President of the Health Council of the Municipality of Centar
Dr. med.Salko Pašović,
Spec. general surgery
Dear fellow citizens,
in the past more than six months, we are witnessing the COVID-19 pandemic, which has greatly affected the world and caused a global pandemic as a health problem, with an impact on other spheres of society and life such as education, information technology, economy, tourism, hospitality , traffic, etc.
The Health Council of the Municipality of Centar Sarajevo has been actively involved with all its capacities to help its community. We had full understanding and support from the leaders of the local community, primarily the Mayor of Centar. After half a year of the pandemic, we can say that as a community we are relatively successful, and that we have not had major foci of infection in our municipality (Center Municipality).
Based on previous experiences with COVID-19 and other infectious diseases, we have written an informative-educational brochure "Informator" whose authors are members of the Health Council and our friends, long-term professional associates.
Therefore, we hope that you will find useful information in the articles, answers to many questions related not only to COVID-19 disease as a pandemic, but also to the prevention of other (non) infectious diseases.
What the facts are, is that the global human community has faced similar challenges many times in its history and emerged victorious, so I have no doubt that we will successfully overcome this difficulty as well.
In the end, in order to successfully overcome this pandemic, we need it
TRUST IN THE MEDICAL PROFESSION, MUTUAL SOLIDARITY, PATIENCE AND FAITH IN TRUE VALUES
INTRODUCTORY WORD 2-2
CONTENTS; THANKS TO CO-AUTHORS 3-3
WORD OF THE MAYOR 4-5
LIFE IN THE AGE OF COVID-19 INFECTIONS 6-7
PANDEMIC THROUGH HISTORY 8-9
THE IMPORTANCE OF DATA COLLECTION FOR EPIDEMIOLOGICAL MONITORING OF THE PANDEMIC 10-11
DIAGONOST METHODS 12-13
THE IMPORTANCE OF RADIOLOGICAL DIAGNOSIS IN THE DETECTION OF COVID-19 INFECTION 14-15
THE IMPACT OF THE COVID-19 PANDEMIC ON MENTAL HEALTH 16-17
EMERGENCIES DURING THE COVID 19 PANDEMIC 18 18-19
PROTECTIVE MEASURES IN PUBLIC PLACES 20-21
THE ROLE OF A PROTECTIVE MASK IN PREVENTING COVID 19 INFECTION 22-25
THE ROLE OF PHARMACISTS IN PRIMARY HEALTH CARE 26-27
KEY OF RESISTANCE OF THE ORGANISM 28-29
ROLE AND SIGNIFICANCE OF VITAMIN D 30-31
NUTRITION DURING INFECTIONS 32-33
HOW AND WHY KEEP ACTIVE 34-35
The Health Council of the Municipality of Centar expresses its gratitude to the health institutions of the Public Health Institute of KS, the Center for Mental Health JUDZKS, the Public Institution for Emergency Medical Aid KS, the Public Institution "Pharmacies Sarajevo" and the professional association Pharmaceutical Chamber of KS. numerous information related to COVID-19 infection.
Mayor of Centar,
Prof. dr. Nedzad Ajnadzic
Dear fellow citizens,
in these extraordinary circumstances and by no means easy times for all of us, I want to thank in the first place all of you who have been and remain responsible to yourself and your local community and respected the measures that have been adopted.
Your responsible behavior not only serves as an example to the citizens of other municipalities, but above all contributes to protecting the health and lives of all people living in our homeland. Responsible and solidary behavior of the citizens of our municipality is a true act of patriotism in these times.
The team of the Municipality of Centar, in cooperation with the Health Council, was deeply aware from the very beginning of the limitations under which a huge number of residents of the Municipality of Centar found themselves. At the first signs of the presence of coronavirus in Bosnia and Herzegovina, we have begun activities to prevent the spread of this infection.
After the first confirmed case in BiH, on March 5, we allocated funds to JUDZKS OJ Center (Vrazova), its regional clinics for the procurement of disinfectants, personal and collective protective equipment (gloves, masks, suits, etc.) and other material resources for smooth operation. After that, we made daily measures and decisions that we worked on and more than is in our competence, all with the aim of preventing the spread of the virus.
We formed teams that visited the most endangered categories of the population on the field and helped when necessary. Material resources were set aside for easier return of students to school. You will agree that our priority at this time is to protect the lives and health of our residents. However, we cannot and must not wait for this crisis to pass in order to address the consequences it has caused. We already know how much impact our economy has suffered so far, especially the workers. We have therefore implemented a set of economic measures to alleviate difficult times for workers and entrepreneurs in the Municipality of Centar. We will make every effort to maintain the level of employment we had before the onset of coronavirus.
Dear fellow citizens, once again I ask you to respect the measures that have been adopted and thus you will best contribute to overcoming this situation. Be sure that in cooperation with the Health Council we monitor the situation and make decisions that are in the best interest of the citizens of our municipality, the Municipality of Centar.
TOGETHER WE SURVIVED MANY DIFFICULT MOMENTS, BUT GATHERED AROUND ONE GOAL, WE CAME OUT THE WINNERS.
LET'S WIN THIS TIME TOO!
Dr. med. Bakir Nakaš
Infectious Diseases Specialist,
Member of ZS
Life in the age of COVID-19 infection
On December 31, 2019, "as a New Year's Eve gift", the World Health Organization (WHO) announced the existence of a new "cluster" of viral pneumonia, of unknown cause located in Wuhan in the Hubie region of China.
Istraživanje uzroka navedene „upale pluća“ počelo je odmah u januaru 2020. godine, a već 30. januara SZO proglasila je postojanje „javno zdravstvene prijetnje“ zbog potvrde 7.818 slučajeva ove bolesti, proširene u 18 zemalja unutar par regija svijeta.
The causative agent of the disease was soon confirmed as a new coronavirus, SARS-CoV-2, with the official name of the disease COVID-19. At that moment, no global problem was expected. The WHO declared a "state of emergency in the world" on January 30, 2020, and on March 11, the WHO officially declared the epidemic a pandemic, the first after the 2009 swine flu pandemic.
