COVID-19 Impact on Access and Performing Dental Care in Bosnia and Herzegovina.

BACKGROUND: The world was struck with a pandemic accompanied by maybe one of the most popular words out there right now, which is COVID-19. It has affected every aspect of life imaginable, especially in the medical sector particularly in our case dental care. OBJECTIVE: This study goes on to analyse and assess the impact of COVID-19 on dental care in Bosnia and Herzegovina, varying from the staff, patients, supplies/equipment, and finances. METHODS: An online survey and over-the-phone surveys were conducted, bringing in raw information to help with this study. RESULTS: In total there were 10 different dental offices that information was obtained from. About 90% say that the pandemic has affected their patient flow, obviously due to some restrictions and regulations. And 60% say that the cost of PPE has increased since the pandemic started, while 40% said otherwise. Other data can be found in the rest of the study. CONCLUSION: Entering into the pandemic, dental practices quickly started to realize the seriousness of this situation, changing the way they do normal everyday work to accustom to this "new norm". During such a problem, both sides have to participate to act upon accordingly to bring health and safety for everyone.

Physician Practice and Knowledge on Diabetes Management During Ramadan in Bosnia and Herzegovina.

INTRODUCTION: Ramadan is the holy month of Muslims including fasting sometimes more than 20 hours. Even diabetes patients can be exempted from fasting it has been shown that almost 80% of diabetes type 2 patients intend and do fasting. To avoid acute complications during fasting, different recommendations on diabetes management are available. Considering the fact that there are more than 226 thousand diabetics in Bosnia and Herzegovina, it is important to provide structured support and healthcare service to those who are practicing fast during Ramadan. AIM: To evaluate knowledge, practice and attitudes of physicians treating diabetes (diabetologists and endocrinologists) in Bosnia and Herzegovina regarding management of diabetes in fasting patients during Ramadan. METHODS: A 32 questions survey has been developed, validated and disseminated to the 27 specialists treating diabetes in Bosnia and Herzegovina through online form examining demographic characteristics, current practices and attitudes and knowledge on diabetes management during Ramadan. RESULTS: All surveyed physicians deal with patients who are fasting during Ramadan. The majority of surveyed physicians 23 (85,2%) proactively initiate a discussion about planned fasting. More than 63,0% are following their experience and only 18,5% ADA/EASD guidelines on diabetes management during Ramadan. There are no significant differences between gender of the physicians, place of work and specialization when it comes to specific knowledge related to treatment guidelines, but some differences are observed. CONCLUSION: Although overall physicians` knowledge of diabetes management during Ramadan is satisfying there is opportunity in additional specialized education and measures introduction into the practice in order to improve treatment outcomes and standards of care.

Diabetology Care During COVID-19 Lockdown in Bosnia and Herzegovina - Diabetologists and Patients Perspective.

INTRODUCTION: COVID-19 pandemic suddenly affected all countries and health care systems from different perspectives including severe disruption of chronic disease services including diabetes. Diabetes is a serious condition and highly present in Bosnia and Herzegovina population, so provision of diabetes care is a important part of good control. Countries had different responses to adopt diabetes care under new circumstances as well as Bosnia and Herzegovina. AIM: To investigate and evaluate the impact of the COVID-19 pandemic on the provision of diabetology care in Bosnia and Herzegovina from the perspective of patients and diabetologists. METHODS: Online survey for diabetologists and patient organizations have been developed with adopted question for different perspectives. The survey has been conducted online early September 2020. Collected data were analyzed in SPSS software for descriptive statistics. RESULTS: 25 diabetologists and 24 diabetes patient organizations responded. 72% of diabetologists believe that pandemic has partially altered work with patients and 56% believe that the organization of diabetes care has successfully responded to the new circumstances but 80% believe that the diabetes care system should change. 75% of patient organizations thought that the organization of diabetes care did not adequately respond and 87.5% believe system should change. CONCLUSION: No significant differences found between RS and FBiH when it comes to majority of questions. Both diabetologists and patients consider that system of diabetes care in Bosnia and Herzegovina should be improved in future. It has been also found that diabetologists in Bosnia and Herzegovina responded and adopted their practices similar to other countries.

Pharmacists' Attitudes and Role in Diabetes Management in Bosnia and Herzegovina.

