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Words of Editor Turning gray clouds packs suitcase for sun, Hearts beat softly, more and more quietly, Passions in chest no longer leaps, The wet autumn walks, summer is no more here.

Like the invisible shadow behind, silently as the maturation of the fruit, bravely as overflowed mountain river, grandiose, like a peacock in a big garden, in a gray cloak of water particles, tailored by skilled hands of natural processes, with a faded look on trees and dead leaves, on wheels of time, in our lives walked the autumn.

How genius is autumn, right? Nobody as autumn can also carry in her so much melancholy, gray and cold, and yet also paint the nature in full domination to hallucinogenic levels such as Van Gogh painting. While through the beams of light faded her palette of beautiful colors, the smell of winter food of hardworking host lures and making us happy, not leaving us indifferent.

And although the fall is dull, gray and foggy, sometimes it is more beautiful than the reality itself and it is submitted with a lot less hassle. That is the reason we are here, stuck in our consciousness, spinning in a vicious circle of life, undoubtedly steeped in transience, while life itself invites us to conquer, last and remain consistent with our aims.

Autumn is known as a period of numerous professional conferences in the field of medicine. And “Medici.com” on the doorstep of No 71. , swinging on the branches of its high trees, had the honor to be present at several such meetings, on which we bring you a wealth of new information.

Children are our greatest and most priceless wealth, the only beings worth true admiring, and it is in this light the Children’s Sunday is celebrated in the Republic of Srpska, during which it has been announced that only happy children become happy people. So let’s protect the children, cuddle and cultivate their velvety world, because it is innocent and as such divine refines and restores hope in the healing of the modern scourge of humanity.

Goodness is a top human virtue which is deficient in all modern societies, but, if we have it, it is our duty and requisite, moral and social to protect, love and help weaker, vulnerable and sick. On this form and model of noble behavior, which preserves the dignity of the sick and infirm, was pointed on the celebration of World Mental Health Day on October 10 at the Administrative Center of the Government of the Republic of Srpska in Banja Luka.

The all are equal in front of the law, no matter the skin color, race, nationality, language or today increasingly popular political affiliation. Laws must protect both doctors, all health entities and institutions, as well as patients themselves. That is the only way to ensure the proper functioning of the health system and the health care of citizens.

Acknowledging and respecting the laws, time’s running out. At the door we have a new time cycle.

Your “Medici.com“ Editor in Chief, prim. Dr. Momir Pusac

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29 September

The World Heart Day

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Replantation of the fist

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Dr.Med.Sci. Predrag Peric

Virtual (cyber) Knife

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Depressive disorders

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Dr.Med.Sci. Snezana Basic

Ganoderma lucidum

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Interview:

Dr. Vesna Jovanovic

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EAGEN

Abdominal microflora

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1-3 October, Banjaluka

VI Balkan’s Orthopedics Congress

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Association “Adults for the Children”

School of Life 2015

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MOSAIC OF MEDICAL

www.medicicom.com

Editor: prim. Dr. Momir Pusac Executive Editor: Andja S. Ilic Technical Editor: Sretko Bojic; Translation into English: Dr. Slavisa Udovicic Expert scientific council of the newsroom: Academician, Professor. Dr.Miodrag Ostojic, Academician, Professor. Dr. Drenka Secerov-Zecevic, Academician Prof. Dr. Miodrag Colic, Professor. Dr.Zoran Popovic, Professor. Dr Miodrag Jevtic, Professor. Dr. Zoran Rakocevic, Professor Dr. Vaso Antunovic, Professor Dr. Danica Grujicic, PhD Dr. Ljiljana Vujotic, Professor Dr. Srboljub Golubovic, Professor Dr. Dusko Vulic, Professor Dr. Dusko Vasic, Professor Dr. Zdenka Krivokuca, Professor Dr. Senad Mehmedbasic, Professor Dr. Sandra Lazarevic, Professor Dr. Miroslav Petkovic, Mr. sci. ph. Pero Rokvic, Mr. ph. Natasa Grubisa, Professor Dr. Snezana Pejicic, PhD.Dr. Slavica Zizic-Borjanovic, Mr. ph. Zlata Zuvela, Academician Professor Dr. Enver Zerem and Professor Dr. Elizabeta Ristanovic.

Expert advice newsroom: Prim. Dr. Lela Popovic, Prim. Dr. Slavko Dunjic, Prim. Dr. Mira Popovic, Mr. ph. Dragana Reljic, Dr. Rade Dubajic, Dr Danica Mihajlovic, Mr.sci Zivana Vukovic -Kostic, Mr. sci. Med. Branislav Lolic, Prim. Dr. Boro Guzvic, Dr. Dusan Bastasic, Dr. Goran Racetovic, Dr. Slavko Pecanac, Mr. ph. Rada Krca and Natasa Aleksic Editorial: 78000 Banja Luka, Branko Copic St 15, Tel : +387 (0) 51 318 606, +387 (0) 65 603 346; e - mail: medici.com@blic.net ; www.medicicom.com Publisher: “Medici.com“ Association Banja Luka, Branko Copic St 15 Director: Vera Pusac Sales, marketing, promotion in BiH: Jelena and Bojan Brocilovic Sales and distributor for Serbia UNA PRESS doo Belgrade, tel: +381 11 2 188 704 Promotion and marketing abroad Beoimpex AD Beograd tel. +381 11 38 09 715 Legal Advisor: Lawyer Jovana Pusac from Banja Luka, tel. +387 65692377 Photo: Bojan Crnokrak, tel. 066 / 454-211; Print “Atlantik bb“ Banja Luka COMMUNICATIONS

By the Decision of the Ministry of Education and Culture of RS, No. 6-09-3783 / 03 of September 25th 2003 registered in the Register of Public Media under No. 430. Any copying, reproduction, copying part or all of the material from magazines and web editions is allowed only with the written consent of the publisher

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Dignity in Mental Health

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he central event marking World Mental Health Day, was held on October 10, in the Republic of Srpska at the Administrative Center, at the Government of the Republic of Srpska, following this year’s main theme of the World Health Organization and the World Federation of Mental Health called “Dignity in mental health “.

The ceremony organized by the Ministry of Health and Social Protection of the Republic of Spska are honored by the presence of high officials led by Minister Dr. Dragan Bogdanić and Assistant Minister prim. Dr Milan Latinovic. There were the National Coordinator for Mental Health of the Republic of Srpska MSc. Dr. Biljana Lakić, representatives of institutions of mental health and social care from Banja Luka and several other cities as well as the representatives of the Mental health project in Bosnia and Herzegovina and other public institutions, NGOs and individuals who are closely related or supporting people with mental disorders in Banja Luka and Republic of Srpska.

Among the guests, as well as special feature of marking this important date in the calendar of mental health, were also members of user associations “Za8

Dignified at World Mental Health Day

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jedno” (Together) from Banja Luka, who were, in partnership with the Ministry of health, the organizers of the part of the planned program for the present professionals, users of mental health services and their families and other guests of the ceremony. The Government of the Republic of Srpska as a real host again hosted people with mental disorders, confirming fighting stigma of mental illness at the highest level.

With apposite compliments, Minister of Health and Social Welfare, representatives of the NGO “Zajedno” Mental Health Project in Bosnia and Herzegovina, Department of Psychiatry, Clinical Center of the Republic of Srpska and the Center for Mental Health Banjaluka reminded of the importance of mental health in the overall integrity and health of each individual, but also stressed the need for constant care for persons with mental disorders, as well as the pres-

ervation of their dignity part of caring about their overall health, with the main task of all of us that we take care of every individual as a special value that we have. On the other hand, it was pointed out that a person with mental disorders must always be truly equal with every other member of the society and the community in which he lives.

As part of today’s event shows the results of recent developments in the reform of mental health in the Republic of Srpska and BiH (MSc. Dr. Biljana Lakić) and as close as desired messages of the World Federation of Mental Health, which are intertwined with the motto of this year’s World Mental Health Day (Prim. Dr. Joka Blagovčanin -Simić).

The ceremonial part of the program was organized by the NGO “Zajedno” from Banja Luka and the drama play of medical students of the Medical Faculty from Banja Luka, a very well-designed

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and organized program in which song, dance, acting and prose, take turns all those present are really felt and showed not only support but also the relationship with the members of NGO “Zajedno”, their friends, current and former high school students, actors, students and friends. Spontaneously and out of protocol, numerous guests, including the Minister of Health and Social Welfare, were joined users and their friends and were part of the providers of the programs. This is the real, true way in which it has been shown that in the Republic of Srpska exist a permanent commitment to the de-stigmatization of people with mental disorders and those who support them and care for them, but also, that the dignity of the mental health is one of the commitments of all of us, on what we must persist.

Prepared by: Dr. Goran Račetović, spec. psychiatry, Health Center Prijedor - Center for Mental Health

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nder the motto “Together for the society health,” the Slovenian government has prepared a draft Resolution on the national health care plan until 2025 which these days take a public hearing. The Slovenian Health Insurance Institute (Institute) engaged in discussion and sent its opinion on the proposed document to the most important proponent of the development documents in the field of Health, along with a series of concrete proposals and request that a public hearing should be extended for at least two months so the current situation in health care can be analyzed in more detail and everybody who can contribute, can give their opinion on the way of development of the Slovenian Health and find the best solutions. It remains to be seen what will be accepted, of all the proposals of the Slovenian Institute, but, given the leading position of the Slovenian Institute among regional institutions and health insurance funds, we transfer the part of their proposals to the readers of the magazine “Medici.com”.

In the first place, in its opinion on the text of the proposed resolution, the Slovenian Institute stands out as a positive correlation of some goals in the resolution to the objectives of the strategic development plan of the Institute relating to the possibility of improving the financial situation in health care, then the possibilities for improvements in the field of law within compulsory health insurance and the possibilities in the field of control and management of health care costs. In this regard the Slovenian Institute states it is good that it is plane to improve the financial situation, by the resolution, among other things, should be achieved by providing solidarity, and justice in the payment of contributions for mandatory health insurance on the way to expand the basis for the calculation and payment of contributions, to reduce differences in base and contribution rate, to increase the responsibility for the regular payment obligations and to find new sources of revenue additional taxation of tobacco, alcohol and other products that damage health.

In correlation with the objectives concerning the package of rights under the mandatory health insurance, the Institute states that it is good that the 10

Slovenia is planning development health path by 2025

Slovenian Health Insurance Institute seeks more autonomy

Biljana RodicObradovic, Executive Director of Planning, analysis and development of health insurance

Milojko Kolar Celarc, Minister of Health of the Slovenia and Samo Fakin, director of the Health Insurance Institute, (taken from slovenskenovice.si)

resolution emphasizes the principle of the universality of rights and equality in terms of their availability within the quality and universally accessible public health. Also, the Institute emphasizes that it is a good thing that the package of compulsory health insurance is adapted to the needs of the population, but at the same time point out the need to introduce a system of evaluation of health technologies, which would be the basis

rational decisions about the introduction of new and exclusion of outdated technologies. As part of the response to how it is possible to better manage costs in health care and stressed the necessity of upgrading accounting model and the payment of health services, which would include the evaluation of efficiency and quality.

Slovenian Institute believes that the adoption of a new resolution is neces-

for any changes in the rights package, which are financed from the mandatory health insurance instead of the current practice of arbitration. For this area the Institute emphasizes the need to establish greater responsibility for their own health and increase the health “literacy”, particularly among vulnerable groups.

In a third area, which relates to control or rationalization of costs, among the measures that can contribute, the Institute emphasizes that it is good that the resolution emphasizes the need to redirect the cost of health promotion and disease prevention and re-emphasize the need for the introduction of a transparent national system of evaluation health technologies that would allow making

sary for changes in health care more than required, and for the current bad situation in health care causes are seen in the fact that the current system laws problems treated only partially and that earlier resolution was not implemented in all counts. Institute sees the new Resolution as a basic national document for the comprehensive reform of the health system and for the assessment of all departments at all levels and on the basis of which it was announced that the proponent offered text cannot respond to these goals because they did not provide answers to the key weaknesses of the existing regulation, nor answer all the questions of the future planning of the health system. Therefore, it is re-

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quested extension of the public debate in order to come to a better document to offer complete solutions. Institute itself sent a number of interesting proposals.

In the area of ​​public health, particularly in health promotion and disease prevention, the Institute proposed to regulate the area of occupational ​​ diseases and to examine the possibility of introducing differentiated rates for insurance against injury at work and occupational diseases.