For these reasons, the people of the world, Bosnia and Herzegovina and Sarajevo soon realized that life with COVID-19 infection will not be the same as before and that everyone, whether we like it or not, must accept life "together" with this infection.
The responsibility of the local community in organizing daily activities in conditions of "coexistence with COVID-19 infection" puts before our Municipality Center (OC), Municipal Council (MC) and Health Council (MA) additional obligations in order to find efficient and quality solutions.
After the first blow at the beginning of the year and the current trend of the epidemiological situation in the world and Bosnia and Herzegovina, the most important thing is to raise awareness and responsibility of the population and society as a whole to get used to living with COVID-19 infection and its consequences.
In addition to the responsibilities of local communities and governments at all levels, public awareness of the need to adhere to and implement proven prevention measures can, at present, help reduce the number of newly infected and deceased citizens until the official discovery of vaccines or new / old drugs. can successfully prevent or treat effectively.
Therefore, the Health Council of the Municipality of Centar, from the first cases of this disease to the declaration of an epidemic, understood its social responsibility and role in raising awareness of residents and its measures and recommendations to the Mayor, Municipal Council and other relevant public institutions all necessary information in order to take prevention and protection measures within the local community.
Osim navedenih mjera ZS svojim preporukama pokušao je unaprijediti organizaciju zdravstvene zaštite u Kantonu Sarajevo, prvenstveno, na nivou primarne zdravstvene zaštite u JUDZKS OJ Centar, te u smislu efikasnijeg zbrinjavanja osoba kod kojih se sumnja na infekciju COVID-19., pa do njihovog konačnog zbrinjavanja unutar hospitalnih kapaciteta „Opće bolnice prim.dr.Abdulah Nakaš“ i UKCS.
With the beginning of the new school year and the appearance of seasonal flu as well as old / new H1N1 virus infections, we considered it necessary to provide additional information and advice for parents, students and the rest of the population of our municipality. prevention and protection from these infections, which we hope will make it easier for us
"LIFE IN THE AGE OF COVID-19 INFECTION".
Prim.mr.sc.med. Gjulera Dedović Halilbegović,
spec. general surgery
Member of ZS
A pandemic through history
Throughout history, there have been numerous mass infections with frequent or occasional reinfections with a high mortality rate. They took more lives than any war, famine or weather and led to a turnaround in the health, economic and demographic spheres of life. As early as the 12th century BC, Homer wrote in the Iliad about the plague that decimated the Greek army during The Trojan War. The oldest recorded epidemic is the Athenian plague, which occurred during the Peloponnesian War in the 5th century BC. The disease has been transmitted from Libya, Ethiopia and Egypt. Two-thirds of the population died then. The epidemic greatly contributed to their defeat by Sparta. The disease pandemic poses a truly catastrophic risk globally.
THE BLACK DEATH from 1347 is the second "bubonic plague" in a row, and probably the deadliest epidemic that killed 200 million people, 60 percent of Europeans and a third of the world's population at the time. It is assumed that the focus was in Asia, and that it was transferred to Europe by the Tatar conquests. The horrific scenes of illness and death were described by Giovanni Boccaccio in the famous work "Decameron" in 1348. England and France were decimated by the plague, so they made a truce in the "Hundred Years' War" that raged between the two countries.
GREAT GODDESS from 1870, the largest pandemic of smallpox began in the 15th century, caused by the DNA major virus, which was also found in the mummy of Pharaoh Ramses V (died 1157 BC). In the period of discovery and conquest of new areas and continents such as America and India, Europeans brought with them infectious diseases, among which were smallpox. Indigenous people became ill and died from this virus, which accelerated the conquest of new areas. Although the vaccine was discovered in 1796, it is estimated that between 300 and 500 million people died from the disease in the 20th century alone. In 1977, the virus was eradicated among the human population, and today we find it exclusively in laboratories. For this reason, routine smallpox vaccination has not been carried out since 1986.
THE SPANISH FEVER of 1918 broke out near the end of the First World War and about 100 million people died from it, and every third person on the planet was infected. It is assumed that the epidemic, caused by the H1N1 virus transmitted by birds, first broke out in China, and then it was transmitted to the European and American continents. It manifested itself in rapid and severe lung damage.
HIV / AIDS was first identified in 1981 in American homosexual communities, but is thought to have developed from a virus in the body of a chimpanzee in West Africa during the 1920s. AIDS destroys the human immune system, which eventually leads to death from diseases that the body cannot fight. So far, 35 million people have died from AIDS. It is estimated that there were about 38 million HIV-positive people in the world in 2019.
SWINE INFLUENZA from 2009 caused a new type of H1N1 virus, which was created by mutations in human, avian and swine viruses. It was first registered in the United States and soon spread around the world. About 575,000 people died, or 1% of the total infected. The most susceptible to "swine flu" are middle-aged children and adults, while the elderly are more resistant.
COVID-19 The WHO declared a pandemic of COVID-19 on March 11, 2020. On 31.08.2020.g. COVID-19 was confirmed in 25,251,334 people on all continents except Antarctica, 846,841 died, and more than 415,000 people recovered (ECDC source). The economic damage caused by COVID-19 disease has already exceeded a billion dollars. At the beginning of the 19th century, life expectancy in the world was only 29 years because many died in childhood from disease, infection during childbirth, or injury. Infectious diseases were overcome by the development of sanitation, and then by countermeasures such as vaccines and antibiotics. COVID-19 reminds us that infectious diseases are not completely gone. The number of new infectious diseases such as Sars, HIV and COVID-19 has increased almost fourfold over the past century. There are several reasons for this upward trend: the number of people on the planet has doubled in the last fifty years, the interconnectedness of the global economy with its long supply chain, and climate change that allows for a wider range of disease-carrying animals and insects.
Antibiotics have saved hundreds of millions of lives since penicillin was discovered in 1928, but bacteria are becoming increasingly resistant to these drugs, posing one of the greatest threats to global public health. The resulting "Apocalypse of Antibiotics" requires urgent solutions. Will a sufficiently powerful acteriophage virus that "eats the bacterium" from the inside or use them as a host in which they replicate and spread to other bacteria?
