Objective - We aim to emphasize the importance of extensive endocrine workup in cases of pituitary masses. Case report - We report on a case of pituitary thyrotrophic hyperplasia in a 12-year-old girl who was thought to have a pituitary macroadenoma with suprasellar extension. The main complaint was headache, while other symptoms of hypothyroidism were present, but weren't recognised. Hormonal testing revealed low total thyroxine (<12.8 nmol/l) and high TSH (310.5 mIU/l) levels, and hyperprolactinemia (prolactin level at 1680 mIU/l). Based on the clinical history, laboratory data, and MRI, a diagnosis of pituitary hyperplasia secondary to primary hypothyroidism, consequent to chronic autoimmune thyroiditis, was made. Therapy with levothyroxine was initiated at 50 I¼g/day and gradually increased to 75 I¼g daily. After three months of thyroxine replacement, she was clinically and biochemically euthyroid. A follow-up MRI, 4 months after thyroxine replacement was initiated, showed complete resolution of the mass, and normal pituitary gland. Conclusion - Primary hypothyroidism should be considered in the differential diagnosis of pituitary masses. Multidisciplinary assessment in these cases will help to avoid delays in diagnosis and prevent unnecessary surgery.

David B. Shires (1931–2011) David Shires was Professor of Family Medicine and Community Health and Epidemiology at Dalhouaie University, Canada (1-3). Dr. Shires has practiced medicine in Africa, United Kingdom and United States and has been a resident in Canada for the past 20 years. His early work includes development of a computerized medical record system for the Apollo astronauts. Dr. Shires was elected President of the International Medical lnformatics Association (IMIA) in 1980, and holds Honorary Fellowship, in IMIA as well as the British Computer Society. In 1983 in Paris, he received the Silver Core award for meritorious services to international computing by the International Federation for Information Processing (IFIP). In 1974 he published a book on Computer Technology called “Computer Technology in the Health Sciences” and in 1986 he co-authored “Family Medicine: A Guidebook for Practitioners of the Art”. David B. Shires assumed the IMIA presidency in 1980, one year after the transition from TC4. During his term (1980-1983), Shires reached agreements with the regional group for Central and South America, known as IMIA-LAC (Latin American Countries), and the most populous country in the world, the People’s Republic of China (PRC), making them active participating members in IMIA. Shires saw IMIA as a family, within which “the then USSR and Eastern Bloc countries as well as other countries such as Cuba, could indulge in animated and mutually productive discussions with their western counterparts with each respecting the other’s political differences.” IMIA worked to become meaningful to developing countries and forged new bonds with the World Health Organization. In 1992, Shires reflected that “IMIA has grown considerably in reputation, recognition and credibility in the ten years since I left the presidency, largely due to the continuing hard work of Presidents Peterson, Kaihara and Willams.” Today IMIA reflects Shires’ goal for his presidency in its international constituency, which goes “beyond the Europe–North America-Japan axis to much greater world vision.” Today, the IMIA family includes a newly invigorated African region (HELINA) and is well on its way to facilitating the establishment of a Middle East Region. (MedInfo 1983: Amsterdam, The Netherlands).

Introduction: Acta Informatica Medica is official journal of the Academy for Medical Sciences of Bosnia and Herzegovina (from 2014 Acta Inform Med is published bimonthly). Aim: To evaluate journal “Acta Informatica Medica” in 2015 and compare findings to previous years. Material and methods: The study has retrospective and descriptive character, and included the period 2008-2015 (included 36 issues of journal). Results: A total of 83 (average 13,8 articles per journal) articles were published in Acta Informatica Medica during 2015. Analyzing the type of articles, original articles are present in majority during 2015 (68,6%) (by analyzing last eight years, 310 (67,3%) were original). During 2015, 27,7% of articles were related to the applied of Health informatics in field of clinical medicine, 63,8% preclinical medicine and 8,5% to public health. Collaboration rate in 2015 was 0,84. Most often the time required for decision on acceptance of article in 2015 is between 50 and 60 days. Articles came from 16 countries. According to scimagojr.com for 2014, Acta Informatica Medica has SCImago Journal Rank 0,166, while Cites / Doc. (2 years) parameter (widely used as impact index) is 0,70. According to GoogleScholar, h5 index is 11 and h5 median is 19. We analyzed the Acta Informatica Medica by “Publish or Perish” software - H index was 14, g index was 19 and e-index was 10.39. Conclusion: Year after year the highest number of original articles are published. Although the period of revision of articles is acceptable, the period up to two months is certainly not long, the goal is to reduce this period. Although the magazine in mentioned field found its place, although it is indexed in numerous bases, including: PubMed, PubMed Central, SCOPUS, EMBASE, EBSCO, etc. The main goal for next year is that the magazine becomes part of the Web of Science. Imperative is further internationalization of the magazine.

