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OSVRT NA TRENDOVE MALIGNIH NEOPLAZMI U FEDERACIJI BIH U PERIODU 2004-2014. GODINE

Author(s): Željko Ler,Jasna Omanić,Marija Zeljko / Language(s): Bosnian Issue: 3/2016

Introduction: Register for cancer in Federation of B&H was established in 2004 as a special activity for gathering, analysis and interpretation of data on every new cancer case in Federation area, trough given time period. Objective:To show data on disease and deaths caused by cancer in Federation of B&H in period from 2004 to 2014 as a result of establishment and activity of Register for cancer. Methodology: This paper uses data from Register on persons diagnosed with cancer (except skin cancer) in period from 2004 to 2014 and data on mortality statistic by Federal Statistic Institute. The methodology is analytical.Results: Cancer appearance average rate in period from 2004 to 2014 for women is 203.9/100000, and for women is 179,2/100000. The average age of registred deseased is 62 years of age. Conclusion: Population Register for cancer enables cancer threat assessment of society (incidence, mortality), analysis of time trends(age, gender, place), as well as detection of weaknesses in quality of registration and the need for correction it. It is insufficiency of reporting malignant neoplasms of the ten cantonal institutions in the Federation of B&H (number of different data sources), and hence longer waiting on the intergration of results in a research year (visible in the results for 2014).

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HEMORADIOTERAPIJA TUMORA GLAVE I VRATA

Author(s): Velda Smailbegović,Nermina Kantardžić,Selma Sokolović / Language(s): Bosnian Issue: 3/2016

Aim: To explore chemo radiotherapy and targeted therapies in the treatment fortumors of the head and neck. We will show the results of incidence and treatment options for patients treated in the Clinic for oncology in Sarajevo from 2010 to2014. Methods and material: We searched the Internet for treatments with chemo and radiotherapy and targeted therapies in head and neck tumors. We considered studies phase II and III, and proposals of NCI and EORT for new standards intreatment of head and neck tumors. In the Clinic of Oncology Sarajevo we treated 480 patients with head and neck tumors. Most of the treatments were radio therapy with standard fractionations of 2Gy/day to total dose of 65 to 70Gy. Some patients also received chemotherapy. Results: In head and neck tumors Cisplatin isthe most often researched chemotherapy. Given concomitantly with radiotherapy it shows better results in both, local control and survival of patients. Targeted therapies show similar results in local control and survival but with less toxicity Grade 3/4. In the Clinic of Oncology in Sarajevo retrospective analysis of results shows that chemo and radiotherapy is the new standard for the treatment of advanced head and neck tumors

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PREVENCIJA I LIJEČENJE ORALNIH KOMPLIKACIJA RADIO(KEMO)TERAPIJE U PODRUČJU GLAVE I VRATA

Author(s): Berislav Topić / Language(s): Bosnian Issue: 3/2016

Aim: Elaborate the role of a stomatologist, who is in charge of oral health of patients undergoing radiotherapy, which is incompletely understood by oncology team and by the patients. Appropriate stomatological care can contribute better quality of life during and particularly after the radiotherapy. Background: The treatment of malignancies of head and neck includes surgery, radiotherapy, chemotherapy and the combination of these methods. Head and Neck cancer accounts for high percentage of radio-therapeutic casuistics. Orofacial region is important area for nuclear medicine. Radiation induces multiple side effects on molecular, cellular, tissue, organ and systemic level. Local and systemic reaction of radiotherapyside effects are known as postradiation syndrome. Methods: Limited number of references was analyzed in relation to epidemiology of oral carcinoma and postradation syndrome of head and neck. Radiation syndrome of head and neck is ascribed by treatments before-, during and after radiation. Resultsand discussion are presented through evaluation: oral mucositis, hyposalivation– xerostomia, radiation caries, trismus, dysfunction of taste – dysgeusia, osteoradionecrosis of jaws, insufficiency of nutrition. These functional disorders: pain,mastication, swallowing, loss of taste, appetite, speech and communication lead to a poor quality of life of these patients. Proceeding head and neck radiotherapy,every patient should undergo a dental examination and receive individualized dental treatment. This article is a detailed preview of stomatogical treatments before-, during and after radiation therapy in order to reduce the mentioned complications and ensure higher possible quality of life of patients with postradiation syndrome. Stable oral health is prerequisite for good general health. Conclusion:Especially educated stomatologist should be an indispensible part of oncology team for patients undergoing a treatment of radio(chemo)therapy. Stomatologist can influence more comfortable and better quality of life for these patients.

