Zikrija Dostovic
University of Tuzla
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Medical Archives | 2016
Zikrija Dostovic; Ernestina Dostović; Dzevdet Smajlovic; Omer Ć. Ibrahimagić; Leila Avdić
Objectives: To determine the incidence of brain edema after ischaemic stroke and its impact on the outcome of patients in the acute phase of ischaemic stroke. Patients and Methods: We retrospectively analyzed 114 patients. Ischaemic stroke and brain edema are verified by computed tomography. The severity of stroke was determined by National Institutes of Health Stroke Scale. Laboratory findings were made during the first four days of hospitalization, and complications were verified by clinical examination and additional tests. Results: In 9 (7.9%) patients developed brain edema. Pneumonia was the most common complication (12.3%). Brain edema had a higher incidence in women, patients with hypertension and elevated serum creatinine values, and patients who are suffering from diabetes. There was no significant correlation between brain edema and survival in patients after acute ischaemic stroke. Patients with brain edema had a significantly higher degree of neurological deficit as at admission, and at discharge (p = 0.04, p = 0.004). Conclusion: The cerebral edema is common after acute ischaemic stroke and no effect on survival in the acute phase. The existence of brain edema in acute ischaemic stroke significantly influence the degree of neurological deficit.
Materia Socio Medica | 2016
Omer Ć. Ibrahimagić; Dzevdet Smajlovic; Zikrija Dostovic; Zejneba Pašić; Suljo Kunic; Amra Iljazović; Denisa Salihović Hajdarević
Introduction: Homocysteine is process-product of methionine demethylation. It has proatherogenic, prothrombotic, prooxidative, proapoptotic, osteoporotic, neurotoxic, neuroinflamatory, and neurodegenerative effects. Hyperhomocysteinemia correlates with C667T MTHFR mutation, decrease of folic acid and vitamin B, as well as prolonged use of certain medications. Materials and Methods: We measured levels of homocysteine in thirty patients (15::15) with “de novo” Parkinson’s disease, with average age 64.17 ± 13.19 (28-82) years (Department of Neurology, University Clinical Center Tuzla). Normal level of homocysteine for women was 3.36-20.44 micromole/l and 5.9-16 micromole/l for men. We followed the effects of medicament approach (folic acid) every six months for next five years. Results: 20% of patients with “de novo” Parkinson’s disease exhibited hyperhomocysteinemia. An average level of homocysteine was 13.85 ± 5.82 micromole/l. Differences due to age and homocysteine levels, regardless of sex, were not concluded. For the next five years intake of folic acid (periodically, 1-2 months, 5 mg per day, orally) was effective to normalized levels of homocysteine in all. Conclusion: Hyperhomocysteinemia is present in every fifth patient with “de novo” Parkinson’s disease. Folic acid is medication of choice in treatment of hyperhomocysteinemia coexisting with Parkinson’s disease.
Medical Archives | 2016
Omer Ć. Ibrahimagić; Amra Cickusic Jakubovic; Dzevdet Smajlovic; Zikrija Dostovic; Suljo Kunic; Amra Iljazović
Introduction: Psychological stress and changes in hypothalamic-pituitary-adrenal (HPA) axis in period after diagnosis of “de novo” Parkinson disease (PD) could be a big problem for patients. Materials and Methods: We measured psychological stress and changes in hypothalamic-pituitary-adrenal axis (HPA) in thirty patients (15:15) with “de novo” Parkinson’s disease, average age 64.17 ± 13.19 (28-82) years (Department of Neurology, University Clinical Center Tuzla). We used Impact of events scale (with 15 questions) to evaluate psychological stress. Normal level of morning cortisol was 201-681 nmol/l, and morning adrenocorticotropic hormone (ACTH) up to 50 pg/ml. Results: Almost 55% patients suffered from mild or serious psychological stress according to IES testing (Horowitz et al.). Non-iatrogenic changes in HPA axis were noticed at 30% patients. The differences between female and male patients regarding to the age (p=0.561), value of cortisol (p=0.745), value of ACTH (p=0.886) and IES testing (p=0.318) were not noticed. The value of cortisol was the predictor of value of ACTH (r=0.427). Conclusion: Psychological stress and changes in hypothalamic-pituitary-adrenal axis are present in patients with “de novo” PD. There is significant relation between values of cortisol and ACTH. Psychological stress is frequent problem for “de novo” PD patients.
