Senada Selmanovic

Therapeutic Effects of Curcumin on Ultrasonic Morphological Characteristics of Liver in Patients with Metabolic Syndrome

Introduction: Metabolic syndrome (METS) represent a simultaneous presence of multiple metabolic disorders in one person. Prevalence is increasing worldwide, which is probably related to increased obesity and sedentary lifestyle. Non-alcoholic steatosis or “fatty liver” is a metabolic disease caused by fat dysfunction. It can be a sign of some other disease, and can often be found in patients with metabolic disorders. Ultrasound is an acceptable method for the identification of fatty steatosis. There is evidence that when turmeric is used as a herbal diet, with its active metabolite of curcumin, can repair fatty acidosis and thus prevent progression of fatty steatosis complications such as cirrhosis and liver cancer. Goal. The aim of the study was to determine the effects of 400 mg curcuminaddition to the nutrition on ultrasound morphological characteristics of the liver in METS patients. Methodology: A prospective cohort study was conducted on 100 subjects with METS, treated in the family medicine practice of the Tuzla Canton, aged 35-70 years. The therapeutic effects of 400 mg curcumin on ultrasound-morphological characteristics of the liver were followed, validated by ultrasound in 50 respondents of experimental groups with METS. The data were processed by the IBM SPSS Statistics 21 statistical analysis program using parametric techniques andStudent’s t-test for paired samples. Results: There were 65% of women in the study. There were no statistically significant differences in the age of respondents within the analyzed groups. The use of 400 mg curcumin per day was statistically significantly improved ultrasound morphological characteristics of the liver in subjects with METS. Conclusion: All respondents with METS who used curcumin had beneficial effects on the morphological characteristics of the liver. Curcumin had stronger effects on subjects with METS and DM type 2 than others.

Impact of work place stresses on work ability index in patients with depressive disorders

INTRODUCTION Depression seriously affects ones ability to perform work tasks and function at work. We studied the impact of both the individual and work factors on work ability index in patients suffering from depression. MATERIAL AND METHODS The prospective study, which was conducted by using questionnaires, included 210 patients with depression, who had been on sick leave from 60 to 360 days. The individual factors were evaluated by the standardized abridged form of Occupational Stress Questionnaire, while the work place factors in relation to work ability were evaluated by the work ability index. RESULTS Poor work ability was observed in 151 (71%) of subjects suffering from depression. All workplace stresses, lack of support by colleagues and supervisors, ergonomically not adjusted work and huge work load are statistically associated with poor work ability index (P=0.001). More than 95% of variables of the evaluated work ability index are the result of varying in the group of stresses at work place (R2=0.95). Perception of bad health condition (Rsq=0.412, P=0.001), low level of life satisfaction (Rsq=0.309, P=0.001), low level of motivation and work knowledge (Rsq=0.309, P=0.001) are predictors for poor work ability. The work ability cannot be related with age and sex. CONCLUSION The key activities for maintaining the work ability at the times when epidemic of depression emerges, as it is nowadays, are timely carrying out the psycho-treatments, mental and professional rehabilitation, occupational therapy and adapted work place.

Screening for Depression Patients in Family Medicine

ABSTRACT Goal: The aims are to establish the prevalence of newfound, unidentified cases of depressive disorder by screening with the Becks Depression scale; To establish a comparative relationship with self-identified cases of depression in the patients in the family medicine; To assess the significance of the BDI in screening practice of family medicine. Patients and methods: A prospective study was conducted anonymously by Becks Depression scale (Beck Depression Questionnaire org.-BDI) and specially created short questionnaire. The study included 250 randomly selected patients (20-60 years), users of services in family medicine in “Dom Zdravlja” Zenica, and the final number of respondents with included in the study was 126 (51 male, 75 female; response or response rate 50.4%). Exclusion factor was previously diagnosed and treated mental disorder. Participation was voluntary and respondents acknowledge the validity of completing the questionnaire. BDI consists of 21 items. Answers to questions about symptoms were ranked according to the Likert type scale responses from 0-4 (from irrelevant to very much). Respondents expressed themselves on personal perception of depression, whether are or not depressed. Results: Depression was observed in 48% of patients compared to 31% in self estimate depression analyzed the questionnaires. The negative trend in the misrecognition of depression is -17% (48:31). Depression was significantly more frequent in unemployed compared to employed respondents (p=0.001). The leading symptom in both sexes is the perception of lost hope (59% of cases). Conclusion: All respondents in family medicine care in Zenica showed a high percentage of newly detected (17%) patients with previously unrecognized depression. BDI is a really simple and effective screening tool for the detection and identification of persons with symptoms of depression.

