Serum biomarkers in normal pressure hydrocephalus.

Aim To investigate the serum value of brain derived neurotrophic factor (BDNF), proteins S-100, NSE, IL-6 in normal pressure patients (NPH) compared to control (healthy) group and also a possible correlation with radiological findings in NPH patients. Methods Study patients were included during the period of 2020- 2022. All NPH patients met the diagnostic criteria for probability of NPH. Control patients group included patients without known brain disorder, without clinical symptoms of NPH. Blood samples were taken before planned surgery for NPH. BDNF serum concentrations were assessed by a sensitive ELISA kit, and serum concentrations of S-100, NSE and IL-6 were assessed by using ECLIA technology for immunoassay detection. Results Among 15 patients who were included, seven NPH patients were compared to eight control patients. Non-significant decrease in BDNF serum concentrations, an increase of protein S-100 serum concentrations, a decrease of NSE serum concentrations, as well as an increase of IL-6 serum concentrations in NPH patients compared to healthy controls was found. Strong positive correlation between BNDF and Evans index was observed (p=0.0295). Conclusion We did not find a significant difference of BDNF, protein S-100, IL-6 and NSE between serum concentration in NPH and healthy patients. More future research is needed to find the role of BDNF in NPH patients.

Cognitive Imapirment in Multiple Sclerosis: Relation to Dysability, Duration and Type of Disease.

Background: Cognitive dysfunctions are often presented as a symptom in multiple sclerosis which is associated with both structural and functional imapirments of neuronal networks in the brain. Objective: The aim of the study was to evaluate the influence of dysability, duration and type of disesase on cognitive functions in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between clinical characteristics and MoCa test scores. Results: Out of 63.33% of patients had EDSS <=4.5. Disease lasted longer than 10 years in 30% of patients. 80% had relapsing-remitting MS and 20% had secondary progressive MS. 84,2 % of patients with EDSS ≤ 4.5 had cognitive dysfunction. Higher disability (rho=0,306, p<0,05), progressive type of disease (rho=0,377, p< 0,01) and longer disease duration (rho=0,282, p<0,05) were associated with worse overall cognitive functions. Level of disability showed statistical significant correlation with the executive functions and language domains of cognition (p<0.01). Longer disease duration was significant correlated with executive functions (p<0,01) and language domains (p<0,01), while progressive type of disease was signifacant correlated only with executive functions domain (p<0,01). MoCa score variables did not show a statistically significant difference in relation to the number of relapses per year and the use of imunoterapy. Statistically significant negative correlation was obtained between executive functions domain and level of disability, disease duration and progressive type of disease, while language domain significantly correlated only with disability level and progressive type of disease. Conclusion: High percentage of MS patients has cognitive impairment. Patients with higher disability were presented with lower cognitive abilities, especially in executive functions and language domains. Higher frequency of cognitive impairment were presented in progessive forms of disaese and longer disease duration with strong influence on executive functions domains of cognition.

Influence of Sociodemographic and Clinical Characteristics on Sexual Function Domains of Health Related Quality of Life in Multiple Sclerosis Patients.

Background: Multiple sclerosis is a progressive inflammatory disease of the the central nervous system. Problems with sexual functions are the common features of multiple sclerosis and important factor that contribute to the quality of life among affected persons. Objective: The aim of the study was to evaluate the influence of sociodemographic and clinical characteristics on sexual functions domains of health related quality of life (HRQOL) in multiple sclerosis patients. Methods: This study included 100 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were an Expanded Disability Status Scale score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. HRQOL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire. Mann-Whitney and Kruskal-Wallis test were used for comparisons between sociodemographic and clinical characteristics and HRQOL scores. Results: Out of 60% of patients reported to have sexual dysfunction, and 55 % were female patients. Younger patients had statistical significant higher median value of sexual function score (91.68 vs. 58,28, p=0.001) and satisfaction with sexual life scores (62.5 vs 37.5 , p =0.019) comparing to older patients. Employed patients also showed statistical significant higher median value of sexual function score (82 vs. 66.7, p=0.003) comparing to unemployed patients and also statisticaly significant higher median scores considering satisfaction with sexual life among employed patients (p=0,001). There were no differences in sexual functions scores considering gender, marital status and education. Patients with higher level of disabilty, progressive type of disease, more relapses and longer diseas duration had statistical significant lower median value of sexual function score and also satifaction with sexual life scores, except for disease duration. Conclusion: Aging, dysability and progression are major factors that contribute to lower sexual function scores and satisfaction with sexual life among multiple sclerosis patients. Althoug women reported sexual problems more often then men, impact of these problems on quality of life are similar in men and women with MS.

The SARS-CoV-2 Delta (B.1.617.2) variant with spike N501Y mutation in the shadow of Omicron emergence.