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STOMATOLOG, ČLAN ONKOLOŠKOG TIMA U RADIO(KEMO)TERAPIJI GLAVE I VRATA

Author(s): Ivan Alajbeg / Language(s): Bosnian Issue: 3/2016

Background: Oral complications of oral, head and neck cancer (OHNC) radiotherapy(RT) account for increased morbidity, mortality and treatment costs. RT induces reversible and irreversible changes of involved tissues in the radiation field. Aim: Introduction of a multimodal team approach that would include responsible dentist would yield better overall treatment results, and would diminishoral sequelae of OHNC treatment. Method: Our currently applied protocol in OHNC patients includes standardized procedures that assess and prepare patients'oral status for RT. Previously, this form of care was not existent, and neither were patients under formal supervision of oral health care professional during radiotherapy. As a consequence, high rate of radiotherapy interruption and delay due to oral mucositis and long term oral complications are encountered. With a common goal to introduce prevention and treatment of oral complications as standardized practice in OHNC patients, we have created a protocol in accordance with internationally accepted clinical practice, based on the inclusion of dental professionals throughout the treatment and follow-up phases. Results: This paper describes our strategies and pitfalls we have encountered. Conclusion: It is isvery demanding and slowly developing process. Our efforts will have substantial clinical and economic impact on OHNC patients’ treatment.

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ZNAČAJ NUKLEARNE MEDICINE U MENADŽMENTU PACIJENATA S KARCINOMOM ŠTITNJAČE

Author(s): Elma Kučukalić - Selimović,Amila Bašić / Language(s): Bosnian Issue: 4/2016

Nuclear medicine has a vital role in the diagnosis, follow-up and treatment of thyroid cancer. In addition to thyroid gland ultrasound and cytology, another important diagnostic tool is thyroid scintigraphy. If thyroid cancer is confirmed, the next step is surgical treatment – a total/near total thyroidectomy according to guidelines. This is followed by diagnostic imaging and, if necessary, radionuclide therapeutic procedures. Diagnostic scintigraphy determines the amount of residual thyroid tissue left over after thyroidectomy and defines the presence of functional metastases. Tg measurement is valuable in patients who have undergone surgical treatment and I-131 treatment. Administration of empirical doses results in a successful ablation of thyroid tissue remnants in the majority of patients after the first administration of radioactive iodine, while therapy for iodine-positive metastases includes high therapeutic doses of radioactive iodine. Radioactive iodine-negative metastases are readily visible using 99mTc-sestamibi or 18F-FDG. More recently, diagnostic scintigraphy of somatostatin receptors is used and, in the event of positive results, PRRT is performed. The targeted therapy is aimed at inhibiting specific molecules that are important for tumor growth and disease progression. If serum Tg rises above previous levels, additional procedures are recommended to check for recurrence: 131I SPECT-CT, 18F-FDG PET, skeletal scintigraphy in suspected bone metastases. Medullar carcinoma diagnosis in patients with a thyroid nodule is best achieved with FNAB. PET/CT is excellent for identifying measurable metastases, but is of no use for miliary pulmonary metastases or hepatic lesions. The nuclear medicine procedures have a direct influence on good prognosis of differentiated thyroid carcinomas

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NODOZNA BOLEST ŠTITNE ŽLIJEZDE: EVALUACIJA ULTRAZVUČNE METODE U DIFERENCIJACIJI BENIGNIH, SUSPEKTNO MALIGNIH I MALIGNIH TIREOIDNIH ČVOROVA