Prim.dr.sc.med.Aida Pitić, spec.epidemiolog,
The importance of data collection for epidemiological monitoring of a pandemic
The collection and processing of epidemiological data is important for the preparedness and response of society in emergencies.
In practice, obtaining relevant data is difficult because the analyzed data will be used for different purposes.
Data collection includes details on the cause of the disease, transmission of the causative agent, time and manner of disease after contact with the causative agent, surveillance of the disease itself (monitoring of all health changes, duration of symptoms, disease outcome and health consequences, environmental impact on health and disease onset, treatment effects Epidemiology also relies on other scientific disciplines, all with the aim of obtaining effective preventive measures.
On March 11, 2020, the World Health Organization (WHO) declared a pandemic of COVID-19. The causative agent is the coronavirus SARS-CoV-2 The devastating and unpredictable spread of COVID-19 disease worldwide has caused global blockages and an immense burden on health systems and called for immediate research actions, including “an urgent assessment of available data to find out which approaches to standard care are most effective” and “an assessment as soon as possible the effect of adjuvant and any therapy applied ”.
Obtaining appropriate clinical data on active and recovery cases after COVID-19 disease.
Following the outbreak of the COVID-19 epidemic in Wuhan, China, clinical data were collected prospectively (in advance) from patients.
Merging data from large hospitals from multiple centers was crucial, requiring a highly developed collection system but also pointing to the need for proper data management.
Data security, patient consent, and ethical statements were key to this situation, but they represent bureaucratic barriers to rapid access to clinical data. Pandemic situations require specific solutions to these issues and should be discussed and simplified in the future.
Case report forms for patients with suspected or confirmed COVID-19, active (still hospitalized and patients with symptoms at home treatment), closed (discharged or deceased) cases of COVID-19, are required to collect and analyze their data in a standardized manner .
Understanding the complexity of disease endpoints
Clinical data depend on the time and duration of symptoms and require advanced statistical methods of analysis to avoid errors.
It is necessary to approach each case individually, the correct length of supervision (to avoid termination of supervision too early) and to determine the time-length of survival.
Development of appropriate analysis strategies
Data should be collected and analyzed in a standardized manner, using appropriate analytical strategies to analyze data collected from standardized protocols. In the event of a pandemic, rapid, clear and precise flow of information and reporting is crucial.
Other methodological challenges in the COVID-19 research
We are witnessing a tremendous increase in articles published on this topic, which already number in the thousands.
For epidemiologists, synthesizing evidence of COVID-19 disease while seeking relevant sources of information supported by scientific evidence is a major challenge. The health system response in the event of an urgent response must have an appropriate balance between a rapid response and the need for accurate data, which will enable the community to establish and implement appropriate disease prevention and control measures.
The knowledge we already have will enable a timely response to a health problem that has occurred in the population, the results we get directly depend on the data we have collected, the greater the accuracy of the data and the more certain the outcome will be.
Dr.med. Dubravka Galić family / family medicine specialist,
Member of ZS
Diagnostic methods are used to find out if a person is infected and contagious or has already overcome a disease. They are used to monitor parameters as indicators (in the case of an already present infection) of how advanced the disease is. The source of infection with COVID-19 infection is an infected person with a different clinical picture (with or without symptoms). Diagnostic methods (lab. Etiological, serological, radiological and others) as well as epidemiological monitoring are used to diagnose, monitor the health of the individual, society, timely information, education, not to create panic and misconceptions, as well as negative reactions to (non) infectious diseases
Tests used to detect COVID-19 infection:
• Laboratory tests from blood:
Significant parameters that are monitored when detecting the presence of infection as well as monitoring the progression of COVID-19 disease are: sedimentation, CRP, lymphocytes, leukocytes, liver enzymes, LDH, CPK, platelets, prothrombin time…
Deviations from the reference values with a shift to a higher value indicate the existence of infection of the organism.
• Etiological diagnosis:
Upper respiratory tract: nasal and throat swab, (PCR method) a sample is taken from the mucous membrane of the back of the nose and throat. This is the test most often used to prove the presence of the virus in the first phase of the current pandemic. It is used in subjects to determine whether they are infected or not.
Lower airway: sputum or airway lavage is taken.
It should be noted:
- the method is also used for other viruses with similar symptoms,
- not 100% reliable for confirmation of diagnosis,
- not be used to detect the presence of antibodies • Serological diagnosis:
It detects people who are infected (sick) with SARS-CoV-2 or have been infected (overcame the disease and acquired immunity). Two methods of immunochromatography and ELISA are used. A blood sample (plasma or serum) is used for testing. The presence of antibodies in response to antigens present on the surface of the microorganism is determined. Microorganisms: viruses, bacteria, parasites and fungi are the causes of various infectious diseases. Antibodies can also be produced when we artificially ingest weakened whole or parts of microorganisms (vaccination). At the beginning of the infection, IgM antibodies appear first, and later IgG antibodies appear The antibody titer changes to 40% on the seventh day and 80-100% on the fifteenth day.
The presence of IgM indicates that you are infected and contagious.
The presence of IgG indicates that you have been in contact with the causative agent and created immunity. In COVID-19, the duration of immunity is still unknown.
It should be noted:
- that the method will not detect the presence of a specific virus,
- that the method determines the presence of antibodies.
How to interpret and how to behave when we have these results after tests and epidemiological surveys:
When are the results: What does that mean? How and what to do next:
If there is any suspicion regarding epidemiological data. Repeat testing at the end of the incubation period.
You may have an infection at an early stage or
you are not infected.
Self-isolation and constant medical supervision.
You are infected.
Imunitet se razvija.
Contact the competent health institution and follow the instructions of the profession.
Zaraženi ste i zarazni.
Immunity did not develop.
Contact the competent health institution and follow the instructions of the profession.
You were infected.
You are not contagious.
There is an immune response.
The condition is monitored under the supervision and instructions of experts.
spec. of radiodiagnostics and emergency medicine,
Vice President of ZS
The importance of radiological diagnostics in the detection of COVID-19 infection
In order for COVID-19 treatment to be as successful as possible, it is important to detect changes in the lungs in time in people with suspected infection. Changes in the lungs can best be detected by imaging the lungs, that is, using radiological diagnostics. Recommended radiological diagnostic techniques to detect changes in the lungs resulting from COVID-19 infection are X-ray (radiography) and scanner (MDCT). Changes in the lungs may occur before PCR shows infection.
