8. Dani BHAAAS-a u BiH - Neum 2016

“ZNANJE JE DJELJIVO BOGATSTVO”

Datum i mjesto održavanja:

Četvrtak 26.05.2016.- Nedjelja 29.05.2016.

Hotel “Sunce”, Neum, BiH

KNJIGA SAŽETAKA

OFICIJELNI JEZICI KONFERENCIJE SU: BHS i ENGLESKI

INTERNACIONALNI SIMPOZIJ O INOVATIVNIM I INTERDISCIPLINARNIM APLIKACIJAMA SAVREMENIH TEHNOLOGIJA (IAT) I

SVI APSTRAKTI SA OVOG SIMPOZIJA SE MOGU NAĆI NA OVOM LINKU:

http://link.springer.com/book/10.1007%2F978-3-319-47295-9

INTERNACIONALNI SIMPOZIJ IZ PORODIČNE MEDICINE

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Sesija: Hronične nezarazne bolesti u ambulanti porodične medicine

Andi Arnautović (Chicago, USA/BHAAAS): Doziranje lijekova kod pacijenata sa hroničnom bolesti bubregaChronic kidney disease affects renal drug elimination and other pharmacokinetic processes involved in drug dispositionDrug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Dosages of drugs cleared renally should be adjusted according to creatinine clearance or glomerular filtration rate. Recommended methods for maintenance dosing adjustments are dose reductions, lengthening the dosing interval, or both. Physicians should be familiar with commonly used medications that require dosage adjustments. Resources are available to assist in dosing decisions for patients with chronic kidney disease.

Boris Pejić, Nataša Miletić, Siniša Ristić, Nikolina Elez-Burnjaković (Foča, BiH): Metabolički sindrom

INTRODUCTION. Important factor in occurrence of cardiovascular disease is metabolic syndrome. Education of medical students is essential in preventing of its occurrence. AIM. Examine knowledge of medical students about risk factors for metabolic syndrome.METHODOLOGY. Participants were final year students, thirty of them, which answered on specially designed questionnaire, by which we obtained information about their knowledge, life habits and attitudes.RESULTS . Based on questionnaires we got these results: (1) about half of respondents know the definition of obesity according to IDF (International Diabetes Federation) criteria, (2) blood pressure and cholesterol is equally in both sexes, (3) male participants were more overweight than female, (4) the frequency of smoking among both sexes is high, (5) most of them have awareness of the existence of the many risk factors for metabolic syndrome.CONCLUSION. Students knew that the metabolic syndrome is a risk factor for cardiovascular disease, but it is necessary to improve, in the direction of increasing awareness the fact that a metabolic syndrome occurs not only as a result of bad health habits, but also as a consequence of drugs administration, for example psychopharmacotherapy. Implementation of knowledge acquired during the study aims at recognizing and advancing the process of labor as young physicians in general practice, as well as to reduce the incidence cardiovascular disease in patients with different risk factors.KEY WORDS: students knowledge, metabolic syndrome, health habits

Saša Bijelić, koautori: Dragana Aleksić i Ljubomir Šermez (Laktaši, BiH): Fizička aktivnost kod pacijenata sa dijabetesom tipa 2 Diabetes mellitus type 2 is a chronic metabolic disease characterized by high level of blood sugar (inability of cells to respond toinsulin that is produced). Physical activity increases the sensitivity of

cells to insulin and stimulates glucose transport. Adults who are regularly active have a 42% lower risk of developing diabetes type 2 diabetes.The goal of the work.To determine the impact of physical activity on patients with type 2 diabetes.

Method of work.Peview before exercise. People with diabetes who want to start excercising should consult their family doctor. People who are over 35 years old and people who suffer from diabetes for more than 10 years need a review before starting exercises as well as controlled stress test during exercises. The type of physical activity -mild aerobic exercises (that amplify pulse) are the best option. Duration - 10 minutes of stretching and warm up followed by 20 minutes of mild aerobic exercise.Duration of exercise should be increased gradually. People who take insulin tend to practice each day at the same time, three times a week.( walking, running, swimming, cycling) .Advantage- maintenance of provided blood sugar level.

Key words : diabetes mellitus type 2, physical activity, physical inactivity, risk factor

Sesija: Problemi javnog zdravlja

Zarema Obradović, Suad Habeš (Sarajevo, BiH): Problem pasa lutalica u javnom zdravstvu The Animal Welfare Act prohibits the killing of animals, in this case dogs without owners, and predicts their placement in dog shelters. It is a human act, but it\'s implementation is complicated and requires financial resources that a country like ours can not provide. Now the Act is partially implemented and a large number of animals without owners are on our streets. It is a great public health importance. Most commonly associated with dogs is the risk of bites, and with bites the risk of rabies. In the area of Sarajevo Canton the number of bitten people that come to the Clinic for rabies prevention is around 500 per year. In addition to the potential possibility of rabies, a dog bite carries the risk for tetanus and for wound infection caused by various species of microorganisms. A dog bite cause also intense stress in the bitten person, which adversely affects the health. Dogs contaminate soil and surfaces by urine and faeces which is another risk. This contamination is not only caused by dogs without owners, but also proprietary dogs that urinate and defecate in the open areas and whose faeces are not removed in the appropriate manner. The faeces of dogs provides a range of parasites and especially important are the eggs of Taenia echinococcus that in can enter the intestines of people in different ways and lead to the formation of echinococcosis. In some parts of our country dogs are hosts for Leishmania that the insect Phlebotomus papatasi transmits to humans and causes the disease Leishmaniasis. All the above-mentioned diseases significantly affect the general morbidity of the population for which the dogs on the streets have great public health importance.Key words. Street dogs, public health importance

Aleksandar Kljajić (Banja Luka, BiH): Suzbijanje scabiesa

Uvod: Svrab je opisana još u Bibliji spominje se u Aristotelovim spisima.Scabies je infekcija kože prouzrokovana parazitom Sarckoptes Scabie variacije hominis.Ukopava se ispod kože brzinom od 2,5 cm u minuti.

Cilj rada: Da se prikaže slučaj oboljevanja od scabiesa u porodici u okolini Grada Banjaluke.Metoda rada: Deskriptivna: porodica se nalazi na periferiji grada Banjaluke u naselju lošeg socialno ekonomskog stanja.Vrijeme nastanka bolesti je drugi mjesec zimski period kad se porodica nalazi na okupu te je mogučnost širenja bolesti veća. Slučaj se odnosi na porodicu samohrane majke sa još pet ukućanaRezultati rada: Kod tri člana prisutna je klinička slika ScabiesaPreduzete su odgovarajuće sanitarno higijenske mjere: Uklanjanje komunalnog otpada. Dezinsekcija aktivni tretman Zdravstveno vaspitni radDiskusija: Novi pravilnik o načinu prijavljivanja ZB Sl. gl. RS 114/10 ne predviđa Scabies kao bolest koja se nalazi pod zdravstvenim nadzorom što nije slučaj u zemljama okruženja

Zaključak: Iako se broj obojelih od Scabiesa prividno smanjuje iz godine u godinu za oko 5%.ratni sukobi u regionu loši sanitarno higjenski uslovi života doprinose njegovom opstanku.Na HES službama je da uskladu sa strukom sprovede suzbianje zaraznih bolesti kroz zdravstveno vaspitni rad i ostale preventivne mjere.

Sesija : Osteoporoza

Amra Osmančević (Gothenburg, Sweden): Značaj edukacije

pacijenata i potencijal klimatske terapije u Bosni i Hercegovini

Patient education is a very important factor to achieve better health care system and improve patients care. In the recent time the importance of patient adjusted information on the specific diseases and healthy life style which can prevent diseases but also improve treatments´ outcome has been in focus of the development of health care system in Western countries. On the other hand a climate therapy is a very popular and established treatment option for many diseases including rheumatic illnesses and many skin diseases such as psoriasis and atopic dermatitis.The incidence of those diseases is about 3% and 20% for psoriasis and AD, respectively. Scandinavia patients with moderate and severe forms of these diseases are commonly treated with climate therapy (heliotherapy) at Canarias Islands, during a period of 3 weeks per year. This therapy include well defined and regular sun exposures, physical activity and education on as well skin disease as on all factors that affect the onset of disease and treatment outcomes such as smoking, overweight, physical inactivity, alcohol consumption etc. This holistic approach to the healthy lifestyle and potential risks for specific diseases are millstones for effective and improved patient care and health care system.The purpose of this presentation is to elucidate importance of improved patient education and use of climate therapy in the treatment of different diseases, in this case psoriasis. I would like to present my own

experience as a dermatologist and a University lector in this field and discuss potential of the same issues in Bosnia and Herzegovina.

Sabina Sarić, Rubina Alimanović - Alagić (Sarajevo, BiH): Vrijednosti vitamina D kod osoba sa osteoporozom u Kantonu Sarajevo

Uvod: D-vitamin ima veoma važnu ulogu u metabolizmu koštanog tkiva. Njegova glavna uloga je održavanje stalne koncentracije kalcijuma u plazmi, što postiže povećanjem apsorpcije kalcijuma iz tankog crijeva kao i mobilizacijom kalcija iz kostiju te smanjenjem renalne ekskrecije kalcija. Vitamin D stimuliše sintezu osteokalcina, vitamin K-zavisnog, kalcijum vezujućeg proteina koštanog matriksa. Cilj: odrediti vrijednosti D-vitamina u pacijenata sa osteoporozom na području Kantona Sarajevo.Materijal i metod: u istraživanje je uključeno 278 pacijenata sa DXA dijagnosticiranom osteoporozom koji su liječeni u CBR- Saraj Polje u periodu od 01.10.2014. do 01.10.2015.g. Svim pacijentima je izmjerena ukupna koncentracija D- vitamina u serumu, ukupni kalcijum u serumu, indeks tjelesne težine. Rezultati: ispitivanu grupu činilo je 98,3% (273) žena bijele rase i 1,7% (5) muškaraca bijele rase,prosječne životne dobi 61,87 godina sa rasponom varijabli od 38 do 84 godine. Prosječna vrijednost T skora lumbalne kičme iznosila je -2.8 SD a proksimalnog femura -2.33 SD.Prosječna vrijednost D-vitamina iznosila je 17.33 µg/ml sa rasponom varijabli od ˂3 µg/ml do 65.9 µg/ml. D-vitamin u referentnim vrijednostima imalo je 11.8% (33) pacijenata prosječne vrijednosti 34.5 µg/ml. Nedostatne vrijednosti D-vitamina imalo je 87.28% (242)pacijenata, prosječne vrijednosti 14.53 µg/ml. D-vitamin iznad referentnih vrijednosti imalo je 0.87% (3) pacijenata, prosječne vrijednosti 65.9 µg/ml. Prosječna vrijednost ukupnog kalcijuma u serumu iznosila je 2.37 mmol/L. Referentne vrijednosti kalcijuma u serumu imalo je 97.5% (271) pacijenata, prosječne vrijednosti 2.4 mmol/L, dok je nedostatne vrijednosti imalo 1.7% (5) pacijenata, prosječne vrijednosti 2.05 mmol/L. Hiperkalcemiju je imalo 0,87% (3) pacijenata, prosječne vrijednosti 2.81 mmol/L. Prosječna vrijednost indeksa tjelesne težine iznosila je 23.8 kg/m² sa rasponom varijabli od 18 do 39.5 kg/m². Zaključak: u našem istraživanju smo pakazali da pacijenti sa dijagnosticiranom osteoporozom imaju veoma nedostatne vrijednosti D-vitamina. Terapijska nadoknada D-vitamina treba biti prilagođena isključivo individualnim potrebama pacijenata i strogo kontrolirana. Ključne riječi: Osteoporoza, D-vitamin.

Edina Tanović, Emira Švraka (Sarajevo, BiH): Osteoporoza i aktivnosti svakodnevnog života (ADL) u rehabilitaciji pacijenata Objectives: To determine the result of rehabilitation and Barthel index (BI) at admission and discharge from hospital in patients with osteoporosis.Materials and methods: A retrospective study was conducted and as a source of data we used medical records. The study included 39 patients with osteoporosis and who were hospitalized at the Clinic for

Physical Medicine and Rehabilitation, University Clinical Center of Sarajevo. Descriptive statistical methods were used: frequency and relative frequency, median and interquartile range (IQR). Results: Out of a total number of patients (n=39), 31/39 (79.5%) were females and 8/39 (20.5%) were males. The median age for females was 70.0 years (IQR=61.0 to 74.0), and for males 72.5 years (IQR=48.3 to 79.5). The median of LOH was 29.0 days (IQR=22.5 to 36.0). The median of BI at admission was 16.0 (IQR=11.0 to 19.5) and the median of BI at discharge was 17.0 (IQR=13.0 to 20.0).Conclusion: Patients with osteoporosis nedd long-term rehabilitation that will continue outside hospital. After short-term rehabilitation, there was not significant improvement in rehabilitation results in these patients.Key words: Osteoporosis, Rehabilitation, Activities of Daily Living (ADL)

Amila Jaganjac (Sarajevo, BiH): Riziko faktori za nastanak osteoporoze kod studentske populacije

Uvod: Osteoporoza je metabolička koštana bolest smanjene koštane mase i poremećene mikroarhitekture koštanog tkiva s povećanom lomljivosti kosti i rizikom od prijeloma. Rana faza prevencije započinje u mladosti. Uvažavajući da je osteoporoza pedijatrijska bolest s gerijatrijskim posljedicama što znači da bismo odgovarajućim načinom života u mladosti spriječili nastanak ove bolesti u starijoj životnoj dobi, postizanjem što većeg vrhunca koštane mase. Najnovije studije ukazuju da se vrhunac koštane mase dostiže u ranijem dobu u prosjeku godina između 16 do 22,5, a ne do 30 godina kao što se prije smatralo. Najmanje 90% maksimalne koštane mase se dostiže do 18 godina. Faktori rizika za nastanak osteoporoze se dijele na: promjenjive i nepromjenjive. Nepromjenjivi faktori su oni na koje se ne može uticati s kojima se rađamo, koje smo naslijedili od roditelja ili su sastavni dio našeg života, dok su promjenjivi faktori oni na koje se može uticati.Cilj: Pregled literature u pogledu riziko faktora za nastanak osteoporoze kod studentske populacije.Materijal i metode: Riziko faktori za nastanak osteoporoze kod studentske populacije istražen kroz naučni pregled literature koja se bavi ovom problematikom. Pretraživanje baze podataka za istraživanje: Cochrane, PubMed, Embase, CINAHL, PEDroRezultati: prikazano je kodiranje istraživanja po zajedničkim varijablama kroz naučne radove. Zaključak: Prisustvom riziko faktora za osteoporozu kod studentske populacije u naučnim istraživanjima, potvrđuje opravdanost mjera intervencije na poljima ishrane i zdravih životnih navika, koje bi mogle smanjiti mogućnost nastanka osteoporoze.Ključne riječi: riziko faktori, osteoporoza, studentiRisk factors for osteoporosis in student population---------------Introduction: Osteoporosis is a metabolic bone disease characterized by low bone mass and compromised microarchitecture of bone tissue with greater risk of bone fragility and fracture. Early stage of prevention begins in youth. Taking in consideration that osteoporosis is a pediatric disease with geriatric consequences, meaning that a proper health style in youth could prevent the development of this disease in older age, by accumulating as much bone mass as possible. The most recent studies show that the peak of bone mass is attained at earlier age between 16 to 22,5 years, and not at 30 years age as it was considered before. At least 90% maximum bone mass is attained until 18 years of age. Risk factor for osteoporosis are divided on:

changeable and unchangeable. Unchangeable risk factors are those on which we can not impact, we are born with them, we inherit them from our parents or they are a part of our life, while we can impact on changeable risk factors.Purpose: Overhaul of literature about risk factors for osteoporosis in student population.Material and methods: Risk factors for osteoporosis in student population examined through the overhaul of literature regarding this subject. The databases that were examined where: Cochrane, PubMed, Embase, CINAHL, PEDroResults: Coding of researches by common variables through scientific studies was shown.Conclusion: Presence of risk factors for osteoporosis in student population in studies confirms validity of prevention measures on fields of diet and healthy life style habits which could decrease the possibility of osteoporosis.

Keywords: risk factors, osteoporosis, students

Arzija Pašalić (Sarajevo, BiH): Uticaj kalcijuma na bioraspoloživost nutrijenata u spriječavanju osteoporoze

Calcium represents an integral part of the skeleton. About 99% of the total amount of calcium is deposed in the bones and teeth, primarily in form of calcium hydroxyapatite. If taken in food, the calcium bound to proteins is being released in the stomach and duodenum to be mainly absorbed by the jejunum at lower pH values. The absorption of calcium is enabled if the solubility of the calcium salts ranges from 0,1-10 mmol/l. The efficiency of calcium’s absorption depends on the presence of certain nutrients, so the bioavailability of calcium received in food is approximately 30%. In case of a larger amount of calcium in a meal, the absorption of calcium becomes lesser, so the food rich in calcium should be split into several meals. Utilization of calcium can be interfered by dietary fibers, tannins, oxalic acid and phytic acid. Oxalates taken in combination with the calcium are considered to be strong inhibitors for they create the salts having solubility of only 0.04 mmol/l. The phytic acid is considered as one of the weaker inhibitors of the calcium absorption, but is more frequently present in the diet. Absorption of calcium is increased by lactose and an amino acid called lysine. Certain nutrients may cause a change in the balance and content of calcium in the bones. The intake of calcium, vitamin D, fruits, vegetables, vitamin K, proteins and inulin is considered positive, while the sodium and excessive use of alcohol are considered as items having the negative impact. Proteins have positive influence on the calcium balance in case their intake varies between 1-1.5 g/kg of body mass, for such amount does not cause any changes in the skeletal homeostasis. The low protein intake, however, reduces the intestinal absorption of calcium. High sodium intake would have a damaging effect on balance of calcium in the bones only if the calcium intake is low.Intake of certain nutrients can significantly change and affect the bioavailability of calcium, while the proper combination of foods and the meal schedule can give significant results in the prevention of osteoporosis and osteopenia.Key words: nutrients, bioavailability of calcium, osteoporosis.

Dijana Avdić (Sarajevo, BiH): Rehabilitacija osoba sa cerebralnom paralizom i osteoporozom Cerebral paralysis is a movement disorder caused by brain damage induced in intrauterine development, during child birth or in early childhood. Persons who live with cerebral paralysis experience high risk of osteoporosis development, a condition related to bone breakage tendency and increased bone fracture risk.

