Showing papers in "Medicinski arhiv in 1999"

[Anatomic-therapeutic-chemical classification of drugs].

Abstract: European Research Association for Pharmaceutical Market and an international group have developed the ADC Drug Classification system, which is recommended by the World Health Organization (WHO). It has been in use since 1987. According to this classification, drugs are grouped into fourteen basic groups according to the organic system of the organism where they work. These fourteen anatomical groups represent the first anatomical level and is labeled with one capital letter, as follows: A Alimentary tract and metabolism B Blood and blood forming organs C Cardiovascular system D Dermatologicals G Genito urinary system and sex hormones H Systemic hormonal preparations, excl. sex hormones J General antiinfectives for systemic use L Antineoplastic and immunomodulating agents M Muscle-skeletal system N Nervous system P Antiparasitic products, insecticides and repellents R Respiratory system S Sensory organs V Various. Drugs are further divided into therapeutic groups and subgroups (2nd and 3rd level), the 4th level is the chemical-therapeutic subgroup. The 5th level is the generic drug name. Each drug is represented by 7 numeric-character bytes code. These seven bytes are determining the group (1st anatomical classification level marked by a capital letter) with the corresponding therapeutic subgroups on the 2nd and 3rd classification level, 4th level labels the chemical-therapeutic subgroup, while the 5th level is signified by the individual chemical compounds (generic name) and is marked by an Arabic number. The importance of the ATC classification is the possibility of the international comparability, monitoring of the use and consumption from various aspects. The standardized monitoring methodology incorporates too the daily doze determining methodology (DDD). Defined Daily Dose (DDD) is the drug amount used for the most common indication, and is, therefore, the basic statistical unit of drug use monitoring. It represents not only the recommended doze, but is also the only means of acquiring the number of patients receiving that particular drug (DDD per 1000 inhabitants). This makes the basis for the comparability of drug use in various places (country, region, institution, etc.).

Integrating intensive psychosocial therapy and low dose medical treatment in a total material of first episode psychotic patients compared to "treatment as usual" a 3 year follow-up.

Abstract: UNLABELLED: Every first episode functional psychosis patient (DSM-IV), age 18-45, with no dominating abuse, and living in an inner city area of 95,000 inhabitants have been treated as far as possible in accordance with the concept of "need adapted treatment" as formulated by Alanen et al 1991. Today about 70 patients have been treated and followed up with different clinical, psychological, and medical methods. The project group to be considered here consists of the first 32 patients, followed up during approximately 3 years. A retrospective comparison group was collected from the same area and from 2 more areas, with the same inclusion criteria. Their first psychotic episode was actualized 1-2 years before the project group was started and 72 cases were collected via records, personal questioning and databases. The outcome regarding in patient care and neuroleptic consumption, work and sickness data could be assessed for this group. RESULTS: In the project group 7/18 patients with schizophrenia diagnoses were free of positive or negative symptoms at follow up. In the non-schizophrenia psychosis group 11/14 had no psychotic symptoms. The mean in patient care consumption was considerably lower than that of the comparison group. 45% of the patients in the project group were on a neuroleptic prescription at the 3-year follow up vs. 71% of the comparison group. For those on a neuroleptic prescription the mean dosage at follow-up was 62 mgm chlorpromazine-eqv/day, vs. 192 mgm for comparison group. All the differences are significant. One conclusion to be made is that, provided a psychosocial support, neuroleptic consumption and in patient care can be considerably lowered with no detrimental effects. This is a pilot study lying behind the so-called "Parachute project", a Swedish multicenter study, which aims at deepening and broadening the clinical and methodological issues for the care of first episode psychosis patients.

Tuberculosis control and surveillance in changing health reform in the Czech Republic.

