Impact of Anxious and/or Depressive Reactive State on the Effectiveness of Rehabilitation of Patients with Multiple Sclerosis.

Background and Objectives: Rehabilitation is a part of the comprehensive treatment of multiple sclerosis (MS). If present, psychological reactive states limit the results of the rehabilitation. The objectives were to determine the impact of psychological reactive states in these patients on the functionality obtained by rehabilitation and QoL, and to determine the connection between the objective and subjective evaluation. Materials and Methods: Based on the Hospital anxiety and depression scale, the patients were divided into a group with anxious and/or depressive reactive state and a group without the reactive state. The values of functional scores-the Berg Balance Scale (BBS) and the Expanded Disability Status Scale (EDSS), as well as the parameters of the QoL-Physical health Component Score (PCS) and the Mental health Component Score (MCS)-were determined at the beginning and at the end of the rehabilitation. Results: There was a statistically significant difference between the BBS, EDSS, PCS, and MCS groups at the beginning and the end of the rehabilitation in both groups. A statistically significant difference at the beginning and the end of the rehabilitation between the groups was found only in PCS and MCS. A highly statistically significant correlation between EDSS and PCS, and EDSS and MCS, was found only in the group without the reactive state. Conclusions: Although rehabilitation leads to an objective improvement of functionality in patients with MS, the presence of the anxious and/or depressive reactive state limits the results of rehabilitation and leads to discrepancies in the aforementioned objective assessment and the patient's subjective experience through the evaluation of their QoL.

Spinal cord stimulation in chronic pain treatment - first experiences in Bosnia and Herzegovina.

Aim To describe results of spinal cord stimulation technique when the conventional multidisciplinary treatment of neuropathic or mixed pain failed. Methods The research was conducted at the Institute for Physical Medicine and Rehabilitation "Dr. Miroslav Zotovic", Banjaluka. Ten patients, who had chronic pain resistant to other therapeutic options and a failed back surgery, were sent for an evaluation. Each patient underwent a 4-week evaluation by a team of medical specialists, phychologist and social workers. Additional diagnostic methods (MRI of the lumbosacral spine, electromyoneurography of lower extermities, congnitive assessment tests) were also performed to establish a proper indication for implantation of the system for spinal cord stimulation. Leads of a system for spinal cord stimulation were implanted percutaneously or surgically at the epidural space. Functional outcome measures (visual analogue scale, Oswestry index, anxiety and depression scales) were taken before the implantation of the system and on several followups. Results Four patients did not meet critea for the inclusion in the study (two were not ready, two showed psychopathological symptoms). One patient had a percutaneous lead implant, but it was removed after six months due to paresthesia. The remaining five had surgicaly implanted epidural leads and showed significant improvement in pain control, Oswestry index had lower values, and all except one patient had improvement registered by anxiety and depression scales. Conclusion. Short-term and long-term follow up showed a long lasting pain reduction and improvement of functionality in all patients.

Problems, interventions, and their outcomes during the routine work of hospital pharmacists in Bosnia and Herzegovina.

Background In the last 30 years, activities of hospital pharmacists have gone through significant changes. Pharmacists are increasingly involved in patient care. Objectives To explore drug-related and logistic problems, interventions, and their outcomes during routine everyday work of hospital pharmacists. Setting Institute for physical medicine and rehabilitation, Banja Luka, Bosnia and Herzegovina. Methods In the period of January 2013-October 2015 a prospective observational study was performed. Medical doctors, nurses, therapists, and patients addressed pharmacists, face-to-face or by telephone, with drug-related problems (DRPs) and/or logistic issues. Main outcome measure Type of DRP or logistic issue, intervention, outcome, initiator and time spent for solving the problem were documented for each consultation. Results Out of 1515 interventions, 48.8% were aimed at solving DRPs. The most common DRPs were the recommendation of a drug or dose and need for additional information about drugs. Drug price and supply were the most prevalent logistic issues. DRPs were more frequently initiated by medical doctors and required more time to solve the problem compared to logistic issues (Mann-Whitney U test, p ≤ 0.001, respectively). The acceptance rate of interventions to solve DRPs (83.7%) was lower compared to logistic issues (95.2%; p ≤ 0.001). Conclusions Hospital pharmacists were faced with an approximately equal number of DRPs and logistic issues during their routine everyday work. The overall acceptance rate of pharmacists' interventions was high, and the results of our study indicate that there is a need for more involvement of hospital pharmacists in Bosnia and Herzegovina in clinical activities. Impact on practice.

