AIM To determine prevalence of depression symptoms in doctors in the Zenica-Doboj Canton and establish whether there is any difference in the prevalence between doctors employed at the Cantonal Hospital Zenica and doctors working in health care centers. METHODS The completed research was of a projective-descriptive character. The research included 200 examinees, 100 doctors employed at the Cantonal Hospital in Zenica and health care centers. The research was conducted in the period between May and July 2008. A questionnaire designed for this purpose, Beck's Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAM-D), Occupational Stress Questionnaire (OSQ), Work Ability Index (WAI) were used in the study. RESULTS The research confirmed that 68 (34%) examined doctors had mild depressive disorders. The number of examinees with mild depressive disorders in the Cantonal Hospital was slightly higher compared to those employed in health care centers. The number of females with such disorders was twice as higher than males. It has been found that 42 (21%) examinees had sick leave caused by this disease. Such examinees did not have adequate help and support by their superiors and they are not satisfied with the state of interpersonal relations. CONCLUSION The research data clearly indicate that there is a significant percentage of doctors with depressive disorders in the area of Zenica-Doboj Canton, and their work ability is diminished due to depressive disorders. The achieved results correspond to similar researches conducted in our country and worldwide.

The aim of the study was to analyze stroke in young adults in Tuzla Canton, Bosnia and Herzegovina. From January 2001 to December 2005, 3864 patients with first-ever stroke were admitted at the Department of Neurology Tuzla. A retrospective analysis of risk factors, stroke types, severity and one month outcome in all young adults (18-45 years of age) with first-ever stroke was carried out. Out of total, there were 154 (4%) young adults with stroke. Mean age was 38.8 +/- 5.7 years and 47% were women. The leading risk factors were smoking (56%) and hypertension (45%). Subarachnoid hemorrhage (SAH) was more frequent in young adults compared with older patients (> 45 years of age) (22% vs. 3.5%, p < 0.0001), intracerebral hemorrhage (ICH) was similar in both groups (16.9% vs. 15.8%, p = 0.7), but ischemic stroke (IS) was predominant stroke type in the older group (61% vs. 74%, p = 0.0004). Young adults had more frequent lacunar stroke (26.6% vs. 16.1%, p = 0.01) and stroke due to other etiology (8.5% vs. 1.8%, p = 0.0004) than stroke patients over 45 years of age. Stroke severity at admission was lower in young adults than in older patients (p < 0.0001), as well as mortality at one month (11% vs. 30%, p < 0.0001). Favorable outcome (modified Rankin Scale < or = 2) had 71% of young adults compared with only 53% of patients in the older group (p = 0.0003). Stroke in young adults in Tuzla Canton is rare. Risk factors profile, stroke types, severity and outcome at one month in young adults are different from those in older patients.

Metabolic myopathies represent a small percentage of rhabdomyolysis causes that could lead to acute kidney injury (AKI). This could be prevented if this condition is suspected and timely treated. Carnitine palmityl transferase (CPT) deficiency is the most frequent metabolic myopathy and should be considered whenever recurrent myoglobinuria is suspected, and distinguished from the second frequent one, McArdle disease. We present a case of a patient with two medically misinterpreted episodes of AKI in whom the subsequent diagnosis of CPT deficiency was established based on high index of clinical suspicion and correlation of clinical manifestations to specific metabolic defects. Application of simple measures and lifestyle changes improved our patient’s life quality and prevented potential new life-threatening complications.

