia and Herzegovina Army who have intensive
war experiences became professional soldiers. After surviving
of severe war traumas at the certain number of these professional
soldiers, Posttraumatic Stress Disorder (PTSD) has been developed
as the answer to traumatic stress. As the Bosnia and Herzegovina
is in the process of transition there is still no law regulation
of the war consequences. Regarding systematic diminishing of professional
soldiers number, to lot of them there is a dismiss threatening.
Psychical illnesses and psychical disorders which appeared as
the consequences of the war trauma are not equal with physical
trauma and somatic consequences caused by wounding, injuring or
caused by illness. The
group of 7 (seven) patients with the chronic PTSD form, who were
treated into Psychiatry Clinic in Tuzla has been analyzed related
to mental, somatic, social and regulations’ problems which follow
up their disability to bear with severe war consequences.
Some better
treatment can be organized with multidisciplinary approach, group
and family psychotherapy, destigmatization of mental disorders
and with concordance of the law regulation for war veterans with
the actual situation in contemporary Bosnia and Herzegovina.
SOME PROBLEMS IN THE TREATMENT OF PROFESSIONAL SERVICEMEN WITH
POSTTRAUMATIC STRESS DISORDERS
Avdibegović
E, Hasanović M, Sinanović O: Department of Psychiatry, University
Clinical Center, Faculty of Medicine University of Tuzla, Tuzla,
Bosnia & Herzegovina
Posttraumatic stress disorders (PTSD) are developing as the response
to the certain traumatic experiences. Response to the trauma is
determinedwith kind of trauma, personality characteristic of survivors
and social support systems. Trauma guesses all function spheres
of people and treatmentrequires comprehensive approach. In the
processes of treatment of the persons with PTSD there were found
some obstacles from patients and from psychiatrist as well as
from community. In this work authors analyzed 44 patients with
PTSD who were treated in Department of Psychiatry in Tuzla.
Patients have been analyzed regarding the time of the treatment
beginning, adherence to a treatment contract, frequency of psychiatrist'
exchange, PTSD recognizing from psychiatrist and social support
systems. In analyzed group the most frequent obstacles from patients
were avoidance to visit psychiatrist, then patients’ expectations
to find out somatic disorders cause symptoms, and obstacles from
psychiatrist were lack of recognize PTSD and in the part of social
support missing of full social support. In the treatment of persons
who suffer from PTSD there were found obstacles from patients,
psychiatrist and community that make influences onto development
of chronic types of PTSD and complicated PTSD by comorbid disorders.
In the prevention of chronic type of PTSD as well as the complicated
PTSD, knowing of obstacles is important for adequate activities
with aim to remove them off.
MOURNING BY ELDERLIES IN THE POST-WAR PERIOD
Jasminka
Hadžialić, The House of Public Health Care Sarajevo, Bosnia and
Herzegovina
In this paper, the problem of the intensity of mourning with groups
of people older than 60 years is analyzed, by observing two subgroups:
-Elderly from
domicile population who have not changed their living place during
and after the war -Elderly
who have come to a new environment as a consequence of war
No report can
found in the literature about any specific investigations of this
problematic – dealing with various kinds of elderly in post-war
conditions.
However, it is the fact that, at these times, the number of elderliness
that is “conditionally left”, increases. The nature of their “conditional
loneliness” is the following: Research
of the above mentioned problematic will be expressed through integral
considering of specific psychological features and needs of this
currently numerous and socially marginalized population group.
With this paper,
I will try to show that the loss of well known living place and
continuing of life in a new environment significantly increases
the intensity of mourning of elderly, with respect to the people
of the same age who have remained at their homes. Specifically,
this problem is even more accented if we take into account that
mourning is a complex mental happening, which is accompanied with
not only mental but also physiological effects.
ABSTRACTS:
DIABETES
IS AN ENDEMIC DISEASE IN THE ARAB COUNTRIES
Khalid
Al-Rubeaan; King Saud University, Riad, Saudi Arabia
Diabetes Mellitus is a leading disease that has brought a great
pressure on the health system over the last decade. Diabetes has
leaded other chronic diseases and infectious diseases in the Arab
Countries. The prevalence of diabetes varies from 7% to 15,7%
with an increase trend of the disease. Gestational diabetes was
found of vary from 4,4% in Bahrain and 9,4% in Saudi Arabia. Type
I diabetes is also changing with time where it has increase by
3 folds in Kuwait in the year 1995. Diabetes
on the Arab countries was found to be more in aged people and
females are higher in urban areas than rural. Risk factors are
increasing with the change in lifestyle, which include aging population;
decrease daily activity, high caloric intake, obesity and higher
rate of consanguinity. These factors in addition to improved health
system and lack of health education and prevention program have
made the problem of diabetes worst Diabetes Mellitus especially
type 2 is putting a lot of burden financially on the health system
of this countries. These pressures have been amplified with the
fact that chronic complications are more prevalent (i.e. retinopathy,
neuropathy, nephropathy). Mortality from diabetes has been estimated
by WHO to be on the range of 9%. Studies from Saudi Arabia have
confirmed the same observation. There
is a clear urgent need for primary and secondary prevention program
in addition to closed observation of the disease in the Arab Countries.
PATTERNS OF DIABETES MELLITUS IN YOUNG JORDANIANS
Aly
A. Mishal, Islamic Hospital, Aman, Jordan
162 young Jordanian diabetic patients, who were under medical
care at the Diabetes Unit of the Islamic Hospital between 1997-2000,
were studied to determine patterns of diabetes, in young Jordanians.
22 patients
were excluded from the study, because of lack of follow up, or
deficient information to fulfill inclusion criteria. The
remaining 140 patients were divided into two subclasses.
Subclass I:
95 patients in the age group 3 months-18 years, when diabetes
was discovered. 57 were males, and 38 were females. Subclass
II: 45 patients in the age group 18-30 years, when diabetes was
discovered. 33 were males, and 12 were females. Sets
of criteria were developed to assign patients to each type of
diabetes, namely: type 1, Type 2, atypical diabetes and maturity
onset diabetes of the young (MODY). Classification
criteria took in consideration: Dependence
on insulin, history of diabetic ketoacidosis, serum C-peptide,
ant islet cells antibodies, family history, evidence of other
autoimmune disorders, and other criteria. In
subclass I: 66 patients (69.5%) were classified as Type 1 (43
males and 23 females). 27 patients (28.4%) were classified as
Type 2 (13 males and 14 females). 2 patients (2.1%) were classified
as Atypical diabetes mellitus (1male and 1 female). In
view of difficulty to firmly diagnose cases of MODY in this study,
no trial was made to separate patients who may have this entity
from Type 2 patients. In
subclass II, 11 (24.4%) patients were classified as Type 1 (6
males and 5 females), and 34 patients (75.6%) as Type 2 (27 males
and 7 females). There
was predominance of obesity or overweight in patients with Type
2 in both group (74% and 64.7% in patients below or above 18 years
of age respectively). Patients with Type I were predominantly
thin (Obesity: 1.5% and 0% in patients below or above 18 years
of age respectively).
