Aim: The aim of the study was to evaluate efficiency of hypertensive urgency treatment using inhibitors of α1-adrenergic receptors and angiotensin converting enzyme inhibitors–ACE inhibitors in the Emergency Room of Outpatient Hospital and Polyclinic „dr Mustafa Šehovic“ Tuzla in relation to age, duration and severity of hypertension. Methods: The study was conducted from June 2011 to May 2012 and included 120 patients of both sexes diagnosed with arterial hypertension, aged 40 to 80 with verified hypertensive urgency. The patients were divided into two groups: the control group treated with sublingual captopril and the experimental group treated intravenously with urapidil. Results: The results show that the largest number of patients belonged to age group from 60 to 69 years (34,16%), and the average age was 58 (11). The largest number of patients (38,0%) had verified hypertension for 11 to 20 years. The average systolic/diastolic artery blood pressure at reception was 213 (19) / 130 (4) mmHg. The average systolic/diastolic artery blood pressure after the first dose of 12,5 mg captopril in the control group was 177,42 (10,91) / 112,33 (3,50) mmHg, while after the first dose of 12,5 mg urapidil it was 179,25 (16,62) / 110,33 (8,78) mmHg. The average systolic/diastolic artery blood pressure after the second dose of 12,5 mg of captopril in the control group was 152,00 (6,32) / 95,50 (3,76) mmHg, while after the second dose of 12,5 mg of urapidil it was 152,55 (7,17) / 95,29 (5,04) mmHg. Conclusion: Urapidil is more efficient in hypertensive urgency treatment, since the decrease of middle artery pressure (MAP) in the group treated with urapidil was statistically significant (p<0,001). No statistical significance was found between the efficiency of urapidil and the patient’s age, while captopril was more efficient in older patients (p=0,02). Also, no statistically significant difference was found between the efficiency of captopril and urapidil in relation to duration of hypertension.

BackgroundIn order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines.MethodsA total of 6187 patients (18–80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012–2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys.ResultsA total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets.ConclusionsDespite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.

Introduction: “Athlete’s heart syndrome” is a condition characterized by structural, electrophysiologic and functional adaptation of the myocardium to physical activity (training), depending on the activity intensity, duration and type. In athletes left ventricular hypertrophy often resembles comorbid conditions (hypertension or hypertrophic cardiomyopathy) so the differential diagnosis of the disease is very important and crucial, especially in people who are in active training. In fact, if an athlete has finding which indicate thickening of the left ventricle walls, should be distinguished hypertrophy which occurred as a result of many years of training from accidental existence of hypertension or hypertrophic cardiomyopathy in the same person. Therefore, it is important to make a diagnostic difference between healthy and sick heart. Material and methods: The study involved male persons aged 20-45 which have increased muscle mass of the left ventricle due to different etiology. Definite sample included 80 respondents divided into two groups. All respondent underwent interview, clinical examination, ECG and echocardiography. Results: Average systolic blood pressure (SBP) for the athletes were 115.8±7.2 mmHg, and in patients, with hypertension 154.4±3.5 mmHg, average values of diastolic blood pressure (DBP) for the athletes were 74.2±8.1 mmHg in patients, hypertensive 96.2 ± 3.9 mmHg. Values of SBP and DBP were significantly lower in the group of athletes compared to patients with hypertension (p=0.001). The value of the SFO/min was significantly lower in the group of athletes compared to patients with hypertension (p <0.001). There was a statistically significant difference in the sum of SV2 RV5 and between groups of athletes and groups of patients with hypertension (p<0.05). There was no significant difference in the echocardiography parameters between two groups. There was a statistically significant difference in the sum of SV2 and RV5 between groups of athletes and groups of patients with hypertension (p<0.05). Conclusion: ECG parameters, PQ, QRS, QT did not prove to be useful in the differentiation between the groups because no statistically significant differences in their values were found. Echocardiography is a reliable diagnostic tool in differentiating physiologic hypertrophy of athletes compared to hypertrophy in patients with hypertension.