Abstract: In the Czech Republic a centralized, governmentally budgeted and vertically structured health system has been reformed to a liberalized health system with fragmentation of organisation, responsibilities and funding after 1989. Tuberculosis (TB) control and TB surveillance followed the general health system reform and implementation of liberalized health insurance system. In the liberalized health system the feasibility and accessibility of methods of TB control rather improved. In contrary to that TB surveillance in the liberalized system suffered bu absence of vertical mechanisms ensuring the completeness and validity of data collected in a centralised notification system (recording and reporting system). The rate of control notification dropped up to 50%. TB surveillance was therefore supplemented in 1996 by vertically oriented mechanisms of the hygienic (public health) service. TB consultants were appointed at regional and mostly also on district level as part-time jobs of the hygienic service and entitled to supervise all notifications from the given region (district), particularly what regards completeness of bacteriological data. As a consequence complete and reliable reports on epidemiological situation are issued and an assessment of antituberculous chemotherapy of new TB cases is made by a regional cohort analysis starting 1st quarter 1998. TB situation in the Czech republic is regarded as stable, being under control, with a decreasing trend of bacteriologically confirmed TB cases and increasing trend of bacteriologically not confirmed pulmonary TB. The TB is slowly shifting to high risk groups of population.

On suicide and suicide prevention as a public health issue.

Abstract: Suicide is becoming one of the major causes of death especially amongst men. In Europe suicide is the second most common cause of death in the ages of 15-44 years. For women in the same age group suicide is the fourth most common cause of death. Suicide causes a lot of suffering not only in the victim but also in persons close to him. As the causative factors are complex, and suicide also costs the community a lot of money suicide and self destructive behavior must be considered an important public health issue. A couple of models which are helpful when trying to develop treatment and preventive strategies for suicided persons are presented. The basic principles for contemporary suicide prevention programmes are also described.

Myocardial infarct in a young man with angiographically normal coronary arteries and atrial septal defect

Abstract: The paper is a case report of a 34 year old man with an inferior wall myocardial infarction, episodes of ventricular tachycardia, normal coronary arteries and a large atrial septal defect. Coronary atherosclerosis causes 95% of all myocardial infarcts and 75% in the age group under 35 years. Other possible causes are coronary arteritis, trauma, valuvlopathy, systemic diseases, infective and non-infective endocarditis, polycithemia, thrombocytosis, cocaine abuse. These can be usually excluded by history, physical or laboratory examination. The existence of a large atrial septal defect with dominantly left to right shunting, but occasional right to left shunting, is an indication and a justification for surgical treatment aiming to prevent recurrence by closure of the atrial septal defect. Paradoxical emboli have been recognised in the recent literature as an important cause of cerebral infarction, more rarely of emboli to other locations. The etiology remains difficult to confirm with certitude except when an embolus is seen by echocardiography in transit through a patent foramen ovale. We have also reviewed previously published cases of paradoxical emboli in literature.

Information technology in medical education

Abstract: The role of information technology in educational models of under-graduate and post-graduate medical education is growing in 1980's influenced by PC's break-in in medical practice and creating relevant data basis, and, particularly, in 1990's by integration of information technology on international level, development of international network, Internet, Telemedicin, etc. The development of new educational information technology is evident, proving that information in transfer of medical knowledge, medical informatics and communication systems represent the base of medical practice, medical education and research in medical sciences. In relation to the traditional approaches in concept, contents and techniques of medical education, new models of education in training of health professionals, using new information technology, offer a number of benefits, such as: decentralization and access to relevant data sources, collecting and updating of data, multidisciplinary approach in solving problems and effective decision-making, and affirmation of team work within medical and non-medical disciplines. Without regard to the dynamics of change and progressive reform orientation within health sector, the development of modern medical education is inevitable for all systems a in which information technology and available data basis, as a base of effective and scientifically based medical education of health care providers, give guarantees for efficient health care and improvement of health of population.

[Neonatal hyperbilirubinemia: evaluation and treatment].

Abstract: We investigated 185 newborns with hyperbilirubinemia hospitalised in Neonatal Unit of Pediatric clinic during 1997. We identified an apparent cause for the jaundice in 76 newborns (41.0%), but in 109 newborns (58.8%) no cause for the jaundice was found. Contributing factors for this jaundice were: male sex, preterm bith, breast feeding, considerable weight loss, instrumental or induced delivery as well as genetic factors. Exchange transfusion was done in only 2 cases (1.08%) with Rh isoimmunisation and positive Coombs test, which is according to attitude that blood exchange transfusion as an expensive procedure with high mortality and morbidity has largely been replaced by phototherapy because of its relative freedom from complications together with its non-invasive nature. The average duration of hospitalisation of hyperbilirubinemic newborns lasted 4.8 days. We consider to make all efforts to short duration of hospitalisation time, because separation of newborn from the mother during phototherapy has a negative impact on early mother-infant social and emotional interaction.

