AIM To assess the psychological health of war-traumatized children in different foster settings and compare them with children living with one or both parents, 7 years after the 1992-1995 war in Bosnia and Herzegovina. METHOD The study was carried out in Tuzla, Bosnia and Herzegovina, in March 2002. We assessed 186 (93 girls and 93 boys) elementary school children aged 12.7-/+1.8 years for war trauma, presence of posttraumatic stress disorder (PTSD), and depression. There were 38 (14 girls) children from the government orphanage, 48 (24 girls) children from the non-governmental organization (NGO) SOS Children's Village, 50 (24 girls) children who lost a parent in the war but lived with the surviving parent, and 50 (31 girls) children who lived with both parents. For data collection, we used Children's Posttraumatic Stress Reaction Index and Children's Depression Inventory. Basic sociodemographic data were also collected. RESULTS Of 186 children, 90 (48.4%) had been forced into refuge because of the war. Loss of a family member was most frequent among children in the SOS Children's Village, who also experienced the highest number of other types of trauma. PTSD was present in 51.6% of 186 children, with the highest prevalence among children in the SOS Children's Village (39/48). PTSD prevalence was higher among children who lost a parent but lived with the surviving parent (29/50) then among children in the orphanage (15/38) or children living with both parents (13/50) (chi(2)(3)=33.075, P<0.001). Depression was present in 42 of 186 (22.6%) children, but with no statistical difference among the groups (chi(2)(3)=6.337, P=0.096). The prevalence of PTSD and depression was similar in boys and girls. Loss of a parent was associated with higher frequency of PTSD and depression. The loss of both parents was associated with high prevalence of PTSD, but not depression. Prevalence of PTSD was positively correlated with the prevalence of depression (Spearman's rho=0.188; P=0.01). CONCLUSIONS All children experienced war trauma and many had psychological consequences. The highest prevalence of PTSD, often comorbid with depression, was found among children who lost one or both parents. The children with the lowest rate of psychological disturbances were those living with both parents.

Aim. To investigate risk factors for brachial plexus palsy in newborns. We analyzed 45 544 live-born children, born over a nine-year period from January 1, 1996 to December 31, 2004. Methods. The analysis was retrospective and based on the medical documentation of the Clinic for Gynecology and Obstetrics, Clinic for Neurology, and Clinic for Physical Medicine and Rehabilitation of the University Clinical Center Tuzla. We compared study and control groups of newborns. Rates among groups were compared using Chi-square, with significance at p < 0.05, and with significance at p < 0.01. Results. Examining epidemiological characteristics, 86 newborns with brachial plexus palsy had been recorded, thus, the prevalence was 1.86 per 1000 live-born children. Analyzing maternal and neonatal factors, and the labor pattern itself, it was found that the highest factors of risk for brachial plexus injury were birth weight of over 4000 g, a precipitous second stage of labor (<15 minutes), and vacuum-extractor assisted labor. Brachial plexus palsy was more frequent when the mothers were overweight, with a body mass index ≥29 kg/m2. None of the parturient women, whose newborns were diagnosed with brachial plexus palsy, had external conjugate diameter <18 cm. Newborns delivered vaginally were not diagnosed with a higher frequency of brachial plexus palsy when compared to newborns who were delivered by cesarean section, but newborns who were vaginal breech-delivered were diagnosed to have a higher incidence of brachial plexus palsy. Newborns whose mothers were older than 35 years were diagnosed to have brachial plexus palsy more frequently, but a statistically significant difference between primiparas and multiparas was not found. A total of 39 newborns (45.2%) were diagnosed with a fracture of the clavicle, which was the most frequently combined damage with brachial plexus injury. Forty-two newborns (48.8%) had an Apgar score of ≤7 in the first minute after delivery, which indicates intrapartal fetal distress and is an indication of the traumatic nature of these deliveries. The average birth weight of newborns with brachial plexus damage was 3858.1±587.7 g, which for an average gestational age of 38.8±1.8 weeks, corresponds to eutrophic newborns. Both male and female newborns were diagnosed to have brachial plexus palsy comparably frequently, and almost all deliveries (97.7%) were initiated spontaneously. The majority of newborns were born between the hours of 02:00 and 03:00 and between the hours of 14:00–15:00.