Recent studies have shown that changes in the lungs can also occur in people whose COVID-19 virus infection has not been laboratory confirmed. Most of them are people who have a positive epidemiological history (people who have been in contact with a person positive for the corona virus or come from an infected area), and in whom the laboratory test was negative. It is important to note that the laboratory test (PCR test), which is the gold standard in diagnosing the presence of coronavirus, is not 100% reliable. Namely, in 19% of cases the PCR test will give a false negative result, in other words the test can be negative in people who are infected. Therefore, in all patients who, based on clinical symptoms or epidemiological history, suspect lung damage caused by COVID-19 virus, as well as to detect possible complications and monitor the course of the disease, radiological examination of the lungs is recommended.
The scanner is the most reliable in detecting pulmonary manifestations of COVID-19 disease.
Chest scanner (MDCT-multidetector computed tomography) is a radiological diagnostic method that has a very high sensitivity (about 94%) and allows early detection of changes in the lungs. detection of pulmonary manifestations of COVID-19 infection. It should be emphasized that X-ray, which is otherwise more accessible to patients, has low sensitivity. For comparison, studies have shown that in patients with a mild clinical picture and laboratory-confirmed COVID-19 infection, X-rays did not detect changes in the lungs in as many as 20% of patients. This fact does not mean that X-ray is not used in the diagnosis of coronavirus, but that it is most adequate in patients with suspected infection, and a milder clinical picture, as the initial method, as well as in patients who for some reason cannot use a scanner.
Who is the candidate for the scanner?
Patients who have clear clinical symptoms of respiratory infection or worsening of the clinical condition must be referred to a scanner. Also, MDCT should be done to patients who, in addition to milder clinical symptoms, have associated diseases that increase the risk of developing severe COVID-19 (cardiovascular disease, lung disease, diabetes, obesity, malignancies). The scanner is also used in people who have a positive epidemiological history and a negative laboratory test.
Typical CT findings: “ground-glass” are most commonly bilateral and more pronounced in the lower lungs. Although the scanner is highly sensitive, these changes in the lungs can also be found in other diseases such as any type of bacterial pneumonia, other viral lung infections, primary lung diseases, other infectious processes and connective tissue diseases. However, patients with this finding are treated as positive for COVID-19 until proven otherwise by PCR test.
Early stage up to day 4: in this stage, both PCR and MDCT methods have the lowest sensitivity (the virus cannot be detected in the blood, and changes in the lungs may or may not be seen). The sensitivity of MDCT to detect changes in the lungs at this stage is about 45%. This means that radiological manifestations of the disease can be detected at the earliest stage of the disease and even in patients who do not have clinical symptoms but have a positive epidemiological history. This is actually the biggest advantage of MDCT examination compared to PCR technique.
Dr.sc. Remzija Šetić, psychologist, Center for Mental Health JUDZKS
The impact of the COVID-19 pandemic on mental health
The COVID-19 pandemic has caused major changes globally and even at our local level. The resulting changes have brought us into a state of crisis in several areas of life. There has been a sudden change, a disturbance in our lives, a disturbance in society, with obvious consequences over a long period of time.
These circumstances have caused a state of stress in most people, we have faced a threatening situation that requires additional engagement to protect themselves. The occurrence of stress in a person's life is expected and people deal with most stressful situations successfully.
However, the stress associated with the COVID-19 pandemic is specific for several reasons:
• we have not met, we have no experience and we have not prepared with this source of stress; • this crisis has introduced many changes in interpersonal relationships where we face the need to change our beliefs, convictions, habits and behaviors; • this crisis has caused new social crises (economic, political…); • This crisis directly affects the individual, family and society, life-threatening a large number of people in our environment, which may have the characteristics of a traumatic event.
So, all of the above brings us into a state of personal well-being, and well-being leads to endangering our mental health. However, it should be noted that this state of crisis does not necessarily cause permanent consequences for our mental health because man has significant and often undiscovered mechanisms for adapting and overcoming many life crises, including these. How did we usually react?
In the first phase of the COVID-19 pandemic, a period of lockdown, most people reacted to the development of anxiety anxiety for the purpose of adaptation, and a smaller number of people experienced panic, despair and depression. After the lockdown, we tried to return, at least in part, to our normal way of life. However, we quickly faced the same threats and continued to live with a lot of anxiety and fear. Anxiety manifested itself primarily in the form of concern for oneself and one's loved ones. Concern can be helpful because it leads us to take action where we will establish some form of control over our lives. By receiving new negative information, where we discover that we are facing a real threat, the concern turns into fear.
Further, when we are not sure that we can avoid something and that we lose control of the situation, panic arises. Panic is characterized by disorganization, and occasionally we are overwhelmed by horror after receiving some information, where we are overwhelmed by the perception that we cannot avoid a tragic event. Anxiety that leads to greater caution is a desirable occurrence, while prolonged and intense fear that turns into panic is not a desirable occurrence and if it occurs it is necessary to seek professional help. How long we can endure a state of fear is individually determined and depends on our coping capacities and support systems in our environment.
Special care in terms of providing mental health support should be provided to persons who have been infected with the virus or who have been exposed to the infection. Then, to those who are sensitive to stress, who have poor skills in dealing with stressful situations, then to those who have certain mental health problems in the past, and finally to health workers and other professional staff involved in the fight against COVID-19. br> It is important to emphasize that in the Sarajevo Canton we have built a network for providing assistance in mental health, and these are the centers for mental health in the JUDZKS system. So, in every health center, there is a mental health center where experts of various profiles can provide you with the necessary services in order to better cope with the state of crisis in which we find ourselves.
Therefore, do not hesitate, contact a mental health professional and use the resources you have in our community to more easily overcome the crisis you are in.