Telemedicine and telematics in medical education

Abstract: Health telematics is a composite term for health-related activities, services and systems carried out over a distance by means of information and communications technologies, for the purposes of global health promotion, disease control and health care, as well as education, management, and research for health. The concept of health telematics encompasses the following functional areas: --tele-education;--telemedicine;--telematics for health research;--telematics for health services management. Communications technologies are rapidly revolutionizing health care. For example, electronic communications support diagnosis and treatment of disease. TeleMedicine is an umbrella term for growing disciplines such as TeleRadiology. TelePathology. TeleCardiology, TelePsychiatry and TeleEducation. TeleMedicine is a component of TeleHealth, which includes the use of telecommunications technology and services for the surveillance and control of diseases and education. In this article authors describes the role of telemedicine and telematics in medical education and medical praxis.

Contribution of EFMI to development of medical informatics. European Federation for Medical Informatics.

Abstract: The European Federation for Medical Informatics has been established in 1976. At the MIE 96 it has celebrated the 20th anniversary of its existence. During these 20 years the number of number of national societies who became a member has been increased from 10 to 26 and nowadays is 29 not mentioning 2-3 applicants. The objectives of EFMI are: a) to advance international co-operation and dissemination of information, b) to promote research and development, c) to promote high standards in the application, d) to encourage high standards in education in this field. The achieve these goals EFMI organizes yearly European Congresses the MIE-s. Through its working groups contributes very well to the scientific development of medical informatics. The Working Group Chairmen regularly organizes tutorials workshops and many of them participate in teaching medical informatics in their homeland as well as on international courses. EFMI publishes scientific papers from its congresses in the Medical Informatics and in the International Journal of Medical Informatics. The most important meeting, however is the regular Council Meeting--twice a year--where council members can exchange opinions, have opportunity to discuss problems of medical informatics and last but not lease recently medical Inform-ETHICS. This Council is operating as a HUMAN-NET counterbalancing the dysinformations coming from the Internet.

[Reconstruction of mental health services in the Federation of Bosnia-Herzegovina].

Abstract: The war in Bosnia and Herzegovina has caused severe suffering of the population, and left behind destruction and misery. Hundreds of thousands were killed, ten thousands were severely injured, and almost the whole population has endured severe psychological traumas. The consequences today are numerous stress related psychical disorders, and especially PTSD. The war has almost destroyed the system of psychiatric services, and lead to lack of professional staff. Because of this, after the war, Federal Ministry of Health of Bosnia and Herzegovina has decided to carry out a complete reconstruction of psychiatric services based on new principles. Comprehensive care for improvement of mental health; prevention of mental illness, treatment and rehabilitation of mentally ill, should be transferred from institutions into the community. Consequently Ministry of Health have designed 38 Community Mental Health Centers in the Federation of Bosnia and Herzegovina in connection with already existing Primary Health Care centers (Dom zdravljas). Each of these centers is responsible for mental health in general within a catchment area of 50,000-80,000 inhabitants. A network of Community Mental Health Centers has started to operate. An efficient and useful training of the staff going to work in these centers have been carried out. Nevertheless, there is still significant resistance towards this new approach to mental health services and treatment of people with mental illness in the community. However, many problems related to this new program of community psychiatry have been identified and are under consideration.

[Diazepam-induced chromosome aberrations in human lymphocytes in vitro].

Abstract: This paper reports results of the research of genotoxic effects of anxiolitic benzodiazepine diazepam in the culture of lymphocytes of human periphery blood. It has been found out that diazepam reduces lymphocytes mitotic activity, causes numeric chromosomal aberrations (mostly hypodiploidy), and shows cytotoxic reactions. Frequency and expressiveness of perceived effects are in correlation with the intensity of concentrations tested.