Regarding the measures which relates to the optimization of health care, the Institute has proposed that the Resolution plans required prescribing the generic name, and the one related to the success of managing the health system proposed to amend the resolution with twelve new measures. Among other things, they seek to amend the resolution on the basis of the elements which make it known that the activities will be developed at all and that only at certain levels, and to indicate the specific needs and possibilities for the development of certain areas of health care. Further, proposed to be defined the role of individual institutions in the health system and the resolution plan activities that will contribute to more efficient division of labor between the different levels of health care and various medical activities. In support of the above activities the measures have been proposed that should contribute to the improvement of health information system, with a focus on integration of information and communication technologies and the computerization of the internal processes in the institutions that provide health services.

Institute has the most objections on that the Resolution is not adequately covered by the mandatory health insurance, despite the fact that most of the cost of health care is funded from this source, as well as the fact that it tends to reduce the autonomy of the Institute. They are especially outraged on the last mentioned and state that the autonomy of the Institute should not only be preserved, but also strengthen, with adequate competence and responsibility, guided by the example

of the organization of insurance companies in Austria and Germany. Dissatisfaction with what is proposed in the resolution for the mandatory health insurance is going to the extent of the losses in business, which is presented since 2008, the Institute openly blamed the reduction of its competence and autonomy. In this regard, Institute based its proposals on the logic of “we are paying; therefore, you have to ask us for an opinion when making decisions that affect our costs.”

Referring to this argument, the Institute requested that it should be written in the Resolution thet the legislative and executive authority required to the planning of measures and activities at all levels and in all areas provide an assessment of the impact on the mandatory health insurance and to look out for the opinion of the Health Insurance on the financial consequences of planned policies and measures. In this context, the Institute seeks a greater role in planning public health care services, especially in terms of its spread and extension activities of the health institution which is already covered by a network, also operated by impact on health care costs. The proposal that the Institute seeks more powers of control and supervision in the sense that it has the authority misdemeanor authorities and inspections within its scope is interesting.

Otherwise, the Slovenian Health Insurance Institute usually draws the ideas by analyzing the practice of developed European countries, especially Germany and Austria, which also arranged the mandatory health insurance by the Bismarck model. At the same time, without complexes they accept good ideas from the region, mainly in the framework of regional meetings that are organized every year. Proof of this is the pursuit of generic prescribing. As far as concrete proposals on the resolution, it is possible that the chance of being accepted is increased by the fact that the Minister of Health of Slovenia as a graduate economist.

University Clinical Centre Ljubljana

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Agreement on the use of data registers

Better control of the insured

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inister of Administration and Local Self Government of Republic of Srpska, Lejla Rešić and General Manager of Health Insurance Fund of the Republic of Srpska, Darko Tomas signed an agreement on the use of data from the central database of another copy of birth certificates, thanks to which the Fund will continue to achieve better control of all users, and control registers of deaths. In this way, we should prevent any possible fraud in the health care system when it comes to data users of health services, but also to provide additional savings. Director HIF RS Darko Tomas said that the Fund would be able to exchange data from records on deceased persons and update its records of insured persons with the Ministry of Public Administration.

“These figures are particularly important at the end of the calendar year, when we determine the number of insured persons and on the basis of that we plan the funds for health centers in the Republic of Srpska,” explained Tomas. Minister of Administration and Local Government Lejla Rešić noticed that the Ministry signed the same agreement with the Pension and Disability Insurance of Republic of Srpska, two years ago. ‘’ The idea is to provide the best and fastest possible services to our customers and give them full access to the register of deaths, “said Minister Rešić.

The signing of the agreement was attended by the director of the Pension and Disability Insurance Fund Mladen Milic, who said that this Fund in the past three years that they use the data of the Ministry, saved several tens of millions of KM. “The agreement is in force for two years, and before that we had a year of testing cooperation. During that time, we have suspended the timely payment of pensions for 110,000 individual members who have died, and thus left at least 20 million in the budget of the Fund and the Srpska’s budget, “said Milic. According to him, on average, the intake in the Register of Deaths is about 1000 to 1100 citizens of the Republic of Srpska per month.

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The World Heart Day was celebrated, 29 September

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n the occasion of World Heart Day, organized by the Foundation “Health and Heart”, the Ministry of Health and Social Welfare and health centers in the Republic of Srpska, free tests of risk factors for cardiovascular disease was organized for all interested citizens on September 29th.

Topic of this year’s World Heart Day is “Healthy Heart for everyone, everywhere”, which implies that by creating an environment for the development of healthy habits for the heart allows making the right choices that will reduce the risk of cardiovascular disease and stroke.

According to Deputy Minister of Health and Social Welfare of Republic of Srpska, Milan Latinovic, six to seven myocardial infarctions daily happens in the Republic of Srpska.

“Men older than 55 and women older than 65 years suffer most often.

In addition to an unhealthy diet, physical inactivity and smoking, risk factors for cardiovascular disease are also high blood pressure, cholesterol and blood sugar, “said Dr. Latinovic.

He added that the Ministry of Health and Social Welfare of the Republic of Srpska is caring out activities in the plans and programs in several directions.

“Our goals are the prevention, early diagnosis and treatment. The Ministry supports a number of prevention programs through health institutions that are primarily related to the determination of the risk factors that contribute to cardiovascular disease. We also support programs of early learning on healthy lifestyles, “said Dr. Latinovic.

Prof. Dr. Dusko Vulic, national coordinator for the prevention of cardiovas-

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Healthy heart for everyone, everywhere

The central event of the “World Heart Day” in Banja Luka, in cooperation with the Family Medical Center Banja Luka

cular diseases in the Republic of Srpska, said that according to data of the State Statistical Office, in the Republic of Srpska, cardiovascular disease and their consequences annually kills about 14,000 people.

“According to the Institute of Public Health, about 15 percent of the popu-

“It happens that the patients from 40 to 45 years, even before the age of 40, have a cardiovascular disease, myocardial infarction, which is a prelude to further cardiovascular diseases. These limits are moving, “said Dr. Nevena Todorovic, assistant director of the Health Center.

lation is affected by cardiovascular disease, and more and more of the patients who are in the third and fourth decade. That’s why today’s action is important against chronic diseases in order to stimulate the citizens to go to the medical exam on time and to implement preventive measures. Our goal is to reduce of premature death from cardiovascular disease by 25 percent, by year 2025.”said Dr. Vulic.

The particular concern is the fact that cardiovascular disease increasingly affects young, working age and about perfectly healthy people. Equally vulnerable are women and men.

Tamara Kovacevic-Preradovic, head of the Clinic for Cardiovascular Diseases of the University Clinical Center of the Republic of Srpska, said that the team of interventional cardiologists and the entire medical staff of the clinic, with the support of management, provide treatment 24 hours a day, seven days a week.

“All patients who come in the Clinic for Cardiovascular Diseases with acute myocardial infarction are being transferred in the catheterization laboratory, to the opening of blood vessels, which is the most modern way of treating these patients,” said Dr. Kovacevic-Preradovic.

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Bijeljina Health Center On the occasion of World Heart Day, the residents of Bijeljina had the opportunity to control their own health for free on the check-points in the city. What is new this year is that the preventive examinations was performed by the medical staff of the Health Center Bijeljina and experts of the HISPA center, the International Association of Centers for hypertension and the prevention of heart attack and stroke, which operates in four CVD (cardiovascular disease) are the biggest killers in the world. They are responsible for the premature death of 17.3 million people each year and by year 2030. it is expected that this number rises to 23 million. However, the occurrence of most CVD can prevent or delay by the impact on risk factors such as smoking, unhealthy diet and lack of physical activity.

Too often, society blames individuals for their cardiovascular disease: because you smoke, because you eat and drink too much, not exercising! But the environment in which we live can affect our ability to select the correct choices for a healthy heart habits.

Many individuals are “trapped” in the environment in which they live

different countries and which is also part of Health Center Bijeljina.

Dr. Med. Sci. Zlatko Maksimovic, General Manager of Health Center Bijeljina said that compared to last, this year preventive check-ups are organized in cooperation with Dr.Med.Sci. Nebojsa Tasic from the Institute for Cardiovascular Diseases “Dedinje”, head of the center for hypertension and prevention of heart attack and stroke, and president of the HISPA association.

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“We want to say that the heart is not a mythical organ, but one without which we can not live. Throughout the region, both in Serbia and here in the Republic of Srpska, every second resident dies of heart attack and stroke. It is a global epidemic, one terrible scourge against which we can and we have to fight.

While the focus of people is to contact a doctor only when symptoms appear, it means you have chest pain, headache, dizziness and high blood pressure, what has been shown is that heart attacks and strokes can be prevented. How? It is an aggressive control of risk factors. Right now, behind us, in a great organization, in addition to preventive examinations, the cardiovascular risk of each individual has been calculated and looking at the risk for heart attack and stroke. Those persons who are under high risk, come in HISPA center at the Health Center Bijeljina and enter into a special program that includes not only drugs and outstanding diagnostic, but also non-pharmacological therapy, “said Dr.Med.Sci. Nebojsa Tasic.

The Elections of habits for a healthy heart

• The lack of green spaces and safe paths for cycling; • Unhealthy diet in schools and workplaces; • Superior advertising and availability of cigarettes, alcohol and fast food; • Exposure to secondhand smoke, air pollution.

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Improve nutrition in your home • Limit the amount of processed foods, which often contain more sugar, fat and salt • Eat more fruits and vegetables • Replace sweets with fresh fruit that is healthy

Pupils of the Economic School from Banja Luka, celebrated World Heart Day. Selfies that were made on the topic of a healthy heart are shared with the world through social networks.

Do not allow smoking in your home • The house where the smoke is forbidden provides a healthier environment for you, the children and all family members • Quitting smoking is a wonderful role model of behavior for your children Passive smoking is a cause of death in more than 600,000 non-smokers each year, including children

Identify your risk for cardiovascular disease, which is present in your family • Visit a health facility where you can measure your blood pressure, cholesterol and glucose levels, weight and BMI • Once you are familiar with CVD risk your family members are exposed to, make a plan to improve heart health - with the advice of a doctor, who can provide the necessary information • Learn to calculate the weight of the risk factors for your heart

Learn the signs and symptoms of cardiovascular disease and stroke • Over 70% of emergencies related to the heart and breathing happens at home when family members are present, who can help endangered • Talk with healthcare professionals about the possibilities for courses in cardiopulmonary resuscitation, to help your relatives; • If you suspect that someone in your area is having heart attack or stroke, seek medical attention immediately.

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Participate In walking, running, sports events, concerts, public discussions and screenings.

Encourage your children to be physically active Based on the data of the WHO, children aged 5-17 years should have 60 minutes of moderate to intense physical activity a day; • Be physically active with your children, walking or riding a bike to school; • Remember, do not take into account only sports activity, but also dance, walk or housework; • Limit television viewing or computer work to no more than two hours a day; • Get involved in the campaign which urges authorities more green spaces and playgrounds for children.

Be active!

helps you to burn more calories while maintaining a healthy weight.

Try walking up the stairs, climbing the hills.

About World Heart Federation The World Heart Federation leads the global fight against the development of CV disease and stroke, with a focus on countries with small or insufficient income. We are doing this through the community with more than 200 member organizations, which brings the power of joint action medical societies and heart foundations in more than 100 countries. We have partnered around efforts of WHO to reduce mortality from CVD by 25% by the year 2025. Through our collective efforts we can help people around the world to live healthier and longer lives.

About Foundation “Health and Heart” Foundation “Health and Heart” supports all activities undertaken to improve public health, particularly with regard to quality of life and prevention of cardiovascular disease. A full member of the European Heart Network and World Heart Federation which connect medical organizations around the world cooperating with international companies (Partners and general sponsors).

• It is never too late to start! Start with easy learning exercises and gradually increase their intensity, striving towards the goal of 150 minutes per week of moderate to intense exercise; • Always consult with your doctor before you start with your exercise program; • In case you have hindering ability to perform physical activity, perform as you can, a little is better For information please contact our than nothing. website: www.zdravljeisrce.com e-mail: info@zdravljeisrce.com Phone: 051/301236 The best ways to fax 051/241246 implement physical or write to us at: activity 78000 Banja Luka • Aerobic exercises are especial- Marka Lipovca 1b ly good for your health - walking Republic of Srpska, Bosnia and fast, jogging, swimming, cycling; Herzegovina • Exercises for the muscles, also

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eplantation is a surgical procedure that is sewing the amputated body part. It is a sophisticated operation that involves the use of a microscope or magnifying glass and special micro instruments and tools.

