Influence of weather regime and local geomagnetic activity on the occurrence of epileptic seizures.

Epilepsy is a common neurologic disease and presents a major public health problem. Patients with epilepsy have unexpected occurrence of seizures with many triggered by existing triggering factors such as alcohol, stress etc. Other potential triggers include certain weather or atmospheric parameters and local geomagnetic activity. We have analyzed the impact of atmospheric parameters grouped in 6 grouped weather types or weather regimes and the local geomagnetic activity through the K - index. In the prospective study, we analyzed a total of 431 seizures over a 17-month period. In the results obtained, we found that the most severely common weather regime grouped type of weather was radiation and then precipitation regime. It was also found that grouped weather types of weather regimes had more impact on generalized than focal epileptic seizures. Local geomagnetic activity had no direct effect on the occurrence of epileptic seizures. Those results confirm the thesis how the impact of certain external factors is complex and that the further study is required in that respect.

Cerebral infarction as initial manifestation of meningovascular neurosyphilis in an immunocompetent patient - A case report with long term follow-up.

To present a 29-year-old immunocompetent patient with neurosyphilitic changes characterized by multiple acute ischemic brain strokes along with significant narrowing of several large intracranial arteries. Ceftriaxone treatment for 14 days followed by benzathine benzylpenicillin weekly for additional 3 weeks, showed improvement in meningovascular changes.

Trends in stroke thrombolysis rate in Bosnia and Herzegovina: a hospital-based observation study.

Aim To assess trends in thrombolysis rates and door-to-needle times in University Hospital Mostar. Methods Data from the University Hospital Mostar Registry were used. Information on the number of ischaemic stroke patients, intravenous thrombolysis rates and "door-to-needle times" (DNT) were collected between January 2013 and December 2021. Results Out of the total of 3100 ischaemic stroke patients, alteplase was given to 130 patients giving a thrombolysis rate of 4.2%. The mean hospital thrombolysis rate increased from 2.4% in 2013 to 10.6% in 2021. Conclusion Although the hospital thrombolysis rate more than quadrupled, there is still a low proportion of acute ischaemic stroke patients who received intravenous thrombolysis therapy. Education and interventions indicating the importance of recognition and treatment of acute ischemic stoke are necessary for all physicians.

The role of TPA I/D and PAI-1 4G/5G polymorphisms in multiple sclerosis.

BACKGROUND: Previous studies have shown impaired fibrinolysis in multiple sclerosis (MS) and implicated extracellular proteolytic enzymes as important factors in demyelinating neuroinflammatory disorders. Tissue-type plasminogen activator (t-PA) and its inhibitor (PAI-1) are key molecules in both fibrinolysis and extracellular proteolysis. In the present study, an association of the TPA Alu I/D and PAI-1 4G/5G polymorphisms with MS was analyzed within the Genomic Network for Multiple Sclerosis (GENoMS). METHODS: The GENoMS includes four populations (Croatian, Slovenian, Serbian, and Bosnian and Herzegovinian) sharing the same geographic location and a similar ethnic background. A total of 885 patients and 656 ethnically matched healthy blood donors with no history of MS in their families were genotyped using PCR-RFLP. RESULTS: TPA DD homozygosity was protective (OR = 0.79, 95% CI 0.63-0.99, P = 0.037) and PAI 5G5G was a risk factor for MS (OR = 1.30, 95% CI 1.01-1.66, P = 0.038). A significant effect of the genotype/carrier combination was detected in 5G5G/I carriers (OR = 1.39 95% CI 1.06-1.82, P = 0.017). CONCLUSIONS: We found a significantly harmful effect of the combination of the PAI-1 5G/5G genotype and TPA I allele on MS susceptibility, which indicates the importance of gene-gene interactions in complex diseases such as MS.