[Bronchial carcinoma--an overview]

Abstract: UNLABELLED The incidence of lung cancer has exploded in this century. The disease is most commonly diagnosed in the 65-75 year age group but can occur as young as 30 years. Cigarette smoking is usually related to lung cancer in men and the risk of developing lung cancer increases with duration of smoking and the number of cigarettes smoked per day. The risk of developing lung cancer decreased to almost that of non smokers after 10-15 years of non smoking. People exposed to asbestos have an 80 fold increase in lung cancer if they smoke. Some increased risk is associated with exposure to radioactive materials--(uranium when mined underground), arsenic and chromium. Lung cancer is more common in city than in rural dwellers. Cell Types: Squamous 34%, Large Cell 28%, Adenocarcinoma and Bronchoalveolar 20%, Small Cell 17%, Mixed 1%. CLINICAL PRESENTATIONS Patients with lung cancer present with several symptoms, signs, and laboratory findings, depending upon the location, growth characteristics, and metabolic activity of the tumour. Asymptomatic: usually patients with solitary pulmonary nodules. Non-specific systemic symptoms: fatigue, weight loss and loss of appetite. Respiratory Symptoms: Haemoptysis, symptoms (and signs) of intrathoracic spread of tumour (hoarseness, pleuritis or pleural effusion, paralysed diaphragm, dysphagia, superior vena cava obstruction, Pancoast s syndrome. Symptoms from extrathoracic metastases: (mediastinal supraclavicular and neck), liver, brain, adrenals, bone and contralateral lung, in approximately that order. Systemic syndromes unassociated with metastatic spread of the primary tumour, often seen with the undifferentiated cell-types: Endocrinopathies (1. hypercalcemia, 2. Cushing s syndrome, 3. inappropriate secretion of antidiuretic hormone (SIADH), 4. gynecomastia, 5. carcinoid syndrome (rare); Neuromuscular disorders (1. myasthenic (Eaton-Lambert) syndrome, 2. peripheral neuropathy, 3. cerebellar degeneration); Connective-tissue syndromes (1. clubbing of fingers/toes (common), 2. hypertrophic pulmonary osteoarthropathy (rare), 3. dermatomyositis, 4. acanthosis nigricans, 5. non specific arthralgia). Diagnosis-The three requirements for diagnosis of lung cancer are: locating the tumour precisely, determining its specific histological cell type, assessing its extent (staging). The next diagnostic procedures are useful: sputum cytology, Pleural aspiration and biopsy, fibre optic bronchoscopy, needle aspiration biopsy. Surgery is the treatment of choice in NSCLC. Chemotherapy: it is the treatment of choice in those patients with small cell carcinoma with limited disease. The combination of chemotherapy with concurrent radiotherapy is now used. Prognosis for patients with lung cancer depends upon cell type, tumour size, location, spread, coexisting disease, and the patient s age. Numerous regimes of palliative radiotherapy and chemotherapy have been investigated as alternatives or adjuncts to surgery; results are often encouraging in the short term, poor in the long term. A great deal of clinical research continues in this area.

[Quality of medical records as a basis for DRG classification in the health care system in Bosnia-Herzegovina].

Abstract: Medical Record contains data about use of health care services of every member of certain population, no matter if they come from preventive or curative health care. Quality of Medical Records is very often in direct as well as indirect connection with health care quality. Better health care systems usually have better Medical Records. These are computer processed and stored on some of contemporary computer media, like: disks, microfilms, magnetic tapes and so-called "smart cards". Good Medical Record should have at least next characteristics: 1. Time dimension, which should contain chronological: past, present and future data, relevant to health care consumers. 2. It should be complete in a sense that every Medical Record must contain adequate medical and other relevant data for health care planning, organization and control. From the aspects of our research described here, it is very important that Medical Records contain all financial data. These usually are consequences of consumption of health care services from various resources of different levels. The results of our research about the application of DRG classification in B&H health system, that have been done in Tuzla University-Clinical Center, show that hospital Medical Records have many inadequacies, both in respect of medical as well as non-medical part. Physicians use very little ICD coding system. There is no uniform anamnesis, no detailed evidences about all hospital services, no adequately defined severity of disease and patient status at discharge. Due to manual based information system, there is no evidence about spending of resources per patient with financial data. The development and application of computer based health information system must go towards direction of solving these problems.