One of the most important things before replantation process is storage and transportation of amputated parts. It is best to learned in gauze the amputated part, then put it in a plastic bag and in a container with water at 4°C. It is believed that the least destructive processes for parts that are not vascularized are at this temperature, without damaging the cell membrane due to freezing. Very important is the time from the moment of amputation until the moment of replantation. If it comes to the forearm or lower leg, then it is a period of six hours to restoring the vascularization, while for the hand and fingers that period is slightly longer but in the terms of cold ischemia at + 4°C. The first time a successful replantation of left hand was made in the University hospital in Foca for young man from Rogatica who sustained amputating injury while working on a heavy machine.

The patient was transferred to the Department of Plastic and Reconstructive Surgery an hour and a half after the injuries and immediately began the process of replantation. Amputation was in the central part of the palm. First, we have been able to find three common digital arteries and the external digital artery of the palm for the index finger in the amputated part in a very short period of

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Replantation of the fist at the University Hospital Foca

Dr. Med.Sci. Drazan Eric, plastic surgeon, University Hospital Foca

Aleksandar Radovic (23) from Rogatica loose half a fist with fingers on September 8th, while working on the circular, after a moment of inattention, and doctors at the right time managed to sew blood vessels, reconstruct bone and soft-tissue structures and so save his arm.

“I Would like to thank Dr. Eric and all the doctors, and I think that only now I know what life is and how it should be appreciated.

The moment of inattention was sufficient for circular to cut my hand,

and after surgery smile returned on my face, “says Alexander. “ Our team of doctors succeeded in optimal time to sew blood vessels that are less than 1 millimeter and restore blood circulation in the fingers and reconstruct all bone and soft tissue structure to the patient who suffered amputation injury of his left hand. The patient feels well, fingers and fist have normal circulation and the young man will not be disabled. This is a major accomplishment for our institution and the whole Republic of Srpska, because

and then followed a dramatic trip to Foca. The pain was unbearable, I was broken, but the thought of my child, who was about to be born, gave me the strength to endure. I was in shock and semi-conscious,

we have shown that such a complex and microsurgical procedures can be done here. I would like to thank the entire team, without which I would not be able to manage successfully such a complex operation”, said Dr. Eric .

time. On the dorsal side of the left hand we were able to find three dorsal veins, and the same blood vessels we found in the amputation stump of left hand. After bone fixation with Kirschner wires with minimal shortening of blood vessels due to their bruises, we were able to make seven microvascular anastomosis with 8-0 Prolene thread without grafts. Once we have established the circulation in the fingers, we were dedicated to the reconstruction of the tendon, common

digital nerves, lumbrical and interossei muscles. We were able to close the wound directly without using lobes. The surgery lasted four hours, and replantacioni team included: Dr.Med.Sci Drazan Eric, plastic surgeon, Dr.Med.Sci Maksim Kovacevic, orthopedic surgeon, Dr.Med. Sci. Milivoje Dostic, anesthesiologist, Dr. Ivana Popadic, a resident of orthopedics, Dr Jelena Andan, clinical doctor, surgical nurse Rada Kunarac and Zorica Dracul and anesthetist Nikola Petrovic.

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he introduction of methods of stereotaxic radiosurgery in neurosurgery, which include Virtual (Cyber) Knife as well as their rapid development over the past 10 years, radically changed the strategy of treating metastatic disease and vascular malformations of the CNS and spinal column, recurrent meningioma and benign tumors of the nerves of the fossa posterior, skull base tumors, as well as some functional disorders (trigeminal neuralgia), which previously required a purely operative neurosurgical treatment. Stereotaxic radiosurgery has enabled patients a shortterm non-invasive treatment, with significantly longer survival or cure, as well as a drastic reduction in the total cost of treatment and the evident improvement of the overall quality of life during treatment. From the perspective of stereotaxic radiosurgery there are no more radio-sensitive and radio resistant solitary or multiple brain metastases (origin sarcoma, melanoma and kidney cancer), because at stereotaxic radiosurgery all cerebral and spinal metastatic tumors are identically radiosensitive, with identical medium survival time of about two years. Also, conventional preventive or postoperative whole brain radiation therapy (WBRT ) with the total dose (TD) 20-30 Gy in 10 fractions after surgery of solitary metastases, is generally being abandoned, or is completely abandoned, especially in “radio-resistant” malignant tumor because more evidence clearly indicate that there is no significant effect on medium overall survival time and survival time to recurrence. As opposed to, there is growing evidence from relevant prospective controlled studies that clearly indicate the significant benefit of applying stereotaxic radiosurgery in the aforementioned purposes. Thereby particularly stands out a very successful implementation of virtual blade “sterilization” postoperative deposits even partially resected mass-lesion cerebral metastases, whether it is solitary or part of multiple cerebral metastatic disease,

18

Virtual (cyber) Knife in neurosurgery Authors: Dr.Med.Sci. Predrag Peric, a specialist in Neurosurgery, Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Dr. med. Stelios Kouvaris, IATROPOLIS Medical Group, Athens, Greece

The radio-surgery intervention plan by the appearance of multiple air beams, which are projected from a number of different angles and directions of fall, that virtual blade “aims and hits” pathological change with the different sides.

in which the Cyber Knife postoperatively treated and remaining inoperable metastatic lesion.

The role and place of radiation therapy (RT) in the treatment of brain tumors and skull base, spine and spinal cord tumor is very well known. However, the main drawback of conventional conformal RT to external radiation is the impossibility of the precise application of optimal doses of radiation that would irradiate the pathological change in the near radiosensitive anatomical structures such as the optic nerves, eyeball or the spinal cord. Consequently, the low tolerance of these anatomical structures significantly limits the actual effective therapeutic dose of radiation, reducing the lesions in the border areas to sub-

optimal level. If the optimal therapeutic dose of radiation could be applied more accurately to the entire volume of the lesions, the probability of successful control of the tumor significantly increases, while reducing the risk of iatrogenic radiation damage radiosensitive anatomical structures. The essence of the philosophy of application and operation of the Cyber Knife is just that - a very precise and concentrated irradiation of the entire volume of pathological changes with maximum exemption or bypassing healthy structure.

In technical terms, Cyber Knife is a robotic system consisting of linear accelerator at the hinge robotic arm, which is performing high irradiation of the entire volume of the targeted path-

H E A L T H

ological changes from different angles and directions with no contact with the body of the patient, but with the appropriate navigation system, which is millimeter precise and focused. The navigation system in real time and real three-dimensional system control the position and movement of the patient at any time, with the simultaneous adjustment of the position and path of the radiation source or air beam in relation to a given plan. Robotic arm allows you to run a linear accelerator or radiation sources in 6 directions and also rotational movement of 360 degrees at the same time, so that all parts of craniospinal axis become available for treatment, with clinical precision and accuracy hitting the set target of less than 1 mm. Given that this is non-invasive method, the term “blade” is only symbolic and indicates a high precision radiotherapy beam from Cyber Knife hits the target with the preservation of the surrounding healthy tissue, like a surgical knife which separates the sick from the healthy tissue, when cut sharply and precisely. The total radiation dose

Additional precision of the whole system in treating endo-cranial lesions, lesions of the skull base, the craniocervical transition and cervical spine is achieved by immobilization mask as it is with conventional RT. However, when treating lesions of the thoracic, lumbar and sacral spine extra precision is achieved by the previous subcutaneous implantation under local anesthesia and under the control of CT special gold guide or markers (Fiducial markers) near the lesions, or bone structure of the spine that are area of interest. Invivo placement of the implanted markers monitors all time Virtual navigation system during operation of the blade in the irradiation of the lesion, where the computer system simultaneously adjusts the direction and angle of the radioactive beam, depending on the current location of the spine where the lesion is located, which may be minimal but significantly changed because of unintentionally, involuntarily or respiratory movements of the patient. Preparing the patients for treatment with Cyber Knife includes standardized MRI

which is in the form of multiple beam of radiation beams of different diameters and from a number of different incident angles and directions is “hitting” a pathological change in one or several less common (3-5) faction, or therapy sessions, is 15-20 Gy for benign tumors , vascular malformations and trigeminal neuralgia, or 30 Gy for malignant tumors. Compared to conventional curative conformal RT, at which TD for malignant tumors is 40-60 Gy in 20-30 fractions divided by 2 Gy per day, TD at the Cyber Knife is half that high but its effectiveness is several times higher because it is precise and concentrated delivered to a whole volume of the target pathological tissues.

and CT examinations of the head or spine in the Cyber Knife center, sometimes when it comes to spinal lesions and PET / CT examination, which is essential to create a fusion of threedimensional treatment plan. The entire process of preparation and treatment of patients with Cyber Knife is performed ambulatory, within two to a maximum of five days a pleasant and relaxing atmosphere that undoubtedly further reduces the anxiety of the patient and better overall treatment outcome. In addition to neurosurgery, Cyber Knife has significant application in the treatment of lung and chest cancer, as well as tumors of the joints, pelvis, liver, pancreas and prostate.

C A R E

IATROPOLIS Medical Group in Athens is a unique private medical center that combines modern non-invasive method of treating cancer using the best technology. Medical Center was founded in 1986 in Athens, where the use of an MRI scanner was first introduced and for many years was the only one in Athens. Medical Center IATROPOLIS Medical Group uses the latest methods of treatment such as radiation Tomo Therapy, which represents a new technology in patient care. TomoTherapy system allows, as never before, precisely, “hitting” the diseased tissue but the amount of radiation that reaches the healthy parts is minimized. The device is a mixed mode of several existing technologies that allows technicians who perform radiation to accurately determine the position of the tumor and have a picture of it on a monitor in real time. The system of “lenses” for the direction of radiation is designed so that the beam can be precisely directed, and determines their intensity.

Medical Center IATROPOLIS Medical Group is the only one in Greece that uses the latest Cyber Knife ​​ from Accuray Company. Our clinic offers modern requirements for the treatment of patients as well as affordable prices. Our mission is to consistently and persistently work to achieve results. Our goal is to be the benchmark company in the medical diagnosis and non-invasive treatment - cancer treatment. We achieve the results by using the continuous education and training of our clinical staff and health workers who are constantly training.

IATROPOLIS Medical Group is equipped with the latest medical technology, accredited according to international standards (ISO9001-2008 certified) provides top-quality medical services.

IATROPOLIS Medical Group, Athens Tel: +30 210 67 96 000 Fax: +30 210 67 96 264 Mob: +30 6981 32 84 34 Email: info@magnitiki.gr http://iatropoli.gr

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D

P H A R M A C Y

epression is one of the most important public health problems of the contemporary world. According to the World Health Organization, in general population, depression is the fourth most important health problem.

There is a trend of rising prevalence of the number of patients in the world and predictions are that by 2020. depression will be the second most important health problem, and the number one health problem, considering only the female population. Depression can occur from childhood to old age, and is often associated, both with other psychiatric disorders, and chronic internist disease.

Anxiety symptoms has 90% of patients with depression, and 50% of patients meet the criteria for a diagnosis of anxiety disorder. The incidence of depression in people with diabetes is between 30 and 40%. According to epidemiological data, about 15% of depressed patients commit suicide, so we can say that depression is a disease that significantly affects the mortality rate, not only due to suicide, but also to influence the outcome of treatment of somatic diseases.

By the socio-economic point of view, depression affects the increasing rate of absence from work, and an increase in the cost of treatment of people who have a depressive disorder along with some other diseases.

Depression involves a wide range of mental health problems characterized by the absence of positive affect (loss of interest or pleasure in usual activities and experiences), lowered mood, and the whole range of associated emotional, cognitive, physical and behavioral symptoms. Taking into account the diverse clinical appearance, unpredictable flow and unsolved pathophysiology, treatment of depression is a long and arduous task. Pharmacotherapy is a cornerstone in the treatment of depression and in the choice of antidepressants, the weight of clinical appearance should be taken into account, the individual characteristics of the patient and the presence of comorbidity.

Selective serotonin reuptake inhibitors (SSRIs) are similar drugs by efficiency, and their differences are reflected in the tolerability, safety profile and spectrum of indications, which should be considered when the optimal treatment is been choosing for each individual patient and his clinical picture.

