Objectives. To determine the severity of stroke and mortality in relation to the type of disturbance of consciousness and outcome of patients with disorders of consciousness. Patients and Methods. We retrospectively analyzed 201 patients. Assessment of disorders of consciousness is performed by Glasgow Coma Scale (Teasdale and Jennet, 1974) and the Diagnostic and Statistical Manual of Mental Disorders (Anonymous, 2000). The severity of stroke was determined by National Institutes of Health Stroke Scale (Lyden et al., 2011). Results. Fifty-four patients had disorders of consciousness (26.9%). Patients with disorders of consciousness on admission (P < 0.001) and discharge (P = 0.003) had a more severe stroke than patients without disturbances of consciousness. Mortality was significantly higher in patients with disorders of consciousness (P = 0.0001), and there was no difference in mortality in relation to the type of disturbance of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness. Conclusion. Patients with disorders of consciousness have a more severe stroke and higher mortality. There is no difference in mortality and severity of stroke between patients with quantitative and qualitative disorders of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness.

1.1 Stroke According to the World Health Organization (WHO), stroke is defined as the sudden development of focal or global symptoms and signs of disturbance of cerebral function lasting more than 24 hours or leading to death, as a result of the pathological processes of vascular origin (Thorvaldsen et al., 1995). The basic classification of stroke, according to the type of pathological process, is into ischemic stroke, which comprises 70-85%, and hemorrhagic. An ischemic stroke develops due to the inability of supply to brain tissue oxygen and glucose due to occlusion vessel. If the "outbursts" of blood within the brain mass, there is intracerebral hemorrhage, which makes 15-20% of strokes, while the penetration of the blood in the subarachnoid space, usually as a result of aneurysm rupture, leading to a subarachnoid hemorrhage, which makes 5-10% of all strokes. Stroke leads to focal or multifocal neuropsychological disorders. Given that in clinical stroke in the forefront of motor deficits, disturbance of consciousness and disturbance of speech functions, a very common disorder and the function of other organ systems, most of the neuropsychological symptoms are observed after the acute phase when the general and neurological status stabilized, or when we are able to perform certain neuropsychological tests (Dostovic, 2007). Stroke leads to the different degree of physical, cognitive and psychosocial dysfunctioning. The recovery of patients depends on the severity of disability, the rehabilitation program, but also the subsequent maintenance of achieved function, as well as care and support of family and environment.

Ischemic stroke (IS) is defined as rapid development (focal or global) of clinical signs of brain function disorder with symptoms lasting 24 hours or longer, or leading to death, without other clear causes except destruction of blood vessel.1 Anxiety does occur in patients with IS, but not in those with intracerebral hemorrhages.2 Astrom found symptoms of anxiety in 28% of patients in acute phase of stroke.3 The aim of this study was to analyze anxiety in patients within 48 hours (hyperacute and acute phase) and 15th day (subacute phase) after the IS in relation to gender and location of the lesion. PATIENTS AND METHODS

Aim: To determine the frequency of delirium in patients with acute stroke. Patients and methods: We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤ 4 days) stroke using the Delirium Rating Scale R-98 and the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition criteria for delirium. Results: Delirium was diagnosed in 59 (25.3%) patients. Patients with delirium were older comparing to those without delirium (70.0±11.3 vs. 64.7±10.4 years of age; p=0.001). Delirium was significantly more frequent in hemorrhagic comparing to the ischemic type of stroke (41.6% vs. 22.3%, p=0.02). In patients with the ischemic stroke, the delirium was more frequent among those with right hemispheric lesion (26.2% vs. 20.5%, p=0.0006); however, in hemorrhagic stroke delirium was more frequent in patients with left hemispheric lesion (42.9% vs. 27.8%, p=0.002). Delirium was also more frequent in patients with ischemic stroke in the anterior than posterior cerebral circulation territory (22.7% vs. 5.6%, p=0.0001). Conclusion: Delirium develops in approximately one quarter of patients in the acute phase of stroke. Possible factors which predispose the occurrence of delirium are ages over 65 years, hemorrhagic stroke, ischemic stroke in anterior cerebral circulation, lesion of right hemisphere in ischemic stroke and left hemisphere in hemorrhagic stroke.

Generally, Arnold – Chiari malformation associated with syringomyelia is not rare. In this case report we present a 52 years old female patient with a history of neck-pain, low-back pain, pain in both arms as well as frequent numbness in the lateral regions of both arms. She also experienced walk disturbance and in her previous history she reports a car accident, twenty-eight years ago. She broke windshield with her forehead, but remained conscious at the time. At the time of admittance at the Department of Neurology, her neurological status was remarkable for cerebellar symptomatology (ataxia, positive Romberg-sign, «finger–nose» test which she did with tremor and was not able to perform «tandem-walk»), hypoestesia of the right side of the body, hyper-reflection of both arms and legs, bilaterally, more pronounced at the right side; right foot subclonus and spastic-ataxic walk. Neurological status could not be explained by previously performed tests: x-ray of cervical spine, lumbal myelography, computerized tomography (CT) of the brain. However, magnetic resonance imaging (MRI) of the brain and cervical spine verified Arnold-Chiari malformation (type I) associated with syringomyelia from C3 to C7. Patient was referred to surgery and subsequent physical rehabilitation.

