OBJECTIVE The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. PATIENTS AND METHODS This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. RESULTS The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (p<0.001). The average time from the onset of symptoms to arrival at the family practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. CONCLUSION The severity of symptoms affected the patients' decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required.

Abstract Background: Despite considerable efforts to promote and support clinical practice guidelines (CPGs) use, adherence has often been suboptimal universally. Objectives: The aim of this study was to assess to which extent family physicians (FPs) in Republic of Srpska (RS), Bosnia and Herzegovina (BiH) accept or reject the concept and practice of CPGs and evidence-based medicine (EBM). Methods: A cross-sectional survey was conducted among FPs from the RS, BiH in the period between January and March 2014. Recruitment of FPs was performed combining two different strategies, in-person recruitment at family medicine conferences and mailed invitations. The Questionnaire included19 questions from the existing Healthcare Monitor Questionnaire, divided into four thematic blocks and 11 self-designed questions. Results: Seventy-seven per cent of 131 interviewed physicians reported already using guidelines in the treatment of patients, while 22.9% of them are undecided or disagree. As the reason for rejecting guidelines, 13.0% of the physicians stated they did not support their content, 12.2% found that limited knowledge about guidelines prevented their application, and another 12.2% reported that the current guidelines were not practical enough. All groups would rather not use guidelines developed by a governmental institution. Conclusion: Most physicians in the RS, BiH accept and declare application of CPG. However, a substantial percentage remains sceptical, using CPGs only as an exception, or rejecting them due to their content or impracticability. Key Messages Most physicians declare application of clinical practice guidelines. Substantial percentage of physicians remains sceptical, using CPGs only exceptionally. Further studies are needed to promote the use of CPG and the concept of EBM.

BACKGROUND Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. AIM To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. PATIENTS AND METHODS Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. RESULTS In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. CONCLUSIONS Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

The aim of this paper is to give a brief overview of research and the newest theoretical considerations on internet addiction classification and treatment. Over the past years we have been increasingly facing the so-called “new age” disease of internet addiction as a serious problem affecting numerous people, especially the young population who has made social networks and other internet contents a modus vivendi. A literature search was conducted for the purpose of locating information on prevalence, diagnosis and treatment of internet and computer addiction. Certain researchers and psychiatrists believe that the excessive internet use is a symptom of other disorders, such as depression and anxiety, or impulse control disorder. However, over the past few years a consensus has been reached that this constellation of symptoms is actually an addiction disorder. The American Society of Addiction Medicine (ASAM) has recently come up with a new definition, according to which addiction represents a chronic brain disorder. Consequently, the new American Classification of Mental Disorders (DSM-V) has introduced this form of addiction under the diagnostic category dubbed “cybernetic disorder”. The field of internet addiction is advancing rapidly through its official recognition as a separate and distinct addiction disorder. Some individuals with internet addiction are at significant risk and merit professional care and treatment. There are several treatments available, but the primary prevention is the most effective intervention. Family practitioners and psychiatrists should be taught to screen their patients for this disorder.

