Adnan Burina

Epidemiology of multiple sclerosis in western Herzegovina

OBJECTIVES To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina. PATIENTS AND METHODS We analysed data from 81 MS patients (49 females, 32 males) on the prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994-2003 in the investigated area. RESULTS Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20-34). Prevalence was highest in the mountainous municipality of Posusje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0-3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0+/-11.6 years, and the mean age at disease onset was 31.0+/-7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients. CONCLUSIONS Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.

Tamoxifen associated bilateral optic neuropathy.

Tamoxifen is a selective estrogen receptor modulator and its use in estrogen receptor positive breast cancer patients can significantly reduce breast cancer mortality [1]. The use of tamoxifen is associated with several ocular toxicities: keratopathy, cataract, optic neuritis, retinopathy and maculopathy [1]. These conditions are reported to be dosedependent and are reversible if the symptoms are recognized on time and tamoxifen treatment is stopped [1–4]. We report a case of severe unrecognized tamoxifen associated optic neuropathy resulting with optic atrophy.

One Year Outcome of Acute Stroke Patients with Sleep Apnea.

The aim of this study was to analyze one year outcome of the acute stroke patients with sleep apnea in order to gender and age. Methods: It was analyzed 110 patients with acute stroke and sleep apnea. Among them 65(59%) were men. Average age of all participant was 65.13±9.27 years. The same number and gender distribution of participants with stroke and without apnea were in control group. Evaluation of sleep apnea has been done with: “The Sleep Disorders Questionnaire”, “Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome” and “The Epworth Sleepiness Scale”. Results: One year after stroke onset survived 91 (82.7%) out of 110 patients with apnea. Average age of survived patients was 63.66±8.78 years. Among them 52(80%) were men. In control group, without apnea survived 104 (94.5%) patients with average age of 65.00±8.62 years. Among them 62 (95.4%) were men. In men with apnea there is significantly lower survival range in order to patients without apnea (X2=8.22, p=0.004). In women there is no difference. Survival of both gender in patients with apnea (22; 64.7%) was the lowest in group older than 70 years of age. Sex ratio (men : women) was 15 (68.2%):7(58.3%). Survival in both gender in patients without apnea was the same in group older than 70 years of age: 27 (81.2%) out of 33. Average age of patients who died with apnea was significantly higher in order to patients without (t=1.97, p=0.03). Conclusion: One year after stroke, significantly more patients survived without (94.5%) than with apnea (82.7%) (p=0.01). In order to sex survived range was significantly (p=0.004) lover in men with apnea than without but in women there is no difference. Survival range of both gender in patients with apnea was the lowest in group older than 70 years (p=0.03).

Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

RISK FACTORS IMPACT ON THE LONG-TERM SURVIVAL AFTER ISCHEMIC STROKE

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.

ARNOLD – CHIARI MALFORMATION AND SYRINGOMYELIA

The Chiari I malformation (CMI) is a caudal displacement of the cerebellar tonsils into the cervical spinal canal. It is generally agreed that CMI is defined by tonsillar herniation more than 5 mm below the plane of the foramen magnum. The disorder affects children and adults and may be congenital or acquired. It is originally described by Arnold in 1894 and Chiari in 1896.1,2 The exact cause of the Chiari malformation is unknown. It has been suggested that during early embryo development of the brainstem and spinal cord, the malformation occurs. The incidence of CMI is not known. Before the availability of nuclear magnetic resonance imaging (MRI), CMI rarely was diagnosed. Recently, an incidence of 0.6% was reported in all age groups, and an incidence of 0.9% was reported in a study of only pediatric patients.3 In patients with CMI, the most common presenting symptom is pain, but also some presenting signs include brainstem, cerebellar, and spinal cord dysfunction: oculomotor (17.1%), vestibulocerebellar (84.8%), bulbar (35.4%), conduction motor (25.9%) and segmental motor sensory disturbances (9.5%).4 Although advances in MRI have significantly enhanced our ability to diagnose CMI, management of this condition remains controversial. Syringomyelia is a chronic progressive degenerative Adnan BURINA Dževdet SMAJLOVIĆ Osman SINANOVIĆ Mirjana VIDOVIĆ Omer Ć. IBRAHIMAGIĆ