Introduction: The most common clinical sign in pediatric cardiology is a heart murmur (organic and inorganic). Organic are sign of heart disease, while inorganic (basically divided into accidental and functional) murmurs occur on anatomically healthy heart. Aim: To determine the justification of the application of the methods of cardiac treatment. Patients and methods: Study included 116 children aged from 1 to 15 years, who were referred due to cardiac treatment to Pediatric Clinic, of Sarajevo University Clinical Center. Results: The first group consisted of children with innocent heart murmur, 97 (53 males). The second group consisted of patients with organic murmur, 19 (13 males). The average age of the first group was 7.69 (1.01–15.01) years old, and of the second group 3.15 (1.01- 8.06) years old, and there is a significant difference between these two groups (p <0.001). Medical history questions about potentially harmful habits of mother in pregnancy, found significant differences in the frequency of the existence of habits between the first and second groups of subjects (14.44% vs. 85.1%, p = 0.013). The values of the pulse of patients showed statistically significant difference (p = 0.012). The most common place of the murmurs’ appearance is the second left intercostal space. In the first group, the most common were vibratory (32.3%) and ejection (31.9%) and in the second the most common were holosystolic (73.7%) murmur. Analyzing the R/S ratio of V1, a significant difference among the two groups was found (mean 0.78 vs. the values for 1.45, p = 0.003). There is a significance in terms of developed hypertrophy of the heart cavities (BVH) between the two groups. The most common accidental murmur was classic vibratory Still’s murmurs (55.43%) and the most common congenital heart defects was ASD (36.8%). Conclusions: A heart murmur itself, should not be the purpose of auscultation. One of the tasks of pediatricians, pediatric cardiologists in particular would be to improve auscultation, as a sovereign method of heart murmurs assessment. Heart murmur assessment should be adapted to recognize whether heart murmur is innocent, or there is suspected or probable congenital heart defect.

Introduction: Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. Material and methods: Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. Results and discussion: So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious.

Introduction: Precise mediastinal lymph node staging in patients with non-small cell lung carcinoma (NSCLC) provides important prognostic information and it is obligatory in treatment strategy planning. 18Fluoro-deoxy-glucose (18F-FDG) positron emission tomography - computerized tomography (PET-CT) based on detection of metabolic activity showed superiority in preoperative staging of lung carcinoma. Materials and Methods: Total number of 26 patients diagnosed with NSCLC were included in this retrospective, cross-sectional study. Status of mediastinal lymph nodes was assessed in all patients comparing contrast enhanced CT and 18F-FDG PET-CT findings. Discussion: We found in our study that 50% of patients had different N stage on contrast enhanced CT comparing to 18F-FDG PET-CT findings. Among the total number of patients which had different nodal status on PET-CT comparing to CT alone, we found in our study that 54% of patients had change in further therapy protocol after PET-CT change of nodal stage. Conclusion: Combined PET-CT which offers advantages of both modalities is excellent method for nodal (N) staging, so it is recommended in initial staging in patients with NSCLC. PET-CT used preopratively for mediastinal nodal staging has significant impact on further therapy planning and also has an consequential impact on health system savings.