Psychosocial research during the war in Sarajevo

Abstract: War in Bosnia and Herzegovina has caused many psychic and social breakdowns. The consequences on mental health of the war which caused stress are of importance, as well as influences on psychic functioning of individuals are caused by changes in social structure of population and economic potential of the society. Project "Psycho-social aspects of war in BiH" carried out within the frame of the Academy of Sciences and Arts of Bosnia and Herzegovina and the Department of Psychiatry of Clinical Center of Sarajevo University. In this article are given the results of the Project, but only partially. The investigations showed that the number of patients visiting hospitals during the war was greatly increased in the field of stress reactions and reactive psychoses. But incidence and prevalence of alcohol psychoses decreased. Findings are the same for out patient clinics. The field investigation on the free territories of Sarajevo s communities shows enormous increase of mental disorders among the citizens: neurotic over 40%, psychotic about 20% and that is, together, more than 60% of the population of the town Sarajevo were disturbed at that time. Among the children and adolescents there was an increase of neurotic and psychotic disorders in the very beginning of the first year of the war, and decrease of the same diagnoses during the second year. This might be explained by particular adaptation of the youngsters to war conditions. When we are talking about invalidity of neurological and psychiatric disorders, the investigations showed that illness is the mostly caused by invalidity (85.1%) among the global invalidity during the war in Sarajevo. Injuries before the war were at 3%, during the war are 11% of cases. But, all those shows temporary, because war caused invalidity more and we are expecting to registration later. Our investigation among the refugee camps and population in Sarajevo shows that "life equipment" among the displaced persons was lower than domestic people. That shows that after the phase of surviving this part of the population was at risk of many psycho-social problems. Also, our investigation shows that very low socio-economical level of inhabitants of Sarajevo leads to the potential of absolutely poverty. The indicators of this trend are: low level of education, very low life standard, unemployment, bad health conditions etc. Among refugees all those indicators are worse. Criminality in Sarajevo during the war has been increased, particularly among adolescents. One fifth of contents of daily newspaper "Oslobodenje" has been during the war oriented to the health system problems.

Adolescent developmental psychology.

Abstract: Adolescence can be described as "the second individuation". It is agreement that the cultural setting will have a decisive influence on the development from preadolescence to post adolescence which is summarised in the article. It seems as the Western culture allows more acting out and provides a subculture to the teenagers which is not found elsewhere. The adolescent period is also much longer nowadays in our culture for many reasons.

Surveillance of tuberculosis in Europe.

Abstract: In 1995, countries of the WHO European Region approved WHO/IUATLD recommendations for the standardisation of tuberculosis in Europe including a common case definition, the notification of cases by both clinicians and laboratories, the computerisation of individual data and a common list of essential variables. Since 1996, the Euro TB programme started collecting data from European countries based on these recommendations. Data on tuberculosis cases, both definite (culture confirmed) and other cases, reported in 1995, 1996 and 1997 have been collected in the 51 countries of the WHO European Region. Close to 350,000 tuberculosis cases were reported each year, of which almost 2/3 were in countries of the former USSR. Most countries located in the eastern part of Europe, Portugal and Spain, reported 20 cases per 100,000 or over. Conversely, most countries situated in the western part of Europe, the Czech Republic and Israel, reported cases per 100,000. Notification rates were highest above 64 years of age in countries reporting cases per 100,000 and peaked in the 35-54 years old age group in other countries. Since 1995, notification rate declined or stabilised in most countries with cases per 100,000, but increased in several other countries, particularly in most republics of ex USSR. Tuberculosis surveillance systems are still heterogeneous among European countries. Regarding the case definition, a few countries notify only new cases, some countries notify only new and relapse cases and some also include other categories of recurrent cases in the notification. Only a few countries have a national reporting system of M. tuberculosis isolated which can be linked to clinical data. In 1997, 20 of the 51 countries had individual computerised data. The availability of essential variables differs between countries but is increasing over time. The standardisation and quality of epidemiological information on tuberculosis in Europe has clearly improved since the beginning of the Euro TB programme. It is hoped that this will help tuberculosis control efforts in the European Region.

Diabetes mellitus and Candida albicans

Abstract: According to Salomon, diabetes mellitus is a chronic disease caused by inadequate insulin action. As a syndrome, it could come in practice in many different forms. This disease, from genetic aspect presents a very heterogeneous phenomenon. For that reason a research of oral cavity tissue in diabetic patients presents a very complex problem from the scientific point of view. Truly, in the research today there are controversial cognition about relationship between diabetes mellitus and oral cavity diseases: diabetic stomatopathy, oral candidiasis, alterations of oral mucosa and periodontia. In this paper a special aspect is given to the research of incidence of candidiasis which is the result of contamination of all other pathological alterations in oral cavity.