INTRODUCTION: Stroke is the second or third cause on a mortality list, and all projections indicate that this will remain in the year 2020. Furthermore, stroke is a leading cause of disability. A number of risk factors have been shown to be associated with stroke: age, sex, hypertension, diabetes mellitus, smoking, history of cardiac diseases, and past history of transient ischemic attack. AIM: To analyze the impact of risk factors on the survival rate within a period of five years after ischemic stroke (IS). PATIENTS AND METHODS: In this study 613 patients were analyzed with a first ever ischemic stroke admitted at the Department of Neurology Tuzla, from January 1st 1997 to December 31st 1998. Data were collected from patient medical records when they were admitted to the hospital. The final examination of patients, who survived IS, took place five years after stroke. Medical history was obtained and presence of risk factors was evaluated on the day of admission. Computed tomography (CT) of the brain was performed for all patients during hospitalization. RESULTS: The average age of patients was 65 ± 10 (from 31 to 90) years, 333 (53%) were women. The most frequent risk factor was heart diseases which is registered in 525 (85.5%) patients, followed with history of hypertension in 419 patients (68%), cigarette smoking in 172 (28%), past history of transient ischemic attack in 168 (27%) and diabetes mellitus in 116 (19%). The risk factors were not registered in 1 (0.1%) patients. Five years after ischemic stroke 188 (31%) patients were survived. No statistical significance was occurred related to survival between men and women (p=0.4). The lowest number of patient that survived were over 70 years old 19 (10%), while the highest number of survived was between 41-50 years 30(60%). The average number of risk factors was 2.65± 1.0 and significantly higher in men compared to women (2.7 ± 1: 2.3 ± 1) (p<0.001). Significant difference was found in patients related to the existence of heart diseases (525 with compared to 88 without) (p <0.001), hypertension (with 419; without 194) (p<0.003), diabetes mellitus (with 116; without 497) (p=0.04) and cigarette smoking (with172; without 441) (p<0.001). Concerning transient ischemic attack there were no significant difference in survival in patients with ischemic stroke (p=0.7). CONCLUSION: The survival rate after ischemic stroke was 31% within a period of five years. Long-term survival rate prognosis was significantly better in the younger patients, with no heart diseases, hypertension, and diabetes mellitus as well as in cigarette non-smokers.

OBJECTIVE Starting from the fact that Palliative Care Centre has been in the existence within the University Clinical Centre Tuzla for a few years, and from the positive daily experience while working with lung cancer patients and relatively small number of research in the area this work has an aim to establish the influence of palliative care on the level of anxiety and depression at lung cancer patients. SUBJECTS AND METHODS The examined group consecutively chosen was consisted of 40 patients who were given symptomatic therapy and who were hospitalized at the Palliative Care Department of the University Clinical Centre Tuzla. The controlled group was consisted of 40 patients who were treated at home after the diagnosed lung cancer by the Tuzla's Heath Centre infirmary in charge. Depression and anxiety were estimated by Zung self-rating scale. Two-level testing was conducted: first of all the initial testing, immediately after the given diagnosis, and then two-week-later testing. The significance ofthe established differences was tested by the students' t-test, while the difference was recognised as significant for the level of probability starting with p < 0.05. RESULTS The average score for depression outcome at the beginning of the treatment of the hospitalized patients at the Palliative Care Department was 62.68 +/- 5.88, while the outpatients had a score of 48.65 +/- 4.90. After two-month treatment at the Palliative Care Department the depression was reduced to 48.73 +/- 4.11 (p < 0.001), while it was 47.33 +/- 5.37 (p = 0.004) of the outpatients. At the beginning the hospitalized patients had an average score of anxiety of 51.55 +/- 2.88, while two weeks later it was 44.53 +/- 2.98 (p < 0.0001). The controlled group ofoutpatients' average score of anxiety at the beginning was 44.43 +/- 2.63, while two weeks later it was 46.15 +/- 2.62 (p < 0.0001). CONCLUSION The treatment of the lung cancer patients at the Palliative Care Centre significantly reduced the level of their anxiety and depression and it represents a better way of treatment than treatment at home that outpatients received.

Objective. Starting from the fact that Palliative Care Centre has been in the existence within the University Clinical Centre Tuzla for a few years, and from the positive daily experience while working with lung cancer patients and relatively small number of research in the area this work has an aim to establish the influence of palliative care on the level of anxiety and depression at lung cancer patients. Subjects and Methods. The examined group consecutively chosen was consisted of 40 patients who were given symptomatic therapy and who were hospitalized at the Palliative Care Department of the University Clinical Centre Tuzla. The controlled group was consisted of 40 patients who were treated at home after the diagnosed lung cancer by the Tuzla’s Heath Centre infirmary in charge. Depression and anxiety were estimated by Zung self-rating scale. Two-level testing was conducted: first of all the initial testing, immediately after the given diagnosis, and then two-week-later testing. The significance of the established differences was tested by the students’ t-test, while the difference was recognised as significant for the level of probability starting with p < 0.05. Results. The average score for depression outcome at the beginning of the treatment of the hospitalized patients at the Palliative Care Department was 62.68±5.88, while the outpatients had a score of 48.65±4.90. After two-month treatment at the Palliative Care Department the depression was reduced to 48.73±4.11 (p<0.001), while it was 47.33±5.37 (p=0.004) of the outpatients. At the beginning the hospitalized patients had an average score of anxiety of 51.55±2.88, while two weeks later it was 44.53±2.98 (p<0.0001). The controlled group of outpatients’ average score of anxiety at the beginning was 44.43±2.63, while two weeks later it was 46.15±2.62 (p<0.0001). Conclusion. The treatment of the lung cancer patients at the Palliative Care Centre significantly reduced the level of their anxiety and depression and it represents a better way of treatment than treatment at home that outpatients received.