Life expectancy for adults suffering from cerebral paralysis increases and therefore there is a perception of increased incidence of bone fractures in this population. Low mineral bone density can be documented in more than 50% of adults experiencing difficulties in development, including persons with cerebral paralysis.Children with cerebral paralysis usually have bones with thiner cortex compared to bones in adults. Those are important parameters that have influence on bone ability to withstand load and resistance to flexion without fracture.Bones of persons with cerebral paralysis often have significantly lower density compared to density of bones in healthy adults, which contributes to increased bone fracture risk. Women with cerebral paralysis have increased risk of osteoporosis and fracture, due to reduced estrogen level, hormone that has a significant role in bone density maintenance.Rehabilitation programe plan, in terms of avoiding occurrence or treatment of osteoporosis consequences in persons with cerebral paralysis, consists of every day walking or standing leading to mechanical load of bones which can, in conclusion, lead to increase of bone endurance. All activities can be performed with help of adjustable standing equipment or by standing in a loom and with help of phisiotherapist in performing kinesiotherapy. Surely, in order to perform a continuous rehabilitation and continuous home domestic rehabilitation programe, the influence of a close relative or a family member is of high importance.

Key words: cerebral paralysis, osteporosis, rehabilitation

Emira Švraka (Sarajevo, BiH): Kvalitet života osoba sa cerebralnom paralizom i osteoporozom

The quality of life of people with cerebral palsy (CP) and osteoporosis depends on genetic factors, health and functioning, disease progression, health care and individual responses. Goals: To determine the quality of life and difference of quality of life, of people with CP and osteoporosis of I, II, III, IV and V disability degree in the Association of people with CP and muscular dystrophy from Gorazde and the Association \"Palm\" (Dlan) from Zenica, according to the degree of disability Gross Motor Function Classification System (GMFCS). Method: The study is a prospective, control and descriptive. Research instruments include: follow-up form,

GMFCS, ladder of life, Life Satisfaction Scale, a questionnaire on healthy lifestyles - Functional Independence Measure (FIM) and questionnaire for assessment of fracture risk (FRAX). Results: Of 42 respondents, 15 (31%) were male, 27 (69%) were female, aged 12-63 years. Of 29 respondents independently mobile or with the assistive aids, 20 (69%) were female and 9 (31%) males. Of 13 respondents who use wheelchairs or are immobile, 6 (46%) were male and 7 (54%) were female.Conclusions: According to the Life Satisfaction Scale, there is a statistically significant difference in life satisfaction between mobile and immobile patients (p<0.05), where the mobile patients are more satisfied with their life compared to immobile patients. Based on the FIM test it can be seen that p<0.05, which means that there is statistically significant difference, which mean that mobile subjects achieved significantly higher scores on the FIM test in relation to the immobile subjects.Keywords: Quality of Life, Cerebral palsy, Osteoporosis

Eldina Nizamić (Washington, USA) : Zdravstvena pismenost

Sesija Hitna stanja u porodičnoj medicini

Milka Mirnić, koautorica: Jasna Granolić (Banja Luka, BiH): Hitna stanja u ambulanti porodične medicineUvod: U ambulanti porodične medicine česte su situacije u kojima je pacijentu potrebna hitna medicinska pomoć.Medicinska sestra je na prvoj liniji susreta sa pacijentom, te od njene reakcije i sprovedenih postupaka zavisi ishod hitnog stanja. Samo edukovan radnik može dalje edukovati pacijente i time skratiti vrijeme utrošeno za uzimanje anamneze i sprovođenje hitnih terapijskih postupaka.Cilj: Prikazati najčešća hitna stanja u ambulanti porodične medicine, te uticaj edukacije na brzinu reakcije medicinskih radnikaMetodologija: Anketiranje medicinskih sestara i pacijenata, te uvid u medicinsku dokumentacijuRezultati: Kontinuiranom internom edukacijom se postiže poboljšanje od 40% u brzini reakcije medicinskih sestara.U analiziranoj ambulanti u toku protekle tri godine nije bilo smrtnih slučajeva, ali je primijećen veliki broj poziva ka Službi hitne pomoći,gdje je tražen hitan sanitetski prevoz.Zaključak: Česta su hitna stanja sa dramatičnom simtomatologijom u kojima ishod i kvaliteta života nakon zbrinjavanja zavise od brzine reakcije .Ukoliko se posjeduju i sprovode smjernice za hitna stanja , veći je kvalitet zdravstvene njege, smanjen je broj poziva ka Službi za hitnu medicinu,te je manje hospitalizacija, čime se smanjuju troškovi u zdravstvu.Dobra saradnja Službe porodične

medicine i Službe hitne medicinske pomoći, će rezultirati boljom organizacijom posla hitnih mobilnih ekipa u smislu da će dobiti veću resursnu raspoloživost ka građanstvu.

Nina Lunić-Radojković (Banja Luka, BiH): Paraverbalna komunikacija sa pacijentom Uvod: Paraverbalnoj komunikaciji pripada trećina ukupne komunikacije I obavezan je alat svih zdravstvenih radnika, jer su svakodnevno u kontaktu sa saradnicima I korisnicima usluga. Osobine glasa ( brzina, ton, jačina, naglašavanje riječi…) daju našem govoru posebne karakteristike koje sagovornik doživljava mnogo jače nego same riječi.Cilj: Prikazati uticaj paraverbalne komunikacije na odnose u zdravstvenoj ustanovi u konfliktnim situacijamaMetod: Posmatranje ishoda konflikta sa planiranim promjenama brzine, ritma, jačine I boja glasa.Zaključak: Tokom tri mjeseca posmatranja odnosa zdravstvenih radnika međusobno I sa pacijentom, može se zaključiti da je neizbježan negativan ishod konflikta ukoliko barem jedna strana ne koristi prikladne paraverbalne znakove.Razumijevanje pacijenta sa negativnim emocijama uveliko olakšava poznavanje paraverbalnih karakteristika , te takav radnik uspješno rješava konfliktnu situaciju I ona ne prerasta u konflikt.Prepreke uspješnoj komunikaciji između radnika su uočene na nivou neverbalne komunikacije, I to posebno zbog neadekvatnog naglašavanja riječi u rečenici, gdje su poruke dobile sasvim drugi smisao I prouzročile konflikt.U oba slučaja , ako se u toku samog konflikta obrati pažnja na ton I brzinu glasa, emocije se stišavaju I sukob izostaje.Medicinske sestre su najčešće prvi kontakt pacijenta u zdravstvenoj ustanovi I trebaju biti edukovane na polju komunikacije kako bi znale prepoznati stvarno zdravstveno stanje pacijenta bez obzira na same izgovorene riječi, a samim tim prikladno pokazati različita neverbalna ponašanja , kako bi zadobile povjerenje pacijenta I time poboljšale kvalitet zdravstvene zaštite.

Biljana Ćurguz (Banja Luka, BiH): Komunikacijske barijere u trijaži hitnih stanja Komunikacija se, kao i svaka druga vještina, usavršava vežbanjem i traži stalnu njegu. Zdravstveni radnici nisu u prilici da biraju sagovornike (pacijente), ali zato mogu izabrati način na koji će prenijeti poruku da bi ona postigla svoj cilj. Trijaža je proces određivanja prioriteta liječenja bolesnika koji se bazira na težini bolesnikova medicinskog stanja, a cilj je identifikovati bolesnike sa životno ugrožavajućim stanjima te im osigurati pravovremenu medicinsku njegu. Trijažna sestra/tehničar mora biti educirana kako bi prepoznala bolesnikove tegobe, mora biti osoba koja ima razvijene komunikacione vještine te biti upoznata s trijažnim sistemom.CILJ:PRIKAZATI STATISTIČKE PODATKE O VRSTI I SAVLADAVANJU KOMUNIKACIJSKIH BARIJERA PRILIKOM TRIJAŽE HITNIH STANJAMETODOLOGIJA. Metoda ispitivanja, tehnika anketnog upitnika radnika u zdravstvenoj ustanovi primarnog nivoa.DISKUSIJA I ZAKLJUČAK: Komunikacija je uspješna ako sagovornik, u ovom slučaju pacijent, shvati i razumije što mu želimo reći, a to zavisi od sadržaja razgovora, osobe koja nas sluša, toka razgovora i načina slanja sadržaja, odnosno izražavanja empatičnosti u komunikaciji. Pozitivni efekti empatije u radu medicinske sestre sa pacijentima su brojni, a neki od njih su:bolesniku pomaže u sticanju povjerenja u medicinsku sestru kao nekoga ko stvarno, iskreno brine za njega,bolesniku pomaže u boljem shvaćanju vlastitih osjećaja,pomaže otkloniti pacijentov osjećaj izolacije i bespomoćnosti,pomaže bolesniku u razvijanju vlastitih sposobnosti u pronalaženju rješenja svih problema koje uzrokuje bolest.Iz statističkih podataka ovoga rada jasno se vidi da su radnici svjesni prisustva komunikacijskih

barijera,koje su naročito izražene u hitnim stanjima.Dio anketiranih medicinskih sestara koji posjećuje sestrinske stručne skupove je jasno opisao vrstu i prevazilaženje barijera što govori u prilog organizovanja edukativnih skupova koji predstavljaju oblik neformalnog nastavka školovanja

Petrijana Kajkut (Banja Luka, BiH): Značaj tehničke ispravnosti EKG-a uhitnim stanjimaUvod: Elektrokardiografija prestavlja snimanje depolarizacije i repolarizacije miokarda i jedna je osnovnih metoda u dijagnostici bolesti srca.elektrokardiograf očitava doktor a tehnički dio procedure izvodi medicinska sestra-tehničar.ova procedura može biti veoma hitna metoda te je može izvoditi samo brza i spretna medicinska sestra adekvatnog znanja , kako bi što prije poboljšali pacijnetovo narušeno zdravlje.Cilj: Prikazati značaj tehničke ispravnosti ekg-a i greške koje se mogu desiti od strane tehničara, a koje mogu utjecati na prenos informacija ka doktoru i reakciju u hitnim stanjimaMetoda: Deskriptivni prikaz slučajaDiskusija i zaključak: Elektrokardiografija je neinvazivna ,jeftina i dostupna dijagnostička procedura čiji je značaj najveći kod hitnih stanja oboljenja srca.moguće je prisustvo otežavajućih faktora kao što su: maljavost,nedostatak jednog ili više udova,pacijent na hemodijalizi,nepodešeni standardi na aparatu...pored znanja i iskustva u provođenju postupka sestra mora poznavati namjenu akvizicije ekg signala na ekranu i papiru i kao poseban dio poznavanje održavanje aparata.od velikog značaja za uspješnu tehničku ispravnost nalaza bitno je poznavati psihologiju i komunikologiju u kriznim situacijama,jer medicinska sestra mora davati znake smirenosti i odlučnosti što je veoma bitno u hitnim stanjima kako bi uspješno pripremila pacijenta i i ispravno izvela postupak.

Rubina Alimanović-Alagić, Sabina Sarić (Sarajevo, BiH): Markeri u menopauziMenopause marks the permanent end of monthly periods and fertility, usually occurs between the ages of 45 and 55. The drop in oestrogen levels that occurs around the time of menopause results in increased bone loss. Women going through menopause have a higher risk of developing osteoporosis, but there are many ways to slow it down and fortify your body against it. Peak bone mass is reached around the age of 25 to 30 years, when the skeleton has stopped growing and bones are at their strongest and thickest. Prevention and determining treatment for osteoporosis is an important assessment of the risk of fracture, which includes analysis of: risk factors, DXA and determination of bone markers. Osteoporosis is best diagnosed using a specialised x-ray technique called DXA (dual energy X-ray absorptiometry). A DXA scan measures bone density (or thickness), usually at the lower spine and at the upper part of the hip. Bone tissue is a highly differentiated tissue whose dynamism is reflected in the constant process of remodeling based on bone resorption and formation. Bone turnover markers (BTMs) measure the rate of bone remodelling allowing for a dynamic assessment of skeletal status and hold promise in identifying those at highest risk of rapid bone loss and subsequent fracture. Bone markers: Total Alkaline phosphatase (ALP), bone alkaline phosphatase (BALP), osteocalcin (OC), Procollagen type 1 amino terminal peptide (P1N1), Beta Cross Laps, NTX in urine, and other bone matrix proteins (glycoproteins). Biomarkers which are determined as: Mineralogram, Parat hormone (PTH), vitamin D3, sex hormones, thyroid hormones. The use of BTMs in clinical trials has been helpful in understanding the mechanism of action of therapeutic agents. They are useful in monitoring the efficacy of antiresorptive therapy in populations of patients with osteoporosis.Key words: menopause, osteoporosis, bone markers

Darija Jović (Banja Luka, BiH): Učestalost karcinoma grlića kod određenih papa nalaza u ambulanti porodične medicineRak grlića materice je drugi najčešći karcinom kod žena mlađih od 45g i kao takav predstavlja vodeći uzrok smrti žena u svijetu(nakon raka dojke i pluća).Otkrivanje bolesti na vrijeme daj dobru prognozu u liječenju karcinoma grlića.Cilj rada:Ispitati učestalost prekanceroznih lezija grlića kao i karcinoma grlića.Ispitati riziko faktore u nastanku karcinoma grlića mateice.Metode rada:Studija je retrospektivna analiza kojom smo obradili preventivne aktivnosti Ca grlića sa nalizom PAPA nalaza.Kod ispitanica smo obradili podatke o samoinicijativnom ginekološkom pregledu i pregledu na prijedlog porodičnog doktora u sklopu prevencije karcinoma grlića.Na osnovu analize podataka u našem radu može se zaključiti da je cilj prevencije da se u ranoj fazi otkriju promjene na cerviksu i karcinom u početnoj fazi .Analiza je pokazala da najveci broj suspektnih nalaza susrecemo kod zena starosti 30/39g.Simptome kao razlog javljanja imalo je 587 od ukupno 2170 žena.Razvrstavanje nalaza sistemu PAPA klasifikacije dobijamo rezultat da je u prvoj grupi koja se posmatra kao uredna 914 nalaza.U drugoj koja pokazuje znake blage upale 1176 nalaza .U trećoj grupi koja pokazuje znake diplazije nalazimo 43 nalaza.Četvrta grupa ima 21 i peta 16 nalaza.Na osnovu analize podataka može se zaključiti da je cilj prevencje da se u ranoj fazi otkriju promjene na cerviksu i karcinom u početnoj fazi .Zato treba posvetiti posebnu pažnju edukaciji žena o ovoj važnoj mjeri zaštite zdravlja.

Dragana Aleksić, koautor: Ljubomir Šormaz (Laktaši, BiH): Prevencija i rano otkrivanje preinvazivnih promjena na grlićuIntroduction: Early detection of cervical preinvasive changes using Papanikolau test and colposcopyshown as best strategy in primary prevention.Objective: Screening of women from 40 to 69 years enable early detection of cervical cancerMaterial and methods: In this presentation were used data from DZLaktaši. The physical examinations and Papanicolau test were conducted in 2006. The aim group enrolled 2581 women, ages from 40 to 69 from municipality Laktaši.Results: Including 2581 women who were called to examine, 2029 women (78.46%) recalled. The most women who came were ages from 40 to 55. After exemination of 2029 women it was established that 36 women had positive Papanicolau test, 6 had CIN I, 13 had CIN II and 12 women had, after pathohistological examination, Carcinoma in situ. 5 women had invasive carcinoma.Conclusion: As early carcinoma is detected, the chances for survival are greater. Because mentioned facts, physical examinations and cervical screening are neccessery. In DZ Laktaši are organised physical examinations of women to enable early detection od cervical cancer, other pathological conditions of reproductive (genital) system, their treatment and health awareness.

Active call by healthprofessionals included a group of women from 40 to 69 years of age.

Minka Hadžiosmanović i Zejna Hadžiosmanović (Mostar, BiH): Vođenje trudnica od strane tima porodične medicine

Melida Hasanagić i Nađa Hasanagić (Mostar, BiH): “Plava knjiga”, kome je zaista potrebna?

Introduction:Legislation and logistics in Family Medicine is wide and we Wonder why is this? "Blue book":who need this?This is going to be main question in our workshop based on "Blue book" in BH and simillar books in USA.What kind of organisation of Family Medicine we want,who need that,is there any moment to change somethingMetdodology:Workshop based on written materilas everybody will get and based on that make discussion.Conclusion should be put in Strategy development of Family medicine in BH

TRANSDISCIPLINARNI SIMPOZIJ IZ OBLASTI RANOG RASTA I RAZVOJA/PEDIJATRIJE I

Selena Bajraktarević (Sarajevo, BiH): Koncept sistema za unaprijeđenje ranog rasta i razvoja u BIH

Vildana Doder, Marina Bera i Goran Čerkez (Sarajevo, BiH): Unaprijeđenje u oblasti ranog rasta i razvoja u FBiH

Milan Latinović, Jasminka Vučković (Banja Luka, BiH): Zakonski okviri za unaprijeđenje ranog rasta i razvoja u RS

Nirvana Pištoljević (Sarajevo, BiH/BHAAAS): Funkcionalan intersektorski pristup razvoju sistema za unaprijeđenje ranog rasta i razvoja u BiH

Eldin Džanko (Sarajevo, BiH): Razvojna bihevioralna skala kao alat za ranu detekciju u pedijatrijskoj službi

Stanislava Majušević (Sarajevo, BiH): Vodič za razvojnu procjenu i izradu individualnog programa i plana kao alat za ranu intervenciju

Lejla Buturović i Zumreta Jeina (Sarajevo, BiH): Kurikulum za edukaciju roditelja kao alat za prevenciju razvojnih kašnjenja

Vanesa Dujso-Radaslić (Sarajevo, BiH): Kurikulum za edukaciju budućih roditelja kao alat za prevenciju razvojnih poremećaja

TRANSDISCIPLINARNI SIMPOZIJ SA TEMAMA RELEVANTNIM ZA OBLAST «JEDNO ZDRAVLJE –JEDNA MEDICINA»

Azra Blažević (Saint Louis, USA/BHAAAS): A Century Long Journey: The past, the present and the future of TB vaccine development

Lejla Velić, Toni Eterović, Tarik Bajrović, Behija Dukić, Benjamin Čengić, Adis Softić (Sarajevo, BiH): Pregled najvažnijih bakterijskih zoonoza u Federaciji Bosne i Hercegovine

Brucellosis and Q fever have always been historically linked to this area. Brucellosis is known as Mediterranean fever while Q fever also known as the Balkan flu.In the period from 2013 to 2015 laboratory for virology and serology has tested a total of 70 503 blood serum of cattle, sheep and goat on brucellosis and found 3 654 positive samples. In the same period we tested only 937 blood sera for Q fever and we have found 63 positive reactor.Brucellosis in small ruminants in Bosnia and Hercegovina is controlled by vaccination for past 6 years with Rev 1 vaccine, while for cattle we still implement the “test and destroy “policy. Several control programs in brucellosis eradication are founded by our ministry, which is not the case with Q fever, therefore the small number of tested samples comes from the fact we test only suspicious animals.

