As the influx of refugees from the Middle East and Africa continues to surge, the European Union and the Balkan countries are becoming more diverse than ever before, both culturally and demographically. Changes that are taking place are affecting every segment of these societies, including health care. Due to this, it is imperative that healthcare systems and professionals reflect on cultural differences and provide adequate care and treatment to patients with diverse cultural values, behaviors and beliefs. In order to do this effectively, they must be trained because the goal of every healthcare system is to deliver the highest quality of care to every patient, regardless of their ethnic origin and/or skin color. Therefore, the significance of intercultural communication in health care is very important because appropriate health care delivery relies on clear, timely and meaningful communication, which is an essential element in every aspect of medical provision between the key stakeholders, namely patients, physicians, and other healthcare professionals. If, in any way, communication between health care providers and patients during the medical interview is unclear, the entire medical treatment process can be hindered. This paper addresses the very current topic of contextually suitable intercultural communication during medical interviews, which is necessary to foster maximum sensitivity among physicians towards their patients' cultural differences.

BACKGROUND The most common lysosomal storage disorder is Gaucher disease (GD). It is a deficiency of lysosomal glucocerebrosidase (GBA) due to biallelic mutations in the GBA gene, characterized by the deposition of glucocerebroside in macrophage-monocyte system cells. The report targets clinical phenotypes of GD in order to correlate them with GBA gene mutations, as well as to identify GBA gene mutation in patients in Montenegro that are diagnosed with GD. CASES SUMMARY Five patients (4 male, 1 female) of type 1 GD (GD1) are reported. The age at diagnosis ranged from 7 to 40. Patients experienced delays of 1-12 years in diagnosis after the original onset of symptoms. The most common mode of presentation was a variable degree of splenomegaly and thrombocytopenia, while other symptoms included bone pain, hepatomegaly, abdominal pain and fatigue. Osteopenia was present in a majority of the patients: 4/5. All patients were found to have an asymptomatic Erlenmeyer flask deformity of the distal femur. On enzyme replacement therapy (ERT), the hematological and visceral parameters showed significant improvement, but no significant progression in bone mineral density was noticed. GBA gene sequencing revealed homozygosity for the N370S mutation in one patient. The genotypes of the other patients were N370S/55bp deletion, N370S/D409H (2 patients), and H255Q/N370S (1 patient). CONCLUSION The phenotypes of the GD1 encountered in Montenegro were severe but all responded well to ERT.

nem

jenta jeste psihološka podrška koja potiče iz odličnog odnosa lekar-sestra-pacijent.Kao primer možemo predstaviti pacijenta sa auto imunim poremećajem -Birgerova bolest. Često kao jedna od najtežih bolesti krvnih sudova ovaj poremećaj može dovesti do komplikacija i uvesti pacijenta u stanje koje zahteva palijativnu negu. Bolest je vrlo teška, a prognoza loša. Zahvata pojedine segmente srednje velikih i male krvne sudove nogu, ruku, nerava, retko mozga i srca. Takođe komplikacije mogu nastati i zbog embolija, dijabetesa ili stanja koja mogu nastati kao posledica aktuelnog oboljenja.Pacijent je osoba koja se nalazi u neizvesnoj situaciji i u strahu od ishoda bolesti. Preko puta sebe ima nepoznatu osobu kojoj mora reći svoje najintimnije stvari. Za većinu pacijenata ovo je veoma teška situacija, dok se može desiti da zdravstveni radnici, krajnje neprofesionalno to zaboravljaju, i ne ophode se prema pacijentima uvek korektno, sa empatijom i poštovanjem njihove ličnosti. Od ljubaznosti zdravstvenih radnika u velikoj meri zavisi koliko će pacijenti prihvatiti svoju dijagnozu, terapiju, kakva će biti prognoza bolesti. Lekari i sestre kao i ceo tim koji učestvuje u rehabilitaciji ili pružanju palijativnog zbrinjavanja, imaju dužnost da doprinesu smanjenju anksioznosti pacijenata tokom pregleda svojim empatskim stavom, osmehom, toplinom, razumevanjem, poštovanjem.Kada se postigne dostojanstven nivo komunikacije i kada se ispoštuje kodeks ponašanja treba obratiti pažnju na neverbalnu komunikaciju koja je izuzetno važna jer savremena istraživanja kažu da 60% kompletnog prvog utiska se formira na osnovu neverbalne komunikacije.Kada se sve gore navedeno uzme u obzir može se reći da su medicinske sestre sa definisanim kompentencijama, neizostavna i važna karika u lancu medicinske i zdravstvene nege, rehabilitacije ili palijativnog zbrinjavanja.

No abstract