Materia Socio Medica | 2016
Zikrija Dostovic; Ernestina Dostović; Dzevdet Smajlovic; Omer Ć. Ibrahimagić; Leila Avdić; Elvir Becirovic
Background: There have been only a small number of studies that have evaluated the outcome of post-stroke delirium. Objectives: To evaluate the effects of gender, age, stroke localization, delirium severity, previous illnesses, associated medical complications on delirium outcome as well as, to determine effects of delirium on cognitive functioning one year after stroke. Patients and Methods: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glazgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. Results: Patients who developed post-stroke delirium had significantly more complications (p = 0.0005). Direct logistic regression was performed to assess the impact of several factors on the likelihood that patients will die. The strongest predictor of outcome was age, mean age ≥ 65 years with a odds ratio (OR) 4.9. Cox’s regression survival was conducted to assess the impact of multiple factors on survival. The accompanying medical complications were the strongest predictor of respondents poore outcome with Hazard-risk 3.3. Cognitive assessments including Mini Mental State score have showen that post-stroke delirium patients had significant cognitive impairment, three (p = 0.0005), six months (p = 0.0005) and one year (p = 0.0005) after stroke, compared to patients without delirium. Conclusion: Patient gender, age, localization of stroke, severity of delirium, chronic diseases and emerging complications significantly affect the outcome of post- stroke delirium. Delirium significantly reduced cognitive functioning of after stroke patients.
Neurological Sciences | 2018
Omer Ć. Ibrahimagić; Dževdet Smajlović; Zikrija Dostovic; Amra Iljazović; Suljo Kunic
Dear Editor-in-Chief Federico, Subclavian steal syndrome (SSS) is a fascinating vascular phenomenon in which a steno-occlusive lesion of the proximal subclavian artery causes retrograde flow in the vertebral artery away from the brain stem, subsequently causing vertebrobasilar insufficiency [1]. Subclavian stenosis is a marker of atherosclerotic disease and presents an increased risk for cardiovascular and cerebrovascular events [2]. In the 1960s, Contorni recognized and described SSS using angiography in a patient with absent radial pulse [3]. We present unusual occurrences of an 80-year-old male Caucasian. He experienced ischemic stroke of the left frontoparietal region with contralateral hemiparesis, as a result of the arterial hypertension, diabetes, as well as active smoking for more than 55 years. Simultaneously, he developed what he described as Bcold, cold winter in the whole left arm,^ and the unusual sensation gradually worsened over a course of few days. With the exception of deregulation of blood sugar values, laboratory findings were normal. During the examination, he had the absence of ipsilateral radial pulse and discrepant brachial systolic arterial blood pressure (BP gradient), approximately 35 mmHg—grade 2 (each time out of five measurements) [4]. Moreover, symptoms and signs were provoked with vigorous exercise of the left arm (supination/pronation and making a fist) and physical maneuvers that compress the vertebral artery (like raising the left arm and rotation of the head towards opposite side). The pulses in lower extremities were intact. There was no history of armclaudication, arm-pain (at rest), syncope, light-headedness, hearing loss, fingers-cyanosis, or evident vascular bruits on the neck regions. Doppler sonography demonstrated characteristic continuous reversed flow in the left vertebral artery. Our patient met criteria for SSS. Due to tremendous and growing problem with uncommon sensation of coldness in the left arm, we came to an idea and decided to measure local skin temperature at symmetric positions of upper extremities. Our patient was lying supine in the bed, without a blanket, and at usual room temperature. We used three accurate digital thermometers for three repetitive measurements—from side to side and from proximal to distal regions. We placed atop of the thermometer: on the medial part of the supraclavicular region, deep in the axillary region, on the medial part of the cubital region (with flexion of the elbow), and on the thenar of the palmar region (with flexion of fingers to fist). We repeated three measurements under the same conditions, with a 5-min break between each. Surprisingly, interarm skin temperature (IST gradient) differences in supraclavicular, axillary, and cubital regions were lower on the left side (approximately 0.6/0.7/0.3 °C), while it was equal in palmar regions. There were no evidence of local skin lesions (ulcers, trophic changes, etc.) or visible local skin diseases. Practically, IST gradients have been identified on three out of four positions of measurements. According to the recent literature, BP gradient was related to severity of SSS. While only 1.4% of patients with a BP gradient of 20 to 30 mmHg were symptomatic, Labropoulos et al. reported that this percentage rose to 38.5% of patients with BP gradient ≥ 50 mmHg [5]. However, asymptomatic and atypical presentation of this unique entity represents a challenge for physicians who require a high index of suspicion [1]. In the case of our patient, we presume that prolonged atherosclerosis and hidden chronic ischemic process in the left arm may have had an unrecognized consequences on local skin temperature. We This paper has not been sent or accepted for publication in any other journal.