Amer Talić, Baris Sareyyüpoğlu (Sarajevo, BiH /Ankara, Turkey): Optimizacija PCR metoda za detekciju abortusa uzrokovanih Listeriom kod preživara /Optimisation of PCR Techniques for Detection of Listerial Abortions in Ruminants

Ruminants play an important role in livestock breeding in our country. In ruminant breeding, abortion is one of the leading problems, and one of the most important abortifacient diseases in Turkey is undoubtedly listeriosis. The main pathogens among Listeria species that cause abortion are L. monocytogenes and L. ivanovii. In this study, development of a PCR technique for the detection of pathogenic Listeria species (Listeria monocytogenes, Listeria ivanovii) causing listerial abortions in ruminants was described. The determined detection limit from bacterial dilutions was only 3 CFU/25 µl, while the detection limit from the artificial contaminated tissue ranged between 75-750 CFU/25 µl. Results obtained with the multiplex-technique from foetal abomasal fluid, fetal liver, and cotyledon samples were found to be more sensitive in case of L. ivanovii rather then L. monocytogenes. Milk is known as a source of bacterial shedding, therefore milk samples were included for artificial contamination research and the results were of equal sensitivity and ideal for both pathogens.A multiplex-PCR technique for the detection of Listeria species causing abortion in ruminants was not found in the literature; therefore, this thesis is considered to be original. Key Words: Abortion, diagnosis, identification, Listeria, multiplex-PCR.

Harun Kurtagić, Suad Habeš, Erna Skenderović (Sarajevo, BiH): Ocjena kvaliteta meda proizvedenog u Bosni i Hercegovini (BiH) na osnovu fizičko- hemijskih podataka

It could be said that the quality od honey becomes more threatened with civilization development, due to increase of environment pollution and at the same time due to appearance of new diseases of honey bees. With growing human population on Earth, the needs for food are increasing, which is directly connected to apiculture production, knowing that bees (Apis mellifera) are the main pollinators for about 80% of plants important for food production. Natural honey can only be produced by bees but artificial and adulterated honeys can be found on the market. The criteria for basic quality assessment characteristics of honey is defined in Codex Alimentarius and international standards [1, 2, 3]. During the honey harvesting season in the year of 2015, honey samples from different areas of B&H were collected from the producers. Tested physico-chemical characteristics were in line with national legislation in B&H and other published papers [4,5]. Tests were performed in duplicates, and the results are presented as averages. Test results were obtained from 32 samples, out of which 8 were acacia honey, 5 were forest honey, 5 were chestnut honey, 7 were meadow honey, 4 were mountain meadow honey, 1 was chestnut-lime honey and 3 were honeydew. Total sugar content was from 66,54% (meadow and forest honey) to 96,24% (honeydew), reducing sugars content was from 58,44% (forest honey) to 77,0% (acacia honey), moisture content was from 13,45% (meadow honey) to 17,22% (mountain meadow honey), mineral content was from 0,097% (acacia honey) to 0,965% (honeydew). Quality assessment characteristics of tested honeys were within producer\'s specifications. Obtained results showed that the quality of honey produced in B&H in the year of 2015 has high quality and as such it\'s highly recommended for use.Keywords: honey, meadow honey, acacia honey, chestnut honey, honeydew, sugar content

Amina Hrković-Porobija, Aida Hodžić, Zlatan Šarić, Ćazim Crnkić (Sarajevo, BiH): Mlijeko i mliječni proizvodi ovaca kao funkcionalna hrana

Adla Kahrić, Andrej Gajić, Kasim Selman,Tarik Brkić, Armin Nikšić, Filip Filipić, Neira Ljevaković, (Il-Hamrun, Malta): Sintetski i semi-sintetski mikroplastični kontaminanti unutar akvatorija Bosne i Hercegovine: Uticaj na biotu i moguće prijetnje za čovjeka

Neum bay is an almost unexplored economic potential which is characterized by flattened bottom with an average depth of 24 meters and muddy bottom sediment, while on the coastal zone occurs sandy sediment. The increasing of the anthropogenic pressures, as well as the improper waste disposal into the sea, led to contamination primarily by wide spectrum of synthetic and semi-synthetic microplastic with particle below 5 mm. Microplastic may enter the ecosystem directly, in the form of granules which are used in plastic industry (eg. pellets), and indirectly by disintegration of a large plastic objects via photodegradation, oxidation and/or mechanical abrasion. Microplastic further can be ingested by different marine organisms and then accumulate in certain parts of the digestive system; plastic fibers easily entangled in the form of nodes and blocks. The case study (December, 2015) indicate a significant amount of microplastic in the stomach and intestine of both invertebrates (primarily crustaceans such as Squilla mantis Linnaeus, 1758) and vertebrates (primarily benthic bonefish such as Mullus barbatus Linnaeus, 1758, and also Merluccius merluccius (Linnaeus, 1758)). The accumulation of microplastic in the different tissue may

results in the mechanical damages of stomach mucosa and intestines developing ulcer, or it may release the toxic chemical components, such as different monomers and plastic additives, which may develop cancer or a series of the endocrine disorders. Furthermore, microplastic can be resorbed in the intestine and move to cardiovascular system. Mentioned pollutants can be further transferred through the trophic chain and even reach the humans (in consumption fish or invertebrates) as the final consumers. Detailed researches of microplastic pollution both in biota and sediment are necessary in order to establish the Strategy of sustainable development and potential resources.

INTERNACIONALNI SIMPOZIJ O INOVATIVNIM I INTERDISCIPLINARNIM APLIKACIJAMA SAVREMENIH TEHNOLOGIJA (IAT) II

SVI APSTRAKTI SA OVOG SIMPOZIJA SE MOGU NAĆI NA OVOM LINKU:

http://link.springer.com/book/10.1007%2F978-3-319-47295-9

TRANSDISCIPLINARNI SIMPOZIJ IZ OBLASTI RANOG RASTA I

RANI RAST I RAZVOJ

Nirvana Pištoljević (Sarajevo-New York/ BHAAAS): Early childhood development: The effects of the environment

Dušica Babović-Vuksanović (Boston, USA/BHAAAS): The effects of alcohol during pregnancy on early childhood development

Ayman Abu Laban (Sarajevo, BiH): Global trends in imunisation in the world

Smail Zubčević (Sarajevo, BiH): Imunizacija u BiH; Nauka i trendovi

Mihela Erjavec (Bangor, UK): Behavioral change in preschool children’s nutritional habits

Selena Bajraktarević (Sarajevo, BiH): Uticaj siromaštva, pothranjenosti, anemije i neadekvatne stimulacije na rani rast i razvoj romske djece

Eldin Džanko (Sarajevo, BiH): Indikatori ranog rasta i razvoja kod romske djece predškolske dobi u BiH

Diana Milojević (Boston, USA/BHAAS): Rheumatic diseases in toddlers and implications for early development

PEDIJATRIJSKA SLUŽBA

Željko Rončević (Mostar, BiH): Zdravstvena zaštita djece u Bosni i Hercegovini, sadašnjost i budućnost

U Bosni i Hercegovini se primjenjuje mješoviti tip zdravstvene zaštite djece u kojem sudjeluju pedijatri i liječnici obiteljske medicine s liječnicima opće prakse.

U Europi su poznata tri tipa primarne zdravstvene zaštite djece: pedijatrijski, tip zaštite bez pedijatra i mješoviti s pedijatrima i specijalistima obiteljske medicine i liječnicima opće prakse.

Bosna i Hercegovina ima relativno dobru zdravstvenu zaštitu djece sudeći prema stopi smrtnosti dojenčadi koja je prilično niska u odnosu na većinu zemalja u regionu Balkana (6,4 za 2014. godinu u FBiH) .

Broj pedijatra u BiH u primarnoj zdravstvenoj zaštiti se stalno smanjivao, a prosjek godina pedijatara je visok bez tendencije podmlađivanja. Dobro je da su sada primjetni novi trendovi jer vlasti podržavaju odobravanje specijalizacija za pedijatre primarne zdravstvene zaštite.

U Bosni i Hercegovini je natalitet u stalnom padu, mortalitet u porastu. Stopa fertiliteta je jedna od najnižih u svijetu s katastrofalnih 1,2 što znači da je Bosna i Hercegovina u depopulaciji i to kako u Republici Srpskoj tako i u Federaciji BiH. Zanimljivo je da vlasti još nedovoljno primjećuju ovaj veliki problem i još ništa ne poduzimaju da bi negativne trendove makar usporili.

Primjetna je i neujednačenost zdravstvene zaštite djece u ruralnim sredinama u odnosu na gradske sredine. Za pohvalu je program Rane detekcije i intervencije poremećaja u razvoju koji uz pomoć UNICEF-a pokušava otkloniti razlike između ruralnih sredina i gradskih područja u ovom važnom segmentu zdravstvene zaštite djece. Budućnost zdravstvene zaštite djece može biti svijetla samo ukoliko cijelo društvo odista shvati da su djeca i njihovo zdravlje jedina stvarna budućnost Bosne i Hercegovine.

Senaida Pjanić, (Tuzla, BiH): Evidentiranje i praćenje neurorizične djece u primarnoj zdravstvenoj zaštiti

Neurorizična djeca imaju pozitivnu anamnezu za jedan ili više faktora rizika koji mogudovesti do oštećenja centralnog nervnog sistema.Ovi faktori mogu djelovati prenatalno, perinatalno i/ili postnatalno. Kako bi se na vrijeme otkrili poremećaji u fizičkom, kognitivnom i socioemocionalnom razvoju i preduzela rana intervencija, neurorizičnu djecu treba evidentirati i kontinuirano pratiti, posebno u prve tri godine života, te njihov razvoj uporedjivati sa odredjenim standardima. Neurorizična djeca čine 10% novorodjene populacije, od toga 3% su visoko rizična. Analizirali smo 1035 zdravstvenih kartona djece rodjene 2015. godine., 91 dijete (8,7%) bilo je označeno kao neurorizično a njih 19-oro (1,7%) je imalo evidentirana odstupanja od normalnog razvoja. Prema zdravstvenoj evidenciji u periodu od 2010. do 2015. god u Dispanzeru je registrovano 81 neurorizično dijete. Najčešći faktori rizika bili su neonatalna sepsa (73%), intrakranijalna hemoragija (63%) i asfiksija (52%).Cilj rada bio je ukazati na značaj ranog evidentiranja i pažljivog praćenja ranog rasta i razvoja djece sa faktorima rizika. Pristupovom problemu mora biti multidisciplinaran.

Ključne riječi: neurorizična djeca, faktori rizika, rani rast i razvoj

Mirzada Kurbašić (Luisville,USA/ BHAAAS): Rano prepoznavanje poremećaja rasta i razvoja od rođenja kroz pubertet u SAD

Jasmina Klebić (Tuzla, BiH): Uloga i značaj Centra za rani rast i razvoj u primarnoj zdravstvenoj zaštiti

CILJ: Utvrditi prevalencu djece sa usporenim razvojem govora ISPITANICI I METODE: Istraživanje je prospektivno i obavljeno je u JZNU Dom zdravlja Tuzla, Dispanzer za predškolsku djecu-Centar za rani rast i razvoj u periodu od 01.10.2015-1.03.2016 godine. Korišten je prvi mjerni instrument u BiH za praćenje ranog rasta i razvoja (Pištoljević, 2015).REZULTATI: Uloga i zadaci Centra za rani rast i razvoj je rano praćenje dječijeg rasta i razvoja s akcentom na

“rizične porodice", detekcija djece sa poteškoćama u razvoju u bilo kojoj od 5 razvojnih oblasti (socio-emocionalni, komunikacijski, kognitivni, motorički, i samopomoć/briga o sebi), rana intervencija, edukacija roditelja, i edukacija stručnog kadra. U periodu od šest mjeseci detektovano je 36 djece uzrasta od 2-5 godina starosti kod kojih je ustanovljen usporen razvoj govora Od ukupno 36 djece kod kojih je detektovan usporen razvoj govora od toga je 9 djevojčica (25%) i 27 (75%) dječaka.ZAKLJUČAK: Cilj ovog istraživanja jeste istaći značaj preventivnih usluga u primarnoj zdravstvenoj zaštiti, važnost rane detekcije, edukacije roditelja koji bi mogli biti prvi detektori u ranom rast i razvoju svoje djece i što ranije uključivanje djece u ranu intervenciju. Rana intervencija može umanjiti kratkoročne i dugoročne posljedice koje razvojne poteškoće i poremećaji imaju na život djeteta i porodice.

Ključne riječi: rani rast i razvoj, rana intervecija,

METODOLOGIJE U RADU SA DJECOM U RANOJ RAZVOJNOJ DOBI

Džana Semanić, Sabina Brkić (Sarajevo, BiH): Analiza efektivnost EDUS naučnog koncepta rane intervencije

Danijela Vukićević, Vesna Radovanović, Jasmina Karić (Beograd, SR): Procjena motoričkog i sveobuhvatnog razvoja dece ranog uzrasta

Cilj istraživanja je bio da se utvrdi da li deca ranog uzrasta pored odstupanja u motoričkom razvoju, odstupaju u još nekoj oblasti razvoja, kao i da se utvrdi mišljenje roditelja o ulozi fizijatra, kao jednog od članova tima za procenu i praćenje deteta. Uzorak za istraživanje činilo je 30 dece koja prvi put dolaze na pregled kod fizijatra, uzrasta od jednog do četrnaest meseci, 14 (846,7%) muškog i 16 (53,3%) ženskog pola. Za procenu razvoja deteta pored fizijatrijskog pregleda korišćen je Vodič za praćenje razvoja deteta i upitnik za roditelje, konstruisan za potrebe ovog istraživanja. Na osnovu fizijatrisjkog pregleda potvrđeno je da se kod 28 (93,3%) dece sumnja pedijatra o postojanju odstupanja u motornom razvoju pokazala opravdanom: hipotonija kod 13 (43,3%), tortikoliks i hipertonija kod 10 (33,3%), hipertonija kod 2 (6,7%), tortikolis i hipotonija kod 2 (6,7%), tortikolis kod 1 (3,3%) i paralysis nervus facialis kod 1 (3,3%) deteta. Rezultati procene na osnovu Vodiča za praćenje dečjeg razvoja pokazuju da je kod 24 (80%) dece primećeno odstupanje u nekoj od procenjivanih oblasti razvoja: 5 (16,7%) ekspresivni govor i fina moltorika, gruba motorika 4 (13,3%), gruba i fina motrika 4 (13,3%), sve oblasti 4 (13,3%), fina motorika i socijalna interakcija 2 (6,7%), receptivni govor 2 (6,7%), ekspresivni govor 1 (3,3%), ekspresivni govor i socijalna interakcija 1 (3,3%) i ekspresivni govor i igra 1 (3,3%). Roditelji, u najvećem broju, od fizijatrijskog pregleda očekuju ne samo procenu motoričkog razvoja, već i procenu celokupnog razvoja17 (56,7%), kao i saveteza stimulisanje razvoja 19 (63,3%). Svi roditelji, bez izuzetaka, smataraju da je praćenje na ranom uzrastu neophodno, pored toga što ne znaju šta da očekuju od koje faze razvoja, ne poznaju dovoljno ni načine za stimulisanje razvoja. Skoro svi roditelji 29 (96,7%) su mišljenja da

na osnovu intervjua i poseta fizijatru mogu da bave stimulacijom svog deteta na kreativniji način. Neophodan je transdisciplinarni pristup u proceni, praćenju i stimulisanju dečjeg razvoja, kao i obuka roditelja o različitim oblicima stimulacije deteta na ranom uzrastu.Ključne reči: rani razvoj, procena ranog razvoja, transdisciplinarni pristup, rana intervencija

Nirvana Pištoljević, Eldin Džanko (Sarajevo, BiH): Intervencija kod razvoja govora kod djece u Autističnom spektru

Nirvana Pištoljević, Stanislava Majušević (Sarajevo, BiH): Uoga EDUS VODIČA za procjenu, izradu programa i praćenja sveobuhvatnog razvoja djece predškolskog uzrasta

Magdalena Perić, Marijana Tomić, Ana Sivrić, Danijela Kegelj (Mostar, BiH): Informiranost roditelja o razvojnim karakteristikama djeteta predškolske dobi/ Parents knowledge about developmental characteristics of preschool child

Predškolska pedagoška praksa zadnjih je godina suočena sa sve izraženijom potrebom intezivnije ili bolje reći drugačije vrste suradnje s roditeljima djece koja borave u vrtiću. Niti struka niti roditelji ne žele više formalnu, rijetku i nedefiniranu suradnju. Priča o partnerskim odnosima na dobrobit djeteta nije samo tek neko preneseno iskustvo od drugih ili rezultat pojedinih znanstvenih radova već potreba svakodnevnice. Ankete za roditelje za potrebe ispitivanja kvalitete rada u vrtići, kao i one koji su sastavni dio razvojnog plana vrtića, pokazuju da su roditelji najzaineresiraniji za teme koje se tiču problema u odrastanju djece ali i tema vezanih za njihove razvojne karakteristike. Cilj ovog rada je istražiti koliko roditelji ili staratelji djece iz naše ustanove poznaju razvojne karakteristike djece uzrasta od 1 do 6 godina, te koji sve faktori utječu na to. Pored toga nastojalo se ustanoviti koji roditelji su bolje upućeni u ovu problematiku u odnosu na to imaju li dijete s odstupanjima u razvoju ili ne. Istražen je i faktor razine obrazovanja roditelja, spola roditelja, radnog statusa, izvora preko kojega dolaze do informacija. Podaci su prikupljeni primjenom anketnog upitnika koji je izrađen u svrhe ovog istraživanja, te anketa za roditelje izrađenih za ispitivanje kvaliteta rada u vrtiću. Sve veća dostupnost informacija i različitih „znanja“ rezultirala je tim da roditelji poznaju različite i mnogobrojne činjenice o djeci predškolskog doba ali te činjenice su prikupljene neselektivno, neprovjereno i uglavnom su im izvori populističke naravi.