Introduction: Because of increasing prevalence of T2MD worldwide, it’s very important to recognize risk factors for diabetic complications, as soon as possible. Symptoms of complications appear a few or many years after tissue damage. So, it’s imperative to establish surveillance of diabetics with laboratory and other diagnostic procedures for early recognition of diabetic complications. Follow up of clinical curs of diabetes, by using databases of patients, provide possibility for permanent analysis of important laboratory parameters and any changes could be registered. Although an emerging evidence suggests a strong association of ALT (alanine aminotransferase) and γGT (gamma glutamyl transferase) activity with type 2 diabetes mellitus (T2DM), only a limited number of studies have analyzed the association of AST (aspartate aminotransferase), ALT, γGT, and ALP (alkaline phosphatase) activities in controlled T2DM. Material and Methods: Gender differences are of special interest in trying to follow diabetes progression and development of its complications. Here the activities of ALT, AST, γGT, ALP were analyzed as well as levels of glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in 40 T2DM patients and 40 age-matched healthy subjects. Blood samples were collected from all participants in regular 3-months intervals up to 6 months period. Standard IFCC enzyme protocols were used to determine enzyme activities. Results and discussion: In first measured interval, significantly higher activities of ALT (p= 0,050) and glucose levels (p=0,045) were shown in male. A significant correlation was shown between ALT and AST activity with FPG and HbA1c levels in first and third measured interval. ALT activity was much higher in the group of patients with poor glycemia control. Average levels of activities of enzymes stay nearly in normal limits, but changes of enzymes activities should be recognized as soon as possible, earlier than tissue changes and diabetic complications become irreversible.

Goal: The aim of the study is to define the MRI appearance of disorder in the Junctional zone (JZ) in women with adenomyosis compared to those without it, given the importance of the JZ in the regulation of various reproductive events. Materials and methods: This was a prospective, comparative and open study. Patients with adenomyosis have been sorted in target group, n = 82, while the control group consisted of patients without adenomyosis, n = 82. All patients, from both groups have undergone a magnetic resonance imaging of the pelvis. Using a software tool for measurement, the thickness of the JZ was measured in T2w sag sequences in all patients from both groups (target and control) n = 164. Patients in the target group type adenomyosis were assessed and categorized either as: diffuse, focal, or Adenomyoma and the results were compared. The presence of endometriosis and myomas in both groups was evaluated and its coexistence with adenomyosis was analyzed as well. Results: Of the 82 patients in the target group, 81.7% of the patients had diffuse adenomyosis, while 18.3% had focal type with statistically significant difference (p <0.05). The results of the Mann-Whitney U test showed that p <0.05, implying that there is a statistically significant difference in the thickness of the JZ between the control and target group, therefore patients from the target group with adenomyosis had a statistically significantly thicker junctional zone than the patients in the control group. The JZ in the target group was on average M = 14,3mm, SD = 1.3mm, while the thickness of JZ in the control group without adenomyosis was M = 5,6mm, SD = 1,3. Chi-square shows that p <0.05, implying that there is a statistically significant difference in the number of patients with myomas between the two groups, where the myomas significantly over-represented in the target group with 32,9 % vs.6 %). Conclusion: MRI is the method of choice for imaging and evaluation of JZ as an important diagnostic marker in the diagnosis of adenomyosis. It is important to recognize this condition as early as possible and distinguish it from other pathologies in order for timely and appropriate treatment.

Aim: The aim of the study was to investigate how immigrants from Bosnia and Herzegovina, Somalia and Kosovo experienced contact with Swedish health-care regarding meeting with health-care professionals. Material and Methods: Eighteen participants, nine men and nine women from Bosnia and Herzegovina, Somalia and Kosovo participated in focus group interviews (FGI). Data were collected from April 2013 to April 2014 through three group interviews using open-ended questions. A qualitative approach, incorporating a critical incident technique (CIT) was used. Results: The findings highlighted patient’s negative experiences regarding the Swedish health care system. Their main complaints concerned delayed ambulances, lack of doctors in outpatient clinics, long journeys to the hospital and long waiting time at the emergency department. Lack of information about the disease, difficulties seeing a doctor in the department, poor language skills and insufficient interpreters were some of other difficulties that mentioned by participants. Conclusions: In order to provide satisfactory health care to patient with different ethnic backgrounds, it is important to be aware of their vulnerable situation and their limit capacity to express their needs. This research could be a starting point in developing strategies for reducing ethnicity-based misunderstandings and inequalities in the health-care system.