Dipresan® (paroxetine) is a serotonin reuptake inhibitor, and its application leads to increasing the concen20

Importance of depression on public health

Dipresan® - the widest range of anxiety and depressive disorders tration of serotonin in certain regions of the brain, which leads to improvement in symptoms of depression, improvement of mood and ease-instinctive function, balances the psycho motor functions, sleep, appetite, and vegetative functions, reduces anxiety and fear. Dipresan® has a wide range of indications including: major depressive episode, obsessive-compulsive disorder, panic disorder with or without agoraphobia, social anxiety disorder / social phobia, generalized disorder, posttraumatic stress disorder (PTSD). In patients with PTSD, Dipresan® improves symptoms such as reliving the event, avoidance, emo-

tional numbing, hyper-alertness, social inclusion and the accompanying symptoms of depression as comorbidity. Dipresan is the drug of choice in the treatment of anxiety-depression disorders in patients with Parkinson’s disease.

Literature:

Abdulah Kučukalić, Alma Bravo-Mehmedbašić, Alma Džubur-Kulenović, VODIČ ZA LIJEČENJE DEPRESIVNIH POREMEĆAJA, Institut za naučnoistraživački rad i razvoj Kliničkog centra Univerziteta u Sarajevu, Sarajevo 2007.

Vera Folnegović-Šmalc, Petra Folnegović-Grošić, Neven Henigsberg, Oliver Kozumplik, Gordan Makarić et. al., Farmakoterapija depresija, MEDICUS 2004. Vol. 13, No. 1, 31 – 39.

Professional team for medical support “Bosnalijek” d.d

By 2020, depression will be in the second place in the number of diseased

On the occasion of October 10th, World Mental Health Day, on October 8 th with the support of the company “Bosnalijek”, in JZNU Health Center Tuzla the lectures were held on the theme of “Dignity in Mental Health”, lecturer Dr.Med.Sci. Aida Sehanovic; “The inclusive approach at the Center for Mental Health”, lecturer Samija Altumbabic, BSc. soc. worker and “Importance of Dipresan® in primary care”, lecturer Dr. Edina Teskeredzic.

Mental health is an integral part of the general health of the man. If the mental health is not good, general health will not be good, also, was the message from these lectures.

“We are trying to raise awareness of the population that mental health is a pillar of a healthy man, a healthy lifestyle, to raise the health awareness of preserving the mental health, of course, the prevention of mental disorders in primary, secondary and tertiary prevention,” said Dr. Med. Sci. Aida Sehanovic, spec. neuropsychiatrist at the Polyclinic for neuropsychiatric diseases at Mental Health Center.

Prevention of mental disorders is possible through the stages, depending on the stage of the individual.

Unfortunately, in Bosnia, and even in Europe, numerous stigma are still present when it comes to mental health, which is why the role of the Centre for Mental Health of the Health Center Tuzla is far greater. Inclusion of patients is of exceptional importance for the recovery of each individual patient.

“The problem in the inclusion that we encounter is stigma or negative attitudes about people like that. Of course they need support, because when we say inclusion we mean acceptance. They easier deal with their disease, their life has more quality, “said Samija Altumbabic, a social worker at the Centre for Mental Health.

“We are honored that we are sponsors and participants of this meeting as part of the Day of Mental Health and I believe that through these types of meetings, lectures and training for all our doctors, their specific analysis and their medical exams will be simpler,” said Nedim Piric Director of Region III of “Bosnalijek”

NAT U R E

S

A N D

HEA LTH

tress, chronic fatigue, poor immune response, allergies, asthma, autoimmune diseases and malignancies, have become, unfortunately, our everyday life. The causes may be different, and many are still being examined. Modern medicine often has no cure, although constantly striving to find new solutions.

The ancient Chinese and Japanese, however, have been familiar for a long time with one drug from nature: the mushroom, which are not easy to find. They called her a mushroom of immortality, heaven mushroom, mushroom of happiness and her botanical name is Ganoderma lucidum. Preparations based on Ganoderma lucidum are not unknown to our practice, and even the general public. It is said for Immuno-G that it can be a product that is unique in this area by technology of making. The Immuno-G is produced by a patented Japanese technology for which manufacturer “Natura Pharma” has exclusive rights for Europe.

The product is produced from a combination of eight medical strains of Ganoderma lucidum, which demonstrated the effectiveness and impact on human immunity in clinical trials, circulation, antiinflammatory effect and other effects..

The composition of Immuno-G has not only parts of fungi, fungal spores and its, so-called extracellular secretion, which are extremely rich in enzymes, beta-glucans and triterpene, which is crucial for an optimal effect, in contrast to products containing a fruit body of the mushroom, and consequently have a smaller range of beneficial effects on the organism. All this ensures that the Immuno-G containing a variety of active ingredients as well as their moisture content in each capsule and the absence of toxicity.

The raw material is entirely European origin, produced and encapsulated by the GMP standard in the European Union. The material used for the cultivation of mushrooms as a substrate was prepared by the EU ECO standards in organic farming, also in the European Union. Each batch of raw materials and the finished product is controlled in accordance with EU regulations and the Ministry of Health of Slovenia. Clinical studies have shown that Ganoderma lucidum, and above all its cracked spores and extracellular fluids, have immunomodulatory, anti-allergy, antioxidant, anticancer, antiviral, antihypertensive and hepatoprotective effect.

In the capsule of Immuno G more than 200 triterpenoids (ganoderic, ganoderinski, ganolucidni) were detected which showed strong anti-hepatotoxic activity 22

Natura Farm

Ganoderma lucidum

- Treasure of medicinal ingredients

Dr.Med.Sci. Snezana Basic

galactosamine-induced cytotoxicity assays with cultured hepatocytes of a rat.

Japanese experts, who are researching the fungus, came to the result that the fraction of G. lucidum triterpenoids may be useful in the treatment of benign prostatic hyperplasia.

The studies that have been published show anti-tumor activity and anti-metastatic activity fractions G. lucidum triterpenoids were originated from inhibition of tumor-induced angiogenesis. Fraction of triterpenoids (100 and 200 mg / kg), Ganoderma lucidum broken spores and excreta inhibit growth of primary solid tumors in the spleen, liver metastasis and the growth of secondary tumors metastatic to the liver in mice with an implanted intra-splenic Lewis lung carcinoma (LLC). By activating macrophages, NK cells and cytotoxic T lymphocytes, that secretion of interferon-gamma and TNF-alpha lead to apoptosis of tumor cells, showing a direct anticancer effect.

splashing out of histamine, and thus prevent the development of allergic reactions.

In recent years, much attention has been focused on the testing of pharmacological effects of polysaccharides from Ganoderma lucidum. Studies have shown that the most active immunomodulatory polysaccharides are soluble glucans (βD-1-3 and β-1-6-D).

Polysaccharides act on the immune system by activating dormant macrophages, increased cytokine production and induce apoptosis.

One of the oldest known protein isolated from Ganoderma lucidum is LZ-8, is responsible for the inhibition of viral replication, and is a potential candidate for the Suppression of Herpes simplex virus.

CHILDREN AND IMMUNO-G The expert team of the Faculty of Pharmacy said that the preparation ImmunoG 100 is safe for use in children from the earliest days, ie. 0-12 years. 1-3 capsules

The patients who are going to chemotherapy and radiation therapy have significantly reduced side effects, such as loss of appetite, general weakness, bone marrow suppression and risk of infection, using GLPSP (Ganoderma lucidum Polysaharido Peptide). Small doses GLPSP (1.5g per day) lead to a reduction in tumor resistance to anticancer drugs.

Their antihypertensive and hypocholesterolemic activity is Clinically proven, as well as antiaggregate effect on platelets, making them a more important when it comes to prevention and treatment of cardiovascular disease.

Triterpenes are also leaders of antihistamine activity. Stabilization of mast cell membranes is preventing them from

daily dosing in children achieved excellent results in the preparation of the body for the upcoming flu season and the flu.

ADULTS AND IMMUNO-G Immuno-G 500 is recommended for adults who have undergone chemotherapy and radiation, suffering from cardiovascular disease and diabetes, who are prone to infections and allergies, chronically tired, and people who suffer from insomnia, as well as any healthy person who wants to keep his good health and vitality.

More information on the preparation and clinical studies that have examined the effects of active ingredients of Ganoderma lucidum can be found at: http:// naturaf.com/.

NAT U R E

Q

A N D

HEA LTH

uantum medicine is a symbiosis of holistic, ie. comprehensive approach to the treatment of human aided by modern technology, unification of energy and modern, complementary and alternative branches of medicine. The rapid development of modern, primarily computer technology is becoming more accessible and has more and more supporters in the official medicine.

The development of modern physics has brought mankind to the knowledge that energy is the essence of life and all that surrounds us. On the revision of the energy flows in the body a new medical approach is based, called quantum medicine.

Each cell represents the electromagnetic unit that sends electromagnetic waves that are the result of biochemical processes in it. When the electromagnetic field is in the normal cells is disrupted, the biochemical processes are changing, leading to various diseases. Changes are first occurring in the electromagnetic activity and the bioenergetics level and then coming up to the visible organic changes, to illness.

A holistic approach to the management observes the man and life, and thus health problems as a combination of energetic forms and vibrations, which are constantly changing and dynamic imbalanced. Quantum approach to treatment is based on the fact that every living organism is a source of electromagnetic radiation.

Diagnosis is based on the fact that healthy organs or body parts sent to a healthy vibration (frequency), as opposed to sick distorted waves. Thanks to modern technology we are now able to measure these vibrations and then to be therapeutic, we can correct and treat it. The stimuli,

Medicine of the 21st century

Quantum Medicine

electromagnetic pulses, frequency, which are sent in the body during therapy, actually stimulate the body in self-healing.

Often these modern techniques of treatment is called medicine of the 21st century. However, for thousands of years it has been known the knowledge and skills of healthy living, prevention and treatment as part of traditional Chinese medicine (acupuncture, Herbalistics, tai chi, chi gong), Indian ayurveda, yoga, aromathera-

Quantum medicine is a focused set of therapeutic and diagnostic methods based on the interaction of low-energy (quantum) dose of ecologically pure electromagnetic radiation from the information-energy structures of the organism. The goal of quantum medicine is restoration of homeostasis in the information, energy and somatic (structural) level.

The essence (essence) of quantum diagnosis is finding the causes of changes in the body with the aim of recommendations for the proper method of recovery and the point of quantum therapy is to encourage their own vital energy of the body by means of self-activity of the natural radiation of low power at which a man accustomed to during evolution.

The purpose of quantum medicine is very generous: do not treat the disease, but to harmonize the relationship “man - nature” by using natural methods and ways.

Quantum Medicine is a brave attempt to be a living organism back to normal natural electromagnetic system in which the life arose on Earth and

24

Dr. Radojka Prelevic works as a doctor of quantum medicine in Manchester, where she lived 25 years, but she has a practice in Belgrade “Quantum One”, which receives patients once a month.

She is an active member of the Royal Society of Physicians of Great Britain, a member of the British Association of Alternative Medicine, a member of the China Medical Institute in London (she completed acupuncture), the British Association of Energy Medicine, and since the last few years she was working in Belgrade, a member of the Serbian Medical Chamber, Association of Acupuncture and Quantum Medicine at the Serbian Medical Society.

from which modern man was tragically and brutally extracted thanks fictitious generated technological requirements of modern civilization. Eastern medicine says that each unit of the Universe (the smallest particles from the stellar giant) will not get sick and, indeed, die while its information-energy processes which it developed are in strict accordance with similar processes taking place in the universe.

A stunning technological explosion is happening today, which is resulting in the emergence of a large number of high-tech inventions: cell phones, televisions, computers, radar systems, cars, etc.

These miracles have made our life really magical and forced us not to forget that the magnetic field, which in itself is rough, disrupts the normal electromagnetic environment of our home and has a direct impact on our immune system which has never been faced with such an amount of electromagnetic factors during biological evolution and therefore does not know how to react!

It takes longer time for the immune system, to get used to the emergence of new factors and

py, crystal therapy, sound therapy,, dance, various herb culture ... etc. All of these methods consider the man as the harmony or disharmony of body, mind, soul and the environment; means as a whole.

With the development of electronics, cybernetics and computer technology this millennial knowledge receive a certificate and official doctrine, and it is a fact that our body is essentially a condensed energy that is moving quickly on a myriad of different vibrations. If we know how to detect and understand them, we will know and recognize that “the proper information of the changed information” and that correcting bring their body into a state of equilibrium - biological health. Re-establishment of “interpersonal communication” between cells during therapeutic procedures we actually begin “healing process”.

In the book “The vibratory medicine,” Dr. Richard Gerber explains that: “Einstein’s theory applied to the vibratory theory sees human beings as a network of complex energy fields that interact with the physical-cell system. The knowledge that all matter is energy in constant motion, the basis of an understanding that human beings are viewed as dynamic energy systems.