Ključne riječi: predškolska dob, razvojne karakteristike, odstupanje u razvoju.

-------------Preschool teaching practice in recent years faced with the increasing need more intensive or rather a different kind of cooperation with parents of children residing in kindergarten. Neither the profession nor the parents do not want more formal, a rare and undefined cooperation. The story of partner relationships for the benefit of the child is not only just a transferred experience of others, or the result of some scientific papers but a necessity of everyday life. Surveys of parents for the purpose of testing the quality of work in kindergartens as well as those who are part of the development plan of kindergarten, show that parents are most interested for topics related with problems in growing children as well as topics related to their

developmental characteristics. The aim of this paper is to investigate how much parents or guardians of children from our institution know about developmental characteristics of children aged 1-6 years, and that all factors affecting it. In addition, efforts were made to establish who the parents are better informed about this issue in relation to this they have a child with deviations in development or not. It was explored and factor levels of parental education, sex, employment status, source through whom access to information. Data were collected using a questionnaire that was developed for the purposes of this research, and surveys of parents made for testing the quality of work in institution. The increasing availability of information and different "knowledge" has resulted in a team that parents know the various and numerous facts about the children of preschool age but these facts are collected indiscriminately, untested and mainly their sources populist nature.

Key words: preschool age, developmental characteristics, developmental deviations.

Emira Švraka (Sarajevo, BiH): Occupational therapy for children with intellectual and developmental difficulties

Common theoretical starting point of an inclusive system and occupational therapy is a holistic view of the world that takes into account all the needs of the child and his family. Occupational therapy involves the management of motor, sensory, cognitive, intrapersonal and interpersonal problems, and problems in the self-care, productivity and leisure activities. Developmental approach involves developing skills to be achieved in a particular developmental stage of the child. The functional approach puts the focus on activities of daily living, while ecological approach identifies the environment in the home and community: kindergarten, school.Occupational therapist is a member of the team for early intervention, education of family members and functional training, which applies knowledge of sensory integration, play therapy, encourages sensomotoric development, adapts aids... Occupational therapist is part of the expert team for the development of communication of children with intellectual and developmental disabilities. Functional communication is the therapeutic target number 1.Goal of this study is to present the occupational therapy that uses developmental, functional and ecological approach as an effective method aimed at families and children with intellectual and developmental disabilities.Conclusion: Occupational therapists are part of the process of social inclusion as team members of early intervention, functional communication, individualized education program, programs and services for children with psychosocial disorders, creation and implementation of program for de-stigmatization and accessible housing.Inclusion aims to build general tolerance for individual differences and needs, and on that basis to create interactions and social relations.Keywords: occupational therapy, intellectual and developmental disabilities, children

GENERALNE PREZENTACIJE

Mladenka Vukojević, Lana Grbeša, Arta Dodaj, Martina Maslać, Ana Boban Raguž (Mostar, BiH): Socidemografski i obiteljski prediktori za razvoj ADHD poremećaja kod djece školske dobi u osnovnim školama u Mostaru

Deficit pažnje/hiperaktivni poremećaj (ADHD; od engl. Attention Deficit/Hyperactivity Disorder) jedan je od najčešćih neuropsihijatrijskih poremećaja u djetinjstvu (1,2). ADHD je karakteriziran simptomima hiperaktivnosti, impulzivnosti i nepažnjom, koji počinju u ranom djetinjstvu i mogu se nastaviti do adolescencije ili odrasle dobi (3). ADHD je najčešći dijagnosticirani poremećaj ponašanja u djece. Oko 5-12% djece diljem svijeta ima poremećaj pažnje i hiperaktivnost (4). Djeca nižeg socioekonomskog statusa češće imaju dijagnozu ADHD-a od djece višeg socioekonomskog statusa (5).

Ispitanici i metode: U istraživanje su bili uključeni roditelji 300 djece u dobi 6-12 godina, od čega je 149 djece II. i III. razreda te 151 djece VI. razreda. Istraživanje je provedeno u šest osnovnih škola na području grada Mostara. godine. U istraživanju je korištena anketa koja se sastojala iz tri upitnika: standardizirani Test za deficit pažnje/hiperaktivni poremećaj, standardizirana Skala procjene ponašanja djece od 6 do 18 godina i opći sociodemografski upitnik. Ispitivanje je bilo anonimno. Prikupljene podatke se testiralo odgovarajućim statističkim metodama.

Rezultati: U istraživanom uzorku 24,7% ispitanika imalo je zadovoljene kriterije za ADHD (P<0,001). U istraživanju je sudjelovalo podjednako ispitanika muškog i ženskog spola (P=1,000). U ispitivanom uzorku, najučestalije obrazovanje oba roditelja, bilo srednjoškolsko majke (P<0,001), isto kao i očevo (P<0,001). Ispitanici su većinom živjeli s oba roditelja (P<0,001), a kuća je bila najučestalije mjesto stanovanja (P<0,001), dok su odnosi u kući najučestalije ocijenjeni kao osrednji (P<0,001). Očevi ispitanika najučestalije nisu imali specifičan status, dok je od skupine očeva ispitanika koji su imali određen status, najučestaliji bio status ratnog vojnog invalida (P<0,001). Zaključak:. U svim sociodemografskim varijablama, varijablama ispitanici koji su u konačnici zadovoljavali kriterije za ADHD imali su srednje obrazovanje roditelja i lošiju socioekonomsku situaciju.

Ključne riječi: sociodemografski i obiteljski prediktori, ADHD, djeca,hiperaktivnost,

Literatura:

1.Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants have a protective effect on the development of psychiatric disorders in youth with ADHD? A ten-year follow-up study.Pediatrics. 2009;124:71–78.

2.LarsonK, Russ SA, Kahn RS, Halfon N. Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007. Pediatrics. 2011;127:462–470.

3.Powers RL, Marks DJ, Miller CJ, Newcorn JH, Halperin JM. Stimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder Moderates Adolescent Academic Outcome. J Child Adolesc Psychopharmacol. 2008;18:449–459.

4.John M. Eisenberg Center for Clinical Decisions and Communications Science. Attention Deficit Hyperactivity Disorder in Children and Adolescents. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007.

5.Elder TE. The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates. J Health Econ. 2010;29:641–656.

Željko Rončević (Mostar, BiH): Auskultacija srca kod djece

Zijo Begić, Senka Mesihović-Dinarević, Almira Kadić, Mirza Halimić, Sanko Pandur, Edin Begić (Sarajevo, BiH): Congenital heart defects treatment options – B&H experience

Introduction:. Modern pediatric cardiology mainly deals with congenital heart defects (CHD); the most common congenital anomalies. The aim of the research was to evaluate the treatment of CHD.Methods: Research was conducted at the Paediatric Clinic UCC Sarajevo (April 1997-January 2016) and included 844 patients.Results: Cardiac treatment was performed on 715 (84,7%) patients with CHD, 521 (72,8%) acyanotic patients and 194 (27,2%) cyanotic patients (complex defects). In 634 children (88,6%) a complete correction was performed and in 81 (13,4%) a palliative operation/correction. Defects with left to right shunt were in 382 (53,4%) patients, complex heart defects with Tetralogy of Fallot in 163 (22,7%), obstructive heart defects in 105 (14,6%), obstructive heart defects with shunt in 52 (7,2%), and others in 13 (1,8%) patients. Isolated CHD was found in 472 (66%) patients. CHD associated with a genetic syndrome was present in 68 patients (9,5%), of which 59 (86.78%) patients had Down syndrome.During surgery, extracorporeal circulation was regulated in 525 (73.4%) patients. Peri and early postoperative complications occurred in 172 (24%) patients. During this time, 129 (15,2% of all CHD treated patients, 38% off all catheterization) had to undergo interventional catheterization - patent ductus arteriosus 50 (38,7%), atrial septal defect type II (34,1%), pulmonic stenosis 26 (20,1%), coarctation of aorta 2 (1,5%), aortic stenosis 2 (1,5%) and others 5 (3,8%) cases. Procedure was unsuccessful in 15 (10,4%) cases.

Conclusion: The development of pediatric cardiology/cardiac surgery has led to the introduction of new diagnostic methods and therapeutics procedures. It has increased the number of CHD corrections, especially of complex heart defects, and moved the time of correction in infancy. It has raised the preferability of the use of catheterization, and brought our country closer to the countries of Western Europe, by imposing the imperative of future development.

Keywords: congenital heart defects, treatment, trend.

Adnan Bajraktarević, Aziz Kurtović, Sanja Putica, Milan Mioković, Fuad Husić, Alija Drnda, Sabina Kurtagić, Teodora Frankić, Ana Maltar, Aida Đulepa Đurđević, Aida Mehić, Alisa Abduzamović, Dijana Dugonjić, Zlatko Guzin, Kenan Karavdić, Zlatan Zvizdić, Almir Masala (Sarajevo, Tešanj, Mostar, BiH): A comparative study of probiotic continuous or discontinous treatment with different antibiotics treatment in preschool children

INTRODUCTION: Diarrhea is a common side effect of antibiotic use, occurring in almost one quarter preschool children who take the antibiotics. There are different attitudes about pediatric continuous or discontinuous probiotic treatment with antibiotic therapy in children. AIMS: This analysis had examined the impact of probiotics on the incidence of antibiotics-associated diarrhea among preschool children in both hospital and outpatient settings.METHODS: In our two separate studies in outpatient settings and pediatrics hospital or clinics, the probiotics

intervention was compared to a placebo control group during antibiotics therapy, two trials compared probiotics to conventional care including continuous or discontinuous therapy. Trials included treatment with either Bacillus spp., Bifidobacterium spp., Lactobacilli spp., Lactococcus spp., Saccharomyces spp., or Streptococcus spp., alone or in combination. RESULTS: No statistically significant heterogeneity was detected for this comparison of continuous or discontinuous probiotic treatment (P ≤ 0.73; I squared ≤ 0.2%). The low risk of bias studies suggested a stronger pooled protective effect of probiotics (RR 0.29; 95% CI 0.19 to 0.42) than the high risk of bias studies (RR 0.42; 95% CI 0.33 to 0.66) although a test of interaction between low and high or unclear risk of bias studies was not statistically significant (P ≤ 0.12). Tests for interaction probiotics therapy with different antibiotics (beta-lactams/penicillins versus cephalosporins; beta-lactams/penicillins versus macrolides) were not statistically significant (P ≤ 0.30; and P ≤ 0.22 respectively. CONCLUSIONS: New research and our research have suggested that probiotics have had help lower the risk of that unwanted side effect. Antibiotics alter the microbial balance within the gastrointestinal tract. Probiotics may prevent antibiotic-associated diarrhea. There were no differencies between continuous or discontinuous probiotic treatment with antibiotic therapy in preschool children. KEY WORDS: Children, Probiotics, Antibiotics.

INTERNACIONALNI SIMPOZIJ IZ MULTIDISCIPLINARNE ONKOLOGIJE, DAN I

PROGRAM: DAN I

KARCINOMI OVARIJA, PLUĆA, NEUROENDOKRINI TUMORI GASTROINTESTINALNOG TRAKTA I HEMATOLOŠKA MALIGNA OBOLJENJA: DIJAGNOZA I TRETMAN

PLENARNO PREDAVANJE

Husić Samir (Tuzla, BiH): Palijativna medicina : Šta imamo u BiH?

HEMATOLOŠKA MALIGNA OBOLJENJA

Dragan Jevremović (Rochester, USA): Diagnosis and new pathological classification of the myelodisplastic syndrome

Gordan Srkalović (Lansing, USA/BHAAAS): New agents in the treatment of hematological malignancies

Gordan Srkalović (Lansing, USA/BHAAAS): Multiple Myeloma: Novel approaches to therapy

Progress in medical research has enhanced our understanding of tumor biology, delineated genetic and molecular mechanisms of tumor growth and survival, and defined the impact of the microenvironment in cancer pathogenesis.This is particularly true for multiple myeloma (MM), in which the introduction of drugs targeting the tumor in its microenvironment, such as the proteasome inhibitor bortezomib and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, into initial, consolidation, maintenance, and salvage therapies has markedly improved patient outcome. The most promising therapies to even further improve MM treatment will be discussed in this presentation, with a focus on drugs inhibiting the ubiquitin-proteasome pathway; histone deacetylase (HDAC) inhibitors (HDACIs); immune therapies including IMiDs, monoclonal antibodies (mAbs), immune checkpoint inhibitors, agents targeting accessory plasmacytoid dendritic cells (pDCs), vaccines, and chimeric antigen receptor–engineered T (CAR-T) cells; drugs targeting tumor cell homing to, and exploiting hypoxia in, the bone marrow (BM) microenvironment; molecularly targeted therapies against kinesin spindle protein (KSP), v-akt murine thymoma viral oncogene homolog 1 (AKT), exportin 1 (XPO1), cyclin-dependent kinases (CDKs), bromodomain and extraterminal (BET) bromodomain 4, and serine/threonine kinase 4 (STK4); as well as delineating the impact of genomics on MM therapy. These advances in understanding the biology of MM will allow for earlier treatment of patients using rationally informed combination therapies with curative potential.

KANCER PLUĆA

Rifat Sejdinović, Edin Jusufović (Tešanj, BiH): Bronhoskopija u dijagnozi, prognozi i terapiji kancera pluća

Bronchoscopy is an invaluable tool in the diagnosis and staging of lung cancer. Integration of radiology, electromagnetic navigation, and ultrasound technology allows for access beyond the airway and greatly facilitates adequate and accurate staging using minimally invasive approaches. Current developments will allow for investigation at the microscopic level, possibly facilitating in vivo pathological evaluation in the future. There are still many unanswered questions: 1. How much training should be required to gain competency in these technologies? 2. How will hospitals afford such technology? 3. For some expensive and complicated technology, should care be regionalized? 4. Will there be reimbursement for hospitals and physicians?Tracheal or bronchial proximal stenoses occur as complications in 20–30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management, as invasive treatment, should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. The goal is to show: 1. the available methods for assessing the characteristics of stenoses; 2. the various techniques available including their preferred indications, outcomes and complications; 3. the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy.

Goran Krdžalić, Nermin Mušanović i Amar Kešetović (Tuzla, BiH): Uniportal VATS u dijagnostici medijastinalnih tumora

Goran Šarkanović (Tuzla, BiH): Patologija kancera pluća

Gordan Srkalović (Lansing, USA): Role of the NextGen sequencing in the therapy of the lung cancer

Therapeutic approaches to lung cancers have quickly shifted towards an emphasis onmolecularly targeted therapy in genotypic subsets of patients. The discovery of activating mutations in the epidermal growth factor receptor (EGFR) gene in 2003 and rearrangements involving the anaplastic lymphoma kinase (ALK) gene in 2007 ushered in an era where the identification of key oncogenic alterations emerged as the critical determinant of benefit to targeted therapy. Recent data from The Cancer Genome Atlas (TCGA) revealed that lung cancers rank among the most genomically-complex of tumors among the 12 cancer types studied by the TCGA Pan-Cancer effort.Next-generation sequencing (NGS) or massively-parallel DNA sequencing represents an important technologic advance in the evolution of molecular diagnostic tools. NGS allows for the simultaneous detection of multiple alterations in relevant cancer genes in a single test, but this ability can depend on the type of target enrichment used, namely hybrid capture or PCR. Hybrid capture-based NGS assays allow the identification of not only hotspot mutations, but also interrogates the entire coding sequence of oncogenes and tumor suppressor genes and the introns of selected genes involved in gene fusions, and allow assessment of copy number alterations, all from a single formalin fixed paraffin embedded specimen.

KANCER OVARIJA

Sulejman Kulenović ( Bihać, BiH): Hirurški pristup kanceru ovarija

Ermina Iljazović (Tuzla, BiH): Kancer ovarija: Moderne teorije patogeneze i porijekla karcinoma

Recent clinicopathological and molecular studies have provided new insight into the origin and pathogenesis of ovarian carcinomas. It has been shown that ovarian cancer is comprised of different tumour types differing not only in morphology, but also in pathogenesis, molecular alterations and clinical progression. A dualistic model of ovarian carcinogenesis has been proposed. Type I tumors are comprised of low-grade serous, low-gradeendometrioid, clear cell and mucinous carcinomas and Brenner tumors. They are generallyindolent, present in stage I and are characterized by specific mutations. Type II tumors are comprised of high-grade serous, high-grade endometrioid,malignant mixed mesodermal tumors and undifferentiated carcinomas. Theyare aggressive, present in advanced stage, and have a very high frequency of TP53 mutations. Mounting evidence suggests that many high grade serous carcinomas originate from the epithelium of the distal fallopian tube, and that serous tubal intraepithelial carcinoma (STIC) represents the putative precursor of these neoplasm.Low grade serous carcinomas arise via transformation of benign and borderline serous tumours, thought to be derived from inclusion cysts originating from the ovarian surface or tubal epithelium. The new model of assigning ovarian epithelial carcinomasinto two groups demands a radical change of current clinicalmanagement.

Dženita Ljuca (Tuzla, BiH): Kontroverze u liječenju kancera ovarija

NEUROENDOKRINI TUMORI GASTROINTESTINALNOG SISTEMA

Emir Pinjo (Oslo, Norway) Neuroendocrine tumors of the GI system

TBA: Patologija neurondokrinih tumora GI trakta

Emir Pinjo (Oslo, Norwey); Therapy of the neuroendocrine tumors of the GI system GENERALNE PREZENTACIJE

Alma Mekić-Abazović, Hakija Bečulić, Senad Dervišević, Branslava Jakovljević (Zenica, BiH): Tumor timusa slučajno otkriven:

Prikaz slučaja

This is a case presentation of a patient with diagnosis of thymoma, incidentaly discovered during general medical exam. Chest X-ray presented with a tumor in the upper mediastinum. Afterwards, patient was reffered to a hospital for extensive diagnostics. Computed tomography of chest discovered a mass in upper mediastinum sized 12x5cm, that had radiographic characteristics of an extragonadal germinative neoplasm or teratoma even, but other etiologies were also explored. Bronchoscopy revealed chronic deformating bronchitis with extensive hemorrhage in mucosal tissue. Cytological rewiev of bronchoalveolar lavage showed great amount of red blood cells, bit of segmented white blood cells, alveolar macrophages and squamous cells derived from oral part of pharynx. Thoracic surgeon indicates surgical approach with total resection of thymic gland, which was done through medial sternotomy and posterolateral thoracotomy approach. Pathohistological diagnosis was thymoma, immunohistochemistry revealed it is a combined type of B2/B3. Afterwards, according to a decision of multidisciplinary team in Podhrastovi Clinic Sarajevo, follow up was indicated, with suggestion from multidisciplinary team of County Zenica Hospital for a PET CT scan, which detected a residual mass around the pancreatic head and enlarged lymph nodes on the left side of mesenteric artery. Patient then received three cycles fo chemotherapy, followed by regression of abdominal lymph nodes without FDG metabolic activity, on the next PET CT scan. Afterwards radiotherapy was administered. Now, disease is stable, and patient is beeing monitored through sheduled follow ups.