Introduction: Information technologies (IT) are becoming a tool without which further education of both medical students and doctors would not be possible. Aim: The aim of this paper was to analyze the use of IT in the prism of two systems, the old system and the Bologna system. Material and methods: Answers from questionnaires from total of 459 students (2012/13–2015/16 generation) were analyzed. Results: The presence of large number of female students, in both systems is significant (p <0.05). About 92% of students of the old system and 98% of students of the Bologna system use computer in everyday work (only 36% of old system and 47% of the Bologna system are using “faculties” computers). The computer is used for entertainment, education, information (via Internet) and for communication (e-mail, chat, social networks) (68.5% of the old system and 84% of students of the Bologna system have chosen all 4 offered answers). MS Word and MS Power Point are significantly more used compared to the use of MS Excel in both systems (p <0.05). The knowledge necessary to use their computers student of both systems have acquired through individual work. Students feel that they need to improve knowledge of the treatment of sub-base (76% of students of the old system and 62% of students of the Bologna system). Having analyzed the generation of 2015/16, 84.5% of students of the Bologna system and 75% of students of the old system used smartphones or tablets. The purpose of using a smartphone is, in most cases for accessing the social networks. 77.4% of smartphone users of the Bologna system, or 73.3% of the users of the old system have installed an application from the medical field. We analyzed the opinions of the availability of online course content and the degree of computerization of the study process and the possibility of electronic access to the literature - the results are not at the appropriate level. Conclusion: Education in software solutions that are connected to databases processing, must be imperative in reform of the teaching process. IT can only improve the teaching process, the organization of the education system in most eminent universities is undeniably linked to information technologies.

Goal: To analyze the appearance of neurodevelopmental disorders in children delivered post-term and to find out whether prolonged pregnancy may be a cause of such disorders in a selected group participants. Patients and methods: This study included a cohort of 34 children born post-term suffering from neurodevelopmental disorders who were treated at the Service for psycho-physiological and speaking disorders in Mostar, Bosnia and Herzegovina during an 18-year period. Results: There were 59.4% of male and 40.6% female patients (P=0.002). The most common neurodevelopmental disorder in the sample was intellectual disability (38.2%), followed by epilepsy (26.4%), delayed psychomotor development (14.7%), and cerebral palsy (11.7%) (P<0.001). The correlation between mothers’ parity and post-term delivery was found (P=0.016). Conclusion: Post-term delivery may be the cause of neurodevelopmental disorders. The most common disorder among them were intellectual difficulties.

Febrile neutropenia is common chemotherapy complication significantly impacting patient’s outcomes, quality of life and costs, too. Febrile neutropenia (FN) often leads to hospitalization, the need for intravenous antibiotics and use of granulocyte colony-stimulating factors (GCSF) in order to avoid its complications. Cost of febrile neutropenia is well described in literature, but no study has been performed in Bosnia and Herzegovina. We have conducted observational cohort study with aim to describe and present costs of FN treatment from payers’ (provider’s) perspective. Only direct medical costs from one middle-sized oncology Clinic in Bosnia and Herzegovina database have been included and presented. We found that overall cost in five months period (January-May 2015) were almost 30.000 euros, or 1.0035 euro per episode/patient in average. The highest cost are allocated to hospitalization (40%), followed by GCSF (36%), while rest of costs are generated by laboratory tests performed and drug application. Proportion of costs is in line with other published studies even with huge differences in absolute values, mainly to low prices of services in Bosnia and Herzegovina. This was the first study on costs of chemotherapy induced FN in Bosnia and Herzegovina suggesting that significant costs are inquired by this conditions and that further research should be performed including larger patient population and other clinical oncology data, including pharmacoeconomic analysis.