BOVINE SPONGIFORM ENCEPHALOPATHY – CREUTZFELDT JACOB DISEASE,
REGIONAL PROBLEM – GLOBAL THREAT
Imamović
Dž, Uzunović J: Cantonal Public Health Institution of Zenica,
Zenica, Bosnia & Herzegovina
In this paper the authors have presented the latest epizootic
and epidemiological data concerning newly arisen zoonosis, the
infectious disease of the cattle, that may produce the similar
disease, V-CJD (The Variant of Creutzfel dt Jacob Disease) in
the humans. The new disease represents the regional public health
problem, but also the threat to the whole Globe. What is interesting
for Muslims is the awareness that BSE and V-CJD became the problem
and the threat almost to the whole world after inducing unnatural
feeding to the cattle, oppositely to the Godly directions; artificial
feeding of the cattle by meat offals, is a step forward to transformation
of herbivorous animals to carnivores. In Kor”an, The Godly revelation,
is commanded: “But observe the measure strictly, nor fall short
thereof”. Evidently the economic and commercial motivation got
in preference to the scientific knowledge and Godly recommendations.
It is emphasized
in this paper that the most developed countries, with their great
economical and financial capabilities, through the artful actions
supported by the sophisticated diagnostic technique and laboratories,
will probably be able to withstand the problem and to nullify
the consequences of the experiment, but the developing countries
in their economic and political transitions, cannot act with such
efficacy, and might enter greater difficulties concerning the
problem. Bosnia and Herzegovina is one of them; three main reasons
for that are:
1. After the Bosnian war (1992-1995)
the post-war pauperization of the people makes humanitarian needs
for the food to be still rather great. 2.
Because of the leakage of the state boundaries the import-export
are not under the satisfying control, and 3.
There is not yet national program for the prevention of V-CJDs.
The other developing countries are not in less danger than Bosnia.
In this paper authors have suggested below cited measures that
should be undertaken in order to prevent the importation of the
disease:
1. To establish National monitoring
of CJD and its variants, 2.
To nominate the group of experts for the prevention of V-CJD,
3.
To delegate experts to the INTERNATIONAL WORKSHOP, 4.
To establish The Survey on BSE according to the International
Animal Health Code, 5.
To ensure stable boundary control of transit of cattle and beef.
WHAT DRUGS DO WE PRESCRIBE TO OUR ELDERLY PATIENTS AND WHAT DISEASES
FOR?
Jatić
Z, Tokić M, Cantonal Health Center Sarajevo, Sarajevo, Bosnia
& Herzegovina
Objective: To get number of drugs per an elderly patient (≥
65), top five diseases and prescribed drugs for elderly.
Design: Retrospective
epidemiological study. Setting:
General practice/family practice offices in the Health Institution
Dom Zdravlja Sarajevo
Subjects: Randomly chosen general practitioners (27) working in
whole area of Canton Sarajevo Methodology:
Collecting all prescriptions copies from general practitioners
using especially printed carbon back prescriptions (250 prescriptions
per physician). The beginning of study was on December 6th
and the end was on December 10th 1999. Many physicians
finished study before Dec.10th, because they had used
all given prescriptions. Results:
Elderly patients 35% (1232) of total number 3520 patients get
50,1% (2738) prescriptions of total 5459 collected prescriptions.
Number prescription per patient was 2,4, per an elderly 2,6 and
per other patients 2,1. High percent elderly (44%) got 3 or more
prescriptions (maximum 10). Top five diseases are hypertension
(prevalence in elderly with prescriptions 1038 is 37%, diabetes
mellitus (17%), cardiomyopathia (15%), chronic ishemic heart disease
[excluding Angina pectoris] (12%) and COPD (7%). Top five drugs
were lisinopril, digoxin, diazepam, verapamil and glyceriltrinitrat
retard. Conclusion:
Physicians prescribed more drugs to elderly than others patients.
Almost half elderly patients take 3 or more drugs. There wasn’t
significant increase of number disease and prescription with increasing
of age of elderly patients.
THE ROLES OF IINTEGRATED TELEHEALTH IN DISEASE PREVENTION
Harun
MH, Medical Online (M) Sdn Bhd, Kuala Lumpur, Malaysia
Common diseases causing significant morbidly and mortality include
cardiovascular, cancer, trauma and antenatal/perinatal diseases.
These diseases affect not only developed nations but also developing
countries. Most of these diseases are behavior related or life-style
related. This trend seems to be on the rise and is worrying.
Early and relevant
dissemination of health information and education to the respective
people may alter the course of these health problems. It
is envisaged that dissemination of just in time personalized health
information and education [PHIE] based on electronic medical record
[EMR] datasets such as age, sex, disease diagnosis and risk factors
(for cardiac disease e.g. age > 40 years, smoker, male etc)
captured during each visit to a healthcare facility is achievable
via artificial intelligence systems. EMR
and PHIE forms the integral part of Integrated Telehealth that
provides just in time and relevant health information and education
to relevant individuals not only when an individual is sick but
more so when the individual is well. Prevention, as they say,
is better than cure. Other unique features of Telehealth are that
it allows dissemination of just in time continuing medical educational
[CME] material to healthcare providers to assist in the management
of the patient at the point of seeing the patient and also it
provides the platform for second opinion or teleconsultation [TC]
to be made without having to present the patient physically thus
saving time, money and most importantly occasionally lives.
By allowing
just in time CME and TC, Integrated Telehealth also aids in reducing
secondary /tertiary disease management by reducing mismanagement
of patients due to ignorance and delay in referring patients.
Leveraging
on current technology such as the Internet and call centers, Integrated
Telehealth deployment on these platforms would increase the accessibility
and affordability to the general masses with the aim of preventing
life style related diseases via cost-effective means. In
conclusion, Integrated Telehealth deployment via the internet
and call centers could play a significant role in preventing life
style related illness either in primary or post-primary prevention
which is affordable and is widely accessible.
DILEMMA IN NATIONAL FAMILY PLANING IN INDONESIA
Asri Rasad,
Yarsi University, Jakarta, Indonesia
The population growth in Indonesia was stedily increasing from
1,5% in 1950 to 2,3% in 1980. With such population growth rate,
it was estimated that Indonesia will have difficulties in meeting
the demand for food and other basic needs of the people based
on the fact that food production lagged behind population growth.
Anticipating
this national problem the government has launched a national family
planning that is directly under the auspice of the President.
It has been carried out successfully which was indicated by the
decrease of the population growth to 1,6% in 1995. The government
set the target of 1% or less in the year 2000 but unfortunately
fails to be achieved. To reach this goal the government intensified
the family planning programs and campaign. On
of the intensifying afford was the introduction of family planning
curriculum into the national medical curriculum, which commenced
in 1994. The goal of the integration is to teach and train medical
students to become highly competent in:
Delivery
of all kinds of all available contraceptives including the skills
of implant, intrauterine devices, diagram and cervical cap application,
tubectomy and vasectomy.Management
of national family planning programsOrganizing
public education and training in family planning.