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 Spinal muscular atrophies (SMA) are group of neuromuscular disorders characterized by degeneration of motorneurons in anterior column of medulla spinalis, and sometimes in motoneurons of cranial nerves and the brain. Causes of SMAs are mutations in genes encoding for SMN, SIP and NAIP that are very low in motorneurons of these patients. Ribonucleases (RNases) are enzymes that depolimerize RNA and may destabilize DNA. AIM The objective of this study was to determine ribonuclease activity in serum and urine of SMA patients. METHODS RNases were purified by anion-kation-exchange chromatographies, and HPLC, and their activity was measured by immunodetection using specific antibodies against rinonucleases in presence of RNA as a substrate. RESULTS Eosinophil-derived neurotoxin (EDN) activity iin serum of SMA patients was 5.6, 3.8 and 2.6 higher in type I, II and III comparing with control group. RNase inhibitor activity in serum of the same patients was 3.0 and 2.4 lower in type I and II vs. Control group, but in type III was unchanged. Similar results are found in urine of the same patients. CONCLUSION Increased serum and urin EDN activities in SMA patients could be used as a new additional clinical marker in their diagnosis.

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.

BACKGROUND Obstetrical brachial plexus lesion (OBPL) (also known in its various forms as Erb's palsy, Klumpke's paralysis, Erb-Duchenne palsy) complicates a very small proportion of births. Furthermore, it seems that more likely many cases recover with little in the way of remaining deficit, but it is equally certain that some cases will not recover. Electro diagnostic examinations are used as following the physical examination and can provide data on both the severity and timing of the injury. The initial study usually is performed 2-3 weeks after injury, when signs of enervation are seen in children with moderate or serious injuries. The incidence of obstetric brachial plexus palsy varies from 0.4 to 1 case per 1000 new born children. This incidence has remained unchanged since the beginning of this century despite current technologic advances. The aim of this paper is to review the literature and authors experience with OBPL. PATIENTS AND METHODS The study included 30 children examined in last 10 years at Electro myoneurography laboratory, Department of Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina. RESULTS AND DISCUSSION Total out of 20 children (66.67%) were male, and 10 (33.3%) female; in 11 (36.67%) palsy was on left, and in 19 (63.33%) on right side. Erb's palsy was seen in 27 (90%) and total palsy in the remaining 3 (10%) limbs. Electromyography was very useful test not only for diagnosis, but also for evaluation of recovery. Good recovery was observed in majority of these children, but some children has difficulty with active shoulder abduction, forward flexion, symmetric elbow flexion and forearm supination at age of one year and more, and mild shortening and atrophy of the limb are also observed.

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.

Bladder, bowel and sexual dysfunction are not rare in multiple sclerosis (MS). The most frequent bladder disorders are in urgency, frequency as well as retention. In this study we analyzed bladder dysfunction (urgency, frequency and retention), defecation (constipation and incontinence) as well as sexual problems (libido, erection and vaginal lubrication) in patients with relapsing-remitting form of multiple sclerosis (MS) depending on disability status. Concerning Expanded Diasability Status Score (EDSS), patients have been divided in two groups: EDSS 0-4.5. (Group A), and EDSS 5.0-10.0 (group B). We analyzed 60 patients: 35 (58.3%) women, and 25 (41.7%) men. In both group A and B, with no bladder disorder was 18 patients (30%). In group A: 15 (25%); in group B: 3 (5%). With urgent incontinence were 36 (60%) patients - group A: 19 (31%); group B: 17 (28%). With retention were 6 (10%) patients - group A: 4 (6.6%); group B: 2 (3.3%). There is no statistical significant difference in number of patients with and with no urinary problems in both groups (p>0.05). Of all analyzed patients in group A and B with no urinary disorders were 9 men (15%) and 9 women (15%). With urinary problems were 16 men (26.7%) and 26 women (43.3%). Statistically it is significant higher number of women than men (p<0.05). With no defecation problems were 54 (90%) patients - in group A: 36 (60%); in group B: 18 (30%). With constipation were 5 (8.3%) - in group A: 2 (3.3%); in group B 3 (5%). In group B one patient (1.6%) had incontinence. There is no statistical significant difference in number of patients with and with no bowel elimination dysfunction in both groups p>0.05). 12 (20%) men had no bowel elimination problems and 24 women (40%), but 10 (16.6%) men and 8 (13.3%) women had the bowel elimination dysfunction. There is no statistical significance (p>0.05). No libido disturbance had 44 (73.3%) patients. In the group A: 35 (58.3%); in group B: 9 (15%). 16 (26.7%) patients had the libido disturbances. In group A: 3 (5%); in group B 13 (21.6%). Statistically there is significant lower number of patients with libido problems in group A (p<0.05). No vaginal lubrication had 21 (35%) women. In group A: 18 (30%); in group B 3 (5%). Vaginal lubrication disturbance had 14 (23.3%). In group A: 7 (11.6%); in group B 7 (11.6%). Statistically it is significant lower number of women with no lubrication in group B (p<0.05). No erection problems had 11 (18.3%) men. In group A: 9 (15%); in group B 2 (3.3%). Erection disturbance had 14 (23.3%). In group A: 4 (6.6%); in group B: 10 (16.6%). There is statistical significant lower number of men with erection problems in group A. (p<0.05). Of all analyzed patients in both groups A and B 18 men (30%) and 26 (43%) women had no problems with libido and 7 (11.6%) men and 9 (15%) women had the problems. There is no statistical significance in sex distribution (p>0.05). 11 (18.3%) men had no erection problems, 14 (23.3%) had the problems. 21 (35%) women had no vaginal lubrication problems, 14 (23.3%) women had the problems. Erection disturbances are not statistically significant to vaginal lubrication problems (p>0.05).