The first records of organized health service in Tuzla and Tuzla area date back to the nineteenth century. Friar Ivan Kljaic, military physicians Muhidin-bey, Mehmed Said-Effendi and Ignatius Gulielmus Petelenz are honourably mentioned. Dr Mehmed Sami Serbic founded the first hospital-Hastahana in Tuzla. Respected both as a physician and a humanist, Serbic’s work leaves a remarkable trace. After the annexation of Bosnia and Herzegovina by Austria-Hungary, three female physicians: Anna Bayerova, Teodora Krajewska and Jadwiga Olszewska were engaged to work in Tuzla area. Each of them made a tremendous contribution to the development of health care, not only in Tuzla area but throughout the country. Physicians Josip Lymberski and Josef Foglar are employed by so called Miners Hospital. Due to malaria and cholera epidemics which affected the region in 1893, two epidemiologists-bacteriologists arrived in Tuzla, Rudolf Fischer and Josef Katz. The objective of this overview is to preserve the memory of physicians who contributed through their work to the development of health care and service in Tuzla area in the nineteenth century.

INTRODUCTION Diabetes mellitus is a risk factor for stroke, but it is unclear whether stroke is different in diabetic and nondiabetic individuals. The aim of the study was to compare characteristics of stroke in patients with and without diabetes mellitus. METHODS This study included 833 acute stroke patients (697 [84%] had ischemic stroke, and 52% were females) admitted at the Department of Neurology Tuzla, Bosnia and Herzegovina, from January 1st 2003 to December 31st 2003. Risk factors, stroke severity (Scandinavian Stroke Scale, SSS)), stroke type, etiology, lesion topography and the outcome at 1 month (mortality and handicap) were assessed in all patients. RESULTS Overall, diabetes mellitus was present in 194 patients (23.5%). Females were overrepresented in the diabetic group of stroke patients (66% vs 48%, p = 0.0001). Initial stroke severity and lesion topography were comparable between the two groups. The diabetic patients reported a significantly lower current smoking (21% vs 29%) and alcohol intake (4.5% vs 9%) (p < 0.05). Patients with diabetes mellitus compared with patients without diabetes had more frequently atherothrombotic stroke (62% vs 33%, p < 0.0001), but less frequently embolic stroke (10% vs 17.5%, p = 0.02) and intracerebral hemorrhage (10% vs 18.5%, p = 0.005). Mortality at 1 month was higher in patients with diabetes mellitus (38% vs 26%, p = 0.001), and diabetes increased the relative death risk by 1.53 (95% confidence interval, 1.19 to 1.96). At the other hand, handicap (Rankin Scale) in surviving patients was insignificantly higher in diabetic group (2.7 vs 2.4, p = 0.07). Older age (70 vs 66 years, p = 0.008), atherothrombotic stroke (76% vs 53%, p = 0.002), and severe strokes (SSS 20.5 vs 39, p < 0.0001) were more associated in died stroke patients with diabetes mellitus compared with surviving diabetic stroke patients. CONCLUSION Diabetes mellitus is present in one fourth of acute stroke patients. Stroke patients with diabetes mellitus are associated with specific patterns of stroke type, etiology and mortality but not with stroke severity and handicap.

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease in adults that occurs in familial and sporadic forms. The mean age of onset of symptoms is 56 years and the mean duration of disease is 3 years. One of the theories on the pathogenesis suggests on mutation in gene that encodes superoxide dismutase, which is involved in metabolism of free radicals (copper, zinc). In this article we showed patient with early onset of disease associated with abnormality of copper level. Co morbidity with Wilson disease has not been proved. According to this case it is possible to think about changes in cuprum level at ALS patients.

INTRODUCTION Incidence of parkinsonism prior age 40 is observed in only 5% of total number of patients, under age of 20 it's very rare. CASE REPORT Male patient, age of 16 was hospitalized at Neurology Clinic regarding depression and anxiety, social withdrawal, studyng difficulties, lack of concentration, hands tremor and impaired balance. Difficulties started slow, three years before hospitalisation with affective symptoms. There was no history of similar disease in patient's family. During neurological examination signs which suggested extrapyramidal lesion were found (tremor, Cogwheel type of rigor, postural difficulties). Diagnosis of juvenile form of parkinsonism was set. Basic laboratory findings including serum caeruloplasmin and cooper level were normal. Neuroradiological investigations were without pathological signs, and visual evoked potentials were patological with left side lateralisation. Psychological tests suggested anxious personality characteristics with high emotional sensitivity, mental control and memory difficulties. Pharmacological approach with direct dopamine agonist (Bromocriptine) was started. On 7.5 mg daily significant reduction of symptoms was observed. CONCLUSION In affective disturbances at younger population differential diagnosis rare form of juvenile parkinsonism should be considered.