Author(s): Amra Jakubović Čičkušić,Belkisa Izić,Maja Sulejmanović,Jasmin Hasanović,Alma Čičkušić / Language(s): Bosnian Issue: 4/2016

The aim of this study was to determine the sensitivity (Se), specificity (Sp), positive (PPV) and negative predictive values (NPV) and diagnostic accuracy of ultrasonography in the evaluation of benign, suspected malignant and malignant thyroid nodules. Methods: This is a retrospective-prospective study of thyroid nodules in 155 patients, of both sexes, the average age of 56.34y132 (85,2%) females and 23 (14,8%) male. The subjects in this study were a specially selected group of patients who had been reffered to a surgeon to have an operation due to suspected cytological findings, the size of goiter or symptoms of compression. Based on ultrasound patterns, thyroid nodules are divided into 3 groups: benign, suspected malignant and malignant lesions. The preoperative ultrasound features of thyroid nodules were compared with postoperative histopathology results. For each tested group - Se, Sp, PPV, NPV and diagnostic accuracy were estimated. Results: The Se, Sp, PPV, NPV and overall diagnostic accuracy of ultrasound methods compared with histological findings in the evaluation of benign thyroid nodules were: 41,74%, 42,30%, 58,90%, 26,82% and 41,93%; in suspect malignant were: 29,50%, 93,61%, 75%, 67,17% and 68,38%; and in malignant thyroid lesions were: 33,87% 94,62%, 80,76%, 68,21% and 70,32%, respectively. Conclusion: The results of this study indicate that the ultrasound examination had high specificity and high PPV in detection suspect malignant and malignant thyroid nodules.

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MOGUĆNOSTI ULTRAZVUČNE DIJAGNOSTIKE U DIFERENCIJACIJI TUMORA ŠTITNE ŽLIJEZDE

Author(s): Lidija Lincender-Cvijetić,Sanja Šehović,Nina Jurić,Amela Begić / Language(s): Bosnian Issue: 4/2016

Purpose: The purpose of this study was to compare ultrasonography (US) results with results of targeted cytological puncture of a nodule of the thyroid, as well as to assess the capabilities of ultrasonography in screening patients with potentially present tumor for cytological puncture. Material and method: The study analyzed results of 133 patients, men and women, between the age of 16 and 75. The patients had a standard ultrasound exam of the thyroid and ultrasound guided cytological puncture. Results: The research showed that nodular diseases of the thyroid were presented in 2/3 of women patients, and in 1/3 of men patients. The largest presence of nodules was among the group of 40-49 years of age. Nodules are the most common in the lower right lobe of the thyroid. The size increase of nodules also increases probability to be malignant. Furthermore, this research has shown that there is a statistically significant connection between ultrasonography results and the cytological puncture test results. Conclusion: Ultrasonography is a reliable method of diagnosis for selecting patients to have a cytological puncture.

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RADIOIODINE THERAPY OF DIFFERENTIATED THYROID CANCER – PRINCIPLES AND PRACTICE

Author(s): Amela Begić,Elma Kučukalić - Selimović / Language(s): English Issue: 4/2016

Differentiated thyroid cancer is defined as a carcinoma deriving from the follicular epithelium and retaining basic biological characteristics of healthy thyroid tissue. Differentiated thyroid carcinoma is an uncommon disease clinically, but worldwide, its incidence shows a noticeable increase. When appropriate treatment is given, the prognosis of the disease is generally excellent. Although the 10-year survival rate in cases of distant metastasis is approximately 25-40%, the 10-year overall cause-specific survival for differentiated thyroid carcinoma patients as a whole is estimated at approximately 85%. Radioiodine therapy is defined as the systemic administration of iodine I-131 for selective irradiation of thyroid remnants, microscopic differentiated thyroid carcinoma or other nonnresectable differentiated thyroid carcinoma or both purposes. The first form, radioiodine ablation, is a post-surgical adjuvant modality. Ablation also allows sensitive “post-therapy” whole- body scintigraphy that may detect previously occult metastases and serves to treat any microscopic tumour deposits. Ablation success is evaluated 6-12 months after the ablation procedure. Conclusion: Lifelong follow-up is needed in all differentiated thyroid carcinoma survivors and subsequent therapy in an appreciable number of patient.