The Frequency of Multifactorial Syndromes in Geriatrics of Tuzla Canton Population

Introduction: There are four main multifactorial syndromes in geriatrics the so-called “4N”, which specifically occur at elderly patients. Listed syndromes often occur related, and they can be the cause and the result of many other syndromes at geriatric patients. Objective: determine the difference in the assessment of the level of immobility, instability, dependence, urinary incontinence (“4N”) in elderly groups. Materials and methods: The research included total 200 elderly respondents experimental group made of elderly persons (>65 years) living alone. Control group included elderly persons living in a family environment. Universal geriatric questionnaire was made for this research. For fast orientation the redone questionnaire was used for our conditions: examination in clinics for usual elderly problems “Short list for examination”. For the assessment of the mental abilities reduction at elderly we used “Short portable mental status questionnaire” (SPMSQ). Results: In total sample the research included 200 elderly respondents, 45% in experimental group and 55% in control group. The average age (±SD) was 75,4±6,2 years in the experimental group, while in the control group the average age was 74,9±5,6 years. We notice nearly equal distribution of falling risk according to groups (50%, 47%). In total sample there were 62% mobile, 22,5% limited mobility, and 4% immobile. Dependence frequency was more represented at examination group respondents (p=0,002). Dependence chances (OR) were 2,05 times larger (95 %CI=1,12-3,75) in examination group than in control group respondents. Frequency of urinary incontinence problem is significantly represented at all our respondents (42,2% v.s. 35%). Conclusion: Permanent gerontology and geriatrics training is needed both family medicine doctors and other experts in the field of elderly health protection and preventive health measures, pharmacotherapy, palliative care, especially about four main geriatrics syndromes at elderly.

THE EFFECT OF FATIGUE SYNDROME ON COGNITIVE FUNCTIONING AND QUALITY OF LIFE OF A PATIENT AFTER AN ISCHEMIC STROKE

Background: Fatigue is usually defined as a subjective lack of physical and/or mental energy necessary for doing everyday activities. Fatigue is a subjective condition, and there is not a valid definition of fatigue after a stroke at the moment. Aim: The analysis of frequency of fatigue syndrome in 200 patients after an ischemic stroke and its effect on cognitive functioning and quality of life after an ischemic stroke was conducted. The measuring instruments for the assessment of fatigue used were the Chalder Fatigue Scale, for cognitive functioning the Mini-Mental State Examination, and for the quality of life SF-36, scale for measuring quality of life. Neurological and neuropsychological testings of the participants were conducted three months after an ischemic stroke – first testing, six months after an ischemic stroke – second testing, and twelve months after an ischemic stroke – third testing. Results: Fatigue syndrome was noted in 68% of the patients three months after an ischemic stroke, in 71% in testing after six months, and 70% after twelve months. The mean values of MMSE score in the patients with and without fatigue syndrome was between 28 and 29 in all testings, which indicates that they had normal cognitive functioning. The significance of differences in the MMSE score in the patients with and without fatigue syndrome in the first, second and third testing was tested using HI-squared test and the results showed that there were no statistically significant differences (p>0.005). In comparison of quality of life between the patients with and without fatigue the results showed that the patients without fatigue syndrome had significantly better quality of life in comparison with the patients with fatigue syndrome in the field of mental and physical health (p< 0.0001). Conclusion: Fatigue syndrome after an ischemic stroke has a significant frequency (68-71%) and duration. Fatigue syndrome does not affect cognitive functioning of patients after an ischemic stroke but it leads to impaired quality of life of patients in all areas.

Qualitative Evaluation of Cardiovascular Diseases Management in Family Medicine Team in One Year Level

Introduction: Cardiovascular diseases (CVD) are the leading death cause in modern world and are the most public health problem. WHO program for CVD contains: prevention, command and follow up of CVD in global level. Aim: Investigate CVD frequency in family medicine team in 2012.year (one year period of time) and qualitative management prevention and clinical services management quality of CVD together with recommended standards. Patients and methods: clinical revision of clinical standard practice patients with CVD was provided in Family medicine team in Public Health Centre Tuzla for the period of time from January 01 2012 - December 31 2012. For quality of realized services, AKAZ standards were based for: chapter 2. Health promotion and diseases prevention 2.5. preventive clinical services; chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke. From CVD register next parameters had been used: age, gender, disease diagnose, therapy, blood pressure values, total cholesterol values, ß blockers therapy, anticoagulant therapy prescription, smoker status, stop smoking recommendation and influenza vaccination recommendation. Statistical approach: All results were taken in Excel program and statistically analyzed. Descriptive standard tests were taken with measurement of central tendency and dispersion. For significant differentials achieved with χ² chances relation was taken (Odds Ratio-OR) with 95% relevant security. All tests were leveled in statistical significant from 95% (p<0,05). Results: Considering total registered habitants number 1448 (males 624 females 824) total diseases of usually CVD in Team 1 family medicine 531 (36,67%). The most frequent disease was hypertension which was presented in 30,31% of registered patients but in total CVD illness was present in 82,67%. In relation with total patients number (531), female prevalence from CVD 345:186 males vs. 65%:35%; P=0,001 and was statistically significantly higher. Almost patients were in age from ≥65 years. Nearly all the standards for chapter 2. Health promotion and diseases prevention and chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke are met in larger percentages than the minimum, however, bad quality signs we have found in total cholesterol control were values of total cholesterol were ≤ 5mmol/l achieved only in 27.58% patients with CVD. Stop smoking recommendation in smokers with TIA and Stroke (total 10 smokers) was registered in 20,00% patients. Indicator was not achieved,(min level 25%). Conclusion: Role of family medicine team is extremely important in patient care who suffer from chronically noncontagious diseases such as CVD, as one of them. Considering that in our country preventive programs for CVD are at small level, results of this study are acceptable. Our plans for personal continuous educations and patient educations about healthy life style are pointed for higher or average of achieved standards and of course everything what have to be done should be written in personal dates of patients.