The
success of the family planning program depends much on the attitude
of the doctors. Many Muslim doctors are reluctant to carry out
some of the contraceptive methods such as I.U.D, tubectomy and
vasectomy following the Indonesian Council of Ulama’s fatwa, which
prohibit such methods. With the economic and financial crisis,
the national family program is now facing another problem. Before
the crisis the contraceptives are provided free of charge. But
now the users have to pay for the contraceptives. The number of
users is decreasing and as a consequence of the decline the birthrate
will increase. A baby boom is anticipated to happen. This baby
boom will be a serious medical dilemma of Indonesia.
INFECTIONS IN DEVELOPING COUNTRIES
ABSTRACTS:
AFRICAN AIDS EPIDEMIC: ARE WE RESPONDING ADEQUATELY?
Anwar
Hoosen, IMA of South Africa, Pretoria, South Africa.
Human immunodeficiency virus (HlV) infections are ravaging the
population of the sub-Saharan Africa and South Africa. A population
of 44 million has been hit particularly hard. National antenatal
seroprevalence surveys have shown an increase from 1.4% to 22.7%
over the last decade. Hence, there is an urgent need for a response
that is different from the currently suggested prevention programs
that are failing. A more lasting and commitment- based initiative
with drastic lifestyle changes is needed. The
IMA of South Africa has taken the initiative and its various activities
are outlined: 1.
There are 3 AIDS subcommittees, one in each of the larger cities
viz. Johannesburg, Cape Town and Durban; 2.
The IMA is active in the Muslim AIDS programmed activity with
a number of community organizations, the 2 prominent ones being
Islamic Careline and Jamiatul Ulema, Transvaal; 3.
The IMA is also an active participant in the Government initiated
Religious AIDS Programme, working with other religious groups;
4. There is
an active collaboration with the IMA of Uganda and a delegation
from Uganda attended the 13th International AIDS Conference and
conjointly conducted a number of workshops; 5.
The committee in Johannesburg has conducted 60 one-day workshops
on AIDS awareness at schools, 10 trains the trainers courses for
AIDS educators and 8 one day clinical workshops for medical practitioners.
The IMA of
S A is responding to the AIDS epidemic in Africa by a variety
of activities, its collaborative efforts and its plans for a regional
summit with Southern and Eastern African countries.
TUBERCULOSIS TODAY
Žutić
H., Mehić B., Dizdarević Z. Clinic of Lung Diseases and TB, Clinical
Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Background: Of total 8-10 million TB cases each year in the world,
95% belongs to developing countries. Poor management TB programmes
makes this disease incourable. Resistant species on one drug exists
now in each country, and species resistant on all anti-TB drugs
are very dangereous in some countries. DOTS produces cure rates
of up to 95 percent even in the poorest countries, prevents new
infections by curing infectious patients and prevents the development
of MDR-TB by ensuring the full course of treatment. National TB
Programme (NTP) started in Feederation B&H (FB&H) during
the War in B&H (1992-1996), in 1995, and DOTS strategy has
been introduced. The
Aim: To analyse TB in FB&H during post-war period.
Material and
method: In retrispective analysis we evaluate all reported cases
of TB in FB&H in period 1995.-1999. In controle groupe of
patients, we analysed all reported TB cases in Republic Bosnia&
Herzegovina in pre-war period, 1986-1990. Results:
All reporetd TB cases in B&H are summerized in the next tables:
Table 1: All
reporetd TB cases in B&H in period1984-1990. and in FB&H
in 1995-1999.
 |
Results
shows that implementation of NTP with DOTS strategy declined
TB incidence rate in spite of 4 year war in B&H.
The number of drug resistance TB cases in 1999. was 42
(2.02%) of all TB cases.
Numebr of MDR in that period was 9 (0.43%) of all TB cases.
Smear positivity was 33.3% and culture positive TB was
58.9%
/POPULATION 2.523.000/
|
Legend:
PULM- Pulmonary TB cases, EP-extra-pulmonary
Conclusion:
Implementation of DOTS strategy in treatment of TB In Post-war
period in FB&H was slightly decreased notification rate of
all TB cases.
HEPATITIS C, B AND D VIRUSES IN PATIENTS WITH LIVER DISEASE
Moslih I. AL-Moslih* & Mohammad A. Al-Huraibi** *University
of Sharjah, Sharjah, UAE, **University Hospital, Sanaa, Yemen
Hepatitis C virus is believed to be an important causative agent
of the liver disease. There is no data yet on the significance
of hepatitis C as a causative agent of the acute and chronic hepatitis
in Yemen. The role of HCV, alone or in conjunction with other
hepatitis viruses, in such liver diseases was investigated.
One hundred
forty three patients with various classes of the liver disease
and a hundred and twenty healthy subjects were investigated for
serological markers of hepatitis C, B, and D viruses using the
ELISA technique. The prevalence of anti-HCV in patients with the
liver disease was 28/143(19.5%)while in the control group it was
5/120 (4.2%). HbsAg was detected in 48/143 (33.5%) in the liver
disease whereas the prevalence was 19/143 (13.3%) in the control
group. Anti-HVC and HbsAg were detected in 11/143 (7.6%) of cases
but they were not detected in the control group .The detection
of anti-HCV, HbsAg, anti-HBe and anti-HDV was reported in three
patients. This pattern was shown in the patients with post viral
cirrhosis. Serum
protein electrophoresis results showed broadly elevated gamma
globulin and low albumin in these patients with positive anti-HCV
who have the liver disease. The present study has revealed
the prevalence of anti-HCV in patients with the liver disease and
the coexistence of three virus markers (HCV, HBV, and HDV) in
three cases of the 143 cases investigated.
Monitoring resistance of esherichia coli as the most frequent
carrier of urinary infections
Jažić Sead 1, Sabira Hadžović2, Fahrija
Bašić2;
1 General Hospital Sarajevo, 2 Faculty of Pharmacy
Sarajevo, Bosnia and Herzegovina
Resistance
of microorganisms to antimicrobial drugs, according to the World
Health Organization, is one of the most serious problems of today's
medicine. Taking
this problem into consideration, which is followed by many difficulties
it creates in the treatment of patients such as: length of hospitalization,
consumption of increasing quantity of antibiotics, costs of the
therapy and patients’ health, directed our research to the monitoring
of resistance of Escherichia Coli (E. coli) as the largest carrier
of urinary infections in women, which is the goal our work.
A lot of research
has been carried out in two directions: a retrospective study
of research into the resistance of E. coli, in the case of the
urinary infection, to a group of antibiotics in the period of
two years, and a prospective study of monitoring the resistance
in the current calendar year, to the same group of antibiotics.
Results of
our retrospective study of the research into the resistance of
E. coli in the period of six months (1999) to a number of tested
samples: 3,270 urino-cultures and a group of antibiotics: tetracycline,
gentamicin, meticilin, amikacin, ciprofloxacin, mezlocillin, azlocillin,
cotrimoxazole, amoxiclav, ampicillin, cefuroxime, azitomicin and
the results of monitoring the resistance in the current year (2000
– 2001) are presented in our paper. The results are presented
by means of tables, shown in percentages (%) and compared with
the values of the resistance of E. coli in some European countries.
Conclusion:
The problem of development bacteria resistance to antibiotics
exists. This is why a system of monitoring resistance, for the
purpose of determining a policy for the use of antibiotics, should
be established everywhere in the world. We would like our study
to be a contribution to monitoring the resistance of bacteria
E. coli as the most frequent carrier of urinary infections to
antibiotics in order to protect health of patients, especially
of women.
