Aim – The aim of the study was to discover risk factors for delivery-plexus brachialis injury in newborns.  Methods – The data on plexus brachialis paralysis during the delivery of 45503 newborns were analyzed studying retrospectively babies who were delivered from 1 January 1996 to 31 December 2004 at Clin­ics for gynecology and obstetrics at the University-clinical centre in Tuzla. In the analyzed population we found 86 newborns with plexus brachialis injury which developed during delivery (examinees). The control group was formed of 86 newborns without plexus brachialis injury, chosen randomly as a sample from the same population (control group). The examinees and control group were compared regardless of gender, gestation period, delivery weight, presentation (occipital and pelvic) of the fetus during deliv­ery, as well as the Apgar score after the first and fifth minutes. The statistic significance of the results was evaluated with the I‡2 test.  Results – There were no differences in gender between the examinees and the control group. A signifi­cant difference in distribution of delivery weight was found between examinees and the control group: a frequency of delivery weight from 4000-4599 grams, and especially weight higher than 4500 grams, was significantly higher than in the control group. The discovered difference in incidence of occipital presentation during delivery in favor of the examinees was not statistically significant. Examinees had a significantly lower Apgar-score (≤7) - after both the first and fifth minutes. In 35 of 86 (42.5%) examinees we found combined clavicle fracture, plus in one humerus fracture and in one rib fracture.  Conclusion – The result of this research corresponds to findings from literature on risk factors for plexus brachialis injury: the most noticeable risk factors are delivery weight over 4000 grams and a low Apgar-score as a result of traumatic delivery, whereas in our research, contrary to other sources, the pelvic posi­tion of the foetus during delivery was not a statistically proven risk factor, at least in our case.

BACKGROUND Obstetrical brachial plexus lesion (OPBL) complicates a very small proportion of births. The aim of this study was to establish incidence of OPBL at Department of Gyneclogy and Obstetrics during a period of nine years, from 01.01.1996 to 31.12.2004, and to analyse intrapartum risk factors for OPBL. SUBJECTS AND METHODS The analysis was retrospective and is based on medical documentation from Departments of Gynecology and Obstetrics, Neurology, and Rehabilitation, University Clinical Center Tuzla. We analyzed a group of 86 newborns with OPBL born form 01.01.1996. - 31.12.2004. Differences among study and control groups were compared using Hi2 test. Probability value of p<0.01 was considered significant. RESULTS During nine years period incidence of OPBL was 1.86 per 1000 live-born children. Analyzing maternal factors, and the delivery pattern itself, we have found that the highest factors of risk for OPBL are shortened second stage of delivery (<15 minutes) (p<0.01), and vacuum-extractor assisted delivery of newborns (p<0.01). Newborns, who were delivered vaginally, were not diagnosed to have a higher frequency of OPBL compared to newborns who were delivered by Caesarian section. CONCLUSION Incidence of OPBL at Departmenf of Gynecology and Obstetrics is 1.86/1000 liveborn children. Most important intrapartum risk factor for OPBL are shortened second stage of delivery and vacum-extractor assisted delivery.

Multiple sclerosis is an insidious, intermittent or chronic progressive inflammatory, autoimmune disease of the central nervous system; it is a major cause of disability, especially in young adults. It affects women twice as often as men. The prevalence varies from 50 to 100 per 100,000 in moderate climate zones. Interferon beta-1b reduces frequency and severity of clinical attacks of relapsing-remitting multiple sclerosis and prolonged time until the progression of disability and time patients suffering from secondary progressive multiple sclerosis become wheelchair-bound.

STAI-state (r1⁄40.200; p1⁄40.039), and the BDI (r1⁄40.350; p<0.001). Conclusions: Correlations between the WURS and other impulsivity-related psychometric scales such as the BIS-11, or the ‘‘emotional stability’’ factor and the ‘‘emotion control’’ and ‘‘impulse control’’ subfactors of the BFQ, provides evidence for the concurrent validity of the WURS. The correlation of this instrument with anxiety and depression scales points to possible clinical implications.

