Za istraživanje precipitirajućih faktora nastanka multiple skleroze ili uvoda u relaps bolesnika s 57 multiplom sklerozom, korišten je specijalno dizajniran upitnik i historije bolesti pacijenata ...kojisu pod dijagnozom multiple skleroze liječeni na Neurološkoj klinici Kliničkog centra Univerziteta u Sarajevu (KCU), u periodu od 01. 01. do 31. 12. 2006. godine. Ukupno je zabilježeno 71 (48 žena i 23 muškarca) oboljelih. Infekcija kao precipitirajući faktor zabilježena je kod 21 (29,5%), a psihički stres kod 12 (16,9%) oboljelih, dok je kod 43 oboljela (60,56%) zabilježen RR tip bolesti.Terapija interferonom provodila se kod 9 (12,67%), a visokim dozama metilpredinisolona kod 47 (66,7%) pacijenata. Depresivni poremećajbio je prisutan kod 23 (32,9%), a kognitivna disfunkcija kod 7 (9,86%) bolesnika. Rezultati ovoga istraživanja, u kojem su prvi put na području Bosne i Hercegovine prikazane epidemiološke karakteristike multiple skleroze, upućuju na potrebu uspostavljanja registra oboljelih i obavezu pridržavanja terapijskih smjernica.
The aim of our work is to determine the total number, age, gender of the patients with the symptomatic epileptic seizures associated with brain tumours, tumour location, clinical signs and ...characteristics of epileptic seizures. We have analyzed medical documentation of the patients with brain tumours hospitalized at the Department of Neurology, University of Sarajevo Clinics Centre. This study is retrospective and includes time period from 1st January 2000 until 31st December 2005. During the observed period at the Department of Neurology in Sarajevo there were in total 9753 hospitalized patients, from which 101 (1,1%) patients with the brain tumour diagnosis. Average patient's age was 62,60 +/- 1,28 years. In one third of the patients (32%) were recorded epileptic seizures, without significant difference between genders. In case of symptomatic epilepsy, significantly more frequent locations of tumours were: in several lobes (28%), parietal lobe (25%), as well as frontal and temporal lobe (18,8% each), while there were no changes in cerebellum and brain stem (chi2 =7,174, p<0,05). The most prominent signs of illness in our sample were hemiparesis with the cranial nerves lesion (56,3%), speech problems (25%). Normal neurologic findings were significantly more frequent among patients with the symptomatic epilepsy (chi2 =6,349, p<0,05). The most often was a single seizure (59%), in 38% of cases there were recorded series of seizures, and only 3% of patients had status epilepticus. In relation to the type of seizures, the most often are simple partial seizures with or without secondary generalization (66%), than generalized convulsive (31%), and the rarest one are complex partial seizures (3%). Symptomatic epilepsy in case of brain tumours occurs in one third of patients, at older age, and in both genders. The lesion usually affects several lobes and cause simple partial seizures with or without secondary generalization. The most often clinical signs in case of all brain tumours are cranial nerves lesion and hemiparesis, while the normal neurologic findings are significantly dominant in the group of patients with the epileptic seizures.
Cilj ovog istraživanja bio je utvrditi utjecaj trajanja dijabetesa i glikemije na nastanak dijabetične retinopatije kod pacijenata s dijabetesom tipa 1 i 2, te učestalost retinopatije prema ...spolu.Pregledano je 278 dijabetičara 1999. i 2004. godine, a anketnim listom uzeti su određeni podaci i upisani rezultati glikemije natašte, HbA1c, glukozurije i ketonurije. Retinopatija je 1999.godine zabilježena kod 80 (28,78 %) bolesnika, a 2004. godine 187 (67,27) (p<0,001). Broj bolesnika 2004. godine s neproliferativnom i preproliferativnom (p<0,001), kao i proliferativnom retinopatijom (p<0,01), bio je značajno viši u odnosu na 1999. godinu. Prosječni HbA1c iznosio je 1999. godine 13,02%, a 2004. godine 10,57%. Loša regulacija dijabetesa bila je bila prisutna tokom oba perioda istraživanja.
Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the' most common affective ...disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.
A case is presented of a 35-year-old woman diagnosed with platybasia associated with Klippel-Feil syndrome type I. She was admitted to University Department of Neurology for clinical examination ...because of walking difficulties, dizziness, and intermittent vision disturbances. Neurological examination revealed a predominance of cerebellar symptomatology. Relevant diagnostic work-up included craniogram, cervical spine x-ray, computed tomography (CT) of the brain and craniocervical junction, magnetic resonance imaging of the brain, electroencephalography, ophthalmologic examination, urinary tract ultrasonography, laboratory tests, and psychological testing. CT of the craniocervical junction showed platybasia, congenital fusion of the second and third cervical vertebrae, and basilar invagination of dens axis. Platybasia is leveling of the angle between the floor of the anterior cranial fossa and posterior cranial fossa in the area of sella turcica, which is normally at 115-140 degrees. Basilar impression or invagination is moving up of the basis of the occiput and occipital condyles into the cranium, which means that the borders of the foramen magnum, condyles and adjacent bone are invaginated into the posterior fossa. Klippel-Feil syndrome type II is massive fusion of two of seven cervical vertebrae associated with short neck and low hair line.
In order to examine precipitating factors for occurrence of multiple sclerosis or inception of a relapse in patients suffering from multiple sclerosis a specially designed questionnaire was used, ...including history records of patients with multiple sclerosis treated at the Clinic of Neurology of the Clinical Center of Sarajevo in the period between January1st and December 31st 2006. The number of patients with MS was 71 (48 women and 23 men). An infection as a precipitating factor was noted in 21 (29.57%) cases, stress was noted in 12 patients (16.9%) whereas 43 patients (60,12%) had the RR type of the disease. Nine patients were treated with interferon therapy (12.67%) and 47 patients (66.1%) with high doses of metilpredinisolone . Depression disorder was noted in 23 (32.9%) patients whereas 7 patients had cognitive dysfunction (9.86%). Results of this study, which have shown epidemiological characteristics of multiple sclerosis for the first time in Bosnia and Herzegovina, indicate that there is a need to create a unified register of patients and to request compliance with therapeutic guidelines.
The aim of this study was to investigate the effect of the duration of diabetes and glycemia on the development of diabetic retinopathy in diabetes types 1 and 2 and the prevalence of retinopathy by ...sex. It examined 278 diabetics in 1999 and 2004, a questionnaire was used to collect data and results of fasting glucose, HbA1c, glycosuria and ketonurie were recorded. Retinopathy was noted in 80 (28.78%) and 187 (67.27%) patients during 1999 and 2004, respectively (p < 0.001). The number of patients with the nonproliferative and preproliferative (p < 0.001) as well as with proliferative retinopathy (p < 0.01) was significantly higher in 2004 in the comparision with 1999. The average HbA1c in 1999 was 13.02%, whereas in 2004 it was 10.57%. Poor control of diabetes was present during both investigations.