ANTROPOZOONOSES IN THE ZENICA-DOBOJ CANTON IN THE PERIOD FROM
1991 TO 2000
E. Hadžić,
L. Čalkić, Department of Infectious Diseases and Febrile Conditions,
Cantonal Hospital Zenica, Crkvice 67, Zenica, Bosnia and Herzegovina
The causes of antropozoonoses are: bacteria, viruses, parasites,
protozoa, fungi, rickettsias and others. The person is infected
through the contact with affected animals, by consuming infected
food and the aerosol. The most common antropozoonoses in our region
are: salmonellosis, Q-fever, trichinellosis, haemorrhagic fever,
leptospirosis, tularemia, psitacosis, amebiasis, echinococcosis,
teniasis, antrax, brucellosis, tetanus, botulismus and vaccinia.
Aim: To indicate
an increase of antropozoonoses in our country, as well as outbreak
of some diseases that we have already forgotten. A
retrospective study was conducted in the period from 1991 to the
end of 2000. A number of zoonoses by certain diseases and by the
years were followed up. In
the 10-year observed period the most common zoonosis in our region
has been salmonellosis (with 298 patients admitted to hospital);
then Q-fever with 159 affected persons and trichinellosis (121
persons). There were 54 cases of hemorrhagic fever, and 33 cases
of leptospirosis. Less common diseases have been: tularemia (16
cases); psittacosis (8 cases); amebiasis (8 cases); echinococcosis
(8 cases); teniasis (8 cases); anthrax (7 persons); brucellosis
(4 cases); tetanus (2 cases), botulisms (2 cases) and finally
vaccinia (2 cases). It
is essential to emphasize an increase of salmonellosis in the
post-war period. During the war practically there was no salmonellosis.
In the post-war period trichinellosis has been a less common disease,
except the epidemic in 1998 with 55 affected persons. During the
war, i.e. from 1992 to 1996, there were two epidemics of trichinellosis:
one with smoked bear meat, and the other with smoked boar meat.
Tularemia occurred
after 40 years in 1995 with 16 affected persons. There were two
Q-fever outbreaks, in 1998 and in 2000. The other zoonoses appeared
in a quite small number of affected persons. Regarding
the increase of zoonoses in our country and the occurrence of
new ones that we have almost forgotten, it is necessary to strengthen
the veterinary supervision of imported cattle, as well as of other
foods. It is also essential to kill the affected animals in a
proper way, and to train the staff working with animals and food.
RIFT VALLEY FEVER IN ASIR REGION (Southern of Saudi Arabia)
Tarik
Al-Azraqi, Kingdom of Saudi Arabia
Background:
Rift Valley Fever (RVF), is a zoonotic disease that may cause
severe disease in both animals and humans leading to high morbidity
and mortality. The death of RVF-infected livestock often leads
to substantial economic losses. Since 1930, when the virus was
first isolated during an investigation into an epidemic amongst
sheep on a farm in the Rift Valley of Kenya, there have been outbreaks
in sub-Saharan and North Africa. In 1997-98, there was a major
outbreak in Kenya and Somalia. In September 2000, RVF was for
the first time reported outside of the African Continent. Cases
were confirmed in Saudi Arabia and Yemen. This virgin-soil epidemic
in the Arabian Peninsula raises the threat of expansion into other
parts of Asia and Europe. Objectives:
To describe the characteristic clinical manifestations and lab.
features of RVF To
identify the risk factors for the disease. To determine the outcome
of the disease. Design:
Descriptive study. Setting:
Asir Central Hospital during the outbreak of RVF in Asir region.
Patients and
Methods: Patients fulfilled MOH and CDC criteria for diagnosis
of RVF are included in the study, Questionnaire datasheet filled
·
Lab Data collected. Results:
61 patients serologically confirmed case of RVF were enrolled
in the study, 51 (84%) males and 10 (16%) females, all cases were
from the lowland Asir region few from Jizan area. Most of these
cases were referral from other hospitals in Asir region (Muhayel,
Rijal almaa, Al Majardah, Al Berk), the age range from 15 to 81
years (mean 48y). The mean hospital stay is ten days, the risk
factors were found to be sleep outdoor in 34%, contact with animal
in 63%, mosquito’s bite 36% and at least one of these factors
in 100%. The
important clinical feature were found to be Fever 95%,
Headache
56%,
Malaise
78%, Gastrointestinal
symptoms were found to be in the majority of the cases. Associated
hepatitis BsAg found in 11 patients (20%). 7 patients (11%) died.
Conclusions:
All cases are from lowland areas with at least one or more risk
factors. Pediatric age group is not affected by the disease, fever,
and flue like illness and G.I symptoms are prominent clinical
manifestations.
OTHERS
ABSTRACTS:
OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR MORBIDITY
Peker Y. Pulmonary Medicine, Sahlgrenska University Hospital,
Gothenburg, Sweden
Obstructive sleep apnea (OSA) affects 24 % of middle-aged men
and 9 % of women in USA but the treatment criterion, daytime 17
and 22 % of these subjects reports sleepiness, respectively. Some
previous studies have suggested an association between OSA and
cardiovascular disease (CVD), but the conclusions have been conflicting
due to co-existing traditionally recognized risk factors. The
main aim of the present thesis was to explore the possibility
of a causal link between OSA and CVD. Moreover, impact of OSA
on mortality in patients with coronary artery disease (CAD) was
addressed. Subsequently, long-term impact of treatment of OSA
with continuous positive airway pressure (CPAP) on CVD was further
explored. In
a case-control study of 62 patients with CAD requiring intensive
care and 62 healthy subjects individually matched for age, gender
and body-mass-index (BMI) among 571 healthy volunteers, OSA was
found in 19 CAD patients and in 8 control subjects. In a multiple
logistic regression analysis, OSA was significantly associated
with CAD with an odds ratio of 3.1 independent of hypertension,
diabetes mellitus, hypercholesterolemia and current smoking.
In a prospective
study of the above-mentioned clinical sample with CAD, cardiovascular
death occurred in 6 of 16 OSA patients (37.5%) compared with in
4 of 43 non-OSA cases (9.3%) during a follow-up period of 5 years.
In a multiple regression model, Respiratory Disturbance Index
(the number of breathing pauses and oxygen desaturations per hour)
was an independent predictor of mortality after adjustment for
age and other traditionally recognized risk factors. Incidence
of a CVD was explored in 175 middle-aged men with or without OSA
but free of hypertension or other CVD, pulmonary disease, diabetes
mellitus, alcohol dependency as well as malignancy at baseline.
During a follow-up period of 7 years, at least one CVD diagnosis
was recorded in 21 of 37 cases (56.8%) with incompletely treated
OSA compared with in 1 of the 15 efficiently treated OSA subjects
(6.7%) and in 8 of 123 (6.5%) subjects without OSA. In a multiple
logistic regression model, incompletely treated OSA was associated
with a 11-fold increase in risk for incidence of CVD, independent
of age, BMI, blood pressure and current smoking. A
retrospective study addressed the need for acute hospitalization
two years prior to and two years following the initiation of CPAP
treatment in OSA patients with co-existing CVD. The total number
of in-hospital days was reduced from 413 to 54 in 19 CPAP-users,
while in 12 non-users there was an increase from 137 to 188 days.