STAI-state (r1⁄40.200; p1⁄40.039), and the BDI (r1⁄40.350; p<0.001). Conclusions: Correlations between the WURS and other impulsivity-related psychometric scales such as the BIS-11, or the ‘‘emotional stability’’ factor and the ‘‘emotion control’’ and ‘‘impulse control’’ subfactors of the BFQ, provides evidence for the concurrent validity of the WURS. The correlation of this instrument with anxiety and depression scales points to possible clinical implications.

AIM To assess psychological consequences of domestic violence, and determine the frequency and forms of domestic violence against women in Bosnia and Herzegovina. METHODS The study was carried out in the Tuzla Canton region in the period from 2000 to 2002, and included 283 women aged 43+/-9.6 years. Out of 283 women, 104 received psychiatric treatment at the Department for Psychiatry of the University Clinical Center Tuzla, 50 women were refugees; and 129 were domicile inhabitants of the Tuzla Canton. Domestic Violence Inventory, Cornell Index, Symptom Checklist-90-Revised, PTSD Checklist Version for Civilians, and Beck Depression Inventory were used for data collection. Basic sociodemographic data and information from the medical documentation of the Department for Psychiatry of the University Clinical Center Tuzla was also collected. RESULTS Out of 283 women, 215 (75.9%) were physically, psychologically, and sexually abused by their husbands. Among the abused, 107 (50.7%) experienced a combination of various forms of domestic violence. The frequency of domestic violence was high among psychiatric patients (78.3%). Victims of domestic violence had a significantly higher rate of general neuroticism, depression, somatization, sensitivity, obsessive-compulsive symptoms, anxiety, and paranoid tendency than women who were not abused. The prevalence of posttraumatic stress disorder (PTSD) symptoms according to the type of trauma was higher in women with the history of childhood abuse (8/11) and domestic violence (53/67) than in women who experienced war trauma (26/57) and the loss of loved ones (24/83). The majority of 104 psychiatric patients suffered from PTSD in comorbidity with depression (n=45), followed by depression (n=17), dissociative disorder (n=13), psychotic disorder (n=7), and borderline personality disorder with depression (n=7). The intensity of psychological symptoms, depression, and Global Severity Index for Psychological Symptoms (GSI) were in significant positive correlation with the frequency of psychological (r=0.45, P<0.001), physical (r=0.43, P<0.001), and sexual abuse (r=0.37, P<0.001). CONCLUSION Domestic violence in various forms had long-term consequences on mental health of women. This should be taken into account when treating women with war-related trauma.

The aim of the study was to analyze the 5-year survival after first-ever ischemic stroke and intracerebral hemorrhage. In this study 836 patients were analyzed with a first-ever stroke admitted at the Department of Neurology Tuzla, Bosnia and Herzegovina, from January 1(st) 1997 to December 31(st) 1998. Of these 613 (73,3%) were ischemic strokes and 223 intracerebral hemorrhages (26,7%) Subarachnoid hemorrhages were excluded. After hospitalization surviving patients examined periodically, and a final examination was performed 5 years after the stroke. Overall, case-fatility at the first month was 36% (301/836) and the mortality rate was significantly higher in the patients with intracerebral hemorrhage (58,3% vs. 27,9%, p<0,0001). The first year survived 60% patients with ischemic stroke, and 38% with intracerebral hemorrhage. After 5 years, 188 (31%) patients with ischemic stroke and 53 (24%) with intracerebral hemorrhage were alive (p=0,5), and the cumulative survival rate for the entire study was 29%. Among 30-day survivors (n=535) surviving rate after 5 years was significantly higher in patients with intracerebral hemorrhage (57% vs. 42,5%, p=0,01). The survival rate was the highest for those 50 years and younger (57%), and the lowest for those aged over 70 years (9%). Predictors of 5-year mortality were older age and hypertension for both types of stroke, heart diseases for ischemic stroke and diabetes for intracerebral hemorrhage. Long-term survival after first-ever ischemic stroke and intracerebral hemorrhage is similar. However, among 30-day survivors the 5-year survival is better in patients with intracerebral hemorrhage.