INTRODUCTION Multiple sclerosis (MS) is the most common, chronic debilitating disease in young adults characterized by a wide variety of neurological symptoms and unpredictable increasing disability. Worldwide, MS affects about 2.5 million people, with a female-to-male ratio of approximately 2:1. The therapies used in the chronic treatment of MS are immune-modulating agents. Interferon beta -1b has been shown to decrease the rate of relapses, the burden of lesions seen on MRI, and the rate of accumulated disability. AIM Determine the efficacy of Betaferon in patients with RR form of MS in terms of the degree of disability and the number of relapses during the two years of continuous treatment. SUBJECTS AND METHODS The study, partly retrospective, partly prospective, included 58 patients of both sexes with MS, RR type, from the Federation of Bosnia and Herzegovina, who received Betaferon treatment, from the Solidarity Fund, during 2 years period. Evaluation of efficacy was based on the degree of disability measured by EDDS scale and number of relapses. RESULTS In our sample, women were represented in the ratio of 3:1 compared to men. 44.8% of patients were referred from Clinical Centre University in Sarajevo (UCCS), 34.5% from University Clinical Centre Tuzla (UCCT) and 20.7% from Clinical Hospital Center Mostar (CHCM). The smallest number of patients have had a relapse sent from CCUS (0.04, SD = 0.196), which was in direct correlation with input EDSS score at baseline (= 1.3) compared to patients from the UCCT, who had an average of 1.05 relapses, SD = 1.35, and the input EDSS score is 2.15. Patients referred from CHCM had an average of 0.08 relapses, SD = 0.93, while the input EDSS score was around 1. In terms of the degree of disability, measured by EDSS, we get a minimal increase in the patients from UCCS and UCCT, while patients from CHCM had a reduction of EDDS for the 0.45 (p < 0.05). CONCLUSION Betaferon therapy must start as soon as possible, preferably when clinically isolated syndrome (CIS) is diagnosed. The reason for early start is to delay the transfer of disease in to definite multiple sclerosis, and thereby reduce disability, which disease brings to young people. Key words:

Introduction: During the war circumstances, women and children are exposed to multiple traumatic experiences, one of which is an violent disappearance of a family member. Goal: The aim of this research was to establish the presence of symptoms of depression, anxiety and somatization in women in Bosnia and Herzegovina who have sought their war missing family members for 15 to 18 years. Subjects and Methods: The research was based on a sample of 120 women with war missing family member and 40 women without a war missing family member as a control group. For assessment of depression, anxiety and symptoms of somatization the self-rating Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Somatic Symptoms Index (SSI) questionnaire and a general questionnaire on the sociodemographic data and data on war missing family members were used. Results: A significantly higher intensity of symptoms of depression (p<0.001), anxiety (p<0.001) and somatization (p = 0.013) was present in women with, in comparison to women without a missing family member. In comparison of the kinship with the missing family members, statistically significantly higher intensity of symptoms of depression, anxiety and somatization was in women with a missing child (p<0.001) in comparison to other missing family members. Conclusion: A prolonged period of seeking, waiting and uncertainty of what happened in the war with the missing family member presents for those women a prolonged suffering manifested through depression, anxiety and symptoms of somatization.

The aim of this study was to assess the influence of sex, age, level and etiology of intellectual disability on visual-motor integration in children with intellectual disability. The sample consisted of 90 children with intellectual disability between 7 and15 years of age. Visual-motor integration was measured using the Acadia test of visual-motor integration. A multiple regression analysis was used for data analysis. The results of this study showed that sex, level of intellectual disability, and age were significant predictors of visual-motor integration. The etiology of intellectual disability did not play a significant role in predicting visual-motor integration. Visual-motor integration skills are very important for a child’s overall level of functioning. Individualized programs for the remediation of visual-motor integration skills should be a part of the curriculum for children with intellectual disability.