Mr.sc.med. Adem Zalihić,
direktor JU ZHMP KS
Hitna stanja tokom pandemije COVID-19
That urgent, urgent conditions can befall citizens during a pandemic, as well as outside it, is the case of a patient on hemodialysis. Namely, colleagues from the Ilidža Hemodialysis Center sent a call to the HMP dispatch center for a patient who fell ill during the hemodialysis process itself. Despite the time of the pandemic, the prescribed protection measures, both for patients and medical staff, which make it difficult for medics to work, because citizens have the right to emergency medical intervention, are being responded to. Therefore, the HMP team - Ilidža checkpoint, responds to this call where it arrives quickly. On the spot, they find a younger male person (1986) without consciousness, pulse and breathing. It is a cardiac arrest, ie clinical death. Cardiopulmonary resuscitation is started according to the protocol. After the resuscitation and delivery of the electro-shock, the patient received a pulse, began to breathe spontaneously, and regained consciousness very quickly. The HMP team, after stabilizing the condition, transports the patient to UKCS for further treatment This is a good example to understand that other diseases and accidents can befall us in a pandemic and that we must meet our basic task.
Thanks to the quick reaction of our fellow citizen and the HMP medical team, another life was saved. Walking through the streets of the Municipality of Ilijaš, he experiences an unusual situation. A middle-aged man collapsed in front of her and suffered a sudden cardiac arrest. With his modest knowledge, but elementary, just like according to the protocol, he indicates first aid. He finds that the victim, without consciousness, pulse and breathing, makes a call to the HMP dispatch center. After that, he starts with cardio-pulmonary resuscitation. He "buys" precious time for the life of our fellow citizens. The HMP team arrives in three minutes and picks up the patient and continues with advanced on-site life support. The thin line between the definitive death and the struggle of medical professionals for the life of our fellow citizens, and for the benefit of life, was decided by the quick reaction of our heroine, and the equipment and education of the HMP team. After the delivered electric shock, the victim's heart beat in its normal rhythm. Spontaneous breathing soon occurs. During transport to the hospital, the patient becomes conscious, communicative, oriented with stable vital parameters.
In such a state, he was handed over to the staff of the UKCS for final consideration.
The responsibility of citizens and public institutions must exist at all times and times. Every human life is important.
KNOW THAT YOU CAN SAVE SOMEONE'S LIFE.
FREE APPLICATION OF EMERGENCY MEDICAL ASSISTANCE KS FOR ANDROID AND OS PLATFORM
The mobile application Ambulance is the first application of the language in Bosnian and related languages in the region of Southeast Europe, which is fully in line with the European Parliament's Declaration on Awareness of Cardiac arrest, and its recommendations on educating citizens about the need for first aid for these victims. In addition to offering citizens information on the most urgent conditions and procedures, the first valuable option, first of all help, also contains some other information about the network of AED devices, as well as the current location of volunteers, .
SIMPLY, LET'S GO FASTER, GIVE MORE TO OUR CITIZENS !!!
Boškailo Ezrema, Hotel Professor, Member of ZS
Protective measures in public places - indoor and outdoor areas
At the end of 2019, the world faced the spread of COVID-19 infection with serious repercussions on the health of the population (including the lethal outcome), which in a very short period of time took on global proportions. Given that the coronary virus pandemic, in addition to having a negative impact on health, also has a markedly negative impact on the global economy, it is necessary to return social and economic activities without consequences and establish reliable and comprehensive control over the spread of the infection.
According to the recommendations of the World Health Organization, any decision to gather people in public places should be preceded by a decision based on an assessment of the risk of possible spread of the infection. The aim of protection is to prevent the transmission of the virus between individuals, and to ensure the safest possible activities with minimal risk of infection. If it is not possible to ensure optimal conditions or unplanned events occur, there should always be an option to cancel activities or suspend gatherings in a public place.
When gathering in public places, if circumstances allow, always choose a public place outdoors, and use indoor spaces only if necessary. Knowing the protection measures to be taken before staying in public places, whether indoors or outdoors, is very important to reduce the risk of COVID-19, as well as to protect personal health. It is necessary to continuously follow the orders and recommendations of the relevant institutions in strict compliance with them.
The general commands are:
• Mandatory wearing of protective masks indoors, with a distance of at least two meters, as well as outdoors if it is not possible to maintain a physical distance of two meters between persons.
• Gathering people in a certain area is allowed under the following conditions:
- not more than 30 people indoors
- no more than 60 people outdoors
• All gatherings within the stated limits must take place in a space that allows a mandatory physical distance of at least 2 meters between persons (except members of the same household).
• At the entrance to the closed spaces in visible places to place important information - educational posters and all important instructions on health protection.
• Provide places and means for hand disinfection.
• Ventilate enclosed spaces and, if possible, allow fresh air to enter as often as possible • Regularly clean and disinfect all contact surfaces used by a large number of people.
• Apply instructions on proper hand washing and disinfection, avoid handling, touching the face, mouth and eyes, and in case of coughing and sneezing, cover the mouth and nose with an elbow or tissue, which should then be placed in a rubbish bin with a lid.
Gatherings in open spaces are recommended if the limits on the number of attendees are respected, and if mutual contact is strictly avoided. Before visiting parks, children's playgrounds, stadiums, etc., it is important to keep a distance during activities, wait in line with adequate distance between them, and use hand sanitizer before and after. If you do not feel well, do not go to a public gathering place, and if you have the slightest symptoms such as malaise, fever, cough, runny nose, contact your doctor and follow further instructions.
Finding an adequate measure between activities that lead to protection against infection and daily activities that are necessary for life remains a challenge for each individual and society as a whole.
Member of ZS
The role of a protective mask in preventing covid-19 infection
The role of the mask in infectious diseases is quite clear. SARS-COV-19 virus is the causative agent of COVIDA-19 disease which is transmitted through air, aerosol, tiny droplets, saliva and mucous contents from the nasal and oral cavities, which is expelled from these spaces largely during sneezing and coughing. Significant expansion was noted even during speech. A protective mask is a form of physical barrier between a person's nose and mouth, and their surroundings. Masks are, like the car belt, a means of protection. The belt protects the person wearing it, and the mask prevents asymptomatic transmission of the virus.