Initial data about organized health work in Tuzla area comes from nineteenth century. Priest Ivan Kljaie, military physicians Muhidin-bey, Mehmed Said-effendi and Ignatius Gulielmus Petelenz are mentioned in it. In Tuzla, Mehmed Sami Serbić in year 1874, found first hospital named Hastahana. As a physician and humanist he leaves indelible trace. Three female physicians: Anna Bayerova, Teodora Krajewska, and Jadviga Olszewska, after the annexing of Bosnia and Herzegovina by Austria-Hungary monarchy, were engaged to work in Tuzla area. Each of them gave important contribution to development of health care in Tuzla area and broader. Physicians Josip Lymberski and Jozef Foglar worked in so called Miners Hospital. Due to cholera and malaria epidemics during the year 1893, two epidemiologists-bacteriologists came in Tuzla. Their names were Rudolf Fisher and Jozef Katz. We believe, that this work contributes to saving the memory of the work of the physicians from the Tuzla area in nineteenth century.

A group of 103 adolescents who have been exposed to war trauma was examined by a specialist of physical medicine and rehabilitation and pedagogue-psychologist, in relation to deformities of spinal cord and other inborn anomalies. Repeated screening and retest on the level of stress and depression was done after two years. In the meantime, majority of adolescents was on physical and psychological treatment. It was established that 47 adolescents (45.6%) have simultaneously had flat back and flat feet, and that 12 of them (25.5%) from the same group had had 4 traumatic experiences. During the first testing, the medium stress level was established with 48 adolescents (46.6%), and during the retest this was established with 60 adolescents (58.2%). At the same time, we used Birleson scale of depression and established that 57 (55.3%) adolescents have had normal results; after the retest 66 (64.1%) adolescents have had normal result and this difference is statistically significant (p<0.002). When we analyzed diagnosis after the two screenings we did not found significant differences. Based on the results of this research, better programs for the team work with adolescents with deformities of spinal cord and depression can be made.

INTRODUCTION Period after ischemic stroke and myocardial infarction is followed by different psychological reactions. Anxiety represents one possible psychological problem. AIM To investigate presence of anxiety in patients within period from 48 hours till 15 days after ischemic stroke and myocardial infarction. SUBJECTS AND METHODS Fourty patients formed analyzed group. Their average age was 65.3 +/- 10.3 years (33-83). Twenty of them were females. Thirty patients formed controled group. Their average age was 57.46 +/- 10.6 years (42-78). Eleven of them were females. Twenty questions self-assessment Zung scales were used for anxiety levels determination, Responses were scored by points, which were summarized as final result. Final score of 50 and more points suggested that anxiety was present. RESULTS Average self-assessment anxiety score within 48 hours since ischemic stroke was 44.4 +/- 8.8 points, and 15-th day 42.2 +/- 7.7 (p=0.237). In twelve patients (30%) anxiety was found during the first surveying, and in 10 patients (25 %) during the second the surveying. Average self-assessment anxiety score within 48 hours since myocardial infarction was 43.1 +/- 8.3 points, and 15-th day 43.2 +/- 6.7 (p=0.959). In seven patients (23.3%) anxiety was found during first surveying, and in 5 patients (16.7%) during second surveying (p=0.52). CONCLUSION Anxiety represents important psychological problem for patients after ischemic stroke and myocardial infarction. Aldo number of anxiety patients is larger within 48 hours after ischemic stroke and myocardial infarction, average value in anxiety scale stays unreduced even 15 days after the beginning of the disease.

Epidemic food poisioning caused by food contaminated by microorganisms, its toxins or chemical toxic substances, emerge in the hospitals as specific kind of intrahospital infections. An occurrence of food poisoning in hospitals is facilitated by several facts as: centralized food preparation, kinds of food, staff carriers, an unfavourable hygienic regime in the kitchens and at the places where food is shared, crossing of clean and unclean paths in a kitchen, carelessness, non-education etc. Danger that contaminated food brought to hospitals is more serious since it is about consumers with disrupted health. Main goal of work was to show conditions in the central kitchen and restaurants in University clinical center Tuzla in regard to sanitary care of the staff hands, which are in direct and indirect contact with food, cutlery and working surfaces, that are in direct contact with food.