Key words: thymoma, prognosis, clinical follow up.

Hajrudin Halilović (Bihać, BiH): Savremeni hirurški stavovi u tretmanu uznapredovalog kolorektalnog karcinoma

INTERNACIONALNI SIMPOZIJ IZ INTENZIVNE MEDICINE: Vještina, istraživački rad i poboljšanje kvaliteta intenzivne medicine

Moreno-Franco Pablo (Jacksonville, USA): Quality improvement in management of severe sepsis

Rodrigues Eduardo (Jacksonville, USA): Quality improvement in blood utilization

Barbosa Maria (Jacksonville, USA): Quality improvement in lung protective ventilation in the operating room

Mira-Avendano Isabel (Jacksonville, USA): Bronchoscopy in critically ill

Gajić Ognjen (Rochester, USA/ BHAAAS): Ekspanzija istraživačkog rada u intenzivnoj medicini i translacija stručnog znanja širom svijeta

Gavrilović Srđan (Sremska Kamenica, SR): Unaprijeđenje kvaliteta akutne i intenzivne medicine u regiji; primjer ICERTAIN-a

Cartin-Ceba Rodrigo (Scottsdale, USA): Introduction to research in critical care

Festić Emir (Jacksonville, USA/BHAAAS):Introdukcija sistematskog pregleda literature i meta-analizeaz-Gomez Jose (Jacksonville, USA): Ultrasound education in the ICU and clinical application

Diaz – Gomez Jose (Jacksonville, USA): Ultrasound education in ICU and clinical application

Šustić Alan (Rijeka, HR/BHAAAS): Perkutana traheostomija vođena upotrebom ultrazvuka

Mujaković Aida, Tijana Muhić-Skalonja, Seniha Hamzić, Edin Bećiragić (Sarajevo, BiH/BHAAAS) : Pregled dijagnoze i tretmana akutne plućne embolije kod hemodinamski nestabilnih pacijenata

Acute pulmonary embolism (PE) is a common but most often urgent medical condition that requires efficient diagnostic and therapeutic approach in order to reduce the associated morbidity and mortality. Hemodinamically unstable patients with PE require additional attention due to often sudden onset of obstructive shock and elevated risk of possible death within 72 hours of admission. The definitive diagnosis should be established by performing a golden standard, computed tomographic pulmonary angiography (CTPA) or, if it is unsafe, portable perfusion scanning and transthoracic or transesophageal echocardiography. Initial support should focus upon restoring perfusion as well as oxygenation and, if necessary, stabilizing the airway with intubation and mechanical ventilation. Regardless the definitive diagnosis, patients with a high clinical suspicion for PE (Wells score), should receive thrombolytic therapy as a life-saving measure and it should be individualized for each unstable patient. If not used, a patient should receive empiric anticoagulation such as in cases of low or moderate clinical suspicion for PE. For unstable

patient in whom thrombolysis is contraindicated, options include repeat systemic thrombolysis, catheter-directed thrombolysis, or catheter or surgical embolectomy, depending upon available resources and expertise. Catheter-directed techniques such asultrasound-assisted thrombolysis, rheolytic embolectomy, rotational and suctional embolectomy, are most commonly utilized in patients with moderate risk for PE, although there is some experience with massive PE. Hemodynamic instability due to acute PE is the usual indication for surgical embolectomy in cases where thrombolysis (systemic or catheter-directed) is contraindicated or has failed. Subsegmental PE still remains a challenge in a diagnostic as well as in therapeutic approach.

Key words: acute pulmonary embolism, hemodynamic instability, catheterdirected thrombolysis

Imamović Goran (Tuzla, BiH): Smanjenje mortaliteta sa visoko-volumnom hemodijafiltracijom

Hemodiafiltration (HDF) is a renal replacement modality that combines diffusion and convection in order to remove small and middle molecular weight compounds, respectively.They are removed along solvant drag effect of ultrafiltration through increased transmembrane pressure, whereas the replacement solution is infused intravenously at equal amount minus the desired fluid volume removal for achieving dry weight. Limiting factors for high-volume online hemodiafiltration (HV oHDF) are blood flow and viscosity (hematocrit, protocrit), filter performance, and technical features of HDF monitor. Most recent advanced technology of dynamic analysis of pressure pulses along the blood flow pathway in the dialyser has enabled optimal ultrafiltration flow performances. HV oHDF offers today the best compromise of cardioprotective option by reducing cardio-vascular risk factors in end stage kidney disease patients. Recent randomized controlled trials, individual participant data metaanalyses and a number of observational studies have shown the evidence of survival advantage of HDF over conventional hemodialysis. Balkan study conducted in Bosnia and Herzegovina, Serbia and Slovenia, while using European Clinical Database (EuCliD®), showed the lowest RR for mortality of 0.29 on high volume oHDF compared to high flux conventional HD. In Europe, equipment for HDF must comply with the International Electrotechnical Commission (IEC) standards 60601-2-16. There is no equivalent acceptance of the IEC standard by the US Food and Drug Administration, so HDF is unlicensed in the United States. The convective volume has become the key quantifier for HV oHDF as themeasure of dialysis dose. Its cut-off values for better survival have been recognized, but the research is still needed in the years to come to set the required optimal volumes tailored to individualpatients' needs.

Tabaković Jasminka (Zenica, BiH): Liječenje politraumatizovanog pacijenta; prikaz slučaja

Marić Sanja (Foča, BiH): ICU Triada; Problem pacijenta ili doktora

INTERNACIONALNI SIMPOZIJ IZ ORTOPEDIJE I TRAUMATOLOGIJE

KUK

Svemir Čustović (Tuzla, BiH): Prediktivna vrijednost faktora rizika za razvojni poremećaj kuka, prikaz doktorata

Bojan Kuzmanović (Banja Luka, BiH): Revaskularizacija glave femura kod avaskularne nekroze

Slavko Manojlović (Banja Luka, BiH): Usporedba nosivih površina u bescementnoj primarnoj artroplastici zgloba kuka, keramika-metal i metal-metal, prikaz doktorata

Enes Kanlić (Phoenix, USA/BHAAAS), Amr Abdelgawad (El Paso, USA): Revizija proteze kuka kod “pelvic dissociation”, prikaz slučaja

Tarik Muharemović, Harun Đozić, Šukrija Đozić, Sakip Korać, Srećko Đikić, Mahir Moro, Severin Žujo (Sarajevo, BiH): Antimikrobna osjetljivost najčešće izolovanih mikroorganizama iz hirurških rana kuka

Introduction: the development of orthopedics and traumatology results in an increase of surgical procedures, which consequently results in an increase of complications in terms of surgical wound infection. There was a prevailing opinion that if patients survive the operation, and if infection and sepsis occurs, death was almost inevitable consequence. Changes requiring surgical treatment on the hip are usually trauma, but also a large number of congenital and acquired hip diseases.The most frequent postoperative complication is wound infection. Infection of surgical wounds has been a significant problem since the existence of surgery. Infection of surgical wounds (Surgical Site Infections, SSIS) is an infection that occurs 30 days after the surgery, and one year after the implantation of operating foreign body (implant), in the part of the body where the surgery was performed. The Center for Disease Control and Prevention (CDC) has defined three types of these infections, adding recently a fourth type: incision, surface, deep and organic infections. Antibiotic prophylaxis elected should act on the most common causes of surgical-site infections, but not necessarily on all possible causes. Materials and Methods: the study is a prospective- retrospective, clinical-microbiological study, performed at the General Hospital „Prim. Dr. Abdulah Nakaš“ in Sarajevo, from January 2007 to April 2013. The study involved the patients observed and surgically treated at the Department of Orthopedics and Traumatology of the General Hospital „Prim. Dr. Abdulah Nakaš“ in Sarajevo. The target group consists of 60 subjects of both sexes and different age. Each patient included in the survey was subjected to microbial processing of biological materials taken in a standard way, prepared and microscoped.

Results: all 60 patients were divided into groups according to their diagnoses, ofwhich 23 (38.33%) patients were diagnosed with femur neck fracture, 15 (25.00%) with

pertrochanteric fracture, 11 (18.33%) patients with coxarthrosis, 5 (8.33%) with intertrochanteric fracture, 3 (5.00%) withsubtrochanteric fracture and 3 (5.00%) patients had other diagnosis.Results of microbiological analysis of the number of agents from the surgical wound, showed that one type of microorganism caused the infection detected in 50 (83.3%), and two infection agents in 10 (16.7%) patients. Of the total of 50 patients with microbiologically proven one type isolates from hip surgical wounds, 23 (46.0%) were diagnosed with femoral neck fracture, 11 (22.0%) patients were diagnosed with coxarthrosis, 9 (18.0%) with pertrochanteric fracture, 4 (8.0%) withintertrochanteric fracture, and 3 (6.0%) with subtrochanteric fractures, etc.

Conclusion: the fracture of the femoral neck is the most common type of injury or disease in which the microorganism is isolated from the hip surgical wounds. Implantation of subtotal hip prosthesis is the most common type of surgery in which microorganisms are isolated from hip surgical wounds. The majority of patients were over 80 years. The most common microorganism isolated from hip surgical wounds was Acinetobaceter spp., followed by Staphylococcus aureus. Isolatedstrains Acinetobaceter spp showed the highest antimicrobial susceptibility to Imipenem with 84.6%, and the highest antimicrobial resistance to ciprofloxacin with 92.6%. Isolated strains of Staphylococcus aureus expressed the highest antimicrobial susceptibility to vancomycin and amikacin with 100.0%, and the highest antimicrobial resistance to sulfometoksazol-trimetoprim with 75.0%. Pseudomnas aeruginosa isolated strains showed the highest antimicrobial susceptibility to cefazolin, with 100.0%, and the highest antimicrobial resistance to cefuroxime, ceftriaxon, cefotaxime and sulfometoksasol-trimetoprim, with 100.0%.

Key words: hip surgical wound, wound infections, antimicrobial susceptibility

KOLJENO

Mirza Bišćević (Sarajevo, BiH): Spolne razlike u kinematici koljena i njene moguće posljedice, prikaz doktorata

Semin Bećirbegović (Sarajevo, BiH): Kvalitet objavljenih rezultata liječenja prednjeg ukrštenog ligamenta u periodu od 2001 - 2012 godine, meta-analiza, prikaz magistarskog rada

Marko Ostojić, Violeta Šoljić, Tomislav Đapić (Mostar, BiH): Rani osteoartritis koljena karakterizira visok stupanj sinovitisa sa povećanim izražajem NF-kB i iNOS

Ismet Gavrankapetanović, Sanja Đorđević-Marić (Sarajevo, BiH): Multimodalna analgezija nakon operacije koljena: prijedlog protokola

STOPALO, KOMPLIKACIJE

Adnana Talić-Tanović (Sarajevo, BiH): Principi operativnog liječenja dijabetičnog stopala

INTRODUCTION: Diabetic foot represents one of many complications of diabetes mellitus and it is considered as bone and soft-tissue changes on the foot of diabetic patients. It is chronic complication of diabetes mellitus that occurs in combination of diabetic peripheral neuropathy and angiopathy. Because of this reason, diabetic patients have 15x more incidences of amputations comparing to the rest of the population. Diabetic foot represents foot of the patient diagnosed with diabetes mellitus with potential risk of numerous pathological consequences including infections, ulcerations and/or destruction of the deep tissues related to neurological abnormalities, different stages of the peripheral vascular disease and /or metabolic complications in lower extremities (WHO). Incidence of disease is similar among men and women in any age group, except it is greater in men older than 60 years. Risk factors for development of diabetic foot include: male gender, diabetes mellitus diagnosed for more than 10 years, peripheral neuropathy, abnormal foot anatomy (including bone abnormality, blisters, and changes in the nails), peripheral vascular disease, smoking, and anamnesis of previous ulcerations or amputations. AIM: In this study we want to show principles of the operative treatment of the diabetic foot hoping to answer following question: What parameters influence reduction of the complications of the diabetic foot? We will show patients with the most risks and operative treatment with the smallest amount of complications. MATERIAL AND METHODS: This research was conducted at the Clinic for Orthopaedics and Traumatology of the University Clinical Center Sarajevo. Including factors are patients hospitalized for operative treatment of the diabetic foot during 2014 and 2015. Total number of 62 patients was hospitalized at the Septic Department of our Clinic. RESULTS: Results of this research show dominant male gender of the average 64 years of age. Statistic analysis of the collected data show that most patients were treated with some sort of the amputation treatment.CONCLUSION: Modern aspects of treatment of chronic diabetic wound and diabetic ulcer requires adjusted treatment collaborated with international guidelines. In case of complications, use of the amputation techniques with possibilities of prosthetics is required. If a proper treatment starts at the early stage of disease, multidisciplinary approach and adequate surgical intervention should lead to the sanation of the tissue lesion.KEY WORDS: Diabetic foot, operative treatment, complications of the diabetic foot

Sahmir Sadić (Tuzla, BiH) : Zastarjela previđena luksacija metatarzofalangealnog zgloba II prsta

Harun Đozić, Tarik Muharemović, Severin Žujo, Mahir Moro, Edin Bećiragić, Midhat Čizmić (Sarajevo, BiH): Uticaj kombinacije

etanola i povidon joda u preoperativnoj pripremi operativnog polja na pojavu postoperativnih infekcija

Ciljevi istraživanja su bili utvrditi učestalost i vrstu infekcije nakon elektivnog opertivnog zahvata preponske kile po Lichtenstein-u kod pacijenata kod kojih je operativno polje preoprativno pripremano sa povidon-jodidom. Utvrditi da li se upotrebom otopine etanola, u preoperativnom pranju operativnog polja može smanjiti incidenca pojave infekcija operativne rane nakon hernioplastike po Lichtenstein-u. Utvrditi prisustvo bakterija u rani 24 sata postoperativno u obje grupe ispitivanih pacijenata.U ovoj studiji 50 pacijenata sa dijagnozom preponske kile bilo je podvrgnuto preoparativnom pranju operativnog polja sa rastvorom etanola i povidon-jodidom. Oni su činili eksperimentalnu grupu. Kontrolnu grupu je činilo 50 pacijenata sa dijagnozom preponske kile koji su bili podvrgnuti preoperativnom pranju operativnog polja sa povidon-jodidom. Pacijentima iz eksperimentalne grupe, neposredno prije uvođenja u opću anesteziju, na operativno polje je naprskan rastvor etanol, izopropanola i ortofenilfenola i ostavljen je da djeluje minimalno jedan minut, odnosno da otopina ispari kako se ne bi kauterom izazvale opekotine kože. Nakon uvođenja u opću anesteziju pristupilo se ponovnom klasičnom preoprativnom pranju. Bez bakterijskog porasta je bilo 28 (56%) briseva u etanol i povidon jod grupi a samo 12 (24%) u povidon jod grupi. Ova razlika je statistički značajna p<0,01. Najznačajnije je djejstvo na Staphylococcus Aureus gdje je izoliran u prvoj grupi samo kod 8 pacijenata dok je u povidonskoj grupi izoliran kod 23 pacijenta. Razlika je visoko signifikantna (p<0,01, CHI TEST). Na prvoj kontroli u etanol i povidon jod lokalni nalaz je bio uredan kod svih 50 pacijenata dok je u povidon jod grupi bilo 5 infekcija operativne rane i dva pacijenta sa lokalnim otokom. Ova razlika je statistički signifikantna (p<0,05, CHI TEST).

Mirza Bišćević (Sarajevo, BiH): Revizije u spinalnoj hirurgiji - naša iskustva u posljednih 5 godina

VENSKA TROMBOZA I PULOMARNA EMBOLIJA

Muhamed Đedović, Hajrudin Halilović, Samed Đedović, Selvira Halilović (Sarajevo, BiH): Hirurški tretman komplikacija venskog tromboembolizma

Obziron na učestalost i klinički značaj, pod venskim tromboembolizmom obično se podrazumije¬vaju venska tromboza i plućni embolizam kao poslje¬dica embolije trombotičnih masa iz dubokih vena ili vena male karlice. Venska tromboza (VT) i plućna embolija (PE) su značajni zdravstveni problemi. U SAD-u svake godine se zapazi 275 000 novih slučajeva venskog tromboembolizma . Incidenca je 50.4 na 100 000 osoba godišnjeUkoliko se tromboza dubokih vena (DVT) potkoljenica adekvatno ne tretira, trombotski proces se širi na proksimalni sistem (kod 25% pacijenata). Znakovi i simptomi su praktično posljedica prekida venskog protoka na magistralnom venskom segmentu donjih ekstremiteta. Venska tromboza dubokih vena (DVT) može rezultirati hroničnom insuficijencijom vena sa dubo¬kim venskim refluksom ili opstrukcijom, ali je dominantan zdravstveni problem mogućnost nastanka plućne embolije, koja trajno može oštetiti respiratornu funkciju ili dovesti do fatalnog ishoda.