When installing the mask, you need:
• Wash hands with soap and water, disinfect hands,
• Remove the mask from the packaging and check for damage or holes,
• Check which is the back and which is the front,
• Attach the mask to the face and cover the nose and mouth properly,
• After removing, place the mask in a bag and close it tightly or wash it immediately
It is important to note that protective masks have their own lifespan, when they get wet it is important to replace them. Wearing masks must not be shared with others.
A person wearing a mask can be protected from droplet transmission of infection and infection by touching infectious surfaces (eg if you touch the surface with your hand and then your nose, mouth or eyes), but only to a limited extent. The most important role is primarily played by the hands.
There are differences between ordinary and surgical masks. The material from which ordinary masks are made is usually cotton, polyester or a combination. In addition to the material, the type of weaving is also important.
Medical surgical masks have mainly three layers, built of micro and nanofiber polymers that act as a filter by stopping the penetration of microorganisms. On the protective mask, there are three folds that serve to stretch the mask to cover the area from the nose to the chin.
FFP filter half masks are considered to be basic protective equipment in the context of occupational safety and are intended for protection against particles, droplets and aerosols in health care institutions. Their application is one-time. The design of the filter mask is different.
There are masks without an exhalation valve and masks with an exhalation valve. Valveless masks filter the inhalation and exhalation of air, and therefore provide self-protection and external protection. Valve masks filter only the inhaled air and therefore provide self-protection.
Wearing can slow down the flow of breath or the transmission of respiratory drops, masks can increase awareness of the need for physical distance, as well as more careful treatment of yourself and others to protect your health. Protection of others from respiratory drops aerosol particles in healthcare facilities
It is understandable that it is difficult with masks, they make it difficult to talk, it is difficult to breathe, they silence speech, smile or trace, blur the glasses.
WE ARE JUST STRONGER TOGETHER UNDER THE MASKS !!!
Prim.mr.ph. Mirsad Sabaredzovic,
Spec.pharmacoeconomics and pharmaceutical legislation,
President of the KS Chamber of Pharmacy
The role of pharmacists in primary health care with special reference to COVID-19
A pharmacist as a highly qualified health worker occupies a very important place in the health system of every country. The role of the pharmacist has changed over time, so that today the pharmacist is a drug expert who actively participates in monitoring the prescribing, dispensing, administration of drugs and monitoring the efficacy and safety of therapy, which ultimately aims at optimal treatment of the patient.
The position of pharmacists in the health care system certainly varies from country to country. In developed EU countries, the position of pharmacists in the health system is far better than in the countries of the region. The role of pharmacists is a very important segment of primary health care.
It is estimated that in the countries of the European Union, somewhere between 22-28% of patients end up in pharmacies. This especially applies to advice related to milder forms of dermatological diseases, various viral infections, milder enterological diseases and other conditions that can be solved with proper advice and therapy provided by pharmacists.
In this way, the number of patients who would otherwise seek the help of a family doctor in such cases is significantly reduced, thus further complicating the work of primary care physicians.
Such services are not charged in pharmacies, thus ensuring the savings of significant financial resources to health insurance institutions, which provides the conditions for redirecting such saved funds for various purposes, all in order to ensure better health care for patients.
During the current COVID-19 pandemic, pharmacists in the world and in BiH have shown their expertise, ability and professionalism in performing their activities.
There are 185 pharmacies in Sarajevo Canton, which employ about 800 masters of pharmacy and pharmaceutical technicians. Although permanently exposed, pharmacists and pharmaceutical technicians actively participated in health promotion and ensuring all hygienic-epidemiological measures prescribed for citizens.
It can be stated with satisfaction, and this is the opinion of the largest number of patients that pharmacies have provided and continue to provide quality, safe and efficient pharmaceutical service, in accordance with the principles of Good Pharmacy Practice and positive legal regulations.
The main task during this pandemic was to ensure sufficient quantities of drugs and enable their unhindered distribution to patients, which was done.
Another major requirement placed on pharmacists is to provide sufficient protective and disinfectants in a timely manner to minimize the spread of the virus.
A particular challenge during a pandemic is to monitor pharmacotherapy and guide the patient to the proper use of various dietary supplements in combination with drugs used for chronic diseases.
It is important to point out that all pharmacies behaved extremely responsibly in the process of forming prices, especially medical aids (masks, gloves, disinfectants), which the competent inspection services were convinced of innumerable controls.
In the flood of quasi-experts, quacks and similar "omniscients" who "with their fists and caps" gave advice to patients, especially on social networks, as well as how to prevent and treat COVID-19, extremely important role was played by masters of pharmacy and demystifying such information, which is harmful to patients. We emphasize that with our knowledge, professionalism, dignity and especially professional authority, we have very successfully "fought" against this scourge by providing patients with professional, proven and useful advice.
Sarajevo Canton has a very well-developed pharmacy business with young, professional, competent pharmacists who are at all times available to the citizens of our canton.
Clinical Pharmacy Specialists,
Master of Management,
Member of ZS
The key to the body's resistance
Immunity is the body's ability to defend itself against disease. By strengthening the immunity, the probability of the disease decreases. This requires a proper diet and a healthy lifestyle, and this includes:
• proper nutrition with regular intake of fruits and vegetables,
• smoking cessation and alcohol consumption,
• regular exercise according to age,
• enough sleep and stress compensation (breathing exercises, meditation, yoga),
• protective measures: hand washing, thorough cleaning of food, ventilation of the room in which you stay, maintaining personal hygiene,
• if necessary, dietary supplements such as vitamin C, vitamin D, zinc, selenium, herbs to strengthen immunity, beta glucan and others.
Vitamin C is an antioxidant from the first line of vitamins in the body's defenses. The recommended daily dose of vitamin C is 75 mg per day, and smokers should take an additional 30 mg. For the purpose of disease prevention and protection against infections, the optimal dose is 200-500 mg per day. At the age when we are susceptible to infections, it is necessary to take from 500 to 1000 mg per day. It is used in the prevention of cardiovascular, carcinogenic, ocular and various degenerative diseases. People who are prone to kidney stones need to be careful when taking vitamin C supplements.