Mental health is not considered only as absence of mental disorders, but rather as the achievement of higher standards of available psychical potentials. True devotion and obedience to The God give the one a huge and incredible strength, constant source of spiritual emotional and moral energy, which is of help in resisting destructive and slavery attacks of the environment and its materialistic-consuming tendencies, as well as social and mental disruption. According to the opinion of numerous worldwide recognized mental health experts, humankind of today is confronted with a number of problems, which are the consequence of spiritual and moral-ethical degradation of human being. Therefore, religiosity became the field of interest of mental health researchers. The results of new studies undoubtedly indicate beneficial effects of religion on life and mental health in humans. Religiosity reduces tendencies for risky behaviour, impulsive reactions and aggression; it corrects tendencies towards psychopathic and paranoid behaviour, reduces converse, depressive and schizoid tendency, and provides successful overcome of emotional conflicts. In comparison to low-religious adolescents, the factors such as inner conflicts, frustration, fear, anxiety, psychological trauma, low self-esteem, unbalance of psychical homeostasis, emotional instability, and negative psychical energy are less present in highly religious adolescents and neutralized in a healthier and more efficient way. Beneficial impact of religion on mental health derives from precise cognitive-behavioural patterns, which provide a clear life orientation, solid basis and safe frames for personality development, assuring human to be continually on the way to achieve its own generic essence and reach its own maturity and self-actualization.

Cultural differences in body dissatisfaction, the relationship of stress to body dissatisfaction and individual and cultural body ideals were investigated. Forty-eight United States women and 48 Bosnian women completed the Body Shape Questionnaire (BSQ), the Impact of Event Scale (IES), and a Body Figure Rating Scale. When Body Mass Index was controlled, United States women demonstrated more body dissatisfaction and chose smaller cultural ideal body sizes than Bosnian women, but did not differ on personal ideal body size ratings. Furthermore, stress was only related to body dissatisfaction for Bosnian women. Additional research is needed to further elaborate the body dissatisfaction differences as they relate to cultural values.

AIM To estimate the frequency, type, and severity of psychological trauma among Bosnian refugee adolescents during the process of repatriation after the 1992-1995 war in Bosnia and Herzegovina. METHODS A sample of 239 pupils (120 girls and 119 boys), with a mean age (+/-standard deviation) of 15.2+/-2.1 years were assessed for war traumatic events, acculturation and repatriation maladjustments, school behavioral problems, and presence of post-traumatic stress disorder (PTSD). The sample consisted of adolescents who were in the process of repatriation after exile in a foreign country (n=120) and internally displaced adolescents (n=119). RESULTS Adolescents who had been exposed to severe psychological war trauma still had high level of trauma more than three years after the end of war. The level of recalling traumas they experienced (mean+/-standard deviation=3.9+/-1.2 on a scale from 0 to 5) and frequency of PTSD symptoms (1.5+/-1.0 on a scale from 0-5) were significantly lower among repatriated than internally displaced adolescents (4.4+/-0.7 and 2.2+/-1.1, respectively; P<0.001). The prevalence of PTSD did not differ between repatriated (56.7%) and internally displaced adolescents (68.1%). Returnees with more acculturation problems reported more functional and relational problems after return but less psycho-emotional dysfunctions. Those who adapted to the culture in the exile country had difficulties in adapting back to the culture in the home country. CONCLUSIONS PTSD was still very frequent among Bosnian refugee adolescents 3.5 years after the end of war. Adolescents who had spent more than five years as refugees in foreign countries had significantly lower level of experienced trauma recall and frequency of PTSD symptoms, as well as less anxious/depressed and withdrawn/depressed behavioral problems, and somatic complaints. Returnees who had more acculturation problems in exile reported more functional and relational problems but less psycho-emotional problems after repatriation. Schools and other institutions involved in the education of adolescents should develop programs to address these issues.