Circulation of the Omicron variant with the reemergence of the N501Y mutation along with many others in the spike protein has once again stirred the academic community. Interestingly, tracing the genetic diversity of SARS-CoV-2 shed light on a less frequent N501Y + Delta variant which has been in the global circulation for some time before the Omicron appearance. This paper aims to present the molecular characteristics of the SARS-CoV-2 Spike_N501Y + Delta variant detected in Bosnia and Herzegovina. The study was conducted during November and December 2021. All patients were tested using real-time RT-PCR for detection of SARS-CoV-2. A representative number of SARS-CoV-2 positive samples was pre-screened using VirSNiP SARS-CoV-2 Spike N501Y kit. The characterization of the viruses was carried out with Illumina RNA Prep with enrichment and the Respiratory Virus Oligo Panel kit. Among the analyzed sequences, we found two isolates of the Delta variant that differ from their most related clade- GK AY.4.3 in additional mutations N501Y and L54F. In this study, we described the presence of a rare form of Delta variant with Spike_N501Y mutation in the shadow of the Omicron emergence. Despite the set of mutations in the Spike protein, this form of Delta variant does not indicate the large-scale consequences for the general population. Further functional studies of this form could provide more information about its antigenicity and infectivity.

Longterm Antiepileptic Therapy and Bone Health: Implications for Patients with Brain Tumors.

OBJECTIVE: The objective of our study was to investigate the effects of carbamazepine (CBZ) and lamotrigine (LTG) treatment on bone metabolism in epileptic patients. PATIENTS AND METHODS: A cross-sectional study was performed on normal controls (N=30) and 100 patients with symptomatic epilepsy caused by a primary brain tumor, divided into two groups according to the treatment: LTG monotherapy group (N=50) and CBZ monotherapy group (N=50). For each participant serum levels of 25-OHD and osteocalcin (OCLN) were measured, and bone mineral density (BMD) was evaluated by the dual-energy X-ray absorptiometry method. RESULTS: There was no statistically significant difference in the average values of vitamin D in serum between the CBZ and LTG groups (Vitamin D CBZ 17.03±12.86 vs. Vitamin D LTG 17.97±9.15; F=0.171, P=0.680). There was no statistically significant difference in the average values of OCLN between the CBZ and LTG groups (OCLN CBZ 26.06±10.87 vs. OCLN LTG 27.87±28.45; F=0.171, P=0.674). The BMD value was lower in both groups using antiepileptic agents compared to the controls, but when comparing the CBZ group to the LTG group, a statistically significant difference was only observed for the Z score (T-score CBZ: 0.08± 1.38 vs. T-score LTG: 0.37± 1.02; F=1.495, P=0.224; Z score CBZ: -0.05±1.17 vs. Z. score CBZ: 0.38±0.96; F=4.069, P=0.046) (Table 3). CONCLUSION: The choice of antiepileptic agents for treating seizures in patients with brain tumors should be carefully evaluated in relation to their impact on bone health. These patients could benefit from supplementation and regular measurement of biochemical markers of bone turnover and BMD.

Interdisciplinary aspects of possible negative effects of dogs on humans in Bosnia and Herzegovina.

The coexistence of humans and dogs, in addition to all positive effects, can result in negative effects on human health. A particular risk is posed by a population of stray dogs, that is, dogs without owners and veterinary supervision. A contact with dogs in addition to bites, carries the risk of viral, bacterial and parasitic zoonoses, and can also cause psychological trauma. Children, the elderly and pregnant women are the categories most susceptible to the negative effects of dogs. The aim of the paper was to make an interdisciplinary analysis of the negative effects of dogs on humans. Dog bites cause wounds and dysfunction of damaged tissue, and often lead to various infections. The risks of rabies and tetanus are particularly significant if proper and timely treatment is not performed. Ongoing training for dog owners can significantly reduce the number of bites inflicted by owned dogs, but stray dogs remain a serious social problem and pose potential health risks of some zoonosis. Timely and adequate management of bite wounds and the use of rabies-post-exposure prophylaxis as well as psycho-therapy, where indicated, significantly reduce possible adverse health effects for patients who have been bitten by dogs.

Elevated serum C-reactive protein concentration in Bosnian patients with probable Alzheimer's disease.

Studies indicate that inflammatory mechanisms may play an important role in the pathogenesis of Alzheimer's disease (AD). C-reactive protein (CRP), marker and mediator of inflammation, has been detected in lesions typical for the affected areas of AD brain. There have been conflicting reports on serum CRP concentration in AD. Scarce data exist on association of CRP and measures of adiposity in AD patients. Thus, we investigated serum CRP concentration in fifteen overweight institutionalized patients with probable AD and fifteen age-matched control subjects. Body mass index (BMI) and waist/hip ratio (WHR) were calculated for each subject included in the study. Age, systolic and diastolic blood pressure, BMI and WHR did not differ significantly between the two groups. Serum CRP concentration was significantly higher in patients with AD compared to controls (p<0.0001). Although not significant, positive correlations between serum levels of CRP and BMI and WHR were found. Obtained results support the notion that low-grade inflammation is present in patients with AD. Absence of significant association between CRP and measures of total and central adiposity in overweight AD patients needs further investigation and explanation.