Expert systems in medicine

Abstract: Expert systems are software systems developed using different techniques of artificial intelligence that can act parallel to the "human" experts. The main role is consultative These are intelligent information systems that use more then 2000 different rules and that are capable to explain their decisions. Databases of such systems can contain huge number of data about different diseases and therapy modalities. In development of Medical Expert systems the rule of human experts is crucial. The teams of such experts are developing expert system considering the changes in medicine. Several modes of work are available. Consultation mode is used in cases when the diagnosis and treatment is uncertain. The human enter data about symptoms and signs of some medical disorder and computer creates a list of possible diagnosis and additional diagnostic test. Therapy for condition is also suggested. Simulation mode can simulate virtual patient and allows students and doctors to learn mode about some medical conditions. Some expert system as HEPAT can make "Decision Tree" for new-born jaundice. Similar expert system will be available in future for other fields in medicine. Some of expert systems are described in article.

[Somatization in post-traumatic stress disorders in soldiers during the war in Bosnia-Herzegovina].

Abstract: While researching psychological disorders in soldiers during the war in Bosnia, besides the psychiatric simptomatology in post trauma stress disorder (PTSD), we analyzed also expressed somatic symptoms. The sample consists of 164 soldiers from the first front lines, divided into three groups: Group A (N = 51), soldiers who during the war asked for psychological and/or psychiatric help, group B (N = 51) soldiers who are after the war on stationary or clinical treatment and group C (N = 62) soldiers who during and after the war, did not ask for psychiatric help even though they had psychiatric problems. With the trauma questionnaire and obvious PTSD symptoms the degree of the traumatic experience and the structure of PTSD was determined, and with the self-evaluation health condition questionnaire the subjective health condition evaluation during the prewar, war and the time after the war was determined with expressed physical disorders. Another important difference was determined (P < 0.01) between soldiers who had a high stress level and suffered from PTSD, who asked during and after the war for psychological and/or psychiatric help (groups A and B) and soldiers who suffered less from PTSD and who did not ask for professional help during nor after the war (group C). 60.8% soldiers in group C and 42.1% in group B during the war, and 41.3% in group A and 92.2% in group B after the war, points out their weak or very weak health condition compared with the soldiers from group C, where 1.6% during the war and 9.7% after the war pointed out their weak or very weak health condition. Somatic symptoms are mainly in conjunction with the cardiovascular system, 47.1% in group A and 78.4% in group B, also gastrointestinal system, 50.9% in group A and 37.3% in group B, followed by back pains, 31.4% in group A and 43.1% in group B. The first signs of somatic symptoms are in direct connection with first signs of traumatic experience and first signs of PTSD symptoms. The results confirm previous researches and that is that soldiers with traumatic experiences which they can hardly bare and who suffer for a long period of time from PTSD have also the biggest number of somatic symptoms.

Dilemmas in the classification of foot injuries caused by land mines

Abstract: In international classification of injuries, very often there are some specific conditions that are not clearly defined. War initiated that about specific conditions before all injuries a discussion in term of more correct presentation through the code is being made. Very often, some conditions in international classification are being led as INSUFFICIENTLY DEFINED or UNMARKED PART. When we have present large destruction due to wounding with projectiles of high kinetic energy (initial velocity), and especially stepping on land-mines, we have the situations that can not be correctly defined. The amount of these injuries which are about to follow in the future period authors will declare in few examples which have been surgically treated in Traumatological Clinic in Sarajevo. All injuries were result of stepping on land-mines and in all cases it was about foot. The stated injuries we were not able to code as amputations because the distal part of the injury was vascularized, later on we found out that there are possibilities of surgical reconstruction in meaning of functional foot, since we do not have open (explosive) fracture here. May-be, as a clinical formulation or for initial observation a more appropriate name is (term analogue in surgery of other regions beside limbs) INTERCALARY amputation of limbs. The same one could be moved from deficiency to a complete lack which surely must be linked to its causality.