The Effects of Continued Rehabilitation After Primary Knee Replacement.

INTRODUCTION: Tasks of rehabilitation after arthroplasty are to provide painless joint movements, to improve the range of motion, to establish a scheme of walking, to achieve independence in activities of daily living. THE AIM: of the study is to determine the effects of continued rehabilitation on the range of the knee motion and reducing the swelling after total knee replacement. METHODS: The study was conducted from 2011 to 2013 and included 140 patients of both sexes, aged 45 to 85 with implanted endoprosthesis based on primary osteoarthritis. They were divided into two groups, experimental, which after early rehabilitation continued ongoing rehabilitation for a period of three weeks, while the control group after completion of early rehabilitation began rehabilitation two months from the surgery for a period of three weeks. The range of motion in the knee joint and the extent of the knee joint in the medium of patella were measured in both groups during the admission and discharge from rehabilitation. In the experimental group, control measurements were carried out three months after surgery. RESULTS: In both groups, there was a significant reduction of the swelling at the discharge in relation to the admission while in the experimental group there was no change on the control of the joint swelling after three months in relation to the release from rehabilitation. In the experimental group, the range of motion of flexion and extension was improved at the discharge in relation to the admission as well as the flexion during the control while the range of motion of extension wasn't significantly changing during the control examination. In the control group, the extension and flexion were significantly improved at the discharge compared to the admission. Comparing both groups, the results showed that there was a significant improvement in flexion movements in the experimental group during rehabilitation in comparison to the control group, while the range of motion of the extension was not significantly different in these two groups. Comparing the range of motion of the experimental group on the control examination and the control group at discharge, it is demonstrated significant improvement in flexion and extension in the experimental group. CONCLUSION: Results of monitoring the reduction of the swelling and the return of the range of motion confirm the advantage of continuous rehabilitation.

[Quantitative analysis of vascular network of oculogyric nerve nuclei].

INTRODUCTION: Nuclei of oculogyric nerves (principal oculomotor nucleus, trochlear nucleus and abducens nucleus) are densely vascularized brainstem structures. The aim of this study was to determine quantitative characteristics of the vascular network of these nuclei. MATERIAL AND METHODS: The study was done on 30 adult brainstems, both male and female, without diagnosed neurological disturbances. Three-millimetre-thick stratums were taken in transversal plane and cut in 0.3 micrometer semi-serial sections stained with Mallory method. The images of studied nuclei were taken with "Leica" DM 1000 microscope and "Leica" EC3 digital camera under 400x magnification, and analyzed by ImageJ software with A 100 grid. The statistical analysis was performed by Statistical Package for the Social Sciences software with 5% level of significance. RESULTS: A statistically significant difference was found in the volume and surface density between principal oculomotor nucleus and trochlear nucleus, and between trochlear nucleus and abducens nucleus. No difference was found in the length density. DISCUSSION: The results of this research match the results of studies on characteristics of vascular network of oculogyric nerve nuclei, while the comparison of vascular networks of these nuclei, substantia nigra, vestibulocochlear nuclei and precentral gyrus illustrates differences in quantitative characteristics of blood vessels in these structures. CONCLUSION: Blood vessels of principal oculomotor nucleus and abducens nucleus have similar dimensions and approximately the same arborization pattern, while vessels of trochlear nucleus have significantly smaller dimensions and density.