Objective: Gerstmann in 1924. observed in a few patients a concomitant impairment in discriminating their own fingers, writing by hand, distinguishing left from right and performing calculations. He claimed that this tetrad of symptoms constituted a syndromal entity, assigned it to a lesion of the dominant parietal lobe. Since than, Gerstmann`s syndrome (GS) was enigma for neuropsychologists. The aim of this study was to analyze frequency and clinical features of GS among acute stroke patients. Patients and methods: We prospectively analyzed 194 acute stroke patients (average age 65±11.06 years, male 113 (58.2%), female 81 (41.8%) hospitalized at department of Neurology, University Clinical Center tuzla, during the six mounths in 2010. For clinical assessment of agraphia, alexia and acalculia we used Minessota test for differential diagnosis of aphasia’s. Results: Among these acute stroke patients, 59 (30.40%) had alexia, agraphia and acalculia or different combinations of these disorders. two patients (3.4%) had agraphia and acalculia associated with other part of tetrad of GS: fi nger agnosia and left-right disorientation. they both where men, right handed, and cranial computed tomography scan showed ischemic lesion in the left parietal and left temporoparietal lobe. Conclusion: Gerstmann`s syndrome is rare clinical entity, and has the high value in localization and the lesion is mainly localized to angular gyrus of the dominant hemisphere.

Psychiatric disorders (PDs) in neurology are more frequent then it verified in routine exam, not only in the less developed but also in large and very developed neurological departments. Furthermore, psychiatric symptoms (PSs) in neurological disorders (NDs) among primary health care physicians and other specialties are often neglected. Anxiety and depression are most common, but hallucinations, delusions, obsessive-compulsive disorder and delirium or confusional state are also frequent comorbidity in many neurological conditions such as stroke, epilepsy, multiple sclerosis (MS), Parkinson disease (PD). Depression and NDs also have a bidirectional relationship, as not only are patients, for example with stroke at greater risk of developing depression, but patients with depression have a two-fold greater risk of developing a stroke, even after controlling for other risk factors. Dementia or cognitive impairment are part of clinical picture of PD, stroke patients, patients with MS, Huntington disease etc. The prototype of dementia in PD and other NDs is a dysexecutive syndrome with impaired attention, executive functions and secondarily impaired memory. So-called "functional" (or psychogenic or hysterical/conversion) symptoms are relatively infrequent in "neurological" conditions, but very often unrecognized and not properly treated. Treatment of PSs in neurology, basically are not different then treatment of these symptoms in psychiatry and should be include pharmacotherapy and psychiatry. This presentation gives an overview of frequency and type of PSs underlying necessity to recognize these disorders in every day routine exam and properly treatment.

Objective: Q uality of life of patients with post-stroke aphasia is very important aspect of research and rehabilitation of these persons. The aim of this study was to investigate the impact of severity and type of aphasia on quality of life in patients after one year of onset of first-ever stroke. Subjects and Methods: It was investigated 51 post-stroke adult aphasic patients (23 males and 28 females) who were treated at the Department of Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina. For determining the severity and type of aphasia Boston Diagnostic Aphasia Examination was used and the quality of life was assessed using The Stroke and Aphasia Quality of Life Scale-39. Results: Patients with aphasia have reduced quality of life at physical, communication, psychosocial and energy domain. Type of aphasic syndrome significantly affects quality of life (r=0.677, p=0.00). Patients with mixed nonfluent and Broca’s aphasia have worst quality of life. Using the multiple comparison (Tukey-test) it was found that persons with these two aphasic syndromes have significantly lower quality of life compared to those with diagnosed anomic aphasia, transcortical sensory aphasia and alexia with agraphia (p<0.05). Aphasia severity was significantly correlated with quality of life (r = 0.730, p = 0.00). Conclusions: Persons with mild post-stroke aphasia have higher of quality of life and persons with more severe post-stroke aphasia have lower qualities of life, one year after onset of first-ever stroke. Type of aphasic syndrome is significantly associated with quality of life. Subjects with mixed nonfluent and Broca’s aphasia have worst quality of life.

Svetomir P. Ivanovic (editor), Montenegrin Academy of Sciences and Arts, Podgorica, 2010,598 pages; ISBN 978-86-7215-254-8; COBISS.CG-ID 16794896