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A. Alajbegović, N. Loga, N. Tiro, E. Mehmedika-Suljić, S. Alajbegović

Results: Thirty percent of our subjects were diagnosed as PPD. Patients with PPD had more severe depressive symptoms during the last 3 months of pregnancy, higher rates of history of depression, PPD, postpartum blues, premenstrual dysphoric disorder, parental depression, poor social support, stressful life events during last 1 year, and problems in marriage as compared those without PPD. There was no significant difference between groups with respect to type of birth and pregnancy, history of abortion and curettage, and emotional re-sponse to oral contraceptive drugs. Conclusions: Assessing the factors that increase the liability to PPD would make it easier to detect the individuals with high risk and to provide earlier professional support to those individuals

E. Mehmedika-Suljić, A. Alajbegović, N. Loncarević, S. Alajbegović

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.

S. Alajbegović, Ž. Metelko, A. Alajbegović, E. Mehmedika-Suljić, H. Resić

Data from the World Health Organization show that there is an increase in the morbidity and mortality caused by ischemic coronary disease. Diabetes has been confirmed as an independent risk factor in the development of coronary disease. The aim of this study was to determine the effect and role of diabetes mellitus in patients suffering from acute myocardial infarction (AMI). The study included 506 patients treated for AMI at Department of Medicine, Cantonal Hospital in Zenica during 1991, 1993 and 1996. In total, there were 94 diabetic patients with AMI: 36 in 1991; 31 in 1993; and 27 in 1996. In the same years, 412 nondiabetic patients were treated for AMI: 127 in 1991; 143 in 1993; and 142 in 1996. The percentage of patients with AMI was significantly higher in the group of diabetics than in nondiabetics (p<0.01). The percentage of women with AMI was significantly higher among diabetics than among nondiabetics in all three study years (1991 and 1993, p<0.01; 1996, p<0.05). Among nondiabetics, the percentage of AMI was significantly higher in men as compared with women in all three study years (p<0.001). The percentage of diabetics with AMI did not change significantly among the three study years.

S. Alajbegović, A. Alajbegović, H. Resić

Neuropathic pain is result of damage or dysfunction of periphery or central nervous system. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pain and suffering and prevention of further development of pathological process. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. The main symptoms of neuropathic pain are described as lancinating, stabbing, or shooting pain. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. In the treatment of neuropathic pain drug such as opioid, nonsteroid antirheumatics, analgetics, tricyclic antidepressant and antiepileptic are used. The most successful treatment is with antiepileptic drugs of second generation. Carbamazepin was the drug of choice till ten years ago. Since then the leader position in treatment has belong to gabapentin in dose from 900-2400 mg daily. Currently the new drug is tested, antiepileptic pregabaline. The first experiences are promising.

S. Alajbegović, A. Alajbegović, H. Resić

Neuropathic pain is result of damage or dysfunction of periphery or central nervous system. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pain and suffering and prevention of further development of pathological process. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. The main symptoms of neuropathic pain are described as lancinating, stabbing, or shooting pain. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. In the treatment of neuropathic pain drug such as opioid, nonsteroid antirheumatics, analgetics, tricyclic antidepressant and antiepileptic are used. The most successful treatment is with antiepileptic drugs of second generation. Carbamazepin was the drug of choice till ten years ago. Since then the leader position in treatment has belong to gabapentin in dose from 900-2400 mg daily. Currently the new drug is tested, antiepileptic pregabaline. The first experiences are promising.

A. Alajbegović, E. Mehmedika-Suljić, S. Alajbegović

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.

H. Resić, A. Alajbegović, Vahidin Šahović, E. Mesic, E. Suljic

Introduction  Uremia is associated with different endocrinologic abnormalities, which in some cases induce polyendocrinopathia. Female patients on dialysis are often subject to menstrual disorders that are variously manifested. The aim of our paper is to evaluate the etiology of menstrual dysfunctions in female dialysis patients. Material and methods  Anamnesis, clinical and hormonal tests were performed on 25 female patients that were in chronic dialysis programs 4 hours, 3 times per week. Oligomenorrhea is considered as menstrual interval between 35 and 90 days and amenorrhea as cease of menstruation in the last six months. Results All patients had had normal menstrual cycles before the dialysis. Mean age of patients was 42.7 ± 9.96 years and mean dialysis duration was 75.5 ± 62.41 months. Out of the 25 patients, 10 developed amenorrhea when beginning dialysis and 5 of them regained regular menstrual cycle after one year. Seven patients had oligomenorrhea and 8 patients had an early menopause. Prolactin concentration was significantly higher in the group which developed menopause (N = 8), cpr = 1222.3 ± 1013.4, amenorrhea (942.2 ± 1061.2), oligomenorrhea (860.4 ± 897.2), compared to the group with a regular menstruation cycle (444.8 ± 299.7). The luteinizing hormone (LH) level in serum was increased in all groups. FSH was insignificantly higher in groups with oligomenorrhea and amenorrhea and amounted to 51.1 ± 69.9, while β-estradiol and progesterone were in normal ranges. Hemodialysis duration influenced the prolactin level and after one year of follow up prolactin level significantly decreased in the group with amenorrhea that regained regular menstruation (cpr = 596.2 ± 297.2). Conclusion  Different menstrual disorders are developed in dialyzed patients. Hyper prolactinemia was present in our dialysis population. Significant lowering of prolactin level in 20% of patients led to normalization of menstrual cycle.