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SAVREMENI TERAPIJSKI ASPEKTI KOD RADIOJOD NEGATIVNIH PACIJENATA S KARCINOMOM ŠTITNJAČE

Author(s): Elma Kučukalić - Selimović,Amila Bašić / Language(s): Bosnian Issue: 4/2016

Tretman dobro diferenciranog karcinoma štitnjače uključuje totalnu/subtotalnu tireoiodektomiju, tretman radioaktivnim jodom I-131 i doživotnu supresivnu terapiju tireoidnim hormonom. Pacijenti s radiojod negativnim karcinomom imaju ograničene terapijske opcije. Prije odluke o tretmanu, provode se dijagnostičke procedure koje mogu uticati na odabir terapije kod pojedinog pacijenta. Tc-99m sestamibi se koristi u dijagnostici jod neavidnih promjena kod tireoidnog karcinoma. 18-FDG PET/CT može pomoći u utvrđivanju stepena proširenosti bolesti i u selektiranju terapeutskog modaliteta. Stratifikacija rizika kod pacijenata sa radiojod negativnim karcinomom štitnjače također se bazira na ponavljanom određivanju vrijednosti tireoglobulina, koji reflektuje okultni tumor ili metastaze. Snimanje somatostatinskih receptora koristeći 68Ga-DOTA-TOC kao traser za PET uključeno je u dijagnostički algoritam kod pacijenata sa jod neavidnim promjenama. 68Ga-DOTA-TOC-PET je od velike dijagnostičke vrijednosti koja se odnosi na proširenost i lokalizaciju bolesti, pružajući mnogo tačniju dijagnozu kod radiojod pozitivnih kao i radiojod negativnih pacijenata sa karcinomom štitnjače, kao i kod miješanih tipova tumora. Navedena pretraga također pruža uvid u mogućnost peptid receptor radionuklidne terapije (PRRT). Nadalje, kod pacijenata koji imaju i negativan somatostatin receptor sken te kod kojih nije indicirana PRRT, molekularna ciljna terapija sa multikinaze inhibitorima ili inhibitorima proteaze može biti razmatrana (sunitinib, sorafenib, bortezomib i drugi). U zaključku možemo reći da kod pacijenata sa radiojod negativnim karcinomom štitnjače modalitete liječenja treba prilagoditi nalazima prethodno provedenih ciljanih dijagnostičkih procedura, a naravno i tipu tumora, stadiju bolesti i cjelokupnom kliničkom stanju pacijenta.

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SLIKANJE MAGNETSKOM REZONANCOM TUMORA ŠTITNE ŽLIJEZDE

Author(s): Šerif Bešlić,Selma Milišić / Language(s): Bosnian Issue: 4/2016

Purpose: To define the position, role, methods and possibilities of magnetic resonance imaging (MRI) of thyroid neoplasms in early diagnosis, staging and the selection of treatments. Background: Malignant tumors of the thyroid gland are the most common endocrine neoplasms. However, mortality from them is relatively rare, especially if they are detected early and if it is a less malignant type of cancinoma. Therefore, their diagnosis at an early stage is of outmost importance. Methods: Although it is a small organ, diagnosis of malignant tumors of the thyroid gland is very complex and includes practically all available imaging methods in addition to clinical evaluation and laboratory findings. Lately magnetic resonance imaging (MRI) has ensured its place among imaging methods, and it is evolving rapidly. Disscusion: In this paper we discuss the role of MRI in the diagnosis and staging of thyroid gland neoplasms due to the rapid development of MR techniques such as MR spectroscopy (MRS), Diffusion Weighted Imaging (DWI), molecular imaging in oncology (MIO), with their advantages such as such as excellent spatial resolution, the ability of entire body imaging and so far little known noxiousness (no radiation), as well as low invasiveness of the method and tissue characterization between healthy and pathological tissues. Conclusions: From the above said it can be concluded that MRI imaging of thyroid gland neoplasms, especially with the application of old and the newly introduced methods, has its place in certain circumstances in the diagnosis, staging and pretherapeutical treatment of the patient in order to achieve the best therapeutical effect.