SUMMARY Stress is defined as a state in which homeostasis, as a dynamic balance of internal conditions necessary for the proper functioning of cells or the living organism as a whole, is affected by the action of various stressors. Stress reaction occurs as a result of stress system activities, which is located in the central and peripheral nervous system. Stress evaluation involves a qualitative and quantitative analyses and valuation of certain biologically active substances (biomarkers of stress) in body fluids that are so often associated with stress. Saliva as a diagnostic medium is being increasingly used for purposes of clinical and basic research because of its composition and content as well as the advantages of the process of sampling, as compared to traditional methods of collecting blood samples and urine samples. Cortisol, as a biomarker of stress, is the most often studied salivary biomarker, which is associated with the activation of the hypothalamic-pituitaryadrenal (HPA) axis. Since stress leads to the suppression of the immune system, values of salivary secretory IgA and salivary lysozyme, as biomarkers of stress, can be analyzed. In saliva, it is difficult to monitor acute stress parameters, catecholamines, due to their low concentrations, rapid degradation and instability in the samples. Chromogranin A (CgA) and α-amylase enzyme can be used as alternative indices of adrenergic activity during stress reactions, due to their stability in saliva and reliability of the obtained values. Stress reaction and the diseases in whose pathogenesis it participates are yet another proof of the constant interaction of physical, psychological and social factors in health / disease SAŽETAK Stres se definiše kao stanje u kome je homeostaza, kao dinamička ravnoteža unutrašnjih uslova neophodnih za pravilno funkcionisanje ćelija ili živog organizma u cjelini, ugrožena djelovanjem različitih stresora. Stresna reakcija nastaje kao posljedica aktivnosti tzv. stres sistema, koji je smješten u centralnom i perifernom nervnom sistemu. Stres sistem, preko odgovarajućih medijatora, stimuliše kataboličke, lipolitičke, antireproduktivne i imunosupresivne efekte stresne reakcije s ciljem preusmjeravanja energije zbog povećane potrebe organizma u trenutku značajnim za njegovo preživljavanje. Evaluacija stresa podrazumijeva kvalitativno i kvantitativno analiziranje i vrednovanje određenih biološki aktivnih komponenti (biomarkera stresa) u tjelesnim tečnostima koje se dovode u vezu sa stresom. Pljuvačka se kao dijagnostički medijum sve češće koristi za klinička i bazična istraživanja zbog mogućnosti koje pruža, s obzirom na njen sastav i sadržaj kao i na prednosti samog procesa uzorkovanja u odnosu na tradicionalne metode prikupljanja uzoraka krvi i urina. Od biomarkera stresa, u pljuvački je najčešće ispitivan kortizol, koji se dovodi u vezu sa aktivacijom hipotalamus-hipofiza-adrenalne (HPA) osovine. S obzirom da stres dovodi do supresije imunog sistema, u pljuvački se mogu analizirati i vrijednosti sekretornog IgA i lizozima kao biomarkera stresa. Parametre akutnog stresa, kateholamine, teško je pratiti u pljuvački zbog njihove male koncentracije, brze degradacije i nestabilnosti u uzetim uzorcima. Kao alternativni indeksi adrenergičke aktivnosti tokom stresne reakcije, zbog stabilnosti u pljuvački i pouzdanosti dobijenih vrijednosti, mogu se koristiti hromogramin A (CgA) i enzim α-amilaza. Stresna reakcija i oboljenja u čijoj etiopatogenezi ona učestvuje još su jedan dokaz stalne interakcije fizičkih, psihičkih i socijalnih faktora u zdravlju/bolesti

The number of elderly with chronic kidney disease (CKD) is constantly increasing worldwide, and irregular screening of CKD leads to disease discovering usually in advanced stages. The aim of the study was to examine the presence of CKD biomarkers in the elderly primary care patients, and to analyze whether the presence of diabetes and hypertension in elderly increases the risk for microalbuminuria and reduction of glomerular filtration rate (GFR). Cross-sectional study included 90 patients older than 65 years of age who are registered in the Family medicine teaching centre of Health centre Bijeljina. Patients were divided into three groups: first consisted of 30 patients who had neither hypertension nor diabetes nor other chronic disease, second of 30 patients with type 2 diabetes mellitus and third of 30 patients with arterial hypertension. Data on patients were obtained by interview, analysis of medical records and physical examinations. Serum and urine creatinine, proteinuria, microalbuminuria (MAU, turbidimetry), and urinary sediment were analyzed. Biomarkers of chronic kidney disease (GFR <60 mL / min / 1.73m2, proteinuria and mikroalbuminurija ¬MAU) were found in 20 (22.2%) patients. Among them, 14 had normal GFR and MAU (12) or MAU and proteinuria (2), whereas 6 had GFR <60 mL / min / 1.73m2 of which 3 had proteinuria and / or MAU. The group with diabetes had significantly more MAU compared to the other two groups, while the groups with diabetes and hypertension had slightly more proteinuria and erythrocyturia than control group. Hypertension and diabetes in the elderly may result in development of CKD biomarkers, so prevention and regular screening of CKD in the patients with these two diseases are necessary.