So, in addition to anatomical and morphological structures of the body that we see the eyes, there is a so-called electromagnetic skeleton of a man through the circulating electromagnetic waves by creating their own coherent field man.

learn how to react appropriately. And because of that this entire situation, neuro-immune-endocrine complex, organism adopts a continuous stress that has become the norm of our life!

State of constant voltage quickly leads any body system to a state of complete consumption.

However, the immune system can not immediately use all its (sometimes last!) resources, as it should also have a supplies “for a rainy day”.

With the help of quantum therapy, treatment for treatment, step by step, the body renews its unique universal natural pharmacy, his enormous fighting potential, its capacity for repair and self-healing! Quantum therapy has a beneficial effect on the somatic (physical, material), structures of the organism: activates the tone of the immune system, stimulates microcirculation processes, normalizes metabolism, and reduces the level of endogenous intoxication and stress.

If, in addition to that, patient also uses healing power of natural products of ancient Eastern medicine, the complete healing comes faster, more efficient and easier....

HEALTH - SERBIA

W

hen she was elected by her colleagues as a director of Serbian Medical Chamber on March 25th 2015., prim. Vesna Jovanovic was welcomed as a “new energy of LKS” in Belgrade press - entirely in line with her more than successful biography which has a lot of specificities.

Born on February 16th, 1965. in Smederevo, she went in the elementary school in Mala Krsna two years earlier than their peers, she attended high school first in Belgrade and then as a thirteen year old girl, not withstanding the pressure of subtenants life continued in Pozarevac, where she graduated. At 17 years old, as youngest student, she enrolled at the Medical Faculty at University of Belgrade. She traveled daily from Pozarevac to the lecture, than she married on the second year of Faculty and gave birth to daughter Jelena and received a degree in 1989.

Dr. Jovanovic started her first job immediately after graduation, in Pozarevac Hospital, where she received, with tears of joy, written recognition of the great contribution of local health care on the September 24th this year, on the celebration of the 184th anniversary of the hospital.

She gave birth to a son Svetozar after she started to work and immediately began specialist studies at the Medical Faculty in Belgrade, where she passed the specialist exam in orthopedic surgery and traumatology in 1999. and started working at the Institute for Orthopedic Surgery “Banjica”. And there she is today, as one of only nine women in Serbia with the title of orthopedists.

“I’ve always had a desire to do something that others do not do, to show that I can do it. So I enrolled in orthopedics, which is still considered a male profession “- says Dr. Vesna Jovanovic.

In the desire for improvement, after the master studies at Megatrend University in 2008, she acquired the title of economist for health management. At that same year, on the Faculty of Medicine in Belgrade, she enrolled the academic specialist studies, and in February 2011 she defended her specialist scientific work “The extension of limbs in children by Ilizarov method”. She was educated in the Russian Ilizarov scientic Centre in Kurgan 2007 and obtained a license to engage in that particular method.

She received the title of Primarius in 26

Interview with prim. Dr. Vesna Jovanovic, General Manager of LKS

New energy of Serbian Medical Chamber Prepared by: Vesna Jovanovic, publisher, associate of “Medici.com”

June 2010. She is a member of numerous professional associations (STA, SOTA) and in 2007 entered in the Register of expert witnesses. And as if all that is not enough, in her spare time she is engaged in agriculture on the farm in a family house in Mala Krsna, where she celebrated another great joy at the end of this summer - the birth of a grandson Pavle.

Such energy allowed her colleagues to believe her when she promised to fulfill, as the newly elected director of LKS, at the inaugural speech “Everything in her power to feel the improvement in the position of doctors, and therefore patients, although, of course, there is no magic stick to do it overnight.”

When she was elected as general manager of this important institution on March 25th this year, at the session of Assembly of the LKS, prim. Vesna Jovanovic knew what was waiting her and was fully prepared to cope with the problems that medical sector is facing. With a number of obligations that she has in her native homeINSTITUT for Orthopedic-Surgery “Banjica”, where she works as an orthopedic-traumatologist, with a forensic examination that she is engaged in for many years , she was active all nine years since the resto-

ration of Serbian Medical Chamber in it as a delegate of the Assembly Chamber, and as Chairman of the Supervisory Board of the Regional Medical Chamber of Belgrade, and after the elections of 2014 till becoming the head of the institution and a member of the Board. Willing to use her experience, she says for our magazine: “I want to make a contribution to one of the most important institutions for medical doctors in our country. Every physician refers to Medical association of Serbia for help, professional, legal or other advice. It is a great responsibility for all of us. The point is to provide the partnership with institutions of importance that would be able to help us to conduct what we agree within the Chamber. That was the primary motive to run for this office. “ The first improvements are already visible in successful attempts to establish good relations with the Ministry of Health of Serbia, with the Parliamentary Committee for Health and Family, with unions, medical schools, all regulatory bodies. The bottom line is, to recognize the importance of positioning the Chamber and the status of doctors and to ensure that they accepted some initiatives of the institution for the benefit of not only doctors, but of the entire health system, explains the general manager of LKS. It seems she says, “It is very important that we have managed to find a common language with the Ministry of Health of Serbia”.

And it was not easy. Dr Jovanovic recalls that in the period after World War II, the chambers were prohibited by decree of the Government, and all powers related to the medicine took over the Serbian Medical Association (SLD).

“That is why now it was necessary to find a way to overcome the existing dif-

HEALTH-SERBIA

ferences and to achieve more successful contacts with the SLD” - says prim. Vesna Jovanovic and remarked that by the Law on Health Workers of 2005 some authority from SLD should have gradually move to the jurisdiction of the Chamber as everywhere in the world.

“I deeply appreciate the tradition of the SLD, its founders and importance, especially in the period when the chambers did not exist when the SLD was a bastion of medicines and professional work of doctors. We will plead now that some activities, among other things awarding professional title Primarius, can by performed by the chamber by law and at some point these activities would be double. Since each physician with license is required to pay the membership fee to LKS, he or she should be able to acquire the expertise and improve the professional status, “says Dr. Jovanovic.

This brings us to the topic, very present in the Serbian public these days, relicensing of doctors.

“The first period of seven years validity of licenses expires this year and we are facing extensive work for the re-licensing of the 32,800 registered doctors in LKS. Unfortunately, we estimate that 10 to 15 percent of doctors will not be able to meet the conditions for renewal of the license though, when it comes to continuing medical education (CME) Chamber supported a number of programs for free membership in recent years and warned the doctors of the need to collect CME points “ told us prim. Vesna Jovanovic.

According to her, currently in collaboration with other health chambers and Serbian Ministry of Health is seeking a way to overcome the situation, “work on the amendment of the existing Rule book to milder the conditions for the issuance, renewal and revocation of licenses of Commerce members by the minister”.

“It shall not be allowed that so many people can not do the job alone. In consultation with the Health Council and the Ministry of Health a solution is seeking that would be not only in material but also in professional terms for the benefit of doc-

tors whose interests LKS protect “- says the general manager of LKS and explains:” In a very short time we had left we will try to make possible for each individual doctor to have access to points electronically for free, based on the ON LINE Education and questionnaires. We found a way to, as always, support some expert meetings in order to allow physicians to gain points, to learn something new. And it’s free. “ In addition to provide professional training LKS must protect the doctors, to provide them good working conditions, to defend their professional interests, but also the material aspect, a better position in society.

“We can not allowed that bad image of doctors survives, of course, about those who have not violated the profession. I will insist on the introduction of treatment protocol. Only in this way we will be able to clarify exactly what is the medical error, and what is not. If there is a protocol and doctor fully respects it then any accident that befell the patient is a question of something else, not a medical error. Protocols would be significant not only for doctors that would facilitate the work, but also for patients. Guides of good clinical practice are undoubtedly important, but they are recommendations, not binding attitudes of the profession “- says Dr. Jovanovic.

In the opinion of the general manager of LKS Dr. Vesna Jovanovic, chamber must have good “media position” to create a real picture of the situation in medical profession.

“The courts of honor which are, by law, within LKS, are very serious and respectable institution. Since 2009 till today they have prosecuted 792 cases, and permanently confiscated three licenses. If the doctor is convicted of a serious crime against human health through regular

criminal proceedings, civil court requires the court of honor to permanently revoke his/her license. For a simple case of the doctor-patient relationship license is revoked for six months to a year. The media has created a false image that the courts of honor only protect doctors “- says our interlocutor.

Prim. Vesna Jovanovic points out that the adoption of the Code of Ethics was entrusted to Chamber by the state of Serbia and that the current is good.

“But, in the meantime, legislation in the field of civil matter was changing and the Code should be adapted to it. It is on the doctor’s chamber “- says Dr. Jovanovic, but reminds of the unfortunate and frequent attacks on doctors in the workplace which, she says, should be treated differently, and not as” bar fight “when the attacked the doctor is left to struggle to protect his/her rights and preserving his/her own dignity and honor. “ There is a Law on medical profession in all countries of the region. Although LKS is not a legislative body, extensive studies were made on the Law of medical profession that we plan to present to the Ministry and the Minister of Health, to find a common language with them and determine how much it is really important “- said the interlocutor.

The financial position of doctors certainly reflected the status of doctors. Data show that our doctors more often go to Germany, Norway, Slovenia and other countries because of the movement of labor in the European market and the needs of individual countries, better wages and conditions. Interlocutor presented us the fact that last year 947 certificates of good standing was issued by LKS. «I will try to make the Chamber as a parent, to create address books of our doctors who are working abroad, to maintain contact with them, and here in our country I want doctor to be sure that in a crisis situation Chamber will stand behind him/ her. Of course, if he/she had not committed a criminal offense. Every physician in Serbia must have a feeling that he/she is protected by the institution whose member he/she is. At the same time, we all will do our best to improve the status of doctors, all for the benefit of the health system and patients whom we›re here for. The work that was entrusted to us by the Serbian government we will, I am sure, continue to perform well, and this is keeping the database, business licensing, licensing, and everything else, «- concluded the prim. Vesna Jovanovic, General manager of LKS in an interview to our magazine.

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he latest revelations regarding the role and importance of abdominal microflora (microbiota) was the topic of the meeting held on 12th September 2015. in Medical Faculty in Belgrade, which brought together more than 100 domestic and foreign experts in the field of gastroenterology.

The rally was organized by Eagen (European Association of Gastroenterology, Endoscopy and nutrition) and the Faculty of Medicine, University of Belgrade, and with the support of “Rosell Lallemand” from France. Support for the rally was given by the Association of Gastroenterologists of Serbia and Gastroenterology Section of the Serbian Medical Society.

Technical organizer was the company ‘Ivancic and Sons “, a leading producer of probiotics in Serbia and the region.

Prof. Dr. Tomica Milosavljevic, president of Eagen (European Association of Gastroenterology, Endoscopy and nutrition) spoke about the importance of continuing the education of gastroenterologists in Europe, in order to improve and harmonize the high standards of prevention and treatment of diseases of the digestive track.

Eagen is one of the sister organizations - the founders of the United European Gastroenterology (UEG) with a decades-long tradition of postgraduate training courses throughout Europe and the Mediterranean region - this year courses in various fields of gastroenterology, endoscopy and nutrition are maintained, near Belgrade, and in Rome, Berlin, Kiev , St. Petersburg, Opatija, Rotterdam, Portugal. For a past decade, area of gastrointestinal microbiota is experiencing a renaissance of interest of experts of various profiles. The connection is proven between changes of the intestinal microbiota with the development of obesity, diabetes, metabolic syndrome. It appears that great importance in disease of the digestive system has nervous colon, inflammatory bowel disease, and some malignancies, such as colon cancer. There is a very important two-way communication, the interaction between the brain and the digestive system, in which the bacteria is very much involved.

Prof. Dr. Peter Malfertheiner, director of the Department of Gastroenterology at the University of Magdeburg - Germany and manager of educational programs Eagen, spoke about work experience .

When we are born naturally, we inherit about 40% of the intestinal microbiota, while the composition is completely different when we are born by Caesarean 28

Eagen expert meeting (European Association of Gastroenterology, Endoscopy and nutrition)

Abdominal microflora (microbiota)

section and in these children is more likely for the emergence of allergies and eczema during their lifetime. Later, the composition of the bacteria and their diversity are changing with age, diet, intake of drugs. The significance of the microbiota is large in digestion of food and absorption of useful substances, but also in the formation of the defense system. Antibiotics have saved millions of human lives, from the forties, but significantly affect the change of intestinal microbiota. The last decade was marked by widespread use of probiotic products in everyday clinical practice. Twenty-first century will certainly marked by stable and preserved intestinal microbiota as one of the crucial criteria of important digestive health - in addition to efficient digestion, absence of diseases of the digestive system, effective defense system and the subjective feeling of well-being.