A potential
mechanism behind the beneficial effects of CPAP on cardiovascular
morbidity was addressed in a separate experimental protocol. An
enhanced vasoconstrictor response to angiotensin II (AT2) in the
forearm arterial bed has previously been demonstrated in 10 normotensive
men with OSA. Compliance with CPAP treatment (n=6) led to a significant
reversal of the constrictor response, while it remained enhanced
in the four non-CPAP-users. This
work supports an independent causal relationship between OSA and
CVD. Moreover, OSA is associated with an increased risk of mortality
in patients with CAD independent of age and traditionally recognized
risk factors. CPAP treatment of OSA reduces the need for acute
CVD- related hospital admissions and offers favorable cost-benefit.
The treatment related reversal of the enhanced vascular response
to AT2 after CPAP suggests that mechanisms related to the renin-angiotensin-system
play an important role in the development of CVD in OSA. These
studies propose that OSA should be treated not only to eliminate
daytime sleepiness. Treatment may also have a beneficial prognostic
impact by reducing cardiovascular morbidity in sleep apneics.
METABOLIC STATE OF THE MUSCLES IN PERSONS WITH AMPUTATED EXTREMITIES
Suljević E.: Institute for Clinical Chemistry and Biochemistry,
Clinical Centre of Sarajevo University, Bolnička 25, Sarajevo,
Bosnia and Herzegovina
About
ten thousands wounded and ill people, and great number of permanent
disabled people, due to their amputated extremities, are present
as the result of the war and total surrounding of town Sarajevo
during 1992.-1995. Regarding the fact that these disabled people
continue their lives in their own specific way, the investigation
performance of biochemical parameters that are directly or indirectly
involved in muscle function, was considered as necessary.
The metabolic
state of muscles was analysed in this study, i. e. the serum levels
of creatinine, creatine, lactate and catalytic activities of serum
creatin kinase and myokinase, were determined in patients with
reduced muscle mass, i.e. in people with amputated extremities.
The concentration levels of mentioned biochemical parameters were
determined in the groups of 15 subjects with amputated extremities
and 15 subjects of control group. The subject preparation, taking
blood, material separation as well as analytical procedures, were
carried out according to standard methods recommended by IFCC
(International Federation of Clinical Chemists). The serum creatinin
level in people with amputated extremities were 42-83 micromoles/L
and 52-103 micromoles/L in control group. The serum myokinase
level were 902-910 nkat/l in people with amputated extremities
and 150-886nkat/L in control group. Statystical procedures indicated
that there was no significant difference of serum creatinin and
myokinase levels in subjects with amputated extremities comparing
with control group at the level of 5%. There is significant difference
at the level of 5% between the creatin serum levels (17,3-109
micromoles/L) , lactate serum levels (1,25-3,25 mmol/L), and creatine
kynase (0,28-1,12 microkat/L) in people with amputated extremities
comparing with control group (creatine: 6,6-49,4 micromol/L; lactate:
1,17-1,89 mmol/L; creatin kynase: 0,34-1,94 microkat/L). These
differences should be applied in the process of interpretation
of laboratory findings. THE INFLUENCE OF VERY LOW CONCENTRAION
OF LEAD ON MAMMARY GLAND AND POSTERITY IN RATS Mornjaković Z.,
Kadić M., Šuško I., Aličelebić S.: Institute of Histology and
Embriology Faculty of Medicine, University of Sarajevo, Bosnia
and Herzegovina The point of support for our study was
the fact that lead, apart from being a poison of wide range, is
mostly poisonous for gonads and to their supervisory neuroendocrine
structures. Diminshed binding of gonadotrophins in ovary and insufficient
production of ovary hormones were established in rats intoxicated
by lead. On the other side, the lead administration during pregnancy
modifies histophysiologic characteristics of mammary gland in
period of pregnancy and lactation. In our experiment we have used
primigravid Wistar rats who were watered during pregnancy and
lactation either by deionized water (Pb:0 mol dm-3)
or by lead acetate solution (Pb: 0,0049 mol dm-3).
On 7th, 14th and 21st day of
pregnancy the uterus of 60 animals has been extirpated and observed
on the number of vital embryo and resorption and the oldest on
macroscopic anomalies. Body weight of born baby rats and nourished
by lead-poisoned mothers was also determined. Qualitative characteristics
and quantitative changes in composition of the mammary gland through
all phases of lactation was investigated by transillumination
and stereological method. Only on 7th day of pregnancy
we found significantly vital embryo minor number of rats exposed
to lead. The number of resorption and macroscopic anomalies were
insignificant as the number of embryo between left and right uterus
horn. Reduction offspring body weights was evident. The analysis
of mammary gland showed significant effects of lead on its epithelial
and stromal tissue. Our results point out at effectiveness of
very low concentration of lead on reproductive characteristics.
RENAL DUPLICATION ASSOCIATED WITH NONFUNCTIONING UPPER POLE, PUJ
OBSTRUCTION OF THE LOWER MOIETY AND URETEROCOELE - PARTIAL NEPHROURETERECTOMY
WITH DRAINAGE OF URETEROCOELE SAVES THE LOWER HALF KIDNEY
Mumtaz
Hussain, Pakistan
Purpose: To discuss the successful management of a 5 years old
girl with right renal duplication associated with nonfunctioning
upper pole and ureterocele, who was admitted with history of recurrent
UTI and failure to thrive. Method:
The diagnosis of right renal duplication associated with nonfunctioning
upper pole, PUJ obstruction of lower renal moiety and ureterocele
was confirmed by various investigations including U/S, IVU, MCU
and isotopic renal scan. The right partial nephroureterectomy
and drainage of right ureterocele was done. The right PUJ was
confirmed to be partially obstructed due to external pressure
of hydronephrotic upper pole.
Result: Postoperative recovery was uneventful. On later follow-up,
the patient is asymptomatic and growing well. The remaining right
kidney (lower pole only) is functioning equal to the left kidney.
Conclusion:
Renal duplication associated with ureterocele is a difficult urological
problem to manage successfully. When upper pole becomes nonfunctional
with functioning lower renal moiety, partial nephroureterectomy
with drainage of ureterocele is a very rewarding procedure.
AETIOLOGY OF THE MOBILE PROSTHESIS FRACTURES UNDER THE CONDITIONS
OF MODERN AGGRESSION – EXPERIENCES FROM SARAJEVO
Redžepagić S., Berhamović E., Dardagan A.: University of Sarajevo,
School of Dentistry, Sarajevo, Bosnia and Herzegovina
War is a destructive process. The basic aim of the war is destruction
as a method of attaining. The set goals, conquering the territories,
destruction of the society and killing people. The consequence
of the war is destruction at all levels. The destruction as a
consequence of the war is also evident in the dental therapy domain,
applied as a therapeutic instrument in the patient”s mouth. Aim:
The aim of the paper is to show aetiological factors leading to
mobile prosthesis fractures under the conditions of modern aggression,
based on the experiences from Sarajevo. Results: Trismus of the
masticating muscle system with the maximal interocclusal pressure
caused by expecting the mortal and destructive bomb explosion.