INTRODUCTION: Diabetes is the fastest growing chronic diseases worldwide and in Bosnia and Herzegovina. International standards for diabetes care have recognized the crucial role of pharmacists in diabetes management. Community pharmacists can provide services beyond medication dispensing inducing patient identification, assessment, education, referral, monitoring and behavioral counseling. Pharmacists' attitudes toward diabetes are generally positive but do not correlate with the degree of their involvement in diabetes management and frequency of providing diabetes-related services varied throughout countries. AIM: To measure pharmacists' attitude toward diabetes management and to identify pharmacy services that are currently provided to patients with diabetes. MATERIAL AND METHODS: We have conducted a descriptive, cross-sectional survey-based study among pharmacists from Bosnia and Herzegovina attending on of the conferences in May 2018. Majority of pharmacist attending such conferences are from community pharmacies across the whole country considering surveyed sample was representative. The questionnaire contained 3 different sections: a) participants' demographics, b) measured participants' attitude toward diabetes using the DAS-3 to measure participants' degree of agreement to 33 diabetes-related statements, on a 5-point Likert type scale and c) a list of possible diabetes patient support activities that could be delivered by pharmacists based on authors experience and available literature. RESULTS: The majority of respondents (86,5%) were female and 53,8% work in private owned pharmacies. Interest in diabetes was indicated by 94,2% while 59,6% completed special diabetes continuing education in the past. All the respondents expressed positive attitudes in all DAS-3 with no significant difference between overall DAS-3 and subscale values. Provided services differ but mainly drug oriented and partially include comorbidity counseling. CONCLUSION: Pharmacists had positive attitudes toward diabetes but they provided limited diabetes-related services to patients. Additional special education is needed.

Use of Food Supplements in Diabetes Mellitus Treatment in Bosnia and Herzegovina from the Pharmacists Perspective.

INTRODUCTION: Food supplements utilization is showing increasing trend among healthy as well as chronic disease population. Diabetes as a pandemic disease is treated by different interventions and traditional pharmacological treatment, but also utilization of natural products and food supplements (FS) are becoming important. Role of the pharmacist in diabetes management includes different interventions like counseling and recommendation of FS. AIM: To explore current trends in dietary supplements utilization among diabetic patients from the pharmacists' perspective, pharmacists' attitudes and knowledge about this group of products and suggest future directions related to this issue. METHODS: We have analyzed pharmacists' perception of FS utilization for diabetes and its complication treatment by conducting online survey. The survey was developed by authors based on research aim and published literature. RESULTS: It has been found that 72% of patients with diabetes are purchasing different FS and that they are willing to pay between 5,0-15,0 EUR per visit for this products. Even in majority of cases pharmacists proactively advice patients about FS selection they identify need for specific education in this field in order to strengthen their competencies and competitiveness. Pharmacists also identified need for FS specially formulated and intended for blood glucose controls and most often diabetes complications and related conditions. CONCLUSION: This is the first study in this field conducted in Bosnia and Herzegovina suggesting further activities and research of this topic.

Pharmacoeconomic Analysis of Antiepileptic Reimbursement for Neuropathic Pain in Bosnia and Herzegovina - Budget Impact Analysis of Pregabalin.

INTRODUCTION: Neuropathic pain resulting from injury to the nervous system. Up to 7% to 8% of the European population is affected. A number of different treatments for neuropathic pain have been studied including antiepileptic. Pregabalin and gabapentin are often considered first-line treatments. Pregabalin provides equivalent efficacy to gabapentin, showing greater potency at much lower doses and is considered as cost-effective intervention. In Federation of Bosnia and Herzegovina (FB&H), gabapentin is fully reimbursed, while pregabalin is enlisted on list B with copayment. AIM: To develop simple budget impact (BI) model and assess BI of introducing pregabalin into full reimbursement in FB&H. MATERIAL AND METHODS: Budget impact model was developed using Microsoft Excel 2010. Local epidemiology data and data on drug consumption from government reports in 2016 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with pregabalin reimbursed at the same level as gabapentin. Two developed scenarios have been compared from health insurance fund (HIF) perspective. RESULTS: In scenario 1 consider both drugs fully reimbursement and without patient switch among alternatives the total cost would be increased for 780,025 KM; 852,027 KM and 943,830 KM over a 3-year period. In scenario 2 considering both drugs fully reimbursed but with patient switch topregabalin total annual cost would be increased for 732,241 KM; 742,395 KM and 751,761 KM. Comparing scenario 1 and 2 it is found that scenario 2 is more favorable from HIF perspective. CONCLUSION: Implementation of pharmacoeconomic principles in reimbursement decisions in Bosnia and Herzegovina would improve access to medicines and contribute rationale resource consumption.