The role of risk factors in developmental diagnosis

Abstract: Cerebral Palsy (CP) is a chronic disorder of motion and postural balance caused by defect or damage of immature brain. Possibility of primary prevention of CP is not big, the most important is early diagnosis. 120 newborns admitted to the Developmental department of Pediatric Clinic as "child at risk" were investigated. The average gestational age was 37.18 weeks, average birth weight was 2820.09 g. In the group of prematurely born children CP has developed in 15 out of 50 children (30%), in the group of term children it was present in 17 out of 57 children (29.83%). 32 children (29.92%) had birth weight below 2500 g. Among them there were 7 cases of CP (21.88%). Children with birth weight of over 2500 g (75 children, 70.09%) had CP in 25 cases (33.33%). There was no statistically significant difference between boys and girls, and between healthy and children with CP. There was high rate of correlation between gestational age, birth weight and score of neonatal optimality, as well as score of pregnancy optimality, score of delivery optimality and neonatal optimality. The important correlation appeared between score of delivery optimality and score of neonatal optimality. There was high correlation between score of perinatal optimality and all three of its components. Diagnosis of "child at risk" made only on the basis of risk factors during pregnancy, delivery and neonatal period is out of discussion, it is not pointing out the developmental outcome. Evaluation by the methods of clinical examination is necessary for prediction of neurological development.

Hepatotoxicity of cyclosporine in patients with kidney transplants

Abstract: In this study we have analyzed the liver transaminases levels in the 15 patients after kidney transplantation. All these patients have taken immunosuppressive cyclosporine therapy. The transaminases levels were determined by using the method Bergmayer kinetic ultraviolet test on the apparatus Tehnicon-Opera. The well known fact is the liver intoxication the same as kidney intoxication, if patients take cyclosporine for a long time. The average of the grafts in these patients were 9 years (ages between 1 and 16). The liver transaminases level was normal in all of groups of patients except for one who had high liver transaminases levels. After the correction cyclosporine therapy in the patient, the liver transaminases levels were normal. There was no possibility for monitoring of cyclosporine during the war, so the patients were determining the dose of cyclosporine on their own without any consulting with doctors. The most reliable method of cyclosporine applications is its determination, every day monitoring, and dosing by monitoring, which means concentrations in the reference values.

Actual problems in medical informatics.

Abstract: Medical informatics has been the first science that connects all traditional medical disciplines, thanking to common information needs and requirements of these disciplines. Its goal is incorporating of information technology into medical praxis, getting medical professionals in touch with capabilities of computer technology and preparing the professionals for the future that belongs to more and more powerful computer technologies. Information as a "crucial" component of medicine is in the focus of each investigation. There are many problems that have to be solved through fundamental investigation: knowledge databases; knowledge structuring problems; joining the different kinds of knowledge; knowledge and representation of decision making process; medical concepts; integration and information and knowledge exchange; education of medical staff; structure and organisation. What kinds of management are the best for application in the field of medical informatics? What are the changes in organisation and structure when computer are used? How to connect education processes in clinical centres, libraries, clinical functions and investigations? In this article author discuss about the theoretical and practical part of the education process on biomedical faculties in Bosnia and Herzegovina, according to new curriculum.

Radiologic diagnosis of congenital anomalies of the digestive tract

Abstract: UNLABELLED The aim of the study is to analyze the frequency of the congenital anomalies of the digestive tract in the period of 1993-1998. The patients and methods: Our group included 67 patients (47 males and 20 females; age range 1-12 months) suspected of digestive tract anomalies. First, all of them have been examined by pediatric surgeon. At the first place, we used the most conventional radiological procedures for digestive tract examination. They were followed by US in cases with suspicion on hypertrophic pyloric stenosis and biliary atresia (bile-duct atresia). CT and MR were performed in patients with anorectal anomalies. In cases with suspected associated anomalies of other organs, intravenous urography and chest radiography were used. RESULTS Congenital anomalies and abnormalities of the digestive tract were diagnosed in 25 patients. The most frequent anomaly was hypertrophic pyloric stenosis (n = 14), followed by invagination (n = 12) and megacolon congenitum (n = 9), all predominant in male sex. All radiological findings we confirmed at surgery (100%). CONCLUSION Conventional radiology is still extremely useful in the diagnosis of the digestive tract anomalies; also US revealed to be essential in the diagnosis of the hypertrophic pyloric stenosis and the intestinal invagination. Recognition of the associated anomalies should lead to application of the other examination techniques like CT and MR. MR might be useful in the anorectal malformations and hepatobiliary tract anomalies, but we have no experience in that field, till now.