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NOVE TEHNIKE U RADIOTERAPIJI KARCINOMA ŠTITNE ŽLIJEZDE

Author(s): Nermina Kantardžić,Velda Smailbegović / Language(s): Bosnian Issue: 4/2016

Aim: To discuss new technologies in radiotherapy treatment for thyroid carcinoma. Traditional radiotherapy for thyroid carcinoma has certain restrictions because spinal medulla is close to the tumor. The radiotherapy dose must therefore be reduced in order to prevent the damage to this structure. Introducing Intensity modulated radiotherapy (IMRT), Image guided radiotherapy (IGRT) or tomotherapy can improve target coverage in cases that are difficult to treat. Patients and methods: According to the hospital malignant diseases register of Clinical Center of Sarajevo University (UKCS) there were 149 patients diagnosed with thyroid cancer and treated in this institution from 2009 to 2013. Retrospective analysis of data from Oncology Clinic during this period showed that 18 patients were treated at the Oncology Clinic of UKCS. Results: Most patients treated at the Oncology Clinic received palliative treatment, and only one patient received curative treatment. 16 patients had metastatic disease at the time of presentation for treatment, and one developed metastases after our treatment. One patient currently shows no signs of disease. Conclusion: In most cases radiotherapy is reserved for palliative treatments, due to the dosage restrictions. New techniques such as IMRT, IGRT and/or tomotherapy have demonstrated efficacy in precise treatment for tumors and also an increase in disease control, while at the same time ensuring a better protection of organs at risk from exposure to unnecessary radiation and thereby reducing long-term toxicity. For these reasons, new techniques may be considered a viable option in the treatment for thyroid cancer.

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HIRURŠKA TERAPIJA KARCINOMA ŠTITASTE ŽLEZDE

Author(s): Ivan Paunović / Language(s): Serbian Issue: 4/2016

Aim: There is still no clear solution for appropriate surgical management of thyroid gland carcinoma. Background: Thyroid gland carcinomas are most frequent carcinomas of endocrine organs, but rare comparing to the carcinomas of other localizations. Unlike other carcinomas, surgical treatment of thyroid carcinomas is primarily the best way of treatment, which means that the thyroid carcinomas are surgical disease. The origin of the cells of the thyroid gland from which the cancer arises determinates histopathological and clinical classification of the thyroid gland carcinomas as well as treatment and follow-up. Well-differentiated (papillary and follicular carcinoma) (DTC) and undifferentiated (anaplastic carcinoma) (ATC) are thyroid carcinomas of the follicular origin. Medullary thyroid carcinoma (MTC) arises from the “C” (calcitonin producing cells) cells of the thyroid gland, which are still incorrectly referred as parafollicular cells even though that “C” cell can be found intrafolliculary. Methods: The published studies were analyzed and compared with author’s personal experience in connection with surgical management of different types of thyroid gland carcinomas. Discussion: In the field of thyroid surgery for DTC discussion about appropriate type of surgery for DTC lasted previous thirty years and from the author opinion will last next thirty years. The author’s thirty year experience in the field of thyroid surgery is that every patient either with preoperative confirmed DTC, or patient with suspicious DTC should be approached individually. Type of the operation should depend of the local findings, age, presence or absence of cervical lymphonodopathy and presence or absence of distant metastases. Compared to DTC, there is no doubt that total thyroidectomy with central node dissection is appropriate surgical procedure both for sporadic and hereditary MTC. From author’s experience ATC diagnosis in the region of Western Balkans is often established lately, when only tumor reduction in order to deliberate trachea is possible. Since, in this area, the ATC is commonly found with coexistent multinodular goiter in author’s opinion, continuous control of these patients and emergency operation in case of FNB biopsy diagnosed ATC are highly recommended. Conclusion: Endocrine surgeon must always have a clear idea about surgical approach to the patient with thyroid gland carcinoma. Preoperative and intraoperative evaluation of the surgeon and the surgeon’s ability to understand the unique characteristic of thyroid gland carcinomas compared to carcinomas of other localizations are still the basis of the successful operation.