Rare Diseases and Orphan Drugs Accessibility in Bosnia and Herzegovina.

INTRODUCTION: Rare diseases are becoming more and more important since awareness is increasing. There are a lot of initiatives to ensure access to orphan drugs intended to treat these diseases but due to high price patients have low access and policy makers and payers are struggling with costs and assuring patient access rights to the available medication. AIM: Objective of this study is to assess current situation regarding rare diseases in Bosnia and Herzegovina (BiH) and availability of orphan drugs. Four domains are examined: legislation and policy, diagnostics and research, patient organizations and reimbursement and availability of medicines for rare diseases. RESULTS: There are official programs and legislation ground for rare diseases in both entities of BiH: Republic of Srpska (RS) and Federation of BiH (FBiH). Diagnostic and genetic counseling are available but only for few rare diseases. Patient organizations are formed and active but still without engagement in some of international organizations. There are no special reimbursement criteria for orphan medicines. Number of reimbursed medicines is significantly lower than those on ORPHANET list, 67 and 26 in RS and FBiH respectively. Huge difference in number of reimbursed medicines within the country entities may be consequence of counting method. CONCLUSION: Even thou rare diseases in BiH are recognized in countries official programs and documents, with patients having their organizations, much more have to be done in availability of medicines and diagnostics in the rare disease field. Insufficient funds are huge obstacle toward this goal. New methods of medicine evaluation are need and recommended in order of better availability.

Surgical treatment and complications of treating pancreatic tumor.

UNLABELLED: Pancreatic tumor is one with the worst prognosis of all cancers, and the tenth most frequent cancer in Europe, making the 3% of all cancers affecting both sexes. Most patients seek treatment when the disease is in its advanced stage and the level for possible resectability is low. Late presentation of the disease is responsible for the short survival period of 6 months and a five-year survival of 0.4 to 5% of patients. At the Clinic for Surgery in Tuzla during period from January 1st 1996, to January 1st 2011, a total of 127 resection surgeries were performed due to malignant tumors. The goal of this study was to show that adequate assessment of operability, proper surgical strategy and modern techniques of creating anastomoses reduces morbidity and mortality, results in fewer postoperative complications and contributes to better surgical results. In our study sample the most common place of tumor location was the head of pancreas, in 69 (59.7%) patients. Men develop this type of cancer more often than women in the ratio of 2:1, while the median age of patients was 62 years. We faced postoperative complications in 37 (29.1%) patients, pancreatic fistula being the most prevalent complication, occurring in 16 (12.6%) patients. Overall early and late postoperative mortality was observed in 12 (9.8%) patients. CONCLUSION: Patients with chronic and hereditary pancreatitis are at a higher risk for developing pancreatic cancer and should be screened for the purpose of early diagnosis. The staging of pancreatic cancer has improved, with the accuracy of 85-90%. Postoperative complications, morbidity, and mortality are significantly reduced (p < 0.05) if the standardized operational procedure is applied and if modern techniques are used to create pancreaticojejunal anastomosis as the anastomosis carrying the highest risk.

Percutaneous treatment of symptomatic non-parasitic benign liver cysts with 20% NaCl solution.

GOAL: The aim of the study is to evaluate efficacy of single-session 20% NaCl solution sclerotherapy in the treatment of symptomatic nonparasitic benign liver cysts. METHODS: 20 patients were chosen (7 man and 13 woman, mean age 52.9 with mean duration of disease before treatment 9.4 months) for a prospective trial. Patients were treated with ultrasound-guided percutaneous aspiration and injection of 20% NaCl solution. Patient demographics, clinical characteristics, treatment outcome and complications were analyzed during the trial. The procedure was considered successful if the cyst disappears. The cyst was considered to have disappeared if it could no longer be visualized on ultrasonography. Other important measures to document the efficacy of treatment included the length of the hospital stay and complications related to the procedure. RESULTS: The average volume reduction was 96.3% (range, 74.9-100%). During the 24-month follow up period, 8 cysts (40.0%) disappeared completely. The hospital stay was one day for all patients. CONCLUSION: Percutaneous treatment and sclerotherapy with hypertonic NaCl (20%) is safe and effective for hepatic non-parasitic cysts.