Each explosion caused the maximal uncontrolled contraction of
the masticating muscle system with the consequent maximal interocclusal
pressure.
1.
Disproportion of the mobile prosthesis size with the toothless
alveolar ridge, caused by the patient”s maximal
loss of weight in the short period.
2. Inadequate diet related to the kind and solidity of food.
3. Parafunctional occlusal movements of psycho-genetic nature.
4. Impossibility of the adequate care for the existing prosthesis
due to the care for survival.
The results of such condition were fractures of the mobile prosthesis.
Out of 150 000 inhabitants, who spent the war in Sarajevo, 12
000 were killed and 56 000 wounded during the war. The care for
the dental prosthesis lost the priority over the care for the
survival. Conclusions: Modern aggression was the main reason of
the mobile prosthesis fractures.
1.
The dominating factors, leading to fractures of the mobile dental
prosthesis are: trismus of the masticating muscle system, maximal
loss in volume of the alveolar bone and mucous membrane, disproportion
of the mobile prosthesis with the supporting alveolar ridge, parafunctional
teeth movements of psycho-genetic nature, inadequate diet, impossibility
of the adequate care for the existing prosthesis.
2. Modern aggression deprives the dentist of the possibility to
apply any and especially not the adequate prosthetics therapy.
THE INTERNET ACCESS TO MEDICAL INFORMATION – THE INTERNET AS A
MODERN MEDIUM
Kabil E 1, Stroil M2, students:
1Faculty of Medicine University of Sarajevo, 2Faculty
of Architecture University of Sarajevo, Polovina V.
WWW-World Wide Web or the Internet has become a modern connection
and communication between man and information. Wide spreader and
an easy to use approach, makes the Internet close to many different
users. Need for spreading and developing medical successes, exchanging
of medical information’s and, finally, contact between patient
and medical information/expert online systems/results with a great
medical contribution in the Internet space. Aim
and goals: Shape and access to the medical information. Knowing
importance of medical information as a base for evaluation
and giving medical decisions, variable medical criteria, we shall
attempt to explain the differences between medical information’s
on the Internet:
1) Medical databases /search engines-interactive
approach/;
2)
Individual medical info /ified or unified/;
3) Larger medical content/publications,
science sites, medical portals/;
4)
Medical date networks;
5) Electronic conferences and medical
forums.
Methods: Global overview with statistic conclusions.
Results: Only completely specified criteria gives the best optimized
results and certainty of finding the appropriate outcome.
Conclusions: All the results brings us to the conclusions that
for the access to the medical information we need to have basic
knowledge in internet use and certainty in purposes we are looking
for. Large databases give us a wide menu of various medical information’s.
The user for fast and efficacious contact between man and information
should separate this information.
NEOPLASIA
ABSTRACTS:
INCREASE OF CANCER INCIDENCE IN THE WORLD – CIRCUMSTANCES AND
CAUSES
B. Mehić, Clinic of Lung Diseases and TB, Clinical Center University
of Sarajevo, Sarajevo, Bosnia and Herzegovina
In 1997, a worldwide total of 6.2 million deaths (11.9%) were
due to cancer (out of a total 52.2 million deaths). Leading causes
of death from cancers were those of the: Lung (1.1 million), stomach
(765 000), colon and rectum (525 000), liver (505 000), breast
(385000). Cancer and cardiovascular (heart) diseases are the leading
causes of death in industrialized countries. The incidence is
almost four times greater in the developing world. In developing
countries infectious diseases are the most frequent cause of death.
By 2025 the risk of cancer will continue to increase in developing
countries, with stable and possibly declining rates in industrialized
countries (partly due to screening). Worldwide cases and deaths
of lung cancer and colorectal cancer will increase, largely due
to smoking and unhealthy diet respectively. Lung cancer deaths
among women will rise in virtually all industrialized countries,
but stomach cancer will become less common generally, mainly because
of improved food conservation, dietary changes and declining related
infection. The possible advent of a vaccine would greatly
benefit both the developed and developing countries. Cervical
cancer is expected to decrease further in industrialized countries
due to screening. Liver cancer will decrease because of the results
of current and future immunization against the hepatitis B virus
in many countries. The characteristics
of cancer patients under age 20 are: over half were males 52.2
% with aged < 10 years, the most frequent hystologic types
were: leukemia 31.0 %, lymphomas and intraspinal neoplasm’s 16.0
%, the most frequent type of tumor was acute lymphocyte leukemia
22.0 %. The frequency of malignant solid tumors in children (interesting
study of Shah SH and al.) of 253 consecutive cases of pediatric
malignant solid tumors, there was:lymphoma 26.1 %, tumors by CNS
16.6 %, osteosarcoma 7.5 %, rhabdomyosarcoma 6.7%, neuroblastoma
5.1 %, Wilm’s tumor 8.1 %, Erwing’s sarcoma 4.7 %, retinoblastoma
4.7 %, germ cell tumor 4.4 %, primitive neuroectodermal tumor
4.0 %. Characteristics of cancer in the elderly population are:
average mortality rates of cancer in the period 1989 – 1995 for
age group > 95 years, increased with increasing age:
-
in the man was 3700/100000 person – years -
in the man was 2500/100000 person – years -
Average incidence of cancer in the period 1989 - 1995 for
age group 85 – 94 years: in the man was 3466/100000 person – years
(first place – prostate carcinoma, second place – breast carcinoma),
in the woman was 1604/100000 person – years (first place – colorectal
carcinoma, second place – breast carcinoma).
The
most frequent cancer related cause of death in age < 85 years
(in the period 1989 – 1995) in the man was lung carcinoma, and
the woman was breast carcinoma.
The
differences in the cancer incidences and mortality rates in the
world are result of professional, ethnohistoric, sex and geographic
differences, but because there are differences in the risk factors,
demographic characteristics, methods of screening, diagnostic
and medical praxis generally. National
center for health statistics of USA:
Of
the 20 leading incident cancers today, both incidence and mortality
are decreasing among 11 sites for men and 12 for women. In men,
the decline in mortality has been notable and is especially apparent
for the smoking-related cancers, including those of the lung,
oral cavity and pharynx, larynx and bladder. In women, all-sites
mortality decreased only approximately 0.4% from 1991 through
1995. Three cancers continued to show substantial increases in
mortality for both women and men – liver, multiple myeloma, and
non-Hodgkin lymphoma. THE PROBLEMS OF DEVELOPING
COUNTRIES ARE: - Absence of national register of cancer: rate
of incidence, rate of prevalence, mortality rate and efficacy
of treatment, -Absence of programs of the prevention of risk factors,
a small general and health erudition of inhabitants, - A bad treatment
of cancer in terminal phases.
 |
"THE BALKAN SYNDROME" - EPIDEMIOLOGICAL VIEW OF HEMATOONCOLOGICAL
CIVILIAN PATIENTS
Berbić-Fazlagić1 J, Landžo E2, 1Clinic
of Hematology, Clinical Center University of Sarajevo, 2Institute
for Blood Transfusion Sarajevo, Bosnia & Herzegovina
The Balkan syndrome is a not well-defined term but is commonly
used in the public and is related to the increase in registered
number of malign diseases within people that were on the territory
of former Yugoslavia during and after the war. Firm proofs for
certain affirmations do not exist and, it can only be analyzed
with existing epidemiological dates. Purpose of the study: use
the epidemiological dates concerning hematooncological patients
hospitalized in the Hematological Clinic in Sarajevo to confirm
an eventual etiological factor linked to the Bosnian war 1992-1995.
