Lafora progressive myoclonus epilepsy (Lafora disease, LD) is a fatal autosomal recessive neurodegenerative disorder (with an onset in teenage years in previously normal adolescents). This paper represents a view of a patient diagnosed with Lafora progressive myoclonus epilepsy, over a course of seven years. A description of the initial manifestation of symptoms, doctors' attempts to combat the symptoms with drug treatment, further attempts towards reaching the correct diagnosis, the final confirmation of the Lafora diagnosis (mutation in the NHLRC1 gene), and the current state of the patient is presented. The absence of a positive family history, the lack of staff specialized in dealing with this or similar pathology, and the diagnostic inability to characterize this type of disorder in Bosnia and Herzegovina have led to a fair delay in diagnosing and beginning of an adequate pharmacological treatment. Overall, recent identification of LD cases in Bosnia and Herzegovina warrants an establishment of a Centre for Genetic Testing in order to ensure more humane counseling of an entire family whose family member(s) might be diagnosed with this devastating and currently an incurable disorder.

INTRODUCTION Education in medicine faces a number of challenges and dilemmas and the onus is on Medical hodegetics, an important but almost forgotten discipline, to address them effectively. The task and final goal of education in medicine is to coach students into professionals, effective and ethical practitioners of medicine, giving them the best available knowledge, skills and attitudes and providing them with a professional identity so that they are able to think, speak, act and feel like medical doctors. During the life course human beings organize their experiences into a meaningful narrative that involves their personal, private, public and professional selves. The self can be defined as a distinct principle of identity, as a narrative construction and as an experiential dimension. AIM The aim of this paper is to address the actuality and vitality of the hodegetic approach in medical education and professionalism. METHODS By cross-sectional study authors of the paper searched on-line scientific data-bases and analyzed references about Medical hodegetics subject. RESULTS Drawing on the literature on psychology of self, identity formation and personality styles as well as on own experience in medical education, the authors stress the increasing importance of medical hodegetics, very useful, but almost completely forgotten discipline. Medical hodegetics which involves all evidence-based medicine, values-based medicine, narrative medicine and person-centered medicine can significantly improve the quality of medical education. The identity of any person in any moment reflects its three domains: individual identity, relational identity, and collective identity, all relevant to medical education. The concept of professional identity formation has recently emerged and attracted great attention in literature on medical education and professionalism. Hodegetics, as a discipline that trains it, seems to us that the essential part of life and what every person should follow. CONCLUSION Medical hodegetics is an important pillar of the triad of medical deontology as well as it could be an important discipline in medical education and professional identity formation.

Title of Days of AMNuBiH 2018” and “SWEP 2018” is “Ethical Dilemmas in Science Editing and Publishing”. Why? If one wants to create a scientific work, must have on his mind that creating a scientific work requires creativity and openness, honesty, trust, and obeying the ethical principles for writing a scientific paper. While working on a an biomedical research involving human subjects medical workers should have on mind that it is the duty of the physician to remain the protector of the life and health of that person on whom biomedical research is being carried out. The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects.

Aim: Aim of the article was to present a case of post transplantation invasive aspergillosis, successfully treated with conservative and surgical treatment. Case report: Patient, male, 44 years old, with second kidney transplant, required special preparation therapy, because he was sensitized, with concentration of Panel Reactive Antibody (PRA) class I 11% and PRA class II 76%. On the day of transplantation, induction was done with anti-thymocyte globulin (ATG) and glucocorticosteroids. After transplantation, plasmapheresis with ATG was performed. On the fourth day patient was anuric. Fine-needle biopsy of the graft was performed and showed positive CD4 antibodies for peritubular capillaries and humoral rejection. 14 plasmaphereses through 14 days, were negative and ATG treatment was suspended completely. Full therapeutic dosage of tacrolimus and mycophenolate mofetil were given during treatment. Four days after treatment patient was stable, but next day clinical status had worsened with dyspnea and fever. In sputum, spores of Aspergillus species were microscopically found, and radiologically by computerised tomography. Caspofungin was administered for seven days. Voriconazole therapy was given for first ten days by intravenous route and after then orally. Even with this treatment, there was no improvement in clinical picture, while CT scan of the lungs showed abscess collection in right lung. Lobectomy was performed and pus collection was found. After graft-nephroctomy, patient was treated with continous veno-venous hemodiafiltration (CV-VHDF) dialyses, with constant voriconazole therapy for the next three months (200mg two times per day). After one month of diagnosis, Galactomannan (GM) test was negative. Conclusion: Although highly sensitized patients, those who are on hemodialysis, in preparation for transplantation, receive intensive immunosuppressive therapy that suppress the immune system. Occurrence of secondary fungal infections especially infection by aspergillosis, is cause of high mortality of infected. Application GM test that detects existence of antibodies against Aspergillus antigens and usage of different type of immunosuppressive preparation can increase longevity of graft and patients in solid organ transplantation program. Aspergillosis is treated with voriconazole and surgery, and sometimes graft-nephrectomy if needed. Recommendation is that in all immunocompromised hosts and organ transplant recipient should have been tested with GM test.