It was performed electroneurographic (ENG) studies with surface electrodes and examined nervus medianus (NM) in 60 patients (38 females), average age of 50,28 years (X+/-SD=50,28+/-11), with clinical diagnosis of carpal tunnel syndrome (CTS) and at least one border or discrete abnormal value of conventional electrophysiological tests. It was also examined 57 healthy individuals (33 females) as control group, average age of 45,65 years (X+/-SD=45,65+/-9,68). The sensitivity and specificity of sensory-motor index (SMI), terminal latency index (TLI) and residual latency (RL) were calculated and compared. SMI is determinate by using following formula: distal distance (DD) (in cm)/distal motor latency (DML) (in ms) + sensory conduction velocity (SCV) (in m/s)/motor conduction velocity (MCV) (in m/s) of NM. SCV of NM was measured by antidromic technique in segment wrist-index finger and MCV of NM in forearm segment above wrist. SMI mean value of control group was 3,45 (X+/-SD=3,45+/-0,45) with lower limit of normal value 2,82 and in patients with CTS 2,13 (X+/-SD=2,13 +/-0,37). The sensitivity of SMI in patients with CTS was 98,51%. SMI is useful parameter in electroneurographical diagnosis of CTS and it's determination is easy and fast and specially important in cases with border or discrete abnormal values of other NM electrophysiological parameters, when SMI values can indicate incipient phase of CTS evolution. In rare cases (about 1%) of CTS with selective NM motor axons affection, SMI may have normal value (false negative result), but DML is always prolonged in this cases. SMI is not dependent on age and DD values in patients with CTS and control subjects.

After the war in Bosnia-Herzegovina, mental illness is very prevalent. With little knowledge about mental health, the stigma of mental illness is still pervasive in many communities. To combat this prejudice, we describe mental health promotion strategies which can empower individuals and educate the communities in which they live.

Acute disseminated encephalomyelitis (ADEM) is a monophasic, immuno-mediated disease with multifocal demyelinated lesions in the central nervous system (CNS). However, the course of disease could be with multiple sclerosis (MS)-like relapses. ADEM is a childhood disease (children 10 years of age and younger) and could be the first phase of MS in 25% or more children. Onset of the disease is acute. The clinical picture depends on the intensity of the process itself, and the parts of the CNS affected. It correlates with an infectious syndrome affecting the menings and different parts of the brain and spinal cord. Prognosis is very uncertain, and the disease is lethal in 1/3 of cases. MS is a chronic inflammatory, non-contagious, progressive multifocal demyelinated, autoimmune disease of the CNS (white matter of the brain and spinal cord) with many and various neurological symptoms. In 85-90% of cases the symptoms come and go in “attacks” (exacerbations and remissions), or slowly progress over time. The cause and pathogenesis of MS still is not well known. Inheritance could have an important possible precipitating role. The pathogenesis of MS includes inflammation, demyelinisation and axonloss. Although demyelinisation could generate relapse, long-term disability is primarily due to irreversible loss of axons and cell death. MS is most frequent in patients 30 to 40 years of age, although it can be seen prior and after this age range. Childhood onset is reported in 3-5% of cases. It is estimated that 2.5% to 5% of all MS patients experience the first MS “attack” before 16 years of age. Onset before the age of 10 occurs in only 0.2% cases. Diagnosis of ADEM and/or MS is based on cerebrospinal liquor analysis, brain evoked potentials (EP’s), and magnetic resonance imaging (MRI) of the brain and spinal cord. Computed tomography (CT) of the brain could be useful, not to diagnose MS but to exclude some other brain disorders (tumors, stroke etc.). Recently, for secure diagnose of MS revised McDonald’s criteria for MS are used. Patients with ADEM are treated with anti-inflammatory medications (corticosteroids) and immunosuppressive therapy administered in the same manner as in MS. Interferon I² (1a, 1b), as well as glatiramer acetate are used to slow the progress of MS.