Zinc is important to consume during colds and flu. It is found in our body in a very small amount. It is needed for the growth and development of new cells in the body, participates in the synthesis of proteins, DNA and collagen, improves brain function, accelerates wound healing, shortens the duration of viral infections, and strengthens the immune system by helping T-lymphocytes mature. The recommended daily dose of zinc is 8 to 10 mg. In zinc deficiency, doses of 30 to 60 mg are recommended.
Selenium is a mineral, an antioxidant whose action is more effective when combined with vitamin E. It strengthens immunity, improves energy, slows aging-brain function (Parkinson's, Alzheimer's disease, epilepsy, etc.) and relieves menopausal symptoms. Its deficiency is associated with the development of malignant, cardiovascular diseases, inflammatory conditions, cataracts and of course is associated with premature aging, imbalance of thyroid hormones (triiodothyronine), imbalance of testosterone biosynthesis and the formation and development of male gametes, decreased immunity. The daily dose is 55 mcg (microgram) per day. It is mostly found in Brazil nuts, followed by seafood, fish and cereals.
Beta glucan is considered one of the safest immunomodulators. It is necessary for people prone to infections and colds to take a daily dose of 100 to 500 mg.
Green Tea Antioxidant, daily use is one cup continuously for three months and then paused.
Wild oregano has antibacterial, antiviral and antifungal effects. The daily dose is a maximum of 12 drops - 20 days. After that it is necessary to take a break of 10 days.
Ginger has anti-inflammatory, antiviral, antioxidant effects. It should be used daily as a spice, tablets, tinctures, tea.
Rosehip fruit is rich in vitamin C and has a strong antioxidant effect.
Echinacea strengthens immunity, especially at the time of viral, bacterial infections, colds and flu. It contains the compound echinacein, which is only characteristic of echinacea and prevents the penetration of microorganisms into cells, so that bacteria and viruses cannot establish a foothold in the body.
Immunity is an important link in maintaining health. It is important to invest in it continuously in correlation with a healthy lifestyle through diet, physical activity, dietary supplements and herbs.
Prim. dr.sc.ph.Vedina Čordalija, spec.clinical pharmacy,
Master of Management,
Member of ZS
The role and importance of vitamin D.
Vitamin D is one of the most important substances that acts more as a hormone than as a vitamin. The basic form is provitamin D, which under the influence of UVB sunlight is converted into calcitriol, which stimulates the whole body from the intestines to absorb calcium. In this way, calcium is incorporated into the bones and builds healthy bone mass. The main role of Vitamin D is the metabolism of phosphorus and increase calcium levels, and participates in other metabolic processes. Foods that contain vitamin D are: fish (salmon, tuna, mackerel), milk and dairy products, egg yolk, mushrooms. Research has shown that it is enough for most people to spend just a few minutes in the sun every day, with only 5% of the exposed body area (face and hands) 2 or 3 times a week.
VITAMIN D3 (CHOLECALCIFEROL) VITAMIN D2 (ERGOCALCIFEROL)
produced in the body is not produced in the body, nor in plants and animals
naturally derived sheep wool supplement (lanolin) is obtained from irradiated fungi or molds or synthetically
significantly increases total vitamin D in the body moderately increases the level of vitamin D in the body
a possible alternative for vegetarians or vegans is recommended for optimal bone health
Serum concentrations of vitamin D
severe deficiency 12.5 nmol / L
moderate deficiency 12.5 - 29 nmol / L
mild deficiency 30 - 49 nmol / L
satisfactory level of 50 nmol / L
elevated values of 250 nmol / L.
Can we link COVID-19 infection and vitamin D?
Good vitamin D status can reduce the risk of viral epidemics and pandemics in a number of ways. Adequate levels of vitamin D are unquestionably important for maintaining bone mineral density, muscle mass and strength, and poor vitamin D status is associated with malignant, cardiovascular, autoimmune and neurological diseases, as well as chronic respiratory diseases, diabetes and hypertension. It is these diseases that are associated with the highest number of deaths among COVID-19 patients.
Presumably, the effect of vitamin D on reducing the risk of respiratory infections is based on three basic mechanisms: maintaining a tight epithelial barrier by acting on tight junctions, killing enveloped viruses by producing cathelicidin and defensin, and reducing the production of anti-inflammatory cytokines and thus reducing the risk from a cytokine storm characterized by severe pneumonia (as with COVID-19).
There are many similarities in the parallel COVID-19 pandemics and global vitamin D deficiency. The risk groups in the COVID-19 pandemic are the elderly and patients with chronic diseases, precisely those groups in which low levels of vitamin D in the blood are recorded. The outbreak occurred at a time when, due to seasonal variations, the population has the lowest levels of vitamin D in the blood. Particularly at risk group in which higher mortality and more severe forms of the disease are recorded are obese people, and in obese people the lack of vitamin D is particularly pronounced because this vitamin is sequestered (stored) in adipose tissue. on average lower levels of vitamin D in the blood.
Expert opinion and practical guidelines for nutritional support of patients with SARS-CoV-2 infection of the European Society of Clinical Nutrition and Metabolism (ESPEN) state that vitamin supplementation or replacement is part of a conventional nutritional approach to prevent viral infections to potentially reduce the negative impact of the disease. COVID-19 was first discovered in the winter of 2019 and is most common in adults and the elderly.
Caccialanza et al., In a paper presenting a pragmatic nutritional protocol for COVID-19 patients published in the journal Nutrition on April 3, 2020, stated that in the case of laboratory-confirmed vitamin D deficiency, colecalciferol compensation should be introduced promptly.
Today, different formulations of vitamin D can be found on the market, in combination with other vitamins, then a combination of K2D3 that acts synergistically, as well as an innovative formula of vitamin D in the form of oil suspension-sublingual spray for children and adults such as DenaVin 3, and spray vitamin D3.