Diabetic neuropathy represents late diabetes complications, and diabetes duration and long-term hyperglycemia are the main reasons for polyneuropathy. The goal was to estimate the effects of ...alpha-lipoic acid on symptoms of diabetic neuropathy after 600 mg i.v. for 3 weeks and 3 months of 300-600 mg of alpha-lipoic acid per os. This study has been designed as a multicentric, in 5-centers in B&H, carried out by 5 physicians with 20 diabetic patients each. Following parameters were monitored in 100 diabetics suffering from Type 1 and Type 2 diabetes, both men and women: diabetes duration, diabetes therapy, duration of polyneuropathy symptoms, height, weight, BMI (body mass index), subjective assessment of patients, objective examinations of physicians and subjective assessment of physicians. 100 diabetics, average age 61,36; oldest 79, youngest 40, suffered from diabetes in average 11,9 years. There were 35 men and 65 women, 16 with Type 1 and 80 with Type 2 diabetes, while 4 patients were not classified. 69 were having insulin therapy and 31 oral hypoglicemics. Shortest diabetic status was less than a year, and longest was 28 years. Average duration of polyneuropathic symptoms was 3,02 years, shortest was less than a year, and the longest was 15 years. Average height was 1,70 m, average weight 76,13 kg, and average BMI 26,51 kg/m2. Significant statistic differences in improvement were recorded (P>0,05) according to Fridman's test for repeated measurements compared to initial findings in assessments: sensory symptoms of polyneuropathy, pain sensations as polyneuropathy symptoms, total score of polyneuropathy symptoms, subjective assessment of patients, subjective findings of physicians, and significant differences were not find (P>0,05) in autonomous and motoric neuropathy. Based on the conducted study, we have concluded that the application of alpha-lipoic acid during 3 months has helped to decrease the symptoms of diabetic neuropathy and in only one case out of 100 included patients there was no subjective improvement after drug application.
The outcome of stroke, especially lethal one is significant, as in the hemorrhagic as well as in ischemic stroke.
was to show the impact on the stroke outcome of tachycardia correlated with lesion ...localization.
Material for our work was patients who were treated due to the stroke at the Neurology Clinic Sarajevo in the period from 31 March 2015 until 01 January 2016. A total of 544 stoke patients were treated in the reporting period, 221 (44.6%) died. There were 70.9% patients with ischemic and 29.1% with hemorrhagic stroke. Each patient underwent ECG, which registered tachycardia during admission and on third day of hospitalization.
In relation to the presence of tachycardia on admission there were statistically significant differences in the group of patients with hemorrhage and ischemia in relation to presence of tachycardia (p <0.01). In the group of patients with hemorrhage coma was more present (78.9%), while tachycardia was statistically more often in those with loss of consciousness than in the group with coma. Group of patients with ischemia has 52.75% of the patients with tachycardia without statistical correlation between the presence and absence of disorders of consciousness. Midline lesions were statistically more often associated with paroxysmal tachycardia in relation to the lateral lesions (p <0.01). Statistical analysis shows that there are statistically significant differences between observed groups χ
=35.576, p=0.0001. Lethal outcome of hemorrhagic stroke was 55.45%, 32.6% for ischemia. A significant statistical significance of ischemic and hemorrhagic stroke compared to the lethal outcome correlated with the registered tachycardia and medial lesion localization.
Tachycardia on admission in patients with stroke is a relevant negative predictor for stroke outcome. Medial localization of changes significantly affects the occurrence of tachycardia and lethal outcome of stroke which is statistically significantly more associated with hemorrhagic stroke.
Aim
The aim of the study is to evaluate the effect of a prospectively conducted interactive 5-day education programme based on Düsseldorf model on glycated haemoglobin (A1C), and total daily ...dose of insulin in type 1 diabetes patients.
Methods
A total of 67 type 1 diabetes patients was analysed; mean age of 11±0.68 years, 43 females and 24 males. The programme was led by a trained team of diabetes specialist doctors and nurses. All subjects and their parents completed a knowledge test about diabetes at beginning, and at the end of education, and after 12 months (30 questions). Subjects were evaluated for total daily insulin, and HbA1c at baseline, as well as 3, 6, 9 and 12 months after the end of the education programme. Results
Results of the knowledge test after the education have shown higher knowledge at baseline. At the end of the education programme an average of total daily insulin dose was significantly lower. There was a 3.17% reduction in HbA1c values over 9 months, and 1.8% over 12 months in the comparison to the baseline values (p<0.001).
Conclusions
Structured education programme of functional insulin therapy was associated with improved glycaemic control in type 1 diabetes patients and their parents. It motivated patients and parents to improve glycaemic control. One year after the follow up, glycaemic control was worsening, due to lack of patients' motivation, therefore, there is a need for yearly re-education.
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