Isabelle Champie spoke about the importance and quality of probiotics, marketing and sales director of the Institute, “Rosell Lallemand”, “Institute” Rosell Lallemand ‘ is engaged in the production and research of probiotic bacteria for over 80

years. Each probiotic strain of Institut ‘Rosell Lallemand’ was registered at the Pasteur Institute in Paris. Permanent control of the manufacturing process prevents the possible occurrence of mutations and the presence of antibiotic resistance. The Institute works on an analysis of more than 340 known genes responsible for this type of resistance, which is unique in the world. Careful selection of strains potentiates interoperability and efficiency.

Technological process of microencapsulation allowed the probiotic bacteria to preserve the vitality and efficiency immediately after entering the body. “ Company “Ivancic and Sons” for 13 years have been cooperating with the Institute “Rosell Lallemand” in the manufacturing of probiotic preparations used just strains this institute. The quality of products, efficiency and support the professional public has led to the probiotics of “Ivancic and Sons” preparations which are the most trusted. Confidence in these probiotics producers crowned with the prestigious “Best of Serbia” in 2014 in the category of pharmaceutical products manufactured in our country.

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n the amphitheater of the Military Medical Academy (VMA) a symposium was held on the theme “Clinical Pathology in continuous medical education.” Organizers of the meeting were the Academy of Medical Sciences of the Serbian Medical Society and the Military Medical Academy.

The symposium was attended by President of the Serbian Medical Society academician Radoje Colovic, the president of the Academy of Medical Sciences, prof. Pavle Milenkovic, Dean of the Medical Faculty of the University of Defence at Military Medical Academy in Belgrade Colonel prof. Nebojsa Jovic, members of the Academy of Medical Sciences and the MMA. Expert meeting was opened by the representative of Chief of VMA Col. prof. Zoran Segrt. He emphasized that the continuous medical education is an important factor in conditioning the knowledge and skills in all professions, especially in those which are directly or indirectly involved in the rescue and improvement of the quality of life of all who appear daily in the VMA for help.

- I am sure that this symposium, through the presentation of papers in the field of clinical pathology, will draw attention to this important medical area, required to each of practicing physicians, and shed more light on certain aspects of diagnosis and treatment, which can have a decisive influence on both the quality and the outcome of the treatment. Recognizing the importance of this area and investing in it is inevitable need of modern medical practice - as pointed out by prof. Dr. Segrt.

The representative of Chief of VMA in the end said that, the VMA is one of the ideal places in which continuous medical education has deep, decadeslong roots and that it is “a place where continuous education is created and implemented”.

The meeting was then greeted by the President of the Academy of Medical Sciences, prof. Pavle Milenkovic.

He said that the Academy pays special attention to continuing medical education and clinical pathology has been present at all meetings of the Medical Society, but never before has been organized in this way.

At the end of his addressing, Professor Milenkovic assigned two letters of thanks - a colonel prof. Dr. Nebojsa Jovic, the Dean of the Medical Faculty of the Military Medical Academy, to whom he also presented a chart of

HEALTH-SERBIA

VMA symposium, Belgrade, October 9th

Clinical Pathology

the status of a regular member of the Medical Society’s and the other to operating organizer of the gathering prof.

Dr. Jovan Dimitrijevic, a regular member of the Academy of Medical Sciences of the Serbian Medical Society.

After that Professor Dimitrijevic held an introductory lecture on clinical pathology in continuing medical education, and 20 copies of his book “Clinical Pathology” was given to the cadets of MMA Faculty of Medicine.

He pointed out that the area of​​ clinical pathology was founded as a

result of collaboration of clinicians and pathologists, about the importance of pathology in the diagnosis of disease and clinical work, spoke the doctors of the Military Medical Academy, Clinical Center of Serbia and Clinical Center - colonels prof.

Nebojsa Jovic, prof. Dragan Mikic, professor. Dr. Djoko Maksic, Lt. Col. prof. Dr. Boban Djordjevic, prof. Dr. Zvonko Magic, prof. Dr. Sonja Radakovic, prof. Dr. Cerovic, prof. Dragan Dankuc and prof. Dr. Marjan Micev.

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International exchange

Student’s visit

Djoko Maksić, spoke about organ transplantation in Serbia at the Youth Center in Belgrade.

The success of the MMA

Hospital nutrition

Five senior students of high medical vocational schools from Switzerland and Sweden came to visit to the Military Medical Academy on October 7th.

The guests were welcomed by Head of the Sector for Education and Scientific Research Col. Miroslav Brocic and chief medical technician VMA Verica Milovanovic who spoke briefly about the mode of functioning of the military medical institutions that they will have the opportunity to see in the coming days during a tour around the organizational units.

Traditional international student exchange is implemented on an annual basis under the leadership of the European network of higher medical schools (European Nursing Module Network - ENM). Military Medical Academy, as a teaching base for the professional practice of high medical vocational schools of the Republic of Serbia, is a member of the ENM and an active participant of this international organization.

Public forum

Organ donations European Day of Organ Donation and Transplantation was celebrated at the Military Medical Academy on October 9th 2015.

At the meeting, which was focused to promote organ donation and tissue and raise awareness in our country, the place and role of the MMA were discussed in the development of transplantation medicine in Serbia, about the importance of organ donation, the role of the anesthetist and achievements of the Center for Organ Transplantation at MMA. After the lecture, all classes of cadets of MMA Faculty of Medicine of the University of Defense in Belgrade, as well as all interested parties, the signing of donor cards was enabled.

On the same occasion, organized by the Association of Organizations of renal patients Serbia, there was a discussion in which the doctors from MMA were participating. Head of the Center for solid organ transplants Col. Mr. Sci. Med. Neven Vavić held a lecture “from dialysis to kidney transplantation - what is important to know” in the small hall of the Kolarac Foundation, and Chief of the Group of internal clinics Col. prof. Dr. 30

At the 37th Congress of the European Society for Clinical nutrition and metabolism, which was held from September 5th to September 8th 2015 in Lisbon (Portugal), the Military Medical Academy, was represented by Dr. Marina Panisic and Mihailo Bezmarevic, as the invited lecturers, from the Department of General Surgery.

3500 doctors, pharmacists and dieticians actively participated at the Congress, which was organized by the European Society for Clinical nutrition (ESPEN). In addition to scientific symposia, educational sessions and poster presentations, multidisciplinary lectures were organized that processed specific areas of application of clinical nutrition.

ESPEN held its regular congress for the past 35 years, which represent the most important world event in the field of clinical nutrition. So far, the MMA has participated four times with its studies. A session with a lecture Dr. Panisic was named best at this year’s congress, and is chosen from among the ten leading speakers ESPEN’s.

The Congress was also attended by Dr. Bezmarevic with two posters of which the first one was rewarded.

Neurologists from MMA

Adriatic Neurology forum The expert team of the Department of Neurology of the Military Medical Academy took part in the 15th Adriatic Neurology Forum held from September 16th to September 20th 2015 in Opatija.

Neurologists Academy, led by the Chief of Security Center Col. prof. Dr. Ranko Raicevic, who was also the co-organizer of the event, gave professional contribution to this important gathering by oral presentations in the field of stroke and multiple sclerosis, and a significant participation had physicians who are specializing.

The traditional meeting of neurologists gathers a large number of eminent speakers from the region and abroad, and this year’s lectures covered the field of epilepsy, movement disorders, dementia and multiple sclerosis, showing the latest diagnostic and therapeutic approaches.

Preparing 4. PECMM

Congress of Military Medicine Delegation of the Ministry of Defence of the Republic of Serbia, within the Pan-chairman of the working group of the International Committee of Military Medicine ICMM) Colonel prof. Dr. Nebojsa Jovic and Secretary of the Pan-European working group, prof. Dr. Slavica Vučinić, official visited the Government of Military Health of the Republic of France in the period from October 6th to October 7th 2015. The Chief of The Government of Military Health of the Republic of France, Major General Patrick Godart was the host of the Serbian delegation.

The aim of the meeting was the development of bilateral cooperation in military health and preparing the 4th Pan-European Congress of Military Medicine (4th PECMM) which will be held from May 23 th to May 26th 2016 in Paris, organized by the ICMM and the Ministry of Defence of the Republic of France.

The main topics of the congress, which will be one of the most important gatherings of military medicine in the world in 2016, will be ethical dilemmas and humanitarian law in the operations, urgent care of injured in combat and re-education and rehabilitation of injured in combat. The cooperation with other international organizations will be discussed at the roundtables, in addition to these topics, especially the International Committee of the Red Cross and NGOs. Delegation of Serbian Ministry of Defense suggested additional topics for panel discussions and keynote speakers.

Experience in organizing the Third Pan-European Congress of Military Medicine, held in Belgrade in 2014, proved to be a valuable, and practical solutions that the Serbian delegation offered were accepted with approval and gratitude. During the visit, the Serbian delegation also visited the military school in Val de Gras in which the 4th PanEuropean Congress of Military Medicine will be D. L. held.

HEALTH-MONTENEGRO

The “HLA typing and HLA laboratories in Montenegro”

Grant to the Clinical Centre of Montenegro

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he Ministry of Science and Ministry of Health on October 5th 2015, signed a contract on scientific research grant with the Clinical Centre of Montenegro for the “HLA typing and HLA laboratories in Montenegro” (HLA-MNE) after successful completion of the negotiation process within the second competition for awarding large research grants. This grant is being financed through project HERIC / INVO “Higher education and research for innovation and competitiveness” in the amount of 315 000 euros, while the Ministry of Health will co-finance the purchase of equipment worth 150 000 euros.

Contract for a grant on behalf of the Ministry of Science signed the Minister of Science prof. Dr. Sanja Vlahovic, on behalf of the Ministry of Health Minister Professor. Dr. Budimir Segrt, on behalf of the Clinical Center of Montenegro general manager prof. Dr. Ranko Lazović and project manager prof. Dr. Marina Ratkovic.

Ministry of Science, the INVO Project, awarded eight grants worth 2.66 million euros aimed at increasing the capacity of research institutions and cooperation with the business sector.

HLA typing in Montenegro has not been implemented due to lack of adequate laboratory equipment, as well as medical staff trained for its performance.

The objective of the Project HLA - MNE is the formation of a national laboratory for HLA typing, which will enable detection system of human leukocyte antigen, which is referred to as HLA diagnostics.

The significance of detection of HLA antigens and formation of a national laboratory for HLA typing is as follows: 1. The importance of HLA typing in population genetics. Detection of HLA antigens typical of our population, which provides planning tests of hereditary diseases.

2. Clinical significance of HLA typing in clinical practice: - Application for everyday diagnosis of various autoimmune diseases - Detection of predisposition (tendency) to the development of malignant diseases, infectious diseases - The most adequate pharmacogenetic importance in the choice of the most 32

appropriate therapy for the treatment of autoimmune and malignant diseases.

3. Application in transplantation medicine.

The necessity of HLA typing in transplantation medicine is to prevent the rejection of transplanted cells, tissues and organs, as well as in the planning of adequate immunological protocol before and after the transplantation.

4. The importance in the formation of the registry of unrelated donors for stem cell transplantation in the treatment of various diseases.

5. Correlation with endemic diseases and diseases in Montenegro.

Reminder: The Ministry of Science announced the results of II tender for awarding large research grants, at the end of December last year, with a total value of up to 1.27 million euros, which is implemented through project HERIC / INVO “Higher education and research

for innovation and competitiveness.” Four projects were recommended for financing to the Ministry of Science of which the two were from the Clinical Center. Grant for the project “Development, validation and application of telemedicine systems TELEMONTEKG (TM ECG) for rapid diagnosis of heart disease in Montenegro”, the Head of the project, prof. Dr. Vesna Miranović was awarded in the amount of 315 000 euros and its implementation began on June 1st 2015. Both projects will be implemented over a period of two M. C. years.

Guide for monitoring of drug prescribing The Ministry of Health, in order to implement the activities predicted by the Action Plan for the implementation of structural reforms in the health system (2015-2017.), adopted by the Government on July 30th 2015, issued the Guide to carry out regular analyzes of the monitoring of prescribing drugs.

The main objective of monitoring the consumption of drugs is evaluating the quantity (amount) and quality (type) of drugs that are used in a particular environment. The aim is also to compare with a pathology (the presence of certain diseases) for which these drugs are prescribed, then accepted pharmacotherapeutic and pharmacoeconomic guidelines and guidelines for its optimization and the use of drugs in other communities.