Introduction: Among long term athletes there is always present hypertrophy of the left ventricle walls as well as increased cardiac mass. These changes are the result of the heart muscle adaptation to load during the years of training, which should not be considered as pathology. In people suffering from hypertrophic cardiomyopathy (HCM), there is also present hypertrophy of the left ventricle walls and increased mass of the heart, but these changes are the result of pathological changes in the heart caused by a genetic predisposition for the development HCM of. Differences between myocardial hypertrophy in athletes and HCM are not clearly differentiated and there are always dilemmas between pathological and physiological hypertrophy. The goal of the study is to determine and compare the echocardiographic cardiac parameters of longtime athletes to patients with hypertrophic cardiomyopathy. Material and methods: The study included 60 subjects divided into two groups: active athletes and people with hypertrophic cardiomyopathy. Results: Mean values of IVSd recorded in GB is IVSd=17.5 mm (n=20, 95% CI, 16.00–19.00 mm), while a significantly smaller mean value is recorded in GA, IVSd=10.0 mm (n=40, 95% CI, 9.00-11.00 mm). The mean value of the left ventricle in diastole (LVDd) recorded in the GA is LVDd=51 mm (n=40; 95% CI, 48.00 to 52.00 mm), while in the group with hypertrophic cardiomyopathy (GB) mean LVDd value is 42 mm (n=20; 95% CI, 40.00 to 48.00 mm). The mean value of the rear wall of the left ventricle (LVPWd) recorded in the GA is LVDd=10 mm (n=40; 95% CI, 9.00-10.00 mm) while in the group with hypertrophic cardiomyopathy (GB) mean LVDd is 14 mm (n=20; 95% CI, 12.00 to 16.00 mm). The mean of the left ventricle during systole (LVSD) observed in GA is LVSD=34 mm (n=40; 95% CI, 32.00 to 36.00 mm), while in the group with hypertrophic cardiomyopathy (GB) mean LVSD is 28 mm (n=20; 95% CI, 24.00 to 28.83 mm). The mean ejection fraction (EF%) observed in GA is EF=60% (n=40; 95% CI, 56.41 to 63.00%), while in the group with hypertrophic cardiomyopathy (GB) mean EF value is 69% (n=20; 95% CI, 62.00 to 70.83 mm). Somewhat higher mean diastolic left ventricular function (E/A) was observed in GA, E/A=1.76±0.15, and lower average values in the group with hypertrophic cardiomyopathy: (GB) E/A=0.78±0.02. Conclusion: Mean values of parameters intraventricular septum thickness in diastole (IVSd), the thickness of the rear wall of the left ventricle (LVPWd), the diameter of the left ventricle during systole (LVSD) were statistically different between groups of athletes (GA) compared to the group of patients with hypertrophic cardiomyopathy (GB).

Introduction: Paracetamol (Acetaminophen) in addition to aspirin is the most commonly used analgesic and antipyretic medication by millions of patients worldwide. It is an example that paracetamol as medicine that in the world is provided without a doctor’s prescription, can lead to death. Today paracetamol became an integral part of a heroin mixture and is very popular at the street market. The main reason for this is that it can be obtained without a prescription, it is cheap, and by most people well tolerated without side effects. It is probably used for “cutting” the pure heroin, as it says in the jargon, and in that manner from small amount of pure drug is obtained greater amount, which is then sold on the street. The goal is to identify presence of paracetamol, by analytical method of gas chromatography mass spectrometer (GC-MS) in postmortem material together with psychoactive substances. Material and methods: For chemical-toxicological analysis is used biological material collected trough autopsy of 20 deceased people, suspected to have died due to psychoactive substance overdose. All received samples are stored at -20 ° C until analysis at our laboratory. From processed 47 samples that were analyzed in the period from 2014 to 2015, 19 are blood samples, urine 19, 3 samples of stomach contents, and 6 samples of bile content. Deceased were middle-aged, of which only 7 were female. The tested samples were processed according to two methods of extraction. Extraction by XAD-2 resin, and the extraction by the method of salting out with sodium tungstate. Extracts of the samples were then dissolved in chloroform and continued analysis at the analytical instrument. Identification of the paracetamol presence, in the test biological samples is demonstrated by the technique of gas chromatography with mass spectometry (hereinafter referred to as GC-MS). The technique of GC-MS is a selective, sensitive and reliable, and is therefore considered a “gold standard” for determining the drug, and the drug substance. Used GC-MS instrument was an Agilent 7890A with helium as the carrier gas. Results: The analysis of blood samples, urine, bile and stomach contents, obtained after the autopsy of deceased persons, by using gas chromatography with mass spectrometry, in analytical manner confirmed the fact that paracetamol is a very common component of psychoactive substances poisoning. In our assay of samples we detected psychoactive substances (heroin, codeine, morphine, sertraline, diazepam), and almost all were found in the combination with paracetamol, indicating the poor quality of illicit drugs sold on the market. Discussion: Paracetamol (Acetaminophen) is a very common component in mixtures of street drugs. Such mixtures almost anyone can afford, but the very quality of these drugs has become extremely low, because it does not sell the pure substance, but is mixed with various medications. According to research Pantazia et al. the heroin mixture proportion of the heroin is very small so a lot of that mixture has only 3% of heroin, a large number of cases can be only 1% of pure heroin. Most of the time it replaces caffeine and paracetamol. According to the Risser et al. reason why acetaminophen component is present in these mixtures is because it can be purchased without a prescription, it is cheap, well tolerated by most people and shows no side effects. Conclusion: When we talk about illegal drugs, we must emphasize the fact that there is no quality control, or the composition of the drug. The composition of the drug purchased on the black market is still unknown to potential user. While reaching the final drug users it pass through many hands, and at each step something is added to increase earnings. Most often present additives or impurities in narcotic drugs that are added are caffeine, ephedrine, acetaminophen, acetylsalicylic acid (aspirin) and additives such as powders, cement and chalk.