Bolesnici koji se podvrgavaju hirurškom zahvatu imaju povećan rizik za razvoj veskog tromboembolizma (DVT i PE). Kod takvih pacijenata, adekvatna tromboprofilaksa nakon operativnog zahvata može smanjiti rizik od stvaranja krvnih ugrušaka nakon operacije. Te moguće prednosti, međutim, moraju se uzeti u obzir zajedno s rizikom od nastanka krvarenja. Prevencija venskog tromboembolizma kod hirurških pacijenata predstavlja obavezu, jer su ovi pacijenti, zbog ograničene pokretljivosti u postoperativnom periodu, pod povećanim rizikom za razvoj venskog tromboembolizma, ali i problem, jer su najefikasnije medikamentozne mjere prevencije ograničeno primjenjljive kod pojedinih pacijenata zbog rizika za nastanak ozbiljnih komplikacija. Ključne riječi: hirurški bolesnici, venski tromboembolizam, tromboprofilaksa

Mirza Bišćević, Jasmin Kapetanović, Mahir Moro, Severin Žujo (Sarajevo, BiH): Tromboprofilaksa u spinalnoj hirurgiji – naš protokol i iskustva

U ovom radu analiziramo incidencu tromboembolijskih komplikacija kod 283 pacijenata liječenih na Odjelu za spinalnu hirurgiju Klinike za ortopediju i traumatologiju UKCS zbog povreda ili bolesti kičme. Ostali uključujući kriteriji bili su ležanje duže od 24 sata zbog povrede, oboljenja ili/i operacije torakolumbalne kičme, hospitalizacija tokom posljednje dvije godine (1.5.2014. 1.5.2016.), primjena tromboprofilakse i rane mobilizacije po našem protokolu. Bez obzira na vrstu profilakse (peroralni antikoagulansi - rivaroksaban ili niskomolekularni heparini - enoksaparin) na sreću nisu zabilježene tromboembolijske komplikacije u ovoj grupi. U diskusiji biđe prezentiran naš protokol medikamentozne tromboprofilakse i mobilizacije, te glavne prednosti i nedostaciji pomenutih antikoagulanasa

Slavko Manojlović (Banja Luka, BiH): Xarelto - šest godina uspješne primjene

Lorenzo Aragón, Emily J. Christenberry (El Paso, USA): Enes Kanlić (Phoenix, USA): Venous thromboembolism, prophylaxis and treatment

RUKA

Enes Kanlić (Phoenix, USA), Amr Abdelgawad (El Paso, USA): Prelomi distalnog radiusa, spoljni fiksator

Senail Sivro (Amsterdam, NL): Prelomi distalnog radiusa, osteosinteza

Stanislav Palija (Banja Luka, BiH): Korektivni zahvati kod loše sraslih preloma distalnog radiusa

Hajrudin Kačar (Tuzla, BiH): Tumor distalnog okrajka radiusa

Sahmir Sadić (Tuzla, BiH): Pseudoartroza radialnog kondila kod djeteta od 3 godine

Enes Kanlić (Phoenix, USA), Amr Abdelgawad (El Paso, USA): Intramedularni čavlovi u tretiranju preloma podlaktice

PRELOMI I KOMPLIKACIJE

Zdenko Ostojić, Marko Ostojić, Jerko Prlić, Goran Moro, Kristijan Juka (Mostar, BiH): Prelomi acetabuluma i pelvisa, naša

iskustva

Enes Kanlić (Phoenix, USA), Amr Abdelgawad (El Paso, USA): Suprapatelarni pristup za intramedularnu fiksaciju potkoljenice, prikaz slučajeva

Petar Cvijić (Banja Luka, BiH): Nadoknada koštanih defekata

Enes Kanlić (Phoenix, USA), Amr Abdelgawad (El Paso, USA): Ortopedske povrede koje ugrožavaju život

INTERNACIONALNI SIMPOZIJ IZ PSIHIJATRIJE I PSIHOLOGIJE I

Deseti Simpozij iz biološke psihijatrije/psihofarmakologije: „Antipsihotici u kliničkoj praksi“

Miroslava Jašović-Gašić (Beograd, SR): Da li su atipični antipsihotici ispunili očekivanja?

The aim of this lecture is to examine and explore the recent studies in the application of atypical antipsychotics in psychiatric practice, show some results from research and try to answer the question if and in what measure have the new antipsychotic medications fulfilled expectations of psychiatrists and patients in regards to efficacy, side effects and overall improvement in quality of life. During the 1990’s, as a result of big effort to achieve higher efficacy and reduce the side effects, new antipsychotics were synthesized. The new concept of serotonin-dopamine antagonists (SDA) was introduced. Based on one of the hypothesis, the “new” second generation antipsychotics heavily block the serotonin (5-HT2), and less dopamine (D2) receptors. There are still debates about the issue of molecular basis of these atypical antipsychotics, if it in the antagonism of serotonin and dopamine neurotransmission or exclusively in the modulation of dopaminergic neurons and the speed of dissociation on D2 receptor basis in specific brain regions. New research point to the need for revision of the so called “fast-off” hypothesis, that is the faster dissociation of atypical antipsychotics on the D2 receptors, as it was believed, for some of the modern functional kinetic studies point out to the small time difference in dissociation on the D2 receptor levels between conventional-typical and new-atypical antipsychotics. Basically, these researches point out that the interpretation of the primary difference of these two groups of antipsychotics about their D2 receptors binding kinetics is unacceptable. Even though the synthesis and the application of the atypical antipsychotics in everyday clinical practice has radically changed not only the basic approach but the quality of life of our patients, still a question remains is this only “new vine in old glasses” which brought us new cluster of side effects and theraporesistence, problems which remain in modern psychiatry.

Abdulah Kučukalić, Sabina Kučukalić (Sarajevo, BiH): Upotreba atipičnih antipsihotika: off-label indikacije i klinička praksa

Atypical antipsyhchotics are used for treatment of shizophrenia and similar psychotic disorders, acute mania and bipolar disorder. In clinical practice we often see treatment resistance and then we use atypical antipsychotics as a adjuvant drug or in combination with other antipsychotics. In this cases our goal is better efficacy and prevention of side effects. Most clinical practitioners agree that some atypical antipsychotics should be used for off-label indications but all acording to inidividualcharacteristics of the patients and clinical studies as well. Meta-analysis suggest us differences in efficacy of some antipsychotics used off label when we look at symptom reduction.The study Lesli et Rosenheck, 2012., show that 57,6% of tested individuals received atypical antipsychotics for off-label indications (indications for which efficacy is proven, but the drug didnt finishthe registration proces for that special indication). A higher prevalence of off-label antipsychotic use is seen in persons younger than 21 years and older than 65 years. Risperidon, olanzapine,quetiapine, and aripiprazole are used for dementia, insomnia, depression, anxiety, alcohol and drug abuse, as well as personality disorders. In this work we are presenting the newest studies regarding

the use of atypical antipsychotics for off-label indications, their efficacy, tolerance and risk of potential side effects.Key words: atypical antipsychotics, off-label indication, efficacy, side effects

Esad Boškailo (Phoenix, USA/BHAAAS): Monitoring klozapina: nova saznanja i preporuke

Clozapine je potentan atipični antipsihotic koji se koristi u liječenju teških i rezistentnih oblike šizofrenije i zahtijeva poseban protokol monitoring zbog moguće teške nuspojave – agranulocitoze koja može biti životno opasna.U USA, od oktobra 2015. na snazi je novi Clozarpine montoring koji se zove REMS. Ovaj program zahtijeva da se pacijenti, farmaceuti i ljekari registruju na jednom centralnom mjestu. Registracija ljekara zahtijeva položen test o normativima o propisivanju ovog lijeka. Prije propisivanja Clozapina, mora se kontrolisati ANC (Absolutni Neutrophil Count) koji mora biti prihvatljiv. Nijedan pharmakolog ne može izdati ovaj lijek bez registracije i bez prihvatljivog ANC. Broj bijelih krvnih zrnaca(WBC) nije više u upotrebi u clozapine monitoringuNovo pravilo omogućava da mnogo više pacijenata može biti na Clozapinu nego ranije.Clozapine tretman se mora prekinuti kod pacijenata u generalnoj populaciji ako ANC padne ispod 1000cells.Kod pacijenata sa Benignom Etnickoj Neutropeniji (BEN) Clozapine tretman se mora prekinuti ako ANC padne ispod 500 cellPo ranijem protokolu, pacijenti kojima je WBC pao ispod 2000 a ANC ispod 1000, ponovni pokušaj terapije clozapinom je bio kontra- indikovan. Po novom protokolu, ovi pacijenti se mogu ponovo tretirati Clozapinom ako je benefit veći od rizika.

Saida Fišeković (Sarajevo, BiH): Analiza upotrebe antipsihotika u praksi sa preporukama svjetskih algoritama i vodiča

Enra Suljić (Sarajevo, BiH): Antipsihotici u liječenju psihotičnih manifestacija kod epilepsije i multiple skleroze

Izet Pajević, Nerminka Aljukić, Leila Avdić (Tuzla, BiH): Bihevioralni i psihički simptomi demencije i antipsihotici

Dragan Babić, Marko Pavlović, Romana Babić (Mostar, BiH): Antipsihotici i prirodni lijekovi u liječenju psihoza: pro et contra

In the second half of the last century and at the beginning of this century thanks to synthesizing numerous quality antipsychotics enormous progress is made in the treatment of psychotic patients. Today’s psychopharmacology has on disposal very powerful: specific, selective and methodically

synthesized antipsychotics that we precisely know on which molecular level they are working and what are target symptoms. In the last few decades, evidence based medicine, after major thrill, came across with many disappointments and gradually begins to realize that some of the natural remedies used and applied earlier in history remedied unnecessarily suppressed and expelled from treatments. On the other hand, there is even more and more scientific evidence about the effectiveness of natural medicines and an increasing number of countries where is legally possible to use them and also there is an increasing number of patients who are seeking for natural remedies which are sometimes taken for self¬treatment, and by that often causing damage. Numerous controlled clinical studies have shown greater efficacy of natural psychoactive drugs compared with placebo and equally effective compared with a chemical psychoactive drugs. Natural remedies, if used properly, showed undeniable effect, good tolerability, known mechanism of action of the active ingredient, and the side effects are very mild and rare. They are not a substitute for conventional antipsychotics nor did their appropriate application diminish the seriousness of treatment of psychosis. They should be used with caution, and also they should be advised with caution as adjunct therapy in the treatment. The aim of this paper is to stimulate thinking about the meaning of natural remedies in the treatment of psychosis and to attempt to prevent and ignore their existence in the time where medicine is based and warranted on scientific facts. Keywords: antipsychotics, natural medicine, treating.

Alma Bravo-Mehmedbašić, Sabina Kučukalić (Sarajevo, BiH): Komparativna analiza prednosti i nedostataka antipsihotika prve i druge generacije

The aim of this work is to emphasize advantages and disadvantages offirst and second generation antipsychotics. The functioning mechanisms involve effects on dopamine receptors, as well as other neurotransmiter systems. The primary target is the effect on D2 dopamine receptors. Antipsychotics differ by their biding and strenght affinity to D2 receptors. The absolute affinity is expressed as a inhibition constant. The smaller the constant is, the bigger is thebiding affinity. The biding strength is expressed as the dissociation speed („unfasten speed“). The definitive antipsychotic effects depend on the affinity ratio for D2 and other neurotransmiter systemsof different antipsychotics.The effectiveness of antipsychotics depends from the occupancy of D2 receptors. This is important for side effects as well. Between antipsychotics we see differences incompatibility. This compatibility differences are the result of effects on various neurotransmiter receptors. Second generation antipsychotics show higher affinity for 5HT2A then for D2 receptors(clozapine, olanzapine, risperidone, sertindole, ziprasidone), lower D2 receptor occupancy to achieve therapeutic effects (clozapine, quetiapine), faster dissociation from D2 receptors (clozapine,quetiapine, amisulpride), partial agonism 5HT1A receptors (aripiprazole, sertindole, ziprasidone), partial agonism of D2 receptors (aripiprazole), anticholinergic effects (clozapine,quetiapine, olanzapine). Every new generation antipsychotic has a unique combination by which they achieve their targets.

Miro Klarić (Mostar, BiH): Uloga psihoedukacije u povećanju suradljivosti i efikasnosti liječenja antipsihoticima psihotičnih bolesnika

Satelitski simpozij Bosnalijek- Lilijana Oruč (Sarajevo, BiH):

Risedon: Značaj u liječenju psihičkih poremećaja

Alma Džubur Kulenović, Amra Memić (Sarajevo, BiH): Novi antipsihotici na horizontu

Alija Sutović (Tuzla, BiH): Antipsihotici + benzodiazepini: Koliko je to opasna kombinacija?

Miro Jakovljević (Zagreb, HR): Dugodjelujući antipsihotici u liječenju shizofrenije: izazovi, mogućnosti i strategije

Marija Burgić-Radmanović (Banja Luka, BiH): Upotreba antipsihotika u dječijoj psihijatriji

Milan Stojaković (Banja Luka, BiH): Forenzičko-psihijatrijski aspekt antipsihotika

Forenzički značaj antipsihotika može korelirati sa specifičnim i tipičnim dejstvima, kao i mogućim komplikacija lijeka, te neuzimanja istog ili nepravilnog uzimanja i slično.U radu su date smjernice vezane za sposobnosti shvatanja djela i mogućnosti upravljanja postupcima od najjednostavnijih psihijatrijskih vještačenja kod upotrebe antipsihotika, do složenijih psihijatrijskih vještačenja kada uz antipsihotike postoje ordinirani drugi lijekovi ili utiču i drugi faktori.Rad obuhvata psihijatrijsko vještačenje počinioca delikta, psihijatrijsko vještačenje svjedoka, opšte poslovne sposobnosti, testatorske sposobnosti (specifična poslovna sposobnost), te vještačenje podobnosti roditelja za dodjelu djece i vještačenje sposobnosti za brak kod ispitanika koji koriste antipsihotike.Sumirajući izneseno o krivičnim i građansko-pravnim aspektima upotrebe psihotika u ovom radu jasno je da forenzičko-psihijatrijsko značenje obuhvata niz kompleksnih elemenata, od kojih zavisi mišljenje vještaka.Prisustvo pacijenta koji koriste antipsihotike zahtijeva angažovanje niza psiho-socio-terapijskih intervencija, čime se vrši prevencija kriminigenog ponašanja. Posebno adekvatan psihijatrijski tretman i preventivni rad u užoj i široj socijalnoj sredini značajno doprinose otklanjanju faktora za kriminogeno ponašanje.

Esmina Avdibegović (Tuzla, BiH): Dugoročno liječenje antipsihoticima: preporuka i klinička praksa

Snježana Marjanović-Lisac, Nermana Mehić-Basara, Miloš Pokrajac (Sarajevo, BiH): Primjena antipsihotika u liječenju ovisnosti o psihoaktivnim supstancama

Introduction: Treatment of substance abuse is very complex and it is applied in different therapeutic conditions, for various substances or multiple substances, through all treatment phases. Due to this use of antipsychotic medication is often necessary, as in the treatment of primary mental disorders, as well as within comorbidity of addiction and other mental disorders, or complications of substance abuse.Goal: Evaluation of antipsychotics use in treatment of addicts of psychoactive substances and alcoholics in the Institute for Addiction Disorders of Canton Sarajevo.Methodology: A retrospective study included patients addicted to opiates and alcohol, treated during 2015, at the Department for drug addiction and Department for alcoholism of the Institute for Addiction Disorders of Canton Sarajevo, as well as the Psychiatric Clinic of the University Clinical Center of Sarajevo and the Public Psychiatric Hospital of Canton Sarajevo. Results were obtained from medical records, which include medical history, discharge letters, treatment charts, outpatient and hospital protocols, as well as forms for treated addicts (Pompidou questionnaires).Results: The study showed in a significant percentage the use of antipsychotic therapy during the treatment of drug addicts and alcoholics, especially in phases of withdrawal syndrome, intoxication, poly drug abuse and comorbidity of psychiatric disorders. Noticed is reduced use of antipsychotic drugs and lower doses of antipsychotic drugs in patients with comorbidity during application of opiate substitution treatment (Methadone, Suboxone, Buprenorphine).Conclusion: Application of antipsychotic therapy during various stages of treatment, for addicted on variety of psychoactive substances, particularly alcohol and opiates, is present in a significant percentage. In order to determine the effect of antipsychotic drugs, on the treatment of addiction, we need further research and elaboration.Keywords: addiction, psychoactive substances, antipsychotics, opiate substitution therapy, comorbidity.

Omer Ćemalović, Biljana Kurtović, Amira Teftedarija (Sarajevo, BiH): Klinička i psihosocijalna remisija kod pacijenata sa shizofrenijom-korelacija sa antipsihotičnim tretmanom (naša  iskustva)

Kvalitet života pacijenta sa shizofenijom podrazumjeva uspostavljenja ne samo kliničke već i psihosocijalne remisije.Sve je više sitraživanja koja se usmjeravaju na odnos kliničke remisije što je definirano težinom simptoma i razine funkcionisanja i subjektivnog oporavka što je definirano kvalitetom života.Našem istraživanje obuhvatilo je 40 pacijenata koji prema MKB 10 klasifikaciji zadovoljavaju kriterije za shizofreniju ( F 20.x).Svi pacijenti su nakon hospitalizacije bili na kontinuiranom ambulantnom tretmanu ,u remisiji koja traje dvije godine i više.Za istraživanje smo koristili našu elektronsku bazu podataka ( Jago),kriterije za kliničku remisiju (PANSS scalu za remisiju),te PSRS skalu za ocjenu psihosocijalne remisije( Barak).Analizirali smo sociodemografske faktore, suport od strane srodnika, kao i terapiju antipsihoticima.Rezultat našeg istraživanja je ukazao na značaj socijalnog suporta u održavanju stabilne remisije.Svi analizirani pacijenti su ispoljili dobru suradljivost, većina pacijenata je u toku remisije na depo obliku antipsihotika prve generacije ( haloperidol) u kombinaciji sa clozapinom, dok su neuroleptici druge generacije ( olanzapin ) na drugom mjestu.

Nera Zivlak–Radulović (Banja Luka, BiH): Dugodjelujući risperidon u terapiji oboljelih od shizofrenije

Uvod: Terapija pacijenata oboljelih od shizofrenije zahtjeva saradnju terapeuta, pacijenta, porodice, ali i društva. Cilj terapije je resocijalizacija, prevencija relapsa i ponovnih hospitalizacija, odabirom odgovarajuće terapije. Uvođenje dugodjelujućeg risperidona u terapiju je napravilo veliki preokret u terapiji ovih pacijenata, naročito kod mladih i nekomplijantnih pacijenata. Metod: Retrospektivna analiza podataka od 2012. godine.Rezultati: Praćena su 53 pacijenta koji su primali dugodjelujući risperidon. U 2012. je uvedeno 15 pacijenata, u 2013. 28, a u 2014. 10 pacijenata. Bilo je 10 žena (19%) , 43 muškarca (81%). Najmlađi pacijent je imao 23 godine, najstariji 58 godina. Prosječna starost je bila 36 godina. Na početku terapije 22 pacijenta su bili na dozi od 25mg, 22 na dozi od 37.5 mg, 9 na dozi od 50 mg. U decembru 2014. 13 pacijenata je bilo na dozi od 25mg, 21 na dozi od 37.5 mg, 19 na dozi od 50 mg. Vidljivo je bilo poboljšanje na CGI skali, a od najvećeg značaja je bilo smanjenje broja hospitalizacija. Prije uvođenja terapije dugodjelujućim risperidonom 43% pacijenata je bilo hospitalizovano, a nakon uvođenja terapije dugodjelujućim risperidonom procenat hospitalizovanih pacijenata se smanjio na 11%. Pacijenti koji su primali dugodjelujući risperidon su prije ove terapije bili na: 20 pacijenata je uzimalo risperidon oralno, 5 pacijenata je uzimalo haloperidol, klozapin 9, flufenazin 2, i na ostalim antipsihoticima je bilo 17 pacijenata.