The consumption of drugs can be traced to the location of the: hospital departments, hospitals, health centers, clinical center, the city or municipality, region, entire country, at the level of more than one country.

Analysis of the use of drugs, both in terms of monitoring the consumption of drugs and the aspect ratio analysis, selection of drugs, indications and dosage, is important to the health of patients and for the education of physicians, pharmacists, and those involved in drug policies or make decisions about it. Monitoring the use of drugs contributes to overview the pharmacotherapeutic practice of one environment and determining the factors that affect the use.

Due the fact that the funds available for the financing of medicines, but also for health care in general, are limited, it is necessary to estimate the monitoring of prescription of the drugs, not only with the traditional aspects of efficiency, safety and quality, but also in terms of economic profitability.

SCIENTIFIC

medical communications

VOLUMEN VII ISSUE 65.

OCTOBER 2015.

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One hundred years of the first orthopedics in Banja Luka (1915-2015)

Bojan Stojnic: Department of Physical Medicine and Rehabilitation “Dr Miroslav Zotovic» Banja Luka

The three-day scientific meeting VI Balkan Congress of arthroscopy, sports traumatology and knee surgery, which was held from October 1st to October 3rd this year in Banja Luka took place in in the spirit of celebrating 100 years since the founding of the first Banja Luka orthopedics at the Department of Physical Medicine and Rehabilitation “Dr Miroslav Zotovic”.

This major milestone was marked by the release of monographs and organizing exhibitions of archival documents entitled “One Hundred Years of the first orthopedics in Banja Luka (1915-2015)”. The author of the monograph and exhibition is Bojan Stojnic, archival consultant and general manager of the Archives of the Republic of Srpska.

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his year, 2015, Department of Physical Medicine and Rehabilitation “Dr Miroslav Zotovic” in Banja Luka is celebrating one hundred years of its existence and work, as we celebrate by the release of this short history and organizing exhibitions of archival documents.

The establishment of the Institute was enabled by the existence of a newly built monumental building of children’s orphanage at the monastery in the village Delibašino near Banja Luka and the existence of the monastery infirmary with a small pharmacy reserves where, as a doctor and a pharmacist, during the rule of Austro-Hungarian (1841-1917), worked Stefan Gaber ,named father Bernardinus in monastery (Stephan Gaber on. Bernardinus), who treated the locals free of charge, giving the patients medication and bandages “all the good deed.” Significant role in the establishment of the Institute was the beginning of the First World War and a large number of disabled persons that it produced, for whom the AustroHungarian military authorities establishing of the Orthopedic Institute in 1915th.

Since the establishment, under the name Orthopedic Institute “Mary’s Star”, the Institute has repeatedly changed names and acted in a number of different socio-political and constitutional frameworks to today’s Department of Physical 36

Medicine and Rehabilitation “Dr Miroslav Zotovic” in Banja Luka. Under the umbrella of the Institute “Reserve Hospital of Imperial and Royal military headquarters in Sarajevo” was created in 1915, or Orthopedic Institute “Mary’s Star” (K. u.

K. Reservespital Banjaluka, Orthopädische Anstalt “Mariastern”), who survived with minor interruptions until today, and near it, and just a little further, appeared numerous new buildings and classrooms, offices, clinics, labs, and, a little further, in Slatina, spas and bathrooms. It firstly

treated the Austrian wounded soldiers, and after that the disabled in the Kingdom of Serbs, Croats and Slovenes, the socialist Yugoslavia, and today, thanks to its expertise and equipment, heal and recover, through a process of comprehensive medical rehabilitation and orthopedic surgery, those who are in need of medical assistance not only from the Republic of Srpska, but also from the wider environment. Thanks to the expertise of physicians, primarily from the Austro-Hungarian and Yugoslav times, and especially

Scientific S M C - Medical B O O KCommunications (SMC)

ISPOR Bosnia and Herzegovina

Therapeutic and diagnostic devices outcomes research S today, in the Republic of Srpska, the Institute has been constantly treating the patients successfully.

It could be said that the Department got all the forms and characteristics of major medical institutions after World War II, in socialist Yugoslavia, primarily thanks to the care of Banja Luka local authorities and working as the Institute for Medical Rehabilitation in the village Delibašino, and the house which is reconstructed almost all over again, edited and organized, and by the medical personnel, who were constantly professionally training and improving. Today this institute in the Republic of Srpska is in the “golden period” compared to earlier times, not only in vaults appearance, but especially for the treatment of patients, ranging from newborn babies to the elderly, who, with great hope and expectation, are coming to doctors under the vaults of the “Medical summer house» of Banja Luka’s health.

M. C.

ociety for Pharmacoeconomics and Outcomes Research of Bosnia and Herzegovina, ISPOR BH, announced a new release in September that will contribute to a better and more advanced understanding of pharmacoeconomics principles. The book entitled “ Therapeutic and diagnostic devices outcomes research,” has been translated into the languages ​​of the people of Bosnia and Herzegovina and represents a continuation of ISPOR BH in the field of increasing the professional literature in the field of pharmacoeconomics, health economics and evaluation of health technology.

Inclusion of pharmacoeconomic analysis, as part of the documentation which is submitted with a request for funding of medicines and their inclusion in the positive list of institutes / funds, health insurance, is a proof that Bosnia and Herzegovina made some progress in this field. In all health care systems, as well as in our country, the financing of health programs is limited by available resources, and the most often mentioned problem is the financing of medicines, and therefore evidence of their effectiveness and cost-effectiveness are required.

Medical devices, which are financed with large funds, are still not in focus, but it is expected that in the near future, which is a trend in all modern health care systems.

The assessment of cost effectiveness and outcomes related to medical devices, which include therapeutic and diagnostic resources or devices, will increasingly gain in importance given the limited resources available, and the demand and supply in the market.

Methodological aspects, dilemmas and examples are just listed and described in this release, which is prepared by a team of editors, and we want to emphasize that the ISPOR Bosnia and Herzegovina, is again leading in the region when it comes to the convergence of themes relating to the

evaluation of health technologies, instantly offering available literature in the languages of ​​ the nations of Bosnia and Herzegovina to all stakeholders, who are concerned with this issue. Authors of BiH edition: Tarik Catic, Begler Begovic, Amer Bajramovic, Igor Martinovic, Rasim Jusufovic and Tanja Savanovic.

We hope that this edition of the ISPOR BH will find its place as the previous one, and that it will serve as a good source of information or instructions for continued search of literature, both professionals and students in Bosnia and Herzegovina and in the wider region, or speaking area.

The book can be ordered via the order form available on the website of ISPOR BH. ISPOR BH also offers the possibility of free attendance of 5 of translated modules that cover the basics of pharmacoeconomics, and which can be accessed via the website www. farmakoekomika.ba T.C.

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he Ministry of Health and Social Welfare of the Republic of Srpska organized a round table on September 11th 2015, on the prevention of diabetes, from which it has been announced that the education of patient is the most important in the therapeutic approach and that the well educated patient is the best doctor for himself.

According to the National Coordinator for the prevention of diabetes, Prof.

Dr. Snjezana Popovic-Pejicic the Republic of Srpska currently has around 90,000 people affected by diabetes.

She pointed out that, according to the Institute of Public Health of the Republic of Srpska, the most common age of people with type two diabetes is 60 to 70. Diabetes type one frequently affects people younger than 35 years.

“If we know that people with type two diabetes have symptomatic course of the disease and on the one patient with diagnosis comes another one undetected case, this means that the number of patients is certainly far higher.

Diabetes has become pandemic and the education of the entire population is the most important part of prevention, which is expected to begin in the preschool years.

Diabetes type one can’t be prevented, but it can very well be controlled by proper diet, physical activity and insulin therapy, “said Professor. Dr. Pejicic.

Specialist in the Department of Physical Medicine and Rehabilitation “Dr Miroslav Zotovic” Dr. Snjezana Novakovic Bursac said that more than 70 percent of amputations in the Republic of Srpska is caused by diabetes.

“The essence of prevention is regular medical exam. All patients should exam-

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Round table

Education in the prevention of diabetes

ine their feet. They must be aware that they often lose their sense and that they must adapt to these changes in terms of using other senses such as vision and touch, to discover the changes on time.

Also, they should know that not to try to solve the problems in the feet themselves “said Dr. Bursac.

Sanja Bajic, representative of the Association of parents of children with diabetes in the Republic of Srpska, said that members of the association, together with the Clinic for Children’s Diseases UCC RS, often gather for further education.

“These are educations related to prevention and treatment, especially for chil-

dren who have a problem with nutrition and regulation of blood sugar, and to save them from chronic complications. It is extremely important for parents, which is most often the only way to obtain information about this disease, “said Sanja Bajic.

The National Coordinator for the prevention of cardiovascular diseases in the Republic of Srpska Prof. Dr. Dusko Vulic concluded that diabetes and cardiovascular diseases are the chronic noncontagious diseases and with malignant diseases represent the greatest burden of the health care system in the world, including the Republic of Srpska.

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M e e t i n g s

VI Congress of general practitioners from Serbia with international participation

The consultations in general practice

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t the Congress hall (Hall of the Guard) in Topcider, Belgrade the VI Congress of general practitioners with international participation was held, from September 24th to 27th 2015.

The gathering was attended by about 400 doctors from the Republic of Serbia and the countries of Southeast Europe.

The organizer of the congress was the Section of General Medicine SLD. The opening ceremony was attended by Academician Dr. Radoje Colovic, the president of SLD; Prim.Dr. Vesna Jovanovic, General manager of LKS; Representative of the City Secretariat for Health of Belgrade, prim. Dr. Lubin Sukriev, president of the Association of general / family medicine SEE, and many other from Serbia and neighboring countries.

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The main topics of the conference were “consultations in general medicine” and “Affiliate doctor-patient relationship.”

The Congress hosted over 30 lectures, workshops, round tables and expert discussions. Within pre-Congress activities all participants had the opportunity to do the test and test their knowledge, this time about the communication.

The test is specifically accredited by the Health Council of the Republic of Serbia by five points for congress participants.

Honor to open the Congress with her lecture, this year went to Prim. Dr. Vesna Janjusevic, with the theme “Conducting consultation in general medicine practice.” Dr Janjusevic managed to draw the attention of all participants to the

important role of the general practitioner in conducting consultations. Prim. MSc. Dr. Miloranka Petrov -Kiurski showed the research on the topic “Violence / abuse of doctors in general practice”.

The congress discussed the scope and limits of treatment in general medicine as well as attitude towards patients with diabetes, rheumatoid arthritis, cardiology, gastroenterology and other diseases.

General Medicine, as a discipline of great scope, with a wide range of conditions that fall within its jurisdiction, is faced with numerous challenges. It requires exceptional knowledge and professionalism and confronts us with a number of risks. The consultation in general practice and partnership doc-

S M C - E x p e r t

tor – patient was the most talked about theme of the Congress.

Skilled consultations, work with group and various forms of learning are different in general practice with respect to other clinical specialties. The Classes organized in general medicine is based on a specific methodology, a special technique of engineering evaluation which may include patients with all the consequences for his health.

Because of all of this, as well as specific knowledge and skills that distinguish general medicine from other clinical branch, there is a requirement for the development of special skills training, which are necessary for learning in general practice, in accordance with the principles of European standards.

Modern principles of management of consultations, in accordance with the competence of general practitioners, are

consultation which is well managed is absolutely necessary basis for all procedures of patient care and has been linked to his satisfaction, empowerment, collaboration in the treatment and outcome of treatment.

During our meetings at the congress, all participants had the unique opportunity to hear great lectures by our colleagues from home and abroad. These were the lectures which encouraged us to discuss and desire to find solutions “how to repair and improve the work of general practice”. Unfortunately, time constraints did not allow us to point out all of our problems at work, but we, nevertheless, thanks to the competence of our speakers, receive instruction, and even more importantly, the strength and the will to fight and continue in the interests of the profession and our general medicine. Generations which are com-

based on the inclusion of the patient in consultation. The patient is at the center of health care and its role is much more active than before. The method of conducting the consultations contains two important differences from the earlier concept. The traditional concept was directed towards the doctor, paternalistic mode of communication led by doctor he is the organizer of consultation and directed toward diagnostic problem by placing the closed questions. The consultation, which is aimed at patients is not concerned with the diagnosis, but the problem that processes in the context of the patient, its physiological, psychological and sociological circumstances. The new principle involves patients who decide in consultation. No matter that it should be sticked to the recommended structure in the consultation, and use the acquired skills in order to get a certain goal, every person in the process of communication and maintains the individuality and personal style. The

ing, less and less want to do the work of general practitioners - specialists in general medicine, we heard why, first of all it is a difficult and responsible job.