Objective: Timely recognition and optimal management of atherogenic dyslipidemia (AD) and residual vascular risk (RVR) in family medicine. Background: The global increase of the incidence of obesity is accompanied by an increase in the incidence of many metabolic and lipoprotein disorders, in particular AD, as an typical feature of obesity, metabolic syndrome, insulin resistance and diabetes type 2. AD is an important factor in cardio metabolic risk, and is characterized by a lipoprotein profile with low levels of high-density lipoprotein (HDL), high levels of triglycerides (TG) and high levels of low-density lipoprotein (LDL) cholesterol. Standard cardiometabolic risk assessment using the Framingham risk score and standard treatment with statins is usually sufficient, but not always that effective, because it does not reduce RVR that is attributed to elevated TG and reduced HDL cholesterol. RVR is subject to reduction through lifestyle changes or by pharmacological interventions. In some studies it was concluded that dietary interventions should aim to reduce the intake of calories, simple carbohydrates and saturated fats, with the goal of reaching cardiometabolic suitability, rather than weight reduction. Other studies have found that the reduction of carbohydrates in the diet or weight loss can alleviate AD changes, while changes in intake of total or saturated fat had no significant influence. In our presented case, a lifestyle change was advised as a suitable diet with reduced intake of carbohydrates and a moderate physical activity of walking for at least 180 minutes per week, with an recommendation for daily intake of calories alignment with the total daily (24-hour) energy expenditure (24-EE), depending on the degree of physical activity, type of food and the current health condition. Such lifestyle changes together with combined medical therapy with Statins, Fibrates and Omega-3 fatty acids, resulted in significant improvement in atherogenic lipid parameters. Conclusion: Unsuitable atherogenic nutrition and insufficient physical activity are the new risk factors characteristic for AD. Nutritional interventions such as diet with reduced intake of carbohydrates and calories, moderate physical activity, combined with pharmacotherapy can improve atherogenic dyslipidemic profile and lead to loss of weight. Although one gram of fat release twice more kilo calories compared to carbohydrates, carbohydrates seems to have a greater atherogenic potential, which should be explored in future.

Various High Dynamic Range (HDR) deghosting algorithms have been developed to solve the problem of merging dynamic content in multi-exposure HDR imaging. Even though these algorithms may be successful in `ghost' removal, they may fail to reduce noise in the resultant HDR image. As a result, the presence of noise in the generated HDR image degrades the overall image quality. HDR deghosting algorithms should also aim to reconstruct values that are approximately proportional to the luminance of the real scene. In this work we evaluate noise and luminance reconstruction in HDR images generated by five state-of-the-art HDR deghosting algorithms. The observations based on the obtained results are instrumental to guide the development of new HDR deghosting algorithms that will also aim to reduce noise and reconstruct original scene luminance to produce a good quality deghosted HDR image.