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MITRAL VALVE DISEASE IN CHILDREN AND ADULTS

Author(s): Senka Mesihović-Dinarević / Language(s): English Issue: 1/2017

Mitral valve / MV / is a functional complex that is based on the normal morphology, geometrical relations and function of all constituents. Its role is triple: 1. regulate blood flow to the LV during diastole with low pressure gradient, preventing the recurrence of systolic blood flow in LA, 2. contribute to the formation of LV outflow tract in systole and 3. its integrity is essential for maintenance of a normal size and geometry function of LV. The disease of heart valves, mitral and aortic caused by degenerative changes, is quite common in adults. In a young person, the more common causes are: inflammatory diseases, cardiomyopathy and ischemic heart disease. Using color Doppler echocardiography, the morphological valve changes and damage to its function can be diagnosed. The goal of treatment is: to reduce or eliminate symptoms of disease, to avoid damage to LV function or right ventricle, improving the quality of patient’s life, prevention of complications and mortality reduction. Treatment options for valvular heart disease are: medical therapy, balloon valvuloplasty and surgical therapy: valve replacement or valve reconstruction. In children there are predominantly acquired valvular heart diseases of rheumatic etiology. Mitral stenosis is rare, more common is mitral regurgitation /MR/. Treatment of MR involves: SBE prophylaxis, afterload reducing agents, diuretics and digoxin. Surgical correction prefers reconstruction over MV replacement. Asymptomatic patients with MV prolapse do not require treatment, and symptomatic patients need beta blocker agents. Reconstructive surgery or MV replacement is indicated in rare patients with severe MR.

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MITRAL VALVE PATHOLOGY: CHALLENGES AND SOLUTIONS – A SHORT OVERVIEW

Author(s): Manferd Marx,Daniel Zimpfer / Language(s): English Issue: 1/2017

Mitral valve prolapse (MVP) is the most common valve disease (prevalence of 2 to 3%). Although MVP is generally regarded as a benign condition, complications such as mitral regurgitation, atrial fibrillation, congestive heart failure, endocarditis and stroke are well known. MVP is a significant cause of SCD where CE-CMR (contrast-enhanced MRI) might allow the identification of this arrhythmic substrate. Transcatheter mitral valve interventions are progressively being introduced into clinical practice targeting a population of patients with mitral regurgitation (MR). Beyond percutaneous edge to edge repair (MitraClip®), a percutaneous surgical-like direct annuloplasty device but also transcatheter chordal replacement and indirect annuloplasty (using coronary sinus devices, radiofrequency-mediated annular remodeling and cinching devices) are in various stages of development. Meanwhile, we do have personal experience using Melody valves as MV replacement using the hybrid approach. Rheumatic fever continues to be the commonest cause of acquired heart disease in the children and adolescent population of most developing countries. Until the early 1980s, the only option for patients with mitral stenosis (MS) uncontrollable by medical therapy was surgery. After several technical modifications balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Patients with sinus rhythm, less gross valve deformity, and a post-balloon mitral valvotomy area >1.75 cm2 will have better intermediate outcomes. Detailed knowledge of MV pathology will lead to perfect solutions for each individual patient.