We should learn “how to feel good as general practitioners.” That advice we received at excellent teaching by prim.

Dr. Nevenka Dimitrijevic and prim. Sc. Zlatko Markov. One thing is certain; we all recognize themselves in at least one segment of lectures and, hopefully, bring a new experience important for our work.

“And finally, to note, we hung out a little, relaxed – had fun, shared experiences, a lot of new information we have adopted and certainly feel richer and stronger as general practitioners,” said Prim. Mirjana Mojković, president of the Section of General Medicine of the Serbian Medical Society and President of the Organizing Committee of the Congress.

Organisation of Congress this year was not easy, but it was successful with help of very small number of people. I hope that next year, the 50 year jubi-

M e e t i n g s

Annual reward “Dr. Dane Zigic” The Commission for allocation of annual awards ‘‘ Dr. Dane Zigic ‘‘ made the decision to award prim. Dr. Slavoljub Zivanovic for 2014.

At the meeting of the Presidency of the Section of General Medicine, held in April 2015, the proposals was discussed, which arrived for the award.

The Commission unanimously adopted the proposal that t award go to prim.

Dr. Slavoljub Zivanovic, for great contribution to the work of the Section and the organization of our meetings.

It is the highest award by the Section of General Medicine of Serbia, which is given to one doctor of general medicine every year, for the results achieved in the field of professional services, scientific research, medical science and practice. lee anniversary of the section of general medicine SLD, the Congress will be more meaningful, said Dr. Mojković.

See you at the VII congress of GM doctors 2016. in hotel “Mona”, at Zlatibor.

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he three-days work of the Sixth Balkan Congress of the arthroscopy, sports traumatology and knee surgery with international participation, which was held in a period of October 1st to October 3rd this year in Banja Luka, will leave a deep mark in the hundredyear history of the current Department of Physical Medicine and Rehabilitation ‘’Dr Miroslav Zotovic‘’. It is a confirmation to an effort of this reference health institution in BiH, not to lose pace with modern knowledge and technologies. Works from 14 European countries, which were worthy of such a tradition were presented at the scientific conference, through nine sessions and two round tables. This jubilee was followed by the exhibition of archival documents entitled: ‘’One Hundred Years of the first orthopedics in Banja Luka (1915-2015)‘’ as well as the edition of the monograph of the same name, from the author Mr.Bojan Stojnic, the current director of the Archives of RS. Appropriate to a general social importance, Congress was opened by the President of the Republic of Srpska, Milorad Dodik, adding that the success of the Institute ‘’Zotovic‘’ is the result of the will of all the employees to work on its development and improvement. On behalf of the Organizing Committee of the participants and guests were welcomed by Prim. Dr. Slavko Manojlovic, president of the Association of Orthopaedic and Traumatology BiH. The impressions of this kind of gathering were presented by some of the famous names of science and engineering for ‘Medici.com’.

Prof. Nikola Cicak - Special Hospital for Orthopedics and Traumatology in Krapinske Toplice, Croatia: ‘’ I took part in the work of the previous Congress. Why? Because each meeting with the colleagues brings a new joy and if you’re the most experienced, you

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Road to institutional cooperation lan, all empty - dry. There is a principle: you pay and you get‘’.

can learn something that you might have missed from beginners, or inspire you to think, no matter who are the participants of the congress or symposium. We, who are experienced, are trying to transfer skillful knowledge and experience, gained through years, to the younger. When you have a full hall - you as a teacher have a sense of obligation to be as professionally correct as you can. The organization of such a meeting requires time, effort and coordinated teamwork, and because all of that my praise goes to prim. Dr. Slavko Manojlovic and his team ‘’ says Prof. Dr. Cicak, with lovely remark: ‘’ When I came to the hotel room, accreditation and handbags with ‘Souvenir small things’ greeted me, and that you will not get today in the West. I was recently at a congress in Mi-

Prim. Dr. Slavko Manojlovic

Prof. Zoran Bascarevic, general manager of the Institute of Orthopedic Surgery ‘Banjica’ in Belgrade - Republic of Serbia: ‘’It is the largest orthopedic companies in the region. It has 550 beds, includes all the pathology and engaged in every kind of orthopedics. Today we are trying to rebuild broken bridges of cooperation with friendly homes. Banjica is developed on that basis, because the bonds of friendship among orthopedists have never ceased to exist. They were only institutional extinguished. The old lost connections in the region begin to develop,thanks to the Institute ‘Zotovic’ from Banja Luka. Institute Banjica has already signed contracts with Slovenian orthopedic house the exchange of all possible content. We are seeing each other at the world, and now in regional conferences. In relation to global trends we can not say that we are at the top, but it is true that we are following them and we have not lost the connection. Arthroscopic, arthroplastic and trauma surgery are at the highest level, as measured by international standards. What we lack is presence in international associations to the extent that we deserve, that is how

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we were present and recognizable once.

Slowly, and it is coming back also. Quality is recognized and I think we’ll even be on the top as institutions ‘, optimistically concludes Professor Zoran Bascarevic.

Prof. Miroslav Milankov - Department of Orthopedics and Traumatology at Clinical Center: ‘‘ Balkan Congress was established six years ago when a small group met in Sofia (Bulgaria) and launched the idea of cooperation. In front of the participants is a huge task, not only to present their knowledge and experience, but also to establish contacts. A healthy competition is the only one that gives a result, prosperity and success for all. If we close ourselves in our small communities, there will be no results for anyone. For now, the Institute ‘Zotovic’ is one of the strongest cohesion factor in these fields, I think, which attracts all the other clinics and doctors in cooperation ‘‘, in the appellate ton said Prof. Dr. Milankov.

The encouraging fact is that an impressive number of participants of the younger generation presented works at the above-mentioned Congress.

Hence the question of our eminent interlocutors: How to motivate young people today in this field of medicine, a scientific research?

Prof. Nikola Cicak: Every other year we organize a symposium in Zagreb. When we send a notice for applying the scientific works, a few doctors sign. But we always get a few scientific works from the institutions’ Zotovic ‘’, which are very serious. Unlike other parts of BiH, I must commend the Banja Luka as a center of excellence, especially in arthroplasty and arthroscopy. Sarajevo is not at the level where it should be, Mostar holds up well, and Tuzla is strong in cardiology. Today you have to have a satisfied man that deal with science. If young people initially don’t have the support of senior colleagues, at one point they stop working. But the one per-

son that had a passion and the will, no one can stop him in his intentions. If you do not have money, you can’t seriously deal with science. The state must help. I was years in the project, which is financed by the Ministry of Science. I bought 16 sheep to which I conducted the experiments. I was a rich man because many of my students, thanks to this project, acquired doctorate.

On the other hand, young people need to go to these conferences. Unfortunately, I can’t pay them, and the older don’t let the younger goes so easy to such rallies. But if the work of younger colleague is accepted, he must go. This is how to stimu-

late them, although the society includes a little, regarding the sciences. Everything is more important than it, and it is the generator of progress in each area. Today you have to follow the new technology and there is a big responsibility on a doctor. The patient does not care. It is an important result. On the other hand, today’s Doctorates are archaic. Often it is just a form to proceed with academic titles. You have now a lot of people, who hold a PhD and have not contributed to the science, did not give anything new to the world. It would be better to publish the work in an indexed medical journal but to prepare a PhD, commented prof.

Dr. Nicholas Cicak, a prominent specialist in orthopedics from Croatia.

Prim. Dr. Slavko Manojlovic, Department of Physical Medicine and

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Rehabilitation ‘’Dr Miroslav Zotovic‘’ Banja Luka: - In this institution education is number one, not only for doctors, but also for other health workers. A sub-specialization is forced a lot. Significant funds from the budget of the Office are spent for it. We are a poor country, but I think that every one of our citizens should receive high-quality operation, for example, as an American, because the most people in the world is comparing with them.

Prof. Zoran Bascarevic: - ‘Banjica is educating surgeons since 1961, since it was established. All we consider ourselves, even when we retire, as Banjica’s children. We are the Institute and we stimulate young doctors in the way we do not put in their hands the decision whether to do something or not, but we tell them: ‘When you enter the gates of this Institution, you read that inscription - Institute’ ‘. It is your responsibility to be trained, because for the big name, which stands in front of you, wherever you appear, some other people are credited by. You know, we have reached the stellar heights rising to the shoulders of our teachers.

Prof. Miroslav Milankov: - People need to have a heart that drives them further, to be players who want to win and not concede defeat. In each generation of young people you have such.

These subliminal messages from experienced colleagues to the younger ones, are visible the signs of progress in every branch of medicine. They are woven in a hundred years old walls in the Banja Luka-based orthopedics that heritage and nurture today with pride, generations of employees in the Department of Physical Medicine and Rehabilitation ‘’ Dr Miroslav Zotovic ‘’ in Banja Luka. Editorial Board of ‘’ Medici.com ‘’ is also proud of its cooperation because of it, worthy of its tradition of leadership in health care institutions.

Prepared by Andja S. Ilic

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he project (summer camp) called “School of Life 2015” is intended for children of the Republic of Srpska, suffering from diabetes type 1. The camp is organized by the Association of children with type 1 diabetes mellitus “Adults for the Children of the Republic of Srpska” in Teslic in the period August 18th to 22nd 2015. Financial support for this project was provided by the Ministry of Health of the Republic of Srpska, University Clinical Center of the Republic

of Srpska and other donors.

Thirty-three children and adolescents from the Republic of Srpska, aged nine to eighteen, were attending the camp. Apart from the Banja Luka region, participants were children from East Sarajevo, Foca, Bijeljina and Doboj. This year, as in previous, there was great interest in this form of education. Staying at summer camp is very important for the extension of continuing education for the acceptance and better understanding of the disease.

The camp was visited by the Minister of Health of the Republic of Srpska, Dr. Dragan Bogdanic and met with each participant. He also provided support for the children in their efforts to successfully master all obligations related to diabetes and told them to play sports more often in everyday life.

The expert team who worked with children in the camp consisted of three pediatric endocrinologist from UCC RS from the Children’s Hospital, cf. PhD.Dr. Gordana Bukara-Radujkovic, Dr.Vesna Miljkovic and Dr. Draženka Subotic, a pediatric endocrinologist from Bijeljina hospital. In working with children actively participated a professor of psychology, Dr. Nada Letic, who actively and continuous44

Association “Adults for the Children”

School of Life 2015 Prepared by: Prim. PhD. Dr. Gordana Bukara-Radujkovic, a pediatric endocrinologist, president of “Adults for the Children of Republic of Srpska”

ly had workshops with children suffering from diabetes. Two experienced nurses, educators Snjezana Gavranovic and Bosa Jagodic from UCC RS, monitored children glycemic during 24h and participated in the training. A physical education teacher was engaged in working with children on a daily basis who has organized and implemented the professional physical activity for children during the day from morning gymnastics and walks through the woods and playing with a ball on the courts and bowling in the evening.

Daily activities in the camp have started by waking up at 0700 hours, measuring the level of blood sugar, which was carried out by nurses with the help of older children who had previously volunteered for this activity. It was followed by a discussion of the morning dose of pre-prandial insulin, which is largely dependent on the planned physical activity.

There was the possibility of walks in the woods and gymnastics. For the planned walk in the woods and gymnastics we decreased the insulin doses up to 50%.

Talk and discussion about the planned dose of insulin was done before each main meal and at bedtime.

Great importance we dedicated to

maintaining of normoglycemia during exercise. It is extremely important that during physical activity children regularly take extra carbohydrates and do not have significant hypoglycemia.

From 10: 00h to 12: 00h was the everyday conducted training in the form of workshops at the Hotel “Kardijal”. This year we have held workshops about diabetes, hypoglycemia, counting carbohydrates and workshops to learn English.

After lunch, we maintained a workshop with a psychologist. New friendships are something the children will remember forever, as well as people with diabetes, who are adopted during the stay.

The main objective of the project is psychosocial integration of children with diabetes and their training in skills self-caring, self-control and self-healing, which is fully realized. “Summer School of Life 2015” was able to prepare children and adolescents with diabetes to live independently, especially in situations of increased physical activity and use of insulin pumps. Big thanks to the University Clinical Center of the Republic of Srpska and other donors to support the camp “School of Life 2015” for children suffering from diabetes.

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