Poremećaji hoda i poremećaji ravnoteže uobičajeni su klinički problemi za starije osobe. Uzroci poremećaja hoda su individualni, često zbog fiziološkog procesa starenja i somatskih bolesti. Poremećaji hoda dovode do gubitka lične slobode, pada i povreda i rezultiraju značajnim smanjenjem kvaliteta života. Kod starijih osoba, kontrola statičke i dinamičke kontrole položaja i ritma je poremećena, što dovodi do izmijenjenog hoda, smanjuje se korak, povećava se širina hoda kako bi se održala ravnoteža, gornji dio tijela se savija prema naprijed da bi se održala ravnoteža, ruke se ne pomiču dok hodaju, hod je nepravilan, teže je započeti prve korake nakon sjedenja ili stajanja, kao i okretanja. Ako je moguće, najbolje je tretirati etiološki faktor, tj. osnovne bolesti, kao što su parkinsonizam, neki metabolički poremećaji itd. Treba voditi računa o nusefektima nekih lijekova, naročito antiparkinsonika, sedativa, hipnotika i antidepresiva. Također je potrebno uključiti i druge specijaliste, kao što su reumatolozi, fizijatri i fizioterapeuti, kao i internisti, kardiolozi i dijabetolozi. Kognitivne strategije također mogu biti korisne, na primjer usmjeravanje pažnje na svaki pojedinačni korak, a ne čin hodanja kao takav, svjesno pokušavajući napraviti pojedinačne velike korake, ili mentalno brojanje, kao i upotreba pomagala za hodanje.

Introduction: The dominant global public health challenge are non-communicable diseases. According to World Health Organization (WHO) data. The fifth leading causes of death in FB&H are diseases of the heart and coronary arteries: stroke, acute myocardial infarction, cardiac arrest, cardiomyopathy and essential hypertension. The prevention of these diseases has great importance in improving health in B&H. Objective: The aim of this study is in estimation of one-year survival and left heart systolic function after the treatment. After the data collection and evidence of their statistical value, the results of the research point to the profile of patients with a LAD disease in one-vessel coronary artery disease that should be subjected to PCI DES LAD and PCI BMS LAD, respectively, or creating guidelines for a better and more effective LAD treatment. Material and methods: The study was performed as retrospective/ prospective, clinically controlled for a period of three years. In this study was included 60 patients, which was followed in 12 months period. With the PCI BMS method was treated 63.3% and 36.7% of subjects were treated with the PCI DES in LAD. Conclusion: The number of complications in patients with one-vessel LAD coronary heart disease, treated with PCI DES and PCI BMS was statistically significant. One possible complication (4 patients) is due to the spread of the disease to other blood vessels. Due to possible complications in the treated or LAD with repeated stenosis, the complication in terms of restenosis of the previously placed stent in 75% are with BM stents justifying the use of drug eluting stent, while the progression of disease in patients (2 patients) indicates the need for detection and prevention of risk factors.

Introduction: Subarachnoid hemorrhage (SAH)represents hemorrhage in the space between arachnoidea and pia mater, due to aneurysm burst, spontaneously or as a consequence of trauma. It is condition that occurs more common in women than men, and its most common complications are rebleeding and vazospasm. As a result of vasospasm, develops ischemia in the portion of brain tissue that can cause additional neurological deficit. Transcranial Doppler Sonography (TCD) is a noninvasive ultrasound diagnostic method that allows monitoring of the state of intracerebral hemodynamics. Goal: The goal is to follow the occurrence of vasospasm after SAH, by the TCD method. Material and methods: We have analyzed 47 patients with SAH, by analyzing the presence of aneurysm, hypertension and smoking, and by the TCD method monitor the state of intracerebral hemodynamics during the first four days, then in the second and third week. Results: SAH was more common in women (61.7%) than men (38.3%), and in the age range from 22 to 64 years. Aneurism was demonstrated in 61.7% of patients, more common in women, with hypertension 68.1% also more common in women and smoking in 87.2% of patients, also more common in women. By TCD method are recorded milder, elevated blood flow velocities at a quarter of patients in the first measurement, during the second measurement at all and it had significantly greater value, and the third measurement also more increased in about a quarter of patients, so that there is a statistically significant difference in the first and second, second and third measurement for each vessel separately, but not between the first and third measurement. Conclusion: Predilection factors for SAH are aneurysms, hypertension and smoking. By using TCD method were recorded milder elevated blood flow velocity in the first days of SAH, with about a quarter of patients, significantly greater increase in blood flow velocity during the second week in all patients and also milder increase blood flow velocity in the third week of the start of SAH is a quarter of patients. TCD is the method of choice in the evaluation and management of vasospasm after SAH, which allows the prevention of delayed cerebral ischemia.