Relapse prevention in schizophrenia - new therapeutic challenges.

Schizophrenia is a chronic progressive illness characterized with frequent relapses and requiring long-term treatment. In spite of the fact that this disorder belongs among ten leading causes of disability worldwide, the consequences and difficulties associated with schizophrenia are frequently underestimated. The course of the illness is further characterized by a high percentage of suicides and attempted suicides, decline in cognitive functions and frequent relapses. The results of numerous studies indicate that early treatment with antipsychotics leads to better long-term outcomes compared with control groups. In the process of deciding about treatment we must bear in mind the importance of individual approach to schizophrenic patients because there are significant differences in the type of disorder, symptoms, co-morbidity, course of disorder (first episode or chronic course), as well as the differences in treatment response and treatment adherence. When choosing an antipsychotic agent we should try to find the drug capable of addressing all aspects of the illness that is safe and well tolerated in long-term treatment; we should start the treatment as early as possible, reduce the psychotic symptoms and avoid negative effects on functioning, whilst avoiding adverse effects and establishing a trusting and productive therapeutic alliance with the patient. Existing evidence strongly suggests the use of adequate doses of antipsychotics as early as in prodromal psychosis. Evidence shows that schizophrenic patients remain longer in treatment with atypical antipsychotics particularly when they are applied as depot injections, because the efficacy of treatment is higher, drug concentration stable and long-lasting, there are fewer adverse effects, and the co-operation with the service provider is better. In this way, the atypical antipsychotics provide us with the opportunity to establish long-term control of the psychotic symptoms, and reduce relapse rate and the number of hospitalizations while improving the quality of life of schizophrenic patients and establishing optimal therapeutic alliance.

Impact of psychoeducation on professional stress reduction among prison guards.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: Through psychological support for prison guard's awareness about professional stress and burn-out, cognitive assessment of stress consequences, insight in coping strategies, as well as prevention of stress consequences is achieved. AIM: Evaluation of psychoeducation effects on professional stress consequences within prison guards. METHOD: In the research were included 122 prison guards from three prisons in Bosnia and Herzegovina. All of them have been tested before and after psychoeducation was finished using following instruments: Index of reaction, STAI questionnaire, SAMACA questionnaire. RESULTS: Differences between first and second measuring of subjects included in this study in Sarajevo prison indicated statistically significant reduction of stress reactions, improvement of coping strategies and communication skills. In prisons Zenica and Kula there are differences between first and second measurement in stress reactions reduction, improvement of coping strategies and overcoming of stress and improvement of communication skills as well, which are not statistically significant. In Kula prison, significant differences between two measurements in attitudes of prison guards toward detainees were observed. CONCLUSIONS: Results of this study show that prison guards within prisons where are detained persons with long period of imprisonment are more exposed to professional stress, comparing to prison guards who are employed in investigation prison. Psychoeducation resulted in positive effects and it should be obligatory included in prison guards training with the aim of decreasing of psychological consequences of prolonged professional stress to which they are exposed to. Psychoeducation should be on continuous basis and led by educated mental health professionals.

[Presence of depressive disorder among patients with epilepsy in relation to the duration of illness and type of antiepileptic therapy]. / Prisustvo depresivnog poremecaja kod pacijenata sa epilepsijom ovisno o duzini trajanja bolesti i tipu atiepilepticne terapije.

INTRODUCTION: Interictal depression as a co morbid disorder can be seen among more than 40% of patients with epilepsy. Epilepsy duration as well as selected antiepileptic drugs can be suitable for the development of depressive disorder in many aspects. AIM: To test relation between depressive disorder in patients with epilepsy, duration of illness and type of antiepileptic therapy. PATIENTS AND METHODS: Prospectively, by random selection, we have tested 300 patients with epilepsy, with or without depressive affective disorder at the Outpatient Department for Epilepsies in the Clinical Center of Sarajevo University. All patients answered Beck and Hamilton depression scales. RESULTS: This research involved male patients which made 54% of baseline at the average age of 37.7 years SD = 12.86, as well as female patients at average age of 32.83 years SD = 12.26. Depressive disorder according to the results at the Beck scale was present in 34%, and according to the Hamilton scale in 38.9% of patients. Carbamazepin as monotherapy was applied for more than a half of the baseline, Phenobarbital as monotherapy and combined with Carbamazepin significantly more frequently among men's (p < 0.0001). Duration of illnesses longer than 20 years had 56% women with the expressed depressive disorder, compared to the 42% men's with depression (p < 0.01). CONCLUSION: Depressive disorder occurs significantly more frequently among women with the longer epilepsy duration, as well as among male patients who had Phenobarbital as single or add on therapy.