E. Mehmedika-Suljić, A. Alajbegović, N. Loncarević, A. Kučukalić

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.

N. Loncarević, Enra Mehmedika-Sulić, A. Alajbegović, A. Kučukalić

Dementias represent nearly the most frequent diseases of the elderly population, out of which nearly 60% are related to the Alzheimer's dementia. According to the United Nations prognosis the number of patients suffering from this disease will raise from 25,5 million of cases, registered in 2000 up to 63 million in 2030, even 114 million in 2050. Therefore the recognition of this disease, earlier and exact treatment are substantially important both for the patient and the society. The treatment of this disease requires multidisciplinary approach. Thus we would like to focus on the neurologist role in this process.

T. Hajro, Ibrahim Ramić, A. Alajbegović

In the paper is shown the case of the patient of the CVI life, age of 40 years. It was about the vascular lesion left of the temperoparienal MRA shew the amputation of amputation of the temporal branches art. cerebri medii from the left side. The patient 6 years before she suffered of CVI infract myocard after which she recovered well. After the performed neurologic and physiatric treatment it came to the strength of the rude motor strength with the normalization of the speech.

H. Resić, A. Alajbegović, V. Sahović, E. Suljic, E. Mesic, Ranka Javorić

INTRODUCTION Correction of anemia in haemodialysed patients by recombinant human erythropoetin (R-Hu Epo) has been reported to improve sexual functions and hormonal disturbances. The purpose of this study was to evaluate how levels of sexual hormones and sexual function differ before and during a 12 month R-Hu Epo therapy. MATERIALS AND METHODS Thirty six male patients, mean age 47.5 +/- 12.78 and thirty six female patients, mean age 53.0 +/- 10.14, were included in this study. All patients were dialyzed 3 times per week with haemodialysis mean duration of 4.56 +/- 3.84 years. In order to evaluate sexual activities, the questionnaire was presented to all patients. The levels of prolactin, testosterone, FSH, LH were measured at the beginning of the study and every forth month during the study. RESULTS During twelve month therapy with Epo, serum hemoglobin significantly increased from 96.0 +/- 13.3 g/dl to 104.0 +/- 17.2 g/dl (p < 0.005), and hematocrit value rose from 0.284 +/- 0.046% to 0.308 +/- 0.052% (p < 0.05). Prolactin was not significantly decreased: at the beginning of the study was 540.3 +/- 302.2 and at the end 537.4 +/- 297.1 microIU/ml. Testosterone concentrations were in normal range in male patients (18.26 +/- 8.61 microIU/ml). There was significant difference in value of LH in female patients which increased from 57.68 +/- 62.58 to 73.79 +/- 68.52 IU/L. Improvement of sexual function was remarkable in female patients. In male patients sexual desire, frequency of sexual intercourse was strengthen after R-Hu epo therapy. CONCLUSION Better sexual functions in our patients after treatment with R-Hu Epo did not correlate with hormonal disturbances except changes of LH that increased at the end of the therapy.

N. Loncarević, Jasminka Dzelinović, A. Alajbegović, E. Suljic, A. Kučukalić, Azijada Suljak

The acute polyradiculoneuritis represent acute inflamatory polyneuropathy with unknown cause, frequently induced by prior virus and sometimes bacteria infection. The purpose of this paper is to establish particularities of the clinical course and results of the disease during the war and the post-war time. Within the retrospective study we performed analysis of all patients suffering from the acute polyradiculoneuritis between January 1992 and December 2003 year who during the mentioned period where treated at the Department of Neurology in Sarajevo. In addition to the anamnysis and the clinical examination, diagnostic criteria where laboratory parameters, EKG, cardiological finding, cerebrospinal liquor (LP) and the EMG finding.

A. Alajbegović, D. Kantardžić, N. Loncarević, E. Mehmedika-Suljić, S. Alajbegović, F. Kovac

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.

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