Patients
and methods: hematooncological patients hospitalized in the Hematological
Clinic in Sarajevo during the period from 1989 to 1999.The method
used is: clinical picture and standard analysis, which were possible
to do during that period. Results: the age of the patients
of M.Hodgins disease has changed from the bimodal shape to a shape
were the disease affects more the young generation. This can be
seen in other underdeveloped countries, which is the proof of
the fall in living standards in this area. The increase in the
number of patients suffering from Leucosis acute and an especially
TMDS/AML after the war, with the highest level in 1999 is the
proof that people were confronted to more harmful agents that
could have caused the disease.
Conclusions: Registries increase in the number of patients in
hematooncological diseases, on the territory of the Federation
of Bosnia and Herzegovina during and after the Bosnian war 1992-1995
cannot be associated with only the use of ammunition with uranium.
The causes are various and combined: stress, inappropriate food,
uncontrolled water with concentration of heavy metal salts, aero
pollution due to dust and other types of munitions, infections
due to oncovirus...of which there do not exist any sure dates,
but one must be aware of these facts, and conscious of the consequences
of war conflicts in other places.
SECOND-LINE TRETAMENT PATIENTS AT RELAPSE OF DISSEMINATED SMALL-CELL
LUNG CANCER (SCLC)
Mehić B., Dizdarević Z., Žutić H. Clinical Centre University of
Sarajevo, Clinic of Lung Disease and TB, Bardakčije 90, Sarajevo,
Bosnia and Herzegovina
Background: although response rates of chemotherapy at diagnosis
are high in SCLC, the great majority of patients will suffer a
tumor relapse after a shorter or longer treatment free period.
In this situation, second-line therapy is often necessary for
adequate palliation. Aim: evaluation response rate (RR) and survival
time (ST) from beginning second line treatment of two different
treating groups. Patients and Methods: Retrospective-prospective
study on 16 patients relapsing within 3 months of induction chemotherapy:
cyclophosphamide, doxorubicin, etoposide (CDE). 10 of them treated
(as second-line treatment) with cisplatin 80mg/m2,
day 1, and etoposide 120 mg/m2, days 1, 2, 3, (P+E)
every 3 weeks. 6 other treated with docetaxel 60mg/m2,
and cisplatin 80mg/m2, day 1, (D+E) every three weeks.
Karnofsky performance status was > 60%, with measurable or
evaluable disease, normal bone marrow, liver and renal function
and there was no symptomatic peripheral neuropathy. Results: patients
treated with P+E had median age 59.4 (44 – 70) years, 7 male and
3 female, received median cycles number 5 (3 – 6) with total cycles
number 50, versus pts treated with D+P with median age 55.5 (40
– 69) years, 4 male and 2 female, received median cycles number
3.7 (3 – 4) and total cycles number 22. In P+E group complete
response had 2 pts, partial 2 pts, and 6 pts was without response
(3 disease stabilization and 3 progressive disease) versus D+P
group, there was 2 pts with complete response, 2 with partial,
and 2 pts was without response (disease stabilization). The one-year
survival in P+E group had 2 pts (20%) and medial survival time
was 6.2 months versus D+E group, there was one-year survival at
2 pts (33.3%) and median survival time was 10.2 months. Conclusion:
D+E combination is an effective regime in second-line treatment
patients at relapse of disseminated SCLC (66.6% overall response
rate and median survival time 10.2 months).
DIET IN CANCER TREATMENT
Jevrić-Čaušević A: Department of Clinical Biochemistry, Faculty
of Pharmacy, University of Sarajevo, Bosnia&Herzegovina
The growth
of malignant tumors by itself is a process characterized by three
phases, merely initiation, promotion and progression. Scientific
date show that nutritional components of certain food products
can influence greatly process of tumor growth in any of these
phases. So far it has been shown that number of diseased people
can be decreased for up to 30-40%, if the patients are being held
on a proper diet and if their body mass is kept under control.
In
this work, all the aspect of tumor growth are analyzed from reveling
nutritional point of view and significance of proper food diet
is stressed once again. The importance of taking food involved
in prevention of formation of free radicals and precarcinogen
action is stressed in initiation phase. In
promotion phase, multiplication of cells has to be kept at minimum
and food taken has to be rich in inhibitors of enzymes involved.
In
progression phase, angiogenesis has to be attacked. The tumor,
in order to proliferate further has to have adequate blood supply
and in this phase, the use of COX2 inhibitors is highly recommended.
CENTRAL NERVOUS
SYSTEM NEOPLASM IN A TEN-YEAR PERIOD AT UNIVERSITY NEUROLOGY CLINIC
IN SARAJEVO
Alajbegović A1, Hrnjica M1, Suljić E1,
Ajanović Z1, Alajbegović S2, Bulić G1.
1Clinic of Neurology, Clinical Center University of Sarajevo,
2Cantonal Hospital Zenica
Tumours of the Central Nervous System in a clinical sample appear
in 1-9% of examinees.The most practical clinical ification include
primary and secondary tumours. The aim of this article is to make
a comparative analysis of primary and secondary tumors in ten–years
period on University Neurology Clinic in Sarajevo, with parameters
of sex, age, neurological symptomatology and relevant diagnostics.
We evaluated on the Clinic retrospectively 10.329 patients from
01.01.1990.until 31.12.1999. and found 279 examinees with CNS
tumours, or 2.7% of the sample, out of whom 231 patient had been
with brain tumour, or 2.2 %. In the total sample we found 158
patients with primary tumours and 73 with matastatic neoplasms.
The mean age of primary tumour patients had been 52.4 years, with
ST 25.01 yrs, while average age of those with secondary neoplasms
had been 63.7 years with SD 8.06 yrs. Evaluation of sex-ratio
discovered statistically significant sex-related difference. The
most common symptom in those with primary tumours has been headache;the
most frequent sign-hemiparesis, significantly more frequent in
primary tumour patients. There has no been any significant diffrence
in symptoms like: vomiting, epileptic fits, mental symptoms, speech
disturbances, kranial nerves symptoms. In further course, in all
of those patients a diagnosis of brain neoplasm had been confirmed.
We concluded that tumours of the brain in our material were discovered
in 2.2% of examinees, with primary tumours significantly more
frequent and in younger group of patients.