Zaključak: Kliničko iskustvo je pokazalo da svaki relaps vodi ka novoj hospitalizaciji. Pacijenti na ovoj terapiji su pokazali dobru podnošljivost, komplijantnost, redukovao se broj hospitalizacija i broj odsustvovanja sa posla, odnosno fakulteta. Sa druge strane, pacijenti su se resocijalizovali, a zdravstvene ustanove su uštedile jer je smanjen broj hospitalizacija.

INTERNACIONALNI SIMPOZIJ IZ MULTIDISCIPLINARNE ONKOLOGIJE, DAN II

KANCER DOJKE

Lejla Hadžikadić-Gušić (Charlotte, USA): The impact of neoadjuvant therapy on breast surgery options

Mahira Tanović (New York, USA): Plastic surgery considerations in breast surgical oncology

Inga Marjanović (Mostar, BiH): Ciljana terapija metastatskog kancera dojke

Timur Cerić (Sarajevo, BiH): HER-2-Neu pozitivni kancer dojke: Gdje smo u ovom trenutku?

Lejla Hadžikadić-Gušić (Charlotte, USA): Considerations in axillary surgery, impacts of neoadjuvant chemotherapy in cNo and cN1 patients

GENERALNE PREZENTACIJE

Lejla Hadžikadić-Gušić (Charlotte, USA): Case presentations in breast cancer: Panel discussion

Dijana Koprić, Lejla Alidžanović Nurkanović, Amela Altumbabić, Lejla Moranjkić, Jasmina Alidžanović (Tuzla, BiH): Neuroendokrini tumori dojke: Prikaz slučaja

Primary neuroendocrine cancer of the breast is very rare and aggressive malignant disease. It represents less than 0.1% of all breast cancers and less than 1% of all neuroendocrine tumors. The 2012 World Health Organization (WHO) classification of breast tumors divides carcinoma with neuroendocrine differentiation in three groups: well differentiated neuroendocrine tumor, poorly differentiated neuroendocrine carcinoma (small cell carcinoma) and carcinoma with neuroendocrine differentiation. According to WHO, neuroendocrine carcinoma (NEC) of the breast is characterized by expression of neuroendocrine markers (mainly chromogranin or synaptophysine) in more than 50% of cells. Approximately 70% of NECs are estrogen and/or progesterone receptor positive and ERBB2 negative. Due to the rarity of the tumor, the clinical features, disease management and outcome are poorly defined. Herein we report a case of a 43-year old patient with breast NEC and lung metastases, who was diagnosed with this disease three years ago. The patient has almost a complete response to chemo- and hormonal therapy.

PLASTIČNA I REKONSTRUKTIVNA HIRURGIJA

Goran Obradović, Adnan Zećo, Zuhra Memić, Alemko Čvorak i Alija Aginčić (Sarajevo, BiH): Rekonstrukcija dojke sa DEIP flapom

Objective: There is few method for breast reconstruction after breast cancer ablatio. We present four patient with reconstructed breast by DIEP flap (deep inferior epigastric perforator). The method is safe in terms of survival lobe and provides excellent cosmetic result by autologous tissueMethods: Reconstruction was done with free flaps from the abdomen using microvascular anasthomosisResults: 4 patient operated have adequate result of reconstructed breast without complication. The method is safe in terms of survival lobe and provides excellent cosmetic result by autologus tissue Conclusions: We demonstrate that DIEP flaps can be productive and safe method for breast reconstruction by autologous tissue.Keywords: DIEP, free flap, breast reconstruction, autologous tissue

Mahira Tanović (New York, USA/BHAAAS):  Breast reconstruction using autologous fat tissue

 OBJECTIVES:

Autologous fat grafting is an excellent option for breast reconstruction. High reconstructive value has been attributed to AFG because fat is easily harvested, is in plentiful supply, has limited donor site problems and can be performed as a day case.

AFG is very predictable, reliable, and sufficient for complete reconstruction in small-chested women, or combined with an implant. Results are long- standing, an esthetically pleasing, with a very low complication rate.

METHODS:

Reconstruction was done with harvested fat using 4mm cannula and negative pressure of 15mmHg, from different donor sites, placed with placement cannulas in small aliquots in amounts of 150 to 600ml per session per breast.

RESULTS:

133 patient treated, 10 patients with minimal small fat necrosis, safe and predictable an esthetically pleasing appearance

CONCLUSION:

Reconstruction of breast with AFG is safe and predictable, with minimal complications and excellent cosmetic results.

Dražan Erić (Foča, BiH) - Reliability of the pedicle perforator flaps

A pedicle perforator flap with good skin texture, reliable vascularity, good arc of rotation, and minimum donor site morbidity is the most desired option for coverage of soft tissue defects. The aim of this study was to show our experiences with freestyle perforator flaps in the reconstruction of defects at various anatomical locations.METHODS:Thirty nine pedicled perforator flaps were performed at the Department of reconstructive, plastic and hand surgery, University Hospital Foca, during the period from january 2010 to december 2013 year. Thelocation of the defects, the size of the flaps, donor site closure, partial and complete flap necrosis and venous congestion were recorded. The defects were located in head (n=6), anterior trunk(n=4), upper limb (n=8), lower limb (n=12) and ischial/sacral (n=9).RESULTS:These flaps were accepted without complications in thirty five patients. Complete flap necrosis appeared in one patient while there was marginal flap necrosis in three case. The donor site was closed directly in thirty patients. Nine patients had partial primary closure complemented by skin grafting. The flaps were advanced, transposed or rotated to cover the defects. Twenty five flaps was advanced, eleven flaps rotated 180° and three flaps rotated 90°. The size of the flaps was from 6x3 to 20x15 cm.CONCLUSION:Free-style pedicle perforator flaps have the advantage of minimal donor site morbidity with preserving muscle and fascia, quick and easy dissection, thickness and quality of the flap as well as lack of sacrifice major arteries. These flaps are a simpler alternative to free flaps.

Keywords: perforator flaps, defects, reconstruction

Katarina Anđelkov (Beograd, SR): Fat grafting for defects after breast augmentation

Breast augmentation with silicone implants is far more performed aestetic surgery among women around the world. There are several types of complications that may occur, but majority of them involve another surgery, implant exchange and prolonged recovery. These patients are usualy not prepared for that and are searching for less invasive solutions. Autologous fat grafting may be a very powerful tool when considering treatment of complications of breast implants such as: double bubble deformity, rippling, correction of breast assymetries and etc. Indications, the process of preparation and surgical technique for each indication will be explained in details as well as complications and limitations.

Esved Vele, Adi Ćorić, Zlatko Guzina (Mostar, BiH): Jednostrana ekstremna hipertrofija dojke

Unilateral hypertrophy of the breast is a rare entity that mostly affects women in middle age. We are introducing 31 year old patient who was admitted because of an enormously large right breast, six months after birth. Clinical and radiological examination were made, where there was no sign of of tumor formation in the breast. Definitive diagnosis was made by histopathology: breast hypertrophy. Treatment included breast reduction surgery with free nipple graft.

Adnan Zećo, Goran Obradović, Zuhra Memić, Alemko Čvorak, Alija Aginčić (Sarajevo, BiH): Case report

A 28-year-old woman had her right extremity traumatic amputated at the middle third of upper arm. Injury was by grain mixer. Operation done by team of plastic surgeon and orthopedics during 4 ours. We made humerus stabilization and sutured all the structure of the upper arm. 21 month later patient the functional had active movement in shoulder, adduction, abduction. At elbow made active movement partial flexion and extension. At wrist joint made minimal movement, and she made limited movement of digital flexion and extension. Patient made opositio of thumb after we did operation of oponens plastica. Aesthetic result is excellent.

INTERNACIONALNI SIMPOZIJ IZ PSIHIJATRIJE I PSIHOLOGIJE II

“NASILJE U SAVREMENIM DRUŠTVIMA”

Charles Tauber (Vukovar, HR/Germany): Healing not so invisible wounds, a bottom up view toward increasing capacity

Mary Fabri (Chicago, USA): Gender based Violence Violence against women is a global public health concern. Violence is also a violation of women’s human rights and is a criminal act in many countries. In a 2013 report, WHO stated that 30% of all women experience some form of gender-based violence in their lifetime. Physical, psychological, and sexual violence occurs in the home, work place, community, and in cultures. These acts have profound and persistent health consequences for the victim, her family, and community as well. This presentation will describe the global epidemiology of violence against women and provide examples of innovative projects from the United States and Rwanda that utilized screening and intervention strategies with positive outcomes. Policy and practice recommendations based on lessons learned from these projects will also be discussed.

Paul A.Fredrickson (Jacksonville, USA): Violence associated with parasomnias

Asim Haračić (Washington, USA/BHAAAS): Neurodevelopmental and psychosocial aspect of violence and aggressive behavior

Determining and explaining the causality of senseless violent act is complex and at times daunting task.This presentation will underline major biological (prefrontal cortex deficits, genetic mutations), developmental (abuse, dysfunctional family, exposure to violence), psychopathological(psychoactive substance abuse, mental illness ) and social ( poverty, racial segregation) indicators that interact and are associated with the increase in aggressiveness and violence. Evolutionary, psychodynamic, behavioral and cognitive aspect of violence and aggression need to be understood and clarified as well. As Erich Fromm would repeatedly emphasized Man is not born evil but becomes evil when conditions for his growth and development are lacking.It is clear that individual belongs to historical, social and political system in which reciprocal reactions are established and from which one cannot be excluded.

Violence and aggressive behavior in children and adults often reflecting the world there they were raised in. Common denominator of these various, complex and heterogeneous causative factors, seems to be eventually linked with the lack of appropriate affective experience early in life and the resulting malorganization off attachment capability. That particular aspect could play a major role and current epidemics of senseless violence in United States. In attempting to understand what makes child or adult violent three points are important :

1. Not all violence is the same 2. Brain mediates all human behavior,

3. The biological propensity of the brain are the result of genotype and developmental experiences

The major setting for violence in USA is home. Intrafamiliar abuse, neglect and domestic battery account for the majority of physical and emotional violence suffered by children. And, sadly, in today's world, millions of children are raised in unpredictable and violent settings -- incubated in terror. This presentation will attempt to clarify and help appreciate how violence in family and chaotic intrafamily environment alters the developing child. The profound impact of domestic violence, community violence, physical and sexual abuse and other forms of predatory or impulsive violence can not be overestimated. Violence impacts the victims, the witnesses -- and, ultimately, us all.

Esad Boškailo (Phoenix, USA/BHAAAS): What to do about Bullying? Bullying is common among youth, beginning at young ages. Kids who are bullied often present with symptoms such as stomach-aches, headaches, depression, anxiety, school violence and suicide, inattention or aggressive behavior at home. Adults who are bullied as children tend to have poor job performance and productivity, depression, increased physical problems and worseoverall physical and mental health. Bullying is one of the leading preventable causes of suffering in theform of both physical and mental health throughout the world. Research suggests that multidisciplinary community based approaches may be the only effective programs to reduce bullying. “For youth, this means that the school board, administration, principals, teachers, staff and THEN children need to all be engaged in preventing bullying. Too often, programs target only children, and this can actually lead to an increase in bullying behavior”! (Thomas Tharshis)Children and adults have the right to a bully-free environment. More action by parents, kids and community leaders to change the culture regarding bullying in all settings should be the universal message for our society.(Dr Tarshis)Some ideas how to prevent bullying in school: Assess bullying in your school, engage parents and youth, create policies and rules, build a safe environment and educate students and school staff andinvolve entire community.

Mihela Erjavec (Bangor, UK): Efektivni programi za smanjenje vršnjačkog nasilja: Iskustva iz Finske i Velsa

Nirvana Pištoljević (New York,USA/BHAAAS): Behavioral techniques tomanage bullying: How ABA can help?

Simon Viktor (Bangor, UK): Externalizing Disorders in Adolescence –What Are the Next Steps?

Elvir Bećirović (Tuzla, BiH): Physical Abuse and adverse childhood experiences a risk factors for combat related PTSD

Introduction: Reported childhood abuse, psychiatric history and family psychiatric history were found to have the most homogeneous and predictive effects for PTSD across studies.Epidemiologic studies showed that PTSD was not an inevitable consequence of trauma. Studies which suggest PTSD is the exception, rather than the rule, have illuminated hypotheses that pretrauma risk factors are important for the development of PTSD. Objectives: To determine whether physical punishment and adverse experiences childhood are risk factors for PTSD in war veterans.Methods: Cross-sectional study of 205 war veterans tested by Harvard Trauma Questionnaire and Socio-biographic Questionnaire (with data of childhood physical punishment and adverse experiences). Results: A significant difference in reported childhood physical punishment and adverse experiences between war veterans with and without PTSD was found. Results are discussed.

Mira Spremo, Tatjana Marković Basara, Nada Vaselić (Banja Luka, BiH): Risk behaviors among high-school adolescents

Adolescence is mainly characterized by great psychical changes, that are result of biological maturation, searching for identity, changes in family relations and many other socio-cultural influences. The aim of our research was to establish how frequent is the misuse of psychoactive substances among adolescents, and how this correlates to risky sexual and aggressive behaviors.The sample consisted of 202 high-school students in Banja Luka, 18 year of age. Adolescents that consume psychoactive substances were in the target group, and those who do not consume those substances were in the comparative group. For data collection, we used Risk behavior questionnaire by K. Berg- Kelly (Q-2000). The data were then statistically processed and analysed. Results show that 35,6% of the examinees smoke cigarettes, 56,9% of them drink alcoholic beverages, 20,2% consume cannabis, while 21,7% were engaged in sexual intercourses, during which 75% of them used contraception.Adolescents who consume alcoholic beverages, have more frequent sexual intercourses than adolescents who do not drink. They were also more aggressive. Similarly, those who consumed cannabis and nicotine products, were more involved in both aggressive and sexual behavior.The results show significant incidence of the misuse of psychoactive substances, and consequently more frequent risk behavior, such as aggressive behavior and engaging in sexual intercourses.

Alisa Vrabac (Sarajevo, BiH): Dynamic of Conflict

Rusmir Softić (Tuzla, BiH): Zašto je važno prevenirati relaps SCH?

Uvod: Relaps može opredjeliti tok i odrediti ishod shizofrenije. Oko 40% pacijenata sa prvom psihozom reagovaće dobro na terapiju, ali usprkos toj činjenici stopa relapsa je još uvijek visoka, a posebno nakon prekida tretmana. Jedan od mogućih uzroka nesaradljivosti i posljedičnog relapsa u nerazvijenim i zemljama u razvoju jeste česta upotreba antipsihotika prve generacije. Cilj: Analizirati stopu rehospitalizacije u pacijenata sa prvom i ponovljenim epizodama shizofrenije i usporediti izbor medikacije. Metod: Rađena je retrospektivna analiza medicinske dokumentacije pacijenata hospitaliziranih na Klinici za psihijatriju, UKC Tuzla u periodu 2011.-2013. godine. Rezultati: U dvogodišnjem periodu hospitalizirano je 37 pacijenata sa prvom epizodom SCH, te 121

sa ponovljenim epizodama. Antipsihotici druge generacije korišteni su u 40,5% pacijenata sa prvom psihozom, te u 21,4% pacijenata sa ponovljenim epizodama. Stopa rehospitalizacije unutar prve godine po otpustu je bila 16,2% u pacijenata sa prvom i 33% u pacijenata sa ponovljenim epizodama shizofrenije. Zaključak: Visoka stopa relapsa pacijenata sa ponavljanim epizodama može biti objašnjena nesradljivošću zbog učestale upotrebe antipsihotika prve generacije.

Zihnet Selimbašić, Osman Sinanović, Esmina Avdibegović, Maja Brkić, Jasmin Hamidović, Nermina Kravić (Tuzla, BiH): Stresne reakcije kod djece i

preadolescenata očeva-veterana rata sa posttraumatskim stresnim

poremećajem

Uvod: Cilj rada je da se utvrdi izraženost stresnih reakcija u djece i preadolescenata i povezanost sa simptomima očeva-veterana rata koji pokazuju simptome posttraumatskog stresnog poremećaja (PTSP).Ispitanici i metode: Analizirana je grupa djece i preadolescenata uzrasta 10-15 godina čiji su očevi ratni veterani. Podijeljeni su u dvije grupe od 10-12 godina (djeca) i 13-15 godina (preadolescenti) prema prisutnosti PTSP-a u očva veterana rata. U procjeni subjektivnog stresa i rakcija korištena je Skala djelovanja dogaćaja (Horowitz, Wilner, Alvarez, 1979), a za procjenu simptoma PTSP-a očeva veterana rata Harvard trauma upitnik-verzija za Bosnu i Hercegoviu (Allden i sar, 1997). Za analizu podataka korišten je SPSS 17 program. Vrijednost p <0. 05 je smatrana signifikantnom.Rezultati: Djeca i preadolescenti iz porodica očeva veterana rata koji pate od posttrauamstkog sresnog poremećaja pokazuju veći nivo subjektivnog stresa i reakcija, kao i grupa simptoma nametanja i izbjegavanja (p<0.001). Utvrđena je visoka pozitivna povezanost između novoa subjektivnog stresa, reakcija djece i preadolescenata sa jačinom,funkcionisanjem i ukupnim posttraumatskim stresnim poremećajem (p<0.01). Uticaj psihičkog stanja očeva veterana rata na njihovu djecu i preadolescente je jak (22.5%) i veoma jak (21.7%).

Zaključak: Djeca i preadolescenti očeva veterana rata koji pate od posttraumatskog stresnog poremećaja pokazuju simptome subjektivnog stresa i da postoji povezanost između simptoma očeva i njihove djece i predstavljaju rizičnu grupu za razvoj psihičkih problema i poremećaja.

Ključne riječi: stresne reakcije, djeca, preadolescenti, očevi-veterani rata, posttraumatski stresni poremećaj.