Rehabilitation of war victims in the Federation of Bosnia and Hercegovina with special reference to physical injuries.

Abstract: The number of war victims in need of physical rehabilitation in Bosnia and Hercegovina is not exactly known but less than one per cent of the population. Anyhow physical rehabilitation services needs to be reorganized in the community taking care of about 70-80% of the patients. The rest are partly in need of institutional care, which is also important for training and research purposes. The reorganization of services for the mentally ill is aimed at both war victims and others and reorganized at Community Mental Health Centers. The number of mentally ill war victims is definitely exceeding the number of physically injured from the war.

Health status indicators and the importance of their use in daily practice

Abstract: Health information undoubtedly has great social, political and economic importance. To have relevant information, it means to have basis for timely reporting, basis for action, and prerequisites for success. The purpose is to produce and use adequately appropriate information about health status, health risks and health outcomes in order to establish priorities. Health information should be useful and easy accessible to all potential users in every moment, from health care providers to the general public. Health indicators, as aggregated health statistical data, present measure instruments in this process, and because of that definition, development and implementation of basic set of health indicators at all levels (public health and clinic) must be the priority activity in the current moment of health sector reform in Bosnia and Herzegovina. Basic set of relevant and measurable indicators should be founded on different aspects of health and health care (health promotion, diseases prevention, clinical treatment, rehabilitation), monitoring and evaluation as a part of everyday's routine in health sector.

Information technology as a support in the area of education

Abstract: Decision Support Systems (DSS) are more and more used and developed, mainly within the management area. It is used at strategic level for global planning and managing the organization; at tactical level for short-term planning, process realization and control. Although many authors state that DSS are used only at global and tactical level, some of them--through practical applications--show that specific DSS can be created in order to support decision in other areas than classical management. Paper describes computer application that efficiently supports organisation of exams at The Department for Medical Informatics of Medical Faculty in Tuzla.

The importance of Internet in medical education

Abstract: Internet is more and more involved in medical education in many countries including Bosnia and Herzegovina. Not only medical student but also physicians are using Internet to find out the latest information in specific field of medicine. Some sites are specially designed to be used for medical education. Information about some programs or courses of medical education can be found here. Improvements of network resources and multimedia technologies have made it possible to satisfy needs for medical Education. Multimedia approach offer possibility to show text, picture, sound or movie considering specific need. All of that is available on Internet. Many search engine are available in the world and student can use all of them when they have access to Internet. The more precise search can be done on specific sites that include information about medical conditions and medical education. The most important is MEDLINE. MEDLINE is bibliographic database of National Library Of Medicine in USA. This database can be explored from several sites. All relevant information about article can be find here including abstract and service to obtain full text of specific article. Database can be searched using specific keywords that can be find in text or in MESH thesaurus. Data about authors, their addresses and title of article can be found, too. The possibility of using Internet in medical education are considered in this article. Some of Internet sites are described, too.

The transition from mental hospital based to community based psychiatry.

Abstract: The reformation of psychiatry has been a central topic in health planning and care in most industrialized countries during the last decades. A short review of the political, professional and other forces behind this development is done. A short history of the development in Sweden is given as an example of the general tendencies in this change and the actors involved. There is now a rapidly growing scientific basis for the psychiatric service with a definite shift into a community based orientation. It is concluded that early intervention and prevention will be in focus for the development during the next decades.

Refugees, returnees and rehabilitation.

Abstract: Health and social security services are the basic elements which people have the right to ask for from their community. Strong efforts are made to reform the function of this support system all over Bosnia-Hercegovina. With a mutual effort made by Ministry of Health and mental health professionals the Community Mental Health Centres might be an excellent support for people with mental health problems in the society. This is true even for the heavy influx of returnees. The Community Mental Health Centres are expected to handle about 80% of people with mental health problems in the society where people live, or in the new establishments for returnees. However there is a great need for Ministry of Health to design the policy and edict precise rules. The same is true for Ministry of Social Affairs which in co-operation with social workers and other professionals have to reform the Centres for Social Work. However, even if resources are slowly growing, there still seems to lack in communication of the two basic elements, health and social security. Respective ministries in The Federation of Bosnia-Hercegovina need to co-operate and the Ministry of Health and Social Affairs in Republika Srpska needs to strong in developing a co-operation between the centres in the field.