Jean–Raoul Scherrer (1932 - 2002) was a pioneer in the development and deployment of clinical information systems (1, 2, 3). He received in 2000 the Morris F. Collen Award of Excellence in medical informatics. Jean-Rauol Scherrer was born in the Canton of Jura, Switzerland, in October 1932 but has lived most of his life in Geneva, Switzerland. He went to college in Fribourg, at a Jesuit School called College of Saint Michel, and followed the classical pathway - ancient Greek, Latin, and strong mathematics studies. In 1959, he graduated from the Medical School of the University of Geneva, where he studied Physiology and Internal medicine. From 1967 until 1969, Professor Scherrer did postgraduate work in Medical physics at Brookhaven National Laboratory, on Long Island, and then returned to Geneva and the Cantonal Hospital of the University of Geneva, where he began to design and build what was to become DIOGENE, the Hospital’s patient information system. The idea was to have a system that would be patient-centric. Professor Scherrer addressed the needs of the physician, and not only that, he did not encumber the physician with the need to learn the computer (1). The basic principle was : One puts orders in through the telephone. One could immediately see on the screen what he had ordered. Behind this outward facade was a bank of individuals who were keying in the information for orders, for medications, for laboratory work, and for radiology. But his objective was to see how the computer could be an enabling tool, to assist the health care provider in doing what he or she needed to do to be giving the best possible care for the patient. Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses (2). Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation. He had groups working on natural language processing and image processing and manipulation in the OSIRIS system. Another of his groups was determining protein constellations in human patients by the use of bi-dimensional electrophoresis of human serum, and correlating these patterns with the identification of genes, using several scattered remote data bases. This Web-based system is called ExPASy. This was one of the first bioinformatics groups assembled any place in the world. In Geneva in 1992, researchers at CERN, a high-energy physics laboratory, invented the World Wide Web. Luckily, the director of CERN was a neighbor of Professor Scherrer, and because of this neighborhood collaboration, the group at Geneva Hospital was really the first to apply World Wide Web technology in health care. They made their protein research databases available to colleagues around the world via the Web and were really the first to do this. Dr. Scherrer was Executive Vice President of IMIA (International Medical Informatics Association) in charge of Working Groups and Special Interest Groups from 1993 to 1996: and President of the EFMI (1996-1998) (2). Figure 1 Scherrer Jean-Raoul (1932.-2002.)