Materia Socio Medica | 2018
Zikrija Dostovic; Dzevdet Smajlovic; Omer Ć. Ibrahimagić; Adnan Dostovic
Introduction: Small number of studies have evaluated the mortality and the degree of functional disability of post-stroke delirium, and our aim was to determine that. Patients and Methods: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glasgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. Results: Delirious patients had a significantly higher mortality (p = 0.0005). As opposed to the type of stroke mortality was higher after ischemic (p = 0.0005). The patients without delirium had significantly better cumulative survival during the first year after stroke (p = 0.0005). Delirious patients aged ≥65 years had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). In relation to the type of stroke delirious patients with ischemic had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). Delirious patients had a greater degree of functional impairment at discharge (p = 0.01), three (p = 0.01), six months (p = 0.01) and one year (p = 0.01) after stroke. Conclusion: Delirious patients have a significantly higher mortality, lower cumulative survival and a greater degree of functional disability in the first year after stroke.
Psychiatria Danubina | 2017
Omer Ć. Ibrahimagić; Dzevdet Smajlovic; Zikrija Dostovic; Svjetlana Mujagic; Zejneba Pašić; Denisa Salihović
Hallervorden-Spatz disease (HSD) is a rare neurodegeneration with accumulation of iron in basal ganglia, dystonia, dysarthria, rigidity, and choreoathetosis. Syndrome may present in childhood and progress relentlessly culminating in early death (classical HSD) or in second or third decade with slow progression (atypical HSD) (Hayflick et al. 2003). Magnetic resonance imaging (MRI) appearance in HSD, revealing bilaterally symmetrical, hyperintense signal changes in the anterior medial globus pallidus, with surrounding hypointensity in the globus pallidus, on T2-weighted scanning. These features are fairly diagnostic of HSD and have been termed the „eye of the tiger“ sign (Dashti & Chitsaz 2014). Unfortunately, exact etiology, predictors, and biochemical markers are not known.
Acta Clinica Belgica | 2017
Omer Ć. Ibrahimagić; Dževdet Smajlović; Zikrija Dostovic; Amra Iljazović; Biljana Kojic; Lejla Zonić
Objectives: To present a case of co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis. Methods: Case report. Clinical presentation: We presented 49-year-old Caucasian domicile female-farmer with a history of headache, weakness, and vomiting for a period of three months. Also, she had significant papilledema. We diagnosed rare co-morbidity of neurobrucellosis (confirmed after ELISA-test in serum samples and CSF analysis of pleocytosis/increase in protein/decrease in glucose level) in the setting of cerebral venous thrombosis developed in left sigmoid/left transverse sinus (confirmed after MRV of brain). Favorable outcome was achieved by applying protracted polymicrobial antibiotic therapy and heparin. Discussion: It may be challenging to diagnose neurobrucellosis, especially in patients with atypical presentation and abortive clinical forms. The co-morbidity of neurobrucellosis and cerebral venous sinus thrombosis is uncommon. However, it provides a possibility of brucella-colonization in cerebral venous sinuses as a potential hidden link between them. Conclusion: Patients with severe and persistent headache, as well as other neurological symptoms/signs should be considered for neurobrucellosis in endemic, but also in brucella non-endemic regions due to migrations. According to literature survey, this co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis is third one reported from Europe.
International Journal of Stroke | 2013
Dževdet Smajlović; Denisa Salihović; Leila Avdić; Zikrija Dostovic; Omer Ć. Ibrahimagić; Mirjana Vidović
It is well known that thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) is the first evidence-based treatment for acute ischemic stroke. In the European Union (EU), rt-PA was approved in 2002 and has been used widely since then. Bosnia and Herzegovina is one of the few European countries not yet part of the EU, and approval for rt-PA in acute ischemic stroke was granted in 2007 under the same conditions as in other European countries. We presented our results with the use of intravenous thrombolytic therapy in patients with acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina. Between April 2008 and December 2011, intravenous rt-PA was administered to 72 patients with acute ischemic stroke, which represents 3·5% of patients with acute ischemic stroke admitted to the Department of Neurology Tuzla in that period (2067 patients). Baseline characteristics of the patients treated with thrombolytic therapy are provided in Table 1. Figure 1 illustrates the three-month outcome of our patients treated with thrombolytic therapy in comparison with the results of the neighboring countries: Sestre milosrdnice University Hospital Zagreb, Croatia (1) and Institute of Neurology Belgrade, Serbia (2). We wish to emphasize that these are only the results from our department, not at the national level. Bosnia and Herzegovina is one of the few countries in Europe that does not have an official National Stroke register, primarily because of the political situation. Therefore, our participation in multicenter studies is limited. With this article we want to demonstrate that we are working in line with the established protocols and show that our results are approximate to the results of other countries, despite the aforementioned shortcomings. These are small steps for world’s neurology but big ones for neurology in Bosnia and Herzegovina.
Cardiovascular Psychiatry and Neurology | 2012
Zikrija Dostovic; Dževdet Smajlović; Ernestina Dostović; Omer Ć. Ibrahimagić
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.