Spec. nutrition and dietetics
PI "Pharmacies Sarajevo"
Diet at the time of infection
As lifestyle and nutritional status can influence the outcomes of various infections and the development of various diseases, so it can play a role in the prevention and treatment of COVID-19 infection. A healthy lifestyle is certainly a combination of several different factors: sufficient amount of sleep (7-8 hours a day), avoidance of smoking, minimization of stress, maintaining body weight within normal limits, regular exercise, balanced diet. The Mediterranean diet is one of the most adequate dietary models, characterized by a relatively high intake of minimally processed fruits, vegetables, legumes, olives, whole grains (rich in dietary fiber), nuts, non-saturated fats, moderate consumption of fermented lactic acid, lactic acid products. ), fish and poultry and finally, low consumption of processed red meat. Today's industrial food contains numerous preservatives and additives, and in the production process itself it uses technological procedures, which include numerous modifications and changes of originally fresh food. Therefore, the intake of fresh fruits and vegetables with as little heat treatment as possible, provides our body with the necessary vitamins and minerals. The recommendation for fluid intake is 30-40 ml / kg of body weight - avoid drinking large amounts of strong coffee, especially soft drinks with caffeine, energy drinks, because they can lead to dehydration. Alcohol intake is also not recommended because alcohol impairs your body’s ability to cope with an infectious disease, including COVID-19. Consumption of alcohol also intensifies the symptoms of depression, anxiety, fear and panic, symptoms that may intensify during eventual isolation and quarantine. A balanced Mediterranean diet is associated with anti-inflammatory and immunomodulatory compounds, including essential vitamins (C, D and E) and minerals (zinc, copper, selenium), which affect an individual’s nutritional status.
Vitamin E je naziv za skupinu tokoferola i tokotrienola topljivih u mastima, a α-tokoferol je biološki najaktivniji oblik vitamina E. Najbolji izvor vitamina E su pšenične klice, orašasti plodovi te zeleno lisnato povrće. Djeluje kao jak antioksidans, i imaulogu u spriječavanju razvoja raznih bolesti.
Selen je mineral koji učestvuje u zaštiti organizma od oksidativnog stresa, održavanju odbrambenih funkcija organizma od infekcija i poremećaja u rastu i razvoju. Ovim esencijalnim mineralom ubedljivo je najbogatiji brazilski orah.Također ga imai u pivskom kvascu i pšeničnim klicama, džigerici, žumancetu, puteru,soji, ribi (tunjevina,bakalar), morskim plodovima, bijelom luku, integralnim proizvodima od cijelog zrna, ovsenoj kaši i suncokret ovom sjemenu. Većina selena u hrani ima visoku biološku raspoloživost–oblik selenometionin se apsorbira istim mehanizmom kao i metionin, i biološka raspoloživost selena u obliku selenometionina veća od 90%. Također, biološka raspoloživost selena u obliku selenocisteina izuzetno je visoka. Oblici selena koji se često koriste u dodacima prehrani, selenatiselenit, imaju biološku raspoloživost veću od 50 %. Selen je u visokim dozama toksičan element, koji izaziva neravnotežu ostalih hranjivih tvari u organizmu, a trovanje selenom može rezultirati i smrću. Imunitet u velikoj mjeri, zavisi od našeg načina života. Izbjegava njelošihnavika u prehrani, može biti jedan od ključnih faktora za jačanje imuniteta. Svakodnevna raznovrsna prehrana bogata navedenim hranljivim tvarima, obezbjedila bi jak imunološki sistem koji bi se puno lakše izbori sa bakterijskim i virusnim infekcijama.
NEW IN JU "APOTEKE SARAJEVO" !!!
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Dr. med.Dubravka Galić
family medicine spec.,
Member of ZS
How and why to stay active
Moderate-intensity activities are important for strengthening immunity, mental health, regulating blood pressure and sugar levels, as well as regulating other chronic (non) infectious diseases. They can be performed outdoors and indoors. If there are no obstacles in performing the exercises, always use open spaces.
Aerobic exercise is used by recreational athletes and those who have had a longer break from exercise. They should last from 20-60 minutes. This speeds up the pulse and breathing, but you can perform the exercises.
Anaerobic exercises are, for example: weightlifting, sprinting and the like. They can be performed for a maximum of 2 minutes. There is a loss of breath Whether they are anaerobic or aerobic exercises is determined by the intensity of the exercise.
High Intensity Activities Moderate Intensity Activities Low Intensity Activities
fast walking with load or uphill, running, spinning, fast walking, walking up stairs, sledding, walking in the park, nature, bowling,
Cycling, rowing, skip,
swimming, high skip, skiing, deep squat, swimming, dancing, rollerblading, pilates, exercise bike,
push-ups, skater, plank, running <7 km / h badminton, tai chi,
tennis, weights, shaft, carrying and lifting loads, light recreation,
narrow and wide push-ups, stepping, hiking, Nordic sports, vertical push-ups - aerobic exercises, exercises with home furniture, stepper,
agricultural and construction works, upholstery and painting works, gardening
For people who sit during their daily activities indoors (at home or at work), it would be advisable to get up, walk or do stretching exercises every 15 minutes.
A sedentary lifestyle increases the risk for diseases of the musculoskeletal, cardiovascular system, malignant diseases, changes in mental health as well as the duration and transition of the disease to chronicity. • During isolation and self-isolation, perform exercises according to age and health.
• People with disabilities (congenital or acquired) should exercise daily between rehabilitations (outpatient or inpatient).
• People who consume tobacco and tobacco products, it is advisable to replace the break for cigarette consumption with stretching exercises.
• Applying exercises with a risk of self-harm or injury, requiring the wearing of protective equipment (gloves, helmets, various shields, etc.)
• Perform the needs for special exercises and their program after consultation with a professional. Special exercises are when certain muscle groups are exercised or in certain conditions after a health incidence. It is important to perform the exercises correctly.
How long do they last
What an intensity
up to 5 years daily for at least 3 hours moderate to high
5 - 18 years
daily at least 1 hour of moderate
2x a week at least 2 hours high
18 – 65
daily at least ½ hours of moderate
2x a week at least 2 hours high
over 65 years
daily 30 minutes low
2x a week at least 2 hours moderate
Exercise is a trump card in your hands in the prevention of various diseases, including COVID-19 diseases. Adapt the exercises to your abilities and always move the limit to more.
Physical activity is best when combined: sports, art and
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