[Catamenial epilepsy]. / Katamenijalne epilepsije.

Seizures are influenced by the physiologic variation in sex hormone secretion during the menstrual cycle and throughout the reproductive life of women with epilepsy. Catamenial epilepsy is defined as the occurrence of seizures around menses or an increase in seizures in relationto the menstrual cycle. The incidence of catamenial epilepsy varies from 10% to 78%, largely because of methodological differences among studies. Variation in concentracion of antiepileptic drugs across the menstrual cycle may also contribute to increased seizure susceptibility. It is important for the physician to work closely with the patient to determine whether her seizures are indeed catamenial and to design an appropriate treatment plan.

Experiences in treatment of multiple sclerosis with betaferon in federation of Bosnia and Herzegovina.

Multiple sclerosis is an insidious, intermittent or chronic progressive inflammatory, autoimmune disease of the central nervous system; it is a major cause of disability, especially in young adults. It affects women twice as often as men. The prevalence varies from 50 to 100 per 100,000 in moderate climate zones. Interferon beta-1b reduces frequency and severity of clinical attacks of relapsing-remitting multiple sclerosis and prolonged time until the progression of disability and time patients suffering from secondary progressive multiple sclerosis become wheelchair-bound.

[Botulinum toxin in spasm treatment in adults]. / Botulinum toksin u tretmanu spazma kod odraslih.

Botulinum toxin (BTX) is a powerful neurotoxin which blocks cholinergic transmission at the neuromuscular junction. Judiciously applied it can reduce local muscle over activity while maintaining the strength in other muscles. For focal or segmental dystony it has been a medication of choice. Refined botullinum toxin A being applied in affected groups of muscles weaker power of contraction. Basic mechanism which weaker contraction remands the same. Controlled trials have provided evidence of the effectiveness of BTX both in reducing spasticity itself and in achieving functional gain. The guidance given here to clinicians involved in the management of spasticity covers the types of patient suitable for treatment using BTX, the appropriate dosage, and the necessary follow-up procedures and documentation.

[Special needs of women with epilepsy]. / Posebne potrebe zena oboljelih od epilepsije.

Epilepsies are one of the most common neurological disorders. Men and women are almost equally affected. Women bear specific features because of their natural characteristics and changes in hormonal status, which can affect the clinical presentation and the course of the disease as well as the comorbidity of various disorders. By this, we have in mind a mutual influence of steroid hormones and antiepileptic drugs, calcium and phosphorus transport disorder, insulin and lipid metabolism, adverse cosmetic effects, sexual dysfunctions, pregnancy, teratogenity and the delay in fetal development and bone diseases.

[Role and significance of measurement of bioelectric signals in neurophysiology--examples from practice]. / Uloga i znacaj mjerenja bioelektricnih signala u neurofiziologiji--primjeri iz prakse.

This paper gives examples of the measurement bioelectrical signals in the diagnosis procedure and therapy of patients treated at the Center for Medical Health of the Clinical Center of the University of Sarajevo. The emphasis of the paper is put on the following methods: electromyography, electroneurography, potentials evoked by hearing, potentials evoked by sight, somatosensory potentials. Each of these methods mentioned calls for the application of modern information technology based on conversion of analog data into digital data and its interpretation during the identification of timely and correct diagnosis.

[Treatment of migraine]. / Tretman migrenskih glavobolja.

The epidemiological parameters of the migraene headaches with the occurrence in the most productive life age with the subjective intensive experience of the characteristic pain in migraene headaches are the reason of interest for migraene as the headache "sui generis" from the pathological and therapeutic aspect. The diagnosis of migraene is put according the criteria for migraene headaches. In persons who suffer from migraene it is certainly, that besides the family anamnesis and the solalled precipiting factors there are also the tresh hold for migraene attack to which the basic change in serotonin generator in the brain branch. In the therapeutic approach are used the profilacted and therapeutic measures. The agents which act as agonists 5-HT 1 receptors have simptomatic effects in migraena, while antagonists of 5-HT 2 recetors are-successful in the prophilaxis. Selective agonist 5-HT 1 receptor is sumatrypane and has broken the more year sterotipy in the treatment of the migraene, while the more recent agonists receptors 5-HT 1D alfa and 5-HT D1berta receptor rizatriptan, zolmitriptan, naratriptan show clearly the therapeutic aim of the treatment or migraene influence on the serotoenergic generator of the brain branch and the consecutive change of the cerebral circulation.