Introduction: In patients with acute myocardial infarction (AMI) early risk assessment of development of complications is of great importance. It is proven that aldosterone level has a major role in progression of cardiovascular pathology. Aim: Determination of influence of aldosterone plasma level in the progression of heart disease in patients without signs of heart failure after AMI. Material and Methods: Research included 207 patients, hospitalized in the acute phase of myocardial infarction, and who were divided into two groups: 127 patients with no clinical signs of heart failure and 60 patients with heart failure. Results: The serum aldosterone concentration was 73.4% higher in the group of decompensated patients, 128 pg/mL (75.4-236 pg/mL) in decompensated and 73.7 pg/mL (42.7 -115.25 pg/mL) in compensated. In the group of compensated patients, changes in aldosterone levels showed a statistically significant effect on the incidence of post-infarction angina (p=0.0001) as well as reinfarction (p=0.009). There is a connection between changes in aldosterone plasma level and positive stress test (p=0.012). Conclusion: In patients with AMI, elevated serum aldosterone level can be prognostic factor of the progression of coronary heart disease, development of heart failure, as well of development of post-infarction angina, myocardial reinfarction and pathological finding on the stress test.

1Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina 2University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina KeYWORdS: natriuretic peptides, brain natriuretic peptide, biomarker of myocardial infarction, Alzheimer’s disease. citAtiON: Cardiol Croat. 2018;13(11-12):435. | https://doi.org/10.15836/ccar2018.435 *AddReSS fOR cORReSpONdeNce: Edin Begic, Sarajevo School of Science and Technology, Sarajevo Medical School, Department of Pharmacology, Hrasnicka cesta 3a, 71000 Sarajevo, Bosnia and Herzegovina. / Phone: +38761303375 / E-mail: edinbegic90@gmail.com ORcid: Edin Begic, https://orcid.org/0000-0001-6842-262X • Suncica Hadzidedic, https://orcid.org/0000-0001-9026-8737 Ajla Kulaglic, https://orcid.org/0000-0003-3410-7079 • Belma Ramic-Brkic, https://orcid.org/0000-0002-8205-0137 Zijo Begic, https://orcid.org/0000-0002-1863-5755 • Mirsada Causevic, https://orcid.org/0000-0002-6099-6415

Introduction: Brugada syndrome (BS) is a dominantly inherited arrhythmogenic disease caused by a mutation in the SCN5A gene. It accounts for 20% of cases of sudden death, without structural heart abnormalities1. Diagnosing the BS is achievable by electrocardiography (ECG), ST segment elevation in V1 to V3, with the right bundle branch block pattern as a hallmark of the syndrome2. BS is divided into three types. However, only type 1 can be verified with an ECG2,3. BS manifests as a syncope that is caused by ventricular tachycardia, which, if converted to ventricular fibrillation, leads to a fatal outcome. An implantable cardioverter defibrilator (ICD) implantation is indicated, while pharmacological therapy on its own is not sufficiently effective. Aim: To present a diagnostic and therapeutic approach towards suspected BS in a younger patient. Case report: 24-years-old patient was admitted to a hospital, after a cardiac arrest and a prolonged cardiopulmonary resuscitation with intubation. ECG findings verified sinus rhythm, with heart rate of 94 beats per minute, normal heart axis with PQ interval of 0.16 s, and right bundle branch block (RBBB) with an ST elevation from V1 to V3. An ajmalin provocation test was performed, and ECG changes (J-wave elevation of >2 mm with ST elevation from V1 to V3 with RBBB) were recorded, but without induced ventricular arrhythmia. Patent foramen ovale was suspicious as a cause, but after transesophageal echocardiography it was excluded. According to electrocardiographic changes, the BS was diagnosed as the cause of malignant ventricular heart rhythm. Genetic testing for Brugada syndrome was not performed and in consultations with the Centre for Electrophysiology in Sarajevo (Bosnia and Herzegovina) and Zadar (Croatia), the implantation of an ICD was indicated, and subsequently performed. The patient was discharged under pharmacological therapy consisting of metoprolol 25 mg twice per day, amiodarone 100 mg per day, with magnesium, and aspirin once per day. Conclusion: In daily clinical work, in all conditions of syncope occurring in younger patients, in order to prevent sudden death, an existence of the BS should be considered. An overall clinical status of a patient, including positive ajmaline test with specific ECG changes, can verify BS, even when information on the presence of the SCN5A gene is not available.