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ECHOCARDIOGRAPHY OF THE MITRAL VALVE

Author(s): Katja Prokšelj / Language(s): English Issue: 1/2017

The mitral valve is a complex anatomical and functional structure, composed of the mitral leaflets, mitral annulus, chordae tendineae, papillary muscles and adjacent myocardium. Normal function of all parts of the mitral valve apparatus is essential for normal function of the mitral valve. Different conditions and diseases can cause mitral valve dysfunction, namely mitral regurgitation and mitral stenosis. Echocardiography is a key diagnostic procedure to evaluate the mitral valve. Transthoracic echocardiography is a basic investigation in assessing the mitral valve. When detailed evaluation of the mitral valve is required, transesophageal echocardiography is indicated with the advantage of better resolution and additional views. Two-dimensional echocardiography is useful in the evaluation of mitral valve morphology, heart size and function. Three-dimensional echocardiography is especially useful before surgical procedures, since it gives a better view of the complex mitral valve structure in a “surgeon’s view”. To detect possible mitral valve dysfunction, colour-Doppler echocardiography is used. To properly evaluate the degree of mitral valve regurgitation and stenosis, pulse and continuous-wave Doppler echocardiography is mandatory. Mitral valve evaluation requires a thorough echocardiographic investigation with different echocardiographic modalities and with the use of novel echocardiographic methods, such as three-dimensional echocardiography.

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CIRCULATORY SYSTEM DISEASES IN SARAJEVO CANTON

Author(s): Sabaha Dračić,Emira Tanović-Mikulec,Seniha Čelik / Language(s): English Issue: 1/2017

Noncommunicable diseases, including diseases of the circulatory system, are very widespread in the population and represent a mass phenomenon in which the etiologic factors are not biological or infectious factors, they have a lengthy course and usually last a lifetime, causing serious consequences for human health. The main risk factors for the development of noncommunicable diseases, except genetic predisposition, are conditioned by habits and lifestyle, and can be significantly reduced by application of effective measures and interventions for prevention and control of these diseases. The diseases of the circulatory system have a major public health importance as the leading causes of mortality and the leading diseases in the world, especially in developed countries, but also in developing countries. The objective of this paper is to present the prevalence and trends of diseases of the circulatory system in the morbidity and mortality of the population of Sarajevo Canton. The paper uses retrospective descriptive statistical methods, such as data on morbidity registered in primary health care in the Sarajevo Canton and mortality data of the Institute for Statistics of Federation of BiH. The results show that hypertensive disease, apart from acute upper respiratory infections, is the leading disease in morbidity of the population of Sarajevo Canton (10.95%), and that the diseases of the circulatory system are the leading cause of death of the population of Sarajevo Canton (41.69%). More women die of these diseases (53.78%) in relation to men (46.22%), but in the age group below 65 years of age more men (69.71%) die from circulatory diseases in relation to women (30.29%). The leading causes of death for women in the Sarajevo Canton among diseases of the circulatory system are stroke/cerebral infarction and chronic ischemic heart disease, while among men these are stroke/cerebral infarction and acute myocardial infarction.

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TREATING DISCUS HERNIA USING A SELF DEVELOPED METHOD - A NEW TECHNOLOGY WITHOUT SURGICAL INTERVENTION

Author(s): Mitrichka Stardelova,Angel Dzambazovski / Language(s): English Issue: 2/2014

This paper includes an experiment that was performed on a hundred patients by using our self-developed methods during a two year period. The treatment of discus hernia was carried out by using our self-developed methods combined with a completely new technology, as well as clinical biomechanics, chiropractics, massotherapy, thermotherapy, cryotherapy and various other specific exercises practiced in esthetic and orthopedic kinesiology - kinesitherapy.50 females and 50 males aged 35 to 55 underwent our therapy and the results we obtained display very high curative effects.