Introduction: In this article are demonstrated differences in the aspects of the metabolic syndrome (MSy) between genders, as well as the association of MSy and neuropathy. The aim: The aim of our study was that in patients with newly discovered metabolic syndrome of both sexes make comparison of fasting blood glucose levels and after oral glucose tolerance test, as well as neurophysiological parameters of n.medianus and n.ulnaris. Patients and methods: All participants were examined dermatologically. The analysis included the 36 male and 36 female respondents with a newly discovered MSy. Results: The average age of men was 52.75±7.5 (40-65) years and women 52.1±7.7 (38-67) years. The average value of fasting blood glucose in women was 5.86±0.87 (4.5-8) mmol/L, and non significantly higher in men (p=0.0969) as 6.19±0.8 (4.7-8) mmol/L. Average values of blood sugar 120 minutes after oral glucose tolerance test were not significantly different (p=0.7052), and was 5.41±1.63 (3.3-9.7) mmol/L in women and 5.27±1.52 (2.7-9.8) mmol/L in men. Median motor velocity were significantly higher in women for n.medianus on the left (p=0.0024), n.ulnaris on the left (p=0.0081) and n.ulnaris on the right side (p=0.0293), and the median motor terminal latency were significantly longer in n.ulnaris on the left (p=0.0349) and n.ulnaris on the right side (p=0.011). There was no significant difference in the sensory conductivity velocity in n.medianus and n.ulnaris between the groups, but the amplitude with the highest peak of the sensory response was significantly higher in n.medianus on the left (p=0.0269) and n.ulnaris on the left side (p=0.0009) in female patients. Conclusion: The results indicate that there are differences in neurophysiological parameters of the investigated nerves between the genders, and that tested nerve structures in the course of MSy are affected slightly more in men. There were no significant differences in skin changes between genders.

Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes.

ABSTRACT Technological diseases are diseases of the modern era. Some are caused by occupational exposures, and are marked with direct professional relation, or the action of harmful effects in the workplace. Due to the increasing incidence of these diseases on specific workplaces which may be caused by one or more causal factors present in the workplace today, these diseases are considered as professional diseases. Severity of technological disease usually responds to the level and duration of exposure, and usually occurs after many years of exposure to harmful factor. Technological diseases occur due to excessive work at the computer, or excessive use of keyboards and computer mice, especially the non-ergonomic ones. This paper deals with the diseases of the neck, shoulder, elbow and wrist (cervical radiculopathy, mouse shoulder and carpal tunnel syndrome), as is currently the most common diseases of technology in our country and abroad. These three diseases can be caused by long-term load and physical effort, and are tied to specific occupations, such as occupations associated with prolonged sitting, working at the computer and work related to the fixed telephone communication, as well as certain types of sports (tennis, golf and others).

ABSTRACT Introduction: Correction of pediatric spine deformities is challenging surgical procedures. This fragile group of patients has many risk factors, therefore prevention of most fearing complication-paraplegia is extremely important. Monitoring of transmission of neurophysiological impulses through motor and sensor pathways of spinal cord gives us an insight into cord's function, and predicts postoperative neurological status. Goal: Aim of this work is to present our experiences in monitoring of spinal cord motor function - MEP during surgical corrections of the hardest pediatric spine deformities, pointing on the most dangerous aspects. Material and methods: We analyzed incidence of MEP changes and postoperative neurological status in patients who had major spine correcting surgery in period April ‘11- April ‘14 on our Spine department. Results: Two of 43 patients or 4.6% in our group experienced significant MEP changes during their major spine reconstructive surgeries. We promptly reduced distractive forces, and MEP normalized, and there were no neurological deficit. Neuromonitoring is reliable method which allows us to “catch” early signs of neurological deficits, when they are still in reversible phase. Although IONM cannot provide complete protection of neurological deficit (it reduces risk of paraplegia about 75%), it at least afford a comfort to the surgeon being fear free that his patient is neurologically intact during long lasting procedures.

AIM In hemodialysis patients renal disease may cause an impairment of central and peripheral nervous system. In most cases of the peripheral nervous system polyneuropathy is reported. The aim of this study was to evaluate the function of small A-delta nerve fibres, whose function is often overlooked. METHODS The function of large diameter nerve fibers was performed by standard routine neurophysiological examination. Cutaneous silent period (CSP) was elicited by single electrical stimulations at the tip of digit II by the bipolar electrodes. The superficial electrodes were placed on the muscle belly of m. abductor pollicis brevis. The onset latency (L1) was recorded at the beginning of voluntary muscle activity suppression, the late latency (L2) at the start of new muscle activity. The difference between two latencies indicates the duration of CSP. RESULTS The study included 38 consecutive patients (male/female - 21/17, median age 56.6±10.9 years) treated with hemodialysis (one month to 30 years) and 35 healthy subjects (male/female 23/17, age 47.4±10.1 years). The results of the conduction study demonstrated a significant prolongation of F-waves of the median and ulnar nerves, decreased motor and sensory velocities of both nervesin patients on hemodialysis (p less than 0.001). In patients with A-V fistulas a significant prolongation of the onset CSP latency L1 was obtained (p less than 0.001), whereas duration of CSP was not changed. CONCLUSION In hemodialysis patients the significant impairment of small nerve fibers was recorded. The evaluation of small nerve fibers contributes to the assessment of the whole peripheral nerve function.

ABSTRACT Introduction: High intensity cutaneous stimulus transiently suppresses tonic voluntary muscle activity resulting in cutaneous silent period (CSP). Aim: The aim of our study was to evaluate the normal values of an onset latency L1, a late latency L2 and a duration of CSP after stimulating sensory fibres of the median nerve. Material and Methods: This prospective study was performed at the Neurology Department, Clinical Center of Sarajevo University in period from January 1st 2013 to December 1st 2013. In our study we examined 61 subjects. The group included our relatives, coworkers and friends. The informed consent from testing subjects was obtained. Results: The origin of silent period is stimulation of small A-delta nerve fibres. The pre-synaptic or post-synaptic interruption of the electrical volley to motor neurons is discussed. Median values of muscle activity suppression in healthy female is 55.0 ms (45.0-74.0) and 59.0 ms (52.0-67) male subjects. There is a correlation between the onset latency L1and the late L2 latency (p‹0.03). In the on-going study it seems that delay of L1 and shorter muscle activity suppression might provide a sign of small nerve fibres involvement. Conclusion: The use of CSP improves the value of neurophysiology examination.