Betaferon efficiency indicators in the treatment of relapsing remitting form of multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is the most common, chronic debilitating disease in young adults characterized by a wide variety of neurological symptoms and unpredictable increasing disability. Worldwide, MS affects about 2.5 million people, with a female-to-male ratio of approximately 2:1. The therapies used in the chronic treatment of MS are immune-modulating agents. Interferon beta -1b has been shown to decrease the rate of relapses, the burden of lesions seen on MRI, and the rate of accumulated disability. AIM: Determine the efficacy of Betaferon in patients with RR form of MS in terms of the degree of disability and the number of relapses during the two years of continuous treatment. SUBJECTS AND METHODS: The study, partly retrospective, partly prospective, included 58 patients of both sexes with MS, RR type, from the Federation of Bosnia and Herzegovina, who received Betaferon treatment, from the Solidarity Fund, during 2 years period. Evaluation of efficacy was based on the degree of disability measured by EDDS scale and number of relapses. RESULTS: In our sample, women were represented in the ratio of 3:1 compared to men. 44.8% of patients were referred from Clinical Centre University in Sarajevo (UCCS), 34.5% from University Clinical Centre Tuzla (UCCT) and 20.7% from Clinical Hospital Center Mostar (CHCM). The smallest number of patients have had a relapse sent from CCUS (0.04, SD = 0.196), which was in direct correlation with input EDSS score at baseline (= 1.3) compared to patients from the UCCT, who had an average of 1.05 relapses, SD = 1.35, and the input EDSS score is 2.15. Patients referred from CHCM had an average of 0.08 relapses, SD = 0.93, while the input EDSS score was around 1. In terms of the degree of disability, measured by EDSS, we get a minimal increase in the patients from UCCS and UCCT, while patients from CHCM had a reduction of EDDS for the 0.45 (p < 0.05). CONCLUSION: Betaferon therapy must start as soon as possible, preferably when clinically isolated syndrome (CIS) is diagnosed. The reason for early start is to delay the transfer of disease in to definite multiple sclerosis, and thereby reduce disability, which disease brings to young people. Key words:

Angiotensin-converting enzyme gene polymorphism in patients with multiple sclerosis from Bosnia and Herzegovina.

BACKGROUND: Increased activity of angiotensin-converting enzyme (ACE) in the blood and cerebrospinal fluid of patients with multiple sclerosis (MS), and the inhibition of ACE in experimental autoimmune encephalomyelitis, suggested that ACE may play a role in the pathogenesis and progression of MS. We recently published the first report on the potential association of MS and ACE I/D polymorphism in Slovenian and Croatian patients with MS, in which it was shown that the DD genotype might contribute to a higher risk of developing MS in men. To confirm these findings in a similar ethnic population, we analyzed ACE I/D gene polymorphism in patients with MS from Bosnia and Herzegovina. SUBJECTS AND METHODS: One hundred and seventy patients with MS and 170 healthy controls were genotyped by the polymerase chain reaction method. RESULTS: There was no significant difference in the distribution of ACE I/D genotypes (p=0.783) or in the allelic frequencies (p=0.538) between patients with MS and control subjects. When patients with MS were stratified by sex, no statistically significant differences in allele or genotype distributions were observed. Finally, there was no indication of an impact of the ACE I/D genotype on disease course or severity. CONCLUSION: The ACE I/D polymorphism is not a risk factor for development of MS, nor does it contribute to disease severity in this Bosnia and Herzegovina population.

Epidemiology of multiple sclerosis in western Herzegovina and Herzegovina--Neretva Canton, Bosnia and Herzegovina.

The aim of this study was to investigate the selected indicators of multiple sclerosis (MS) in Herzegovina (Western Herzegovina Canton and Herzegovina-Neretva Canton). By using all available health and medical sources in the studied area and using McDonald's criteria, a total of 96 patients were identified in the period from 1996 to 2006. Results of the study show that the crude prevalence of MS was 30.99/100,000 (95% confidence interval [CIC 24.8-37.2), the highest one in the municipality of Posusje (49.6/100,000) and the lowest one in the municipalities of Neum and Ravno (no recorded cases); the female/male ratio was 1.5; the mean age of the patients on the prevalence day was 41.4 +/- 10.2 years and the mean age at the disease onset was 30.7 +/- 6.4 years; the most often clinical course of the disease was relapsing-remitting (58%), secondary progressive course was present in 28% patients, primary progressive in 9% and progressive relapsing in 1% of patients; the most frequent initial signs of the disease were motor (33%) and sensory ones (24%). According to the results of the study, the south-western part of Bosnia and Herzegovina is an area on the crossing from moderate risk to high risk zone for MS. The distribution of MS is heterogeneous. MS was more prevalent in the municipalities with colder climate and more winter precipitation and it is not present in the coastal region with warmer climate and almost without winter precipitation.

Epidemiology of multiple sclerosis in western Herzegovina.

OBJECTIVES: To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina. PATIENTS AND METHODS: We analysed data from 81 MS patients (49 females, 32 males) on the prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994-2003 in the investigated area. RESULTS: Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20-34). Prevalence was highest in the mountainous municipality of Posusje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0-3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0+/-11.6 years, and the mean age at disease onset was 31.0+/-7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients. CONCLUSIONS: Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.