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DELINQUENT BEHAVIOUR OF CHILDREN FROM DYSFUNCTIONAL FAMILIES

Author(s): Sandra Bateva / Language(s): English Issue: 2/2014

The subject of my research in the paper is the children from dysfunctional families, primarily their delinquent behavior, education and moral, actually, who takes care of them and who undertakes the family roles and whether this care is sufficient for building these personalities.This research approaches towards the study of the delinquent behavior of children from dysfunctional families. It examines to what extent the educational level of parents, the material condition, the health condition, the leisure time, the average monthly income of the family, the available permanent goods, the educational resources, the social communications within the very family, all affect the delinquent behavior of children from dysfunctional families.

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Zdravstveno vulnerabilne kategorije stanovništva i njihovo pravo dostojanstva na radu

Author(s): Sanja Stojković Zlatanović / Language(s): Serbian Issue: 2/2016

Vulnerability may arise from individual characteristics of individuals or social groups, employment conditions or as a result of difficulties in exercising fundamental social human rights. Principle of equity in terms of labor and employment as well as equity in health are closely linked and represented in a concept of decent work for all, promoted by the International Labor Organization. The concept of decent work aims to improve work conditions for the marginalized and vulnerable workers, where the notions “vulnerable” and “marginalized” represent people on the periphery of formal, standard employment, people working in an environment where the risk of being denied employment rights is high and also those who do not have the capacity to protect themselves from the abuse. The labor status of social groups whose personal characteristics, i.e. health characteristics, make them vulnerable in terms of work conditions and labor rights has been analyzed. In international, comparative and Serbian law, workers with disabilities are already protected by the special law provisions of professional rehabilitation and employment of people with disabilities. On the contrary, the status of workers who are not considered as people with disabilities but who are faced with some health problems are not recognized in the labor legislation and protected by the law. People with health problems may be those who are chronically ill i.e. people in a remission of a disease. Considering the current demographic process of population aging, an increase of elderly in economically active population/labor force could be expected, which also means the increase of chronically ill workers. This fact, argue in favor of regulation the labor status of people with health problems. Furthermore, according to the World Health Organization, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, where the third component of health – social well-being could be used as justification for the integration of workers with health problems in the workplace. The aim is to prevent the occurrence of disability in terms of preventive approach. The integration and protection measures are represented in a form of flexible work arrangements (for instance, part-time work, tele-work), assignment a person with a health problem to another adequate job, establishment the right to a paid leave for the purpose of therapy by the law, prohibition of a night shift and overtime job for worker with health problems. The Serbian Labor Act (2005) has introduced a category of workers with the health problems and stipulates that those workers could not be assigned to a job that could have a negative effect to a health status/condition of an individual. A broader protection measures in terms of decent work and health equity, meaning that everyone should have a fair opportunity to attain their full health potential with the aim of performing major life activities, including working activities, are not introduced by the Serbian Labor Act. That need to be changed, taking into account the fact that the Serbian Disability Act does not recognize the workers with temporary or/and occasional health impairments, meaning that the special measures of professional integration of people with disabilities could not be applied to the people with health problems.

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Etyka w pracy przedstawiciela medycznego

Author(s): Marta Makowska / Language(s): Polish Issue: 2/2009

Over the last few years, the pharmaceutical industry intensified marketing activity in Poland. One of the most important ways of promotion are visits by pharmaceutical sales representatives in physicians’ offices. Representatives during those meetings are using different sorts of tactics to manipulate physicians such as: gift-giving, free meals, travel subsidies, “fake” research, ‘white Saturdays’, sponsored teaching and conferences. An ethical ambiguity can be easily find in this work. The paper describes briefly the results of the research concerning the influence of the relationship between physicians with the pharmaceutical companies on prescribing habits which were conducted in other countries. The article presents law regulations and ethical codes present in Poland, but it concentrate on describing the results of 31 in-depth interviews with pharmaceutical sales representatives conducted between the June – November 2007. The main aim of this paper is to show how important are ethical and law standards for the pharmaceutical sales representative. Do they know it? Does companies take care about proper training and information in the area for their employees? Work ethics of the pharmaceutical sales representative is very important, and should be discussed. Drugs are special kind of goods which can influence people health and sometimes even lives so we should pay attention to the ways medicaments are advertise and promote.

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