POSTER SESSION
ABSTRACTS:
NEWS IN THE TREATMENT OF CHRONIC VIRAL HEPATITI C - REVIEW OF
THE CASE -
Osmić A.: Clinic of Infective Disease, University Clinical Center
Sarajevo, Bosnia & Herzegovina
At our clinic we started the treatment of a 21-year old i.v. drug
addict for the chronic HCV infection with a combination of Peg
interferon (conjugate of recombined Interferon Alfa-2b with Monomethoxypolyethylene
glycol) and Ribavirin. At the beginning of the treatment our patient
was ELISA anti HCV and PCR HCV RNA positive with a high virus
burden (quantity) of the virus (752000 UI or 1880000 Copies/ml
of serum) of hepatitis C, genotype 1-a, which requires a longer,
one-year (more expensive and with less favorable prognosis) treatment.
We administered 50 micrograms of Peg interferon a week in the
form of s.c. injection and 1000 milligrams of Ribavirin in the
capsule form, per os. After 3 weeks of the treatment we noticed
a perceptible drop of the values of aminotransferase (ALAT from
18941 to 2404 utkl/L) and Bilirubin (from 40,5 to 22,1 umol/L),
as well as normalized values of proteinogram. In a 3-month treatment
the above-mentioned values remained mostly unchanged, after that
normal, and HCV RNA negative. The patient complained about a raised
body temperature, up to 38 degrees C, which lasted for several
hours after receiving the injection, weak appetite, "nervousness",
weak concentration and insomnia, but their intensity did not require
therapy interruption. Six months after the beginning of the therapy,
all control tests were normal; they prove the combination of medicines
useful. The therapy will continue in the next six months.
ANALYSIS OF THE OUTBREAK OF THE FOLLICULAR EPIDEMIC KERATOCONJUNCTIVITIS
(EKC) IN THE AUTUMN OF 1999 IN ZENICA
Čaušević-Drino A.: Ophtalmologic Department, Cantonal Hospital
Zenica, Bosnia & Herzegovina
Aim: To contribute to the investigation of follicular keratoconjunctivitis
epidemic (EKC), its origins, course, the ways of spreading, consequences,
etc. Our particular intention is to emphasize the importance of
preventive activities in order to fight epidemics. Materials
and methods: The study comprised 158 patients with follicular
epidemic keratoconjunctivitis referred to the Ophthalmologic Outpatient
Clinic of the Cantonal Hospital in Zenica, in the autumn in 1999.
All the patients, affected by this disease for the first time,
were treated in the Outpatient Clinic. The average disease duration
was 25 days. Of total number of the patients, 60 were males of
age from 8 months to 80 years. 98 patients were females. Results:
Of 158 patients, 112 were cured, 81 females and 31 males respectively.
29 females and 17 males still had corneal infiltrates still 6
months after the disappearance of the epidemic. Conclusion: Epidemic
keratoconjunctivitis is a serious ophthalmologic disease that
occurs sporadically in families, schools, health units and it
can affect the anterior eye segment like turbidities that influence
the eyesight sharpness. It is necessary to recognize the disease
on time, to treat it adequately, to carry out the antiepidemic
activities, and to cut the ways of transmission. It is also necessary
to pay attention to the health education of population as well
as to improve hygienic habits. The prevention is the best protection
of keratoconjunctivitis affection.
FIXATION BY FixAS OF THE SUBGLENOID OSTEOTOMY AT KNEE DEFORMATIONS
Šabić N.: Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
The aim of this work is to point out the advantages comparing
with other methods: 1)
full stability and faster healing, 2)
full flexion of the knee and maximal comfort, 3)
possibility of full deformity correction during the operation,
but also postoperatively, until the hypercorrection. In the last
12 years we have operatively treated total of 112 patients - 145
osteotomies. In the last 5 years, we have used this method for
28 patients with 35 osteotomies, and we achieved much better results.
With all of them, with full flexion of the knee and walking with
burdening up to20 kg within the first 7 days. The
best results are achieved with hypercorrection up to 10o with
younger, and hypercorrection up to 150 with older patients.
With FixAS
(Anatomical - Stabile and Accommodation - Successful) treatment
one can provide: -
continuing safety for the patient, and -
sovereignty for the surgery in all phases of the treatment.
POSTOPERATIVE LEFT SITED COLON
Abd Al-Kader Hegazy, Takseem Al-Rekaba Al-Edaryia, Beside Kasr
Al-Kobba, Al Amal Hospital, Cairo, Egypt.
After exploration due to perforated appendix and generalized
peritonitis, the patient suffered from abdominal colic, right-sided
abdominal colic and disturbed bowel motion .The patient presented
to me three years after the operation. Clinical examination
revealed distention and fullness of the right side of the
abdomen along the right colon. Barium enema revealed that left
colon is lying along side the right colon on exploration, there
was a left tortuous meso-colon starting from the splenic
flexure .the left colon is adherent through its serous with the
right colon and lying anterior to the small intestine. Dissection
and repositioning of the left colon in its place was done .The
possible underlying cause is congenital failure of movement of
the hindgut and rotation of the mid gut together with postoperative
adhesions.
Discussion: This patient has a congenital malrotation of
hind gut causing mobile descending colon with duplicated loop
which become attached to the Mc Burney incision fixing the mobile
loop to the right side of the abdominal cavity in front of the
cecum and ascending colon causing distention and difficult evacuation
due to sub acute colony obstruct. In the embryo the descending
possess a midline dorsal mesocolon containing the left colic vessels
between its layers .The mesocolon hinged to the left like a door
and become fused with a parietal peritoneum of the post abdominal
wall. Thus in the adult the peritoneal floor of the infra colic
compartment is the right leaf of the original dorsal mesocolon
and left colic vessels lie immediately beneath it.
THE STABILISATION OF THE FRACTURE AS A PART OF THE EMERGENSY TREATMENT
AT THE POLYTRAUMA
Maksic S, Tanovic H*, Zjakic A, Tanovic E, Omerovic
D.:
Orthopedic Clinic, Clinical Center University of Sarajevo,
*Abdominal Surgery Clinic, Clinical Center University of
Sarajevo, Sarajevo, Bosnia and Herzegovina
The stabilisation of the fractures means operative procedures
which using the methods of internal and external fixation stabilise
fragments of the fracture. At the life-threatening patient with
polytrauma, stabilisation of fracture prevents blood loss, decreases
pain, and prevents the appearance or aggravation of the schok
but at the sametime makes conditions for surgical care of the
soft tissues and vascular injuries. It has been presented 61-year-old
severe injured patient after car exident. At the admission he
was unconsciousness, with clinical signs of the haemorrhage and
traumatic shock, and with multiples fractures. The patient was
examined using laboratory, radiological, and ultrasound procedures
and final diagnoses were intraabdominal bleeding as consequence
of the liver injury, reciprocally multifragmentary open tibial
factures, penetrative wound the both knees, multifragmentary supra
condylar fracture of the left femur, intertrochanteric fracture
of the right femur and crush injury of the right foot. After primary
resuscitation, at the same time there were undertaken suture of
the liver rupture, amputation front part of the right foot and
stabilisation of the fractures by internal or external fixation.
Patient was discharged two months after the admission with suggestions
for further rehabilitation and additional conversion kind of fixation.
This case has confirmed that the stabilisation of fracture at
the patient with polytrauma is emergency treatment and continuation
of the primary resuscitation.
BIMA-FIMA
CONVENTION June 2001 Sarajevo, Bosnia and Herzegovina