Luka Kovacic Luka, MD, PhD, passed away in Zagreb on April 21st, 2015. He was specialist in Social medicine and organization of health care. Luka Kovacic graduated from the School of Medicine in Zagreb in the year 1965, and after a few years of medical practice he joined the Andrija Stampar School of Public Health in Zagreb. He earned both, MSc and PhD degree from the University of Zagreb School of Medicine in 1972 and 1983, and he advanced in academic career from the assistant position in the Chair for hygiene, social medicine, and epidemiology to full professorship in 2003. He was also trained in Sweden (1964), Scotland (1966), USA (1968 and 1971 when he was trained in Public Health, Epidemiology and Research Methods at the Johns Hopkins School of Hygiene and Public Health in Baltimore), Finland (University of Kuopio, 1977) and Alma-Ata (WHO training in Planning and Management in 1985). He paid study visits or served as a consultant in the UK, the USSR, Kazakhstan, Sudan, Cameroon, India, Iran (UNDP), Nigeria (WHO) and elsewhere. At the Andrija Stampar School of Public Health he used to held numerous posts and responsibilities: he was a head of the Department for Hygiene, Social Medicine and Epidemiology 1993-1997 and continued to head the Department for social medicine and organization of health care and was director of the Andrija Stampar School of Public Health till his retirement in 2006; he was deputy coordinator from 1984 and coordinator 1997-2000 of the WHO Collaborating Centre for primary health care; he served as an assistant to the director and deputy director (1984-2004). He served firstly as the coordinator and later as director (1990-1996) of the International 9-week course “Planning and management of primary health care in developing countries” which was held 16 times between 1978 and 1996 at the Andrija Stampar School of Public Health with the support of the Government of the Netherlands and had altogether more than 350 participants coming form 66 countries. His activities and duties were so numerous both within his institution and in the broader Croatian and international public health and medical community that we mentioned only those mostly pronounced or internationally visible. Luka was gifted and dedicated teacher, mentor of six MSc theses and one PhD dissertation as well as altogether more than 200 diploma works for medical and nursing students at the School of Medicine and School of Applied Health Sciences. He was principal investigator in many domestic projects and played a leading role in several international projects and networks. He actively participated in the work of the European network of districts “Tipping the Balance Toward Primary Health Care” (TTB) from 1987, being also its Chairman of the Board and president of the Assembly from 1997 to 2005 and the coordinator of the whole network and the project “TTB Second Decennial Survey of the Health Needs and Health Care for Older People in Europe”, which was implemented in five European countries including Croatia in 2005-2006. He was also a member of the European Society for Public Health and its Scientific Committee since 2000. Professor Luka Kovacic had coordinative role and contributed enormously to the establishment of the Forum for Public Health in South Eastern Europe (FPH-SEE) as a network of academic institutions aimed for the reestablishment of professional cooperation between public health teachers and professionals in SEE. As the result of this cooperation six books were prepared and published between 2004 and 2010 encompassing altogether more than 4300 pages, containing some 250 teaching modules authored by more than 200 authors, among them professor Kovacic co-edited the volume “Management in Health Care Practice” and authored four modules only within it. He has published almost 200 scientific and professional articles and edited several books and authored a few textbooks, among them also a textbook in Social Medicine. He coordinated a number of national and international projects and networks, has organized numerous national and international conferences in the field of public health and health care organization. As Public health expert and educator Luka Kovacic has been a person with great treasure of warmth and experiences. He was right person from whom always you can ask advice for solving a problems. Everybody of us will miss his friendship and honesty and his students will miss his great educational lectures. Sarajevo, September 2015

Introduction: Stroke is a rapid loss of brain function due to disturbance blood flow to the brain. The existence of multiple risk factors, the length of their duration, and severity of each factor individually, is positively correlated with the occurrence of stroke. Stroke is the third cause of disability and premature death for men and women. Aim: The aim of this research is that through clinical and epidemiological studies the origin and development of stroke to inspect the same level of representation in the population of the Herzegovina-Neretva Canton. Material and methods: This survey covers the entire population of residents in the Herzegovina-Neretva Canton, and the number of patients who had a need for primary and secondary treating the symptoms of stroke. The very setting of this model of anthropological research modern human groups and theoretical estimates of the impact of genetic and / or environmental risk factors in the formation of phenotypic expression of complex traits of stroke, at the population level, resulted in the realization of the very methodology of this research. The study was conducted at the Department of Neurology, Regional Medical Center (RMC) “Dr. Safet Mujic” and the Department of Neurology, Clinical Center Mostar. These two health institutions, in addition to primary care are at the disposal for entire population of the Herzegovina-Neretva Canton and beyond. Data were collected by examining the details of the history of the board of hospitalized patients in the period from 1 January 2010–to 31 December 2014. The processed are 10 risk factors–potential causes of stroke. We also as research material, used records of hospital morbidity–the disease-illness statistics form (form number: 03-21-61; 03/02/60; 03/02/61; 09/03/60). Results: In our study, stroke is the second most frequent in the period of investigation, and noted the rapid growth that is in 2010 and 10.21% to 14.52% in 2014. There was a slight statistically significant differences in relation to the number of infected men and women, and the same is in favor of the patients are female. The number of patients with ischemic stroke, 954 of them or 48.38% was male and 1,018 or 51.62% were female. Of the 10 possible risk factors, factor 6 has a statistically significant canonical factor value, of which hypertension–CVI and the level of P = 0009 *, p = secondary hypertension, 0034 *, hypertensive heart disease, p =, * 0021, Diabetes mellitus of P = 0029 *, p = Anemia, 0052 * and C-reactive protein (CRP) of p = 0049 *, respectively, these canonical factors carry the entire amount of information about the relations impact of certain risk factors in the onset and development of the brain shock. Conclusion: We conclude that there is a statistically significant correlation between the studied risk factors in the genesis of the origin and development of different types of stroke.