The reform of the higher education system and the introduction of the Bologna Process throughout the University of Bosnia and Herzegovina, the PhD study became the next step in education after the completion of an integrated study of medicine.

Background: The aim of the article was to define etiological factors for the occurrence of thromboembolism venous and arterial segments and preview of the sensitivity and specificity of diagnostic procedures in the treatment algorithm. Patients and Methods: The study included 60 patients during the 4-year period. The patients are classified into two groups according to the type of thromboembolism, in the group under the diagnosis of venous thromboembolism and group under the diagnosis of arterial thromboembolism. Results: Statistical analysis showed that arterial thromboembolisms occurred statistically significant later in comparison to venous (t = 4.0969; P = 0.0001). The mortality relationship with all analyzed parameters (age, erythrocytes, hemoglobin, platelets, gender, D-dimer, fibrinogen, immobility, veins surgery, pregnancy, smoking, orthopedic trauma, neoplasms, and pulmonary embolism) showed that statistically significant association was observed only in the case of pulmonary embolism. Conclusion: Biochemical parameters of the blood of patients; red blood cell count, hemoglobin concentration, and platelet counts in the study conducted showed a positive relationship with the occurrence of venous thromboembolism while D-dimer and fibrinogen present in increased values in most patients with venous and arterial thromboembolism. Pulmonary embolism directly affects the outcome of patients with thromboembolic diseases taking into account that in the study conducted in venous thrombosis complicated pulmonary embolism resulted in deaths.

Introduction: Heart rhythm disorders are quite common in the clinical course of acute myocardial infarction and have a significant influence on the prognosis of the disease. Aim: To investigate the type and frequency of ventricular arrhythmias in patients with acute myocardial infarction (AMI) by sex and age, according to localization of myocardial infarction, and correlated with troponin and C reactive protein (CRP). Material and Methods: A prospective, analytical, comparative clinical study was performed. A total of 100 patients was included who were hospitalized at the Clinic for Heart Disease and Rheumatism at the Clinical Center University of Sarajevo for a period of 6 months, of both sexes, aged from 20 to 90 years. The occurrence of ventricular arrhythmias, CRP and troponin, were observed in relation to the localization (anterior and inferior myocardial wall). Results: It was found that men are more represented in comparison to women and that the largest number of males were in the age group of 51-60 years of life and women in the age group of 71-80 years. It has been established that there is no significant difference between ventricular arrhythmia according to localization of AMI. By determining the mean CRP and troponin levels, a positive correlation was found between CRP and troponin values and recorded ventricular arrhythmias. Conclusion: There is a positive correlation between the troponin and CRP values and ventricular arrhythmias, not related to the localization of AMI, which is important in prevention and planning the treatment of complications of potentially malignant ventricular arrhythmias and fatal outcome at AMI.

The aim of this study was to present a patient (acute allograft dysfunction after a kidney transplantation) with previously detected minimum plaque on both iliac arteries by scintigram and afterward a pathological Color Doppler Ultrasound (CDU) record and to point on possibility of avoiding toxic computed tomography (CT) angiography in certain renal graft recipients. Ultrasound (US) findings showed normal graft size, whereas Doppler signals detected parvus-tardus waveforms pointing to arterial stenosis. Isotope perfusion scintigraphy registered a slow flow on both iliac arteries and normal graft perfusion. CT angiography has not been performed because of the possible toxic effects to the graft. We believe that favorable clinical and biochemical findings along with US and isotope ratio monitoring are sufficient to avoid CT contrast angiography.

Introduction: In addition to the fastest reperfusion procedure of coronary arteries blood flow, identification of patients with increased risk of early and late complications is of the utmost importance in acute myocardial infarction (AMI). Methods: We included total of 207 patients in the acute phase of myocardial infarction, which were divided into two groups, 127 patients without clinical symptoms of heart failure (HF) and 60 patients with HF symptoms. For all patients serum aldosterone levels were determined 24 hours after acute MI. Results: In the group of decompensated patients, changes in aldosterone level did not show a statistically significant effect on paroxysmal supraventricular tachycardia (PSVT) occurrence (p > 0.05), while in the group of compensated patients there is statistically significant effect on PSVT occurrence (p =0.004). Changes in aldosterone level in the group of decompensated (p=0,030) and compensated patients (p=0,024), showed statistically significant influence on the ventricular tachycardia (VT) occurrence. In the group of compensated patients, changes in aldosterone level showed a statistically significant effect on ventricular fibrillation (VF) occurrence (p = 0.024). Conclusion: Plasma aldosterone level in patients with acute myocardial infarction has a significant influence on the occurrence of cardiac rhythm disorders irrespective of the existence of cardiac decompensation. Keywords: aldosterone, myocardial infarction, prediction.