Mitra Miković-Hajdukov, Kanita Hadžibeganović, Elvir Bećirović, Rusmir Softić (Tuzla, BiH): Porodične prilike kao prediktor nastanka ovisnosti o heroinu

Signifikantno je povećana zloupotreba psihoaktivnih sredstava među mlađom populacijom u poslijeratnom periodu u BiH, što je ekvivalent i porastu broja ovisnika o opijatima (heroin), uključenih u program liječenja bolesti ovisnosti. Obzirom na svjetska istraživanja u kojima su dobijeni podaci o određenim sociodemografskim obilježjima i porodičnim prilikama, kao prediktorima nastanaka ovisnosti o psihoaktivnim supstancama, opravdano je bilo pretpostaviti da postoji značajna razlika u sociodemografskim karakteristikama i porodičnim prilikama u ovisnika o heroinu i studentske populacije, nekonzumeneta psihoaktivnih supstanci u BiH.Ispitivanje je provedeno na uzorku od 160 ispitanika, podijeljenih u dvije grupe, eksperimentalnu i kontrolnu grupu. U eksperimentalnoj grupi je ispitano 61 ovisnika o heroinu, liječenih na Klinici za psihijatriju UKC Tuzla, a uzorak kontrolne grupe je sačinjen od 99 ispitanika, studenata Elektrotehničkog i Filozofskog fakulteta Univerziteta u Tuzli, nekonzumenata psihoaktivnih supstanci. Prosječna dob ispitanika kontrolne grupe bila je 21,46±1,95 godina dok je prosječna dob ispitanika eksperimentalne grupe bila 27,66±2,48 godina. Prema spolu uzorak je činilo 107 muškaraca (41 u eksperimentalnoj i 66 u kontrolnoj grupi) i 53 žene (20 u eksperimentalnoj i 33 u kontrolnoj grupi). Uzorak je testiran pomoću opštog upitnika vlastite konstrukcije, koji nije standardiziran i napravljen je samo u svrhu ovog istraživanja i pomoću Skale kvalitete obiteljskih interakcija-KOBI koja mjeri interakcije djeteta i roditelja na dvije dimenzije, u literaturi opisane kao prihvatanje i odbacivanje.Opšti upitnik vlastite konstrukcije sadrži podatke o spolu, starosnoj dobi, porodičnom statusu, obrazovanju roditelja, bračnom statusu, školskoj spremi, zanimanju, zaposlenosti, ekonomskom statusu, ekonomskom statusu roditelja, ordinalnoj poziciji u porodici, red somatskim i psihičkim poremećajima, dosadašnjem liječenju, konzumaciji alkohola i nikotina. Rezultati su pokazali da postoji povezanost odnosa unutar porodice sa nastankom ovisnosti,tj. da su odbijanje i neprihvatanje djece/osoba od strane porodice i roditelja, nekvalitetna komunikacija i disfunkcionalnost porodičnih odnosa izrazit prediktor u nastanku ovisnosti o heroinu, te da su konzumenti alkohola i duhana, stanovnici grada i prigradskih naselja i osobe kod kojih su roditelji skloni nasilnom ponašanju i konzumiranju alkohola, u značajnije povećanom riziku za ulazak u svijet ovisnosti.

Ključne riječi: heroinska ovisnost, prihvatanje, odbacivanje, nasilno ponašanje

Ivanka Hidžar (Sarajevo, BiH): Agresivnost u ljudskoj prirodi - filogenetski programirana ili strast ukorijenjena u karakteru

Porast nasilja u nacionalnim i svjetskim razmjerima skrenuo je pažnjustručnjaka i javnosti na teoretsko ispitivanje prirode i uzrokaagresije čovjeka.Terminološki, višesmislena upotreba riječi „agresija“ je u literaturi izazvala mnogo zbrke. Ako se konstruktivna i destruktivna djela označe jednom te istom riječju, nema nade da se shvati njihov uzrok, jer ga nemaju, potpuno su različita, pa dolazi do teoretski beznadežne pozicije. Danas se, nažalost, smanjuje osjetljivost na sve što je destruktivno i rušilačko, a raste privlačnost za sve što je negativno, što su osobine današnjeg kibernetskog i industrijskog svijeta. Porast razine nasilja i strah od novog rata, polovinom prošlog vijeka, bio je jedan od razloga za ispitivanje prirode i uzroka čovjekove agresije.

Konrad Lorenz ( „ O agresiji“, 1966. )zalaže se za tzv. urođenu agresivnost čovjeka, smatra da čovjekovo agresivno ponašanje proizlazi iz filogenetski programiranog instinkta: agresija je evolucijski instinkt koji služi opstanku jedinke i vrste. Oprečna ovoj teoriji, stoji dominantna teorija u psihologiji: bihejviorizam, koja dostiže vrhunac u Skinnerovom neobihejviorizmu, koga zanima kako se čovjek ponaša i koji društveni uvjeti formiraju to ponašanje. Da li smo prisiljeni birati između Lorenza i Skinnera, ili postoje i druge mogućnosti? From razlikuje dvije različite vrste agresije: benignu i malignu. Prva je zajednička svim životinjama, filogenetski je programiran impuls za napad ili bijeg kad su ugroženi vitalni interesi, biološkije prilagodljiva i nestaje onda kad nestane njen uzrok. Druga, maligna agresija, tj. destruktivnost i okrutnost, specifična je za čovjeka, čovjek je jedini primat koji muči i ubija članove svoje vrste bezrazloga, a pri tome osjeća zadovoljstvo, što zahtijeva da se napravi razlika među porivima koji imaju fiziološke korijene i specifično ljudskih strasti ukorijenjenih u karakteru (sociobiološko-historijskekategorije). Podaci iz neurofiziologije govore o mozgu kao dualnom sistemu i ukoliko on nema podražaja, agresija se nalazi u stanju „ tekuće ravnoteže „ . Ovdje leži koncept defanzivne agresije, ali nema odgovora na pitanje čovjekove sklonosti prema mučenju i ubijanju bez razloga, koje je cilj sam po sebi. From ( „Anatomija ljudske destruktivnosti“ ) zaključuje da je agresija biološki determinirana, benigna i defanzivna kad je izraz odbrane vitalnih interesa. Maligni oblici agresije nisu urođeni i moguće ih je reducirati. Tzv. humano savremeno društvo donijelo je eksploataciju, dosadu i trivijalnost koje osakaćuju čovjeka i pretvaraju ga u psihičkog bogalja, preobraćaju ga u sadistu i destruktora. Stvaranje uvjeta za potpuni razvoj čovjekovih istinskih potreba isposobnosti-kreativnosti i stvaralaštva, jedini je mogući način redukcije maligne agresije.

Tatjana Marković Basara, Mira Spremo, Nada Vaselić (Banja Luka, BiH): Bullying and irrational beliefs among adolescents

Bullying is defined as repeated aggressive behavior toward another person, in which there is imbalance of power and strength between two parties. Researches show that the prevalence of bullying is constantly increasing. It is a complex problem that correlates with numerous personal and family factors. Starting from the main hypothesis of rational emotive behavior therapy (REBT), that human behavior is mostly determined by the way we think about things and relations, we can assume that certain beliefs influence adolescents\' involvement in bullying.The aim of our research was to examine frequency and dominant types of bullying in our population, and to determine whether the irrational beliefs of adolescents correlate with their involvement in bullying.The sample of the study was a convenience sample of 250 high school students (first and second grade). The research was quantitative. Three questionnaires were used: a socio-demographic questionnaire, Child and adolescent scale of irrationality (CASI, Bernard, Cronan, 1999) and Olweus bullying questionnaire (Olweus, 1996).The results show that irrational beliefs of self-downing correlate with victimization in verbal and relational bullying. Being a bully correlates with the irrational beliefs of low frustration tolerance of rules and work. Low, positive and statistically significant correlation was found between general score of irrationality and perpetrating verbal, relational and physical bullying. Irrational beliefs regarding inability of tolerating rules correlate with all forms of bullying. Recommendations made on the basis of these results are that there is a need for prevention

programs based on theory of REBT, with the aim of restructuring of irrational beliefs that facilitate adolescents’ involvement in bullying, whether as victims or bullies. Keywords: bullying, irrational beliefs, adolescents

Vesna Srkalović (Lansing, USA): Solution for drug related violence: Adequate Substance abuse treatment

INTERNACIONALNI SIMPOZIJUM IZ HUMANISTIČKIH I DRUŠTVENIH NAUKA

ŠKOLSTVO, PEDAGOGIJA, DRUŠTVO: STARE DILEME, NOVE SOLUCIJE

Nebojša Nikolić (Novi Sad, SR): Detection Zone of Stability - the Advanced Techniques of Stress Management.

Dealing with stress professionals often has the expected outcomes because no matter how complex and stable integrity of each of us, in front of the obstacles that are placed daily on becomes sometimes or always compromised, but over time will weaken the defense mechanisms and the development of common vulnerabilities.Knowledge and skills that we have all necessary to mobilize in the process of prevention targets of stress, which we will be one step closer to the psychosomatic stability and higher self-esteem, even in inapropriate and stressful situations.Analysing the authors\' research, and the scientific literature, we have conceived a set of workshop activities that successfully updates the cognitive diversification with a tendency of gradual, direct or indirect, behavioral changes in the approach to the everyday professional and personal stress.Highlighting the significant influence of traditional techniques and methods of suppression of negative reflections of stress, we glorified the advanced techniques of verbal design predictable and unexpected stressful situations grounded in cognitive behavioral approaches and techniques to improve self-awareness and self-confidence from the corpus hypnotherapist and neurolinguistic directions.Education is based on certain initial hypotheses, repeatedly confirmed and positively evaluated.The aim of education is contained in the idea of authors that every professional can rise above stressful situations, and that education alone is not contained in the consultation, but in shaping and structuring of existing knowledge and skills in effective coping strategies and professional load.Participants will be interactive, integrative psychodynamic approach An approximate character and unconscious association of colors, emotions, values and stress, as well as the opportunity to an interesting way to discover their secret, and defense mechanisms zone of stability in daily protection from stress. Keywords: stress managment, detection of stability area’s, advanced approach

Čelebija Tikveša (Mostar, BiH): Školska sredina i međuljudski odnosi u školi – temelj razvoja i unapređivanja socijalnih kompetencija učenika

Tijana Borovac, Silvija Ručević (Osijek, HR): ´Living´ Ethical Dilemmas for Researcher

Contemporary research in the field of early childhood has grown awareness about the role that executive functions play for all children and the significant impact they have on behavior and performance in home, school, and community settings. In this article we explore our experiences of conducting longitudinal study, involving preschool children, their families and preschool teachers. We trace the relationship between executive functioning, individual, social and behavioral outcomes in children, on some ethical and methodological issues which arose in the course of conducting our field work and consider issues of consent, confidentiality, power. Drawing upon our research with over 160 pairs of children and

their parents we pose questions about the relationship between the researcher, families and preschool teachers. Conducting such type of research demands participation of everyone involved in the educational process, and this paper focuses especially on the importance that establishing partnership between the child, child's family and the institution for early and preschool education has for the success of the research.

Ferida Huković, Alija Drnda, Sabina Semiz, Jasminko Grebo, Amra Halilovic, Erna Topalovic, (Sarajevo, BiH): BH Education Without Borders: ‘Knowledge is donorable and sharable’

Current globalization and European integration promote increased communication, collaboration, and exchange of the knowledge and expertise around the world. In line with this trend, it is pertinent to stimulate networking and collaboration between the health and educational institutions in Bosnia and Herzegovina (BH) through joint projects, consulting, students\' exchange, etc. A significant number of medical experts, scientists,students in BH diaspora are willing to contribute in BH hospitals and universities to share their knowledge and expertise with colleagues. Increased mobility and nonprofit volunteering from diaspora through 5-10 days-visits could offer a great opportunity for the continued professional education of the medical staff as well as education of students. \"BH doctors without borders\", which know the culture and language of the local people could offer consultation to the patients; should be more efficient as compared to the efforts of similar international organizations. Special focus should be given to the discussion and the results of domicile medical teams, whose volunteer work has already been recognized, and is aimed at vulnerable, genocide-affected areas of the country. Previous projects \"Bosniaks help Bosniaks\" 1996-2003, \"Bosnian Medical Initiative\" 2004-2015, present APU networking, and others are inspiration. Furthermore, additional initiatives in the area of biomedicine, Intensive students\' training the Point of Care Ultrasound (POCUS), widespread use of ultrasound will be discussed Importantly, this type of collaboration through the joint projects could help to improve quality of the clinicaly, scientific research in BH and eventually attract experts to cooperate to exchange more or return to their home country.

Enes Kujundžić (Zenica, BiH): Presentation of the ‘Open School of Cultural Heritage’

The educational program with the title "Open School of cultural heritage" is envisioned as a part of life long learning program. It should encompass continuing education short term courses particularly in the field of intangible cultural heritage (theoretical basis for study of traditional culture as a part of humanistic tradition of Bosnia and Herzegovina.traditional culinary arts,traditional pottery making, woodcarving, carpet weaving etc). Emphasis will be placed on theoretical as well as practical aspects of the subjects thought during school, which should be organized outside of traditional classes with the aim of revitalizing economically depressed rural areas.

POSLIJERATNA BIH U ŠIREM KULTURNOM, DRUŠTVENOM I POLITIČKOM KONTEKSTU

Edin Osmančević (Gothenburg, Sweden): How Can Bosnia-Herzegovina’s Diaspora Be More Efficient in Benefiting the Socio-political Reforms in the Country?

Bosnian Herzegovina’s diaspora holds a sick patient on the infusion a long period through its investments and donations which are up to half of the annual budget of Bosnian and Herzegovina.Despite these facts, nonchalant attitude of the state has marginalized the role of diaspora. This is not strange when there is a lack of awareness of the significance of this population and an open opposition of the governing structures. Bosnian-Herzegovina´s diaspora organizations are meeting misunderstanding and obstructions. Galloping crime and corruption in the judiciary and society make those barriers more difficult.Today the question is to locate a model which will make Bosnia-Herzegovina´s diaspora more significant player in the social and economic reforms in the country.My presentation would be based on my experiences in the conduct of the Party of the Diaspora in the period 2012 to date and responded to model more efficient involvement of the Diaspora in the future.

Edina Striković (Marburg, Germany): Images of War: An Empirical Approach to U.S. Media Icons of ‘The War on Terror’

Since the beginning of news coverage, photographs have been an essential element in the cogwheel mechanism of media and story telling. The image since has long outgrown its mere supplementary purpose to the written part of the news. Especially with the rise of photojournalism, the might of photography lies in its ability to evoke humanity.The purpose of the study is to identify and investigate the characteristics and themes of iconic photographs of the War on Terror in order to identify reasons behind their iconic status and the messages that the photographs convey. A brief overview is given of the two dominant subjects: the history of photography as witness to conflict and genocide, as well as an introduction into theories of qualitative image analyses. Two images, deemed iconic of the war on terror, were chosen: Raising the Flag at Ground Zero and Malboro Marine. The analysis is administered via qualitative image analysis, following guidelines of structural-hermeneutic symbol-analysis. The results reveal that themes of patriotism, courage, strength and freedom prevailed throughout the images, mirroring past icons in American culture. Furthermore, it is found that elements of humanity and the grim realities of war are evident in both images. The principal conclusion is that the images convey uniform messages that reflect ideals and value of American culture and society, whilst adding a human element to their scope. In addition, the results are discussed within the context of collective memory, developments in the style of photojournalism and a look towards the future of photography in depicting and historically embedding conflict and war.Further research possibilities are addressed, suggesting the importance of social media in reporting, the open gates of image proliferation and citizen-journalists .

Narcisa Puljek/Bubrić (Sarajevo, BiH): Open Access Repository : The Academic Portal of the Bosniak Institute – Adil Zulfikarpašić Foundation

The Paper if focused on providing open and free access to the Knowledge in Bosnia and Herzegovina, especially, to academic papers and doctoral theses of Bosnian-Herzegovinian scholars resident abroad. Works by Bosnia and Herzegovina nationals published abroad, as well as material dealing with issues relevant to Bosnia and Herzegovina abroad, have long been collected only ad hoc and sporadically, without any systematic, institutionalized approach. As a result, there is no systematic record of an irrefutably important body of B-H national material, leaving the national heritage noticeably impoverished, and even lost for good in certain areas.As a result of the absence of a central database of the intellectual production of the BH academic research community abroad, BH scholarship is suffering from the loss of important sources of information, and the BH academic community in the diaspora is deprived of contacts with scholars of similar interests and origin, both at home and abroad.With a view to unifying Bosnia and Herzegovina’s cultural production abroad and to preserving and promoting the national identity of Bosnia and Herzegovina, the Bosniac Institute – Adil Zulfikarpašić Foundation, using the advanced solutions offered by digital technology, is establishing a new information and communication space, the Academic Portal, for the digital storage and exchange of academic information between scholars and other interested parties at home and abroad.The Academic Portal is an institutional digital academic and open access research repository of doctoral dissertations, designed to bring together, support and connecting scholars and researchers of the cultural and scholarly heritage of B&H.The Portal consists of three repositories:1. doctoral dissertations and academic papers by BH scholars resident abroad2. academic work by BH scholars living in B&H who defended their theses abroad, or written their papers abroad3. doctoral dissertations and academic paper on B&H by foreign nationals

Haris Alibašić (Pensacola, USA): A New Approach to Transforming City Operations Using Quadruple Bottom Line: Measuring Sustainability Impact

Using a case study of local government, the presentation will focus on new developments in the field of sustainability with specific application to local governments. Recently, the city of Grand Rapids released its fifth-year sustainability plan report showing remarkable progress made in implementing a variety of sustainability and resilience goals. The Sustainability Plan Progress Report states that in the past five years, Grand Rapids completed over eighty-one percent of its targets with another eighteen percent in progress. Those sustainability projects include the implementation of alternative fuels in city vehicles, use of renewable energy, installation of electric vehicle charging stations, investment in brownfield redevelopment projects, stepped-up flood resilience and planning, additional energy and water conservation measures, and continued dedication to improved water quality in the Grand River and its tributaries. This report serves as a

snapshot of the cumulative work performed over the last five years of Sustainability Plan implementation. The City’s next phase FY17-FY21 Sustainability Plan will tie directly to the City’s Transformation Investment Plan, creating a comprehensive approach that links sustainability with streets and infrastructure, quality of life, and transforming city operations. The new FY17-FY21 Sustainability Plan will additionally use the extended quadruple bottom line approach, addressing economic vitality, environmental quality, social equity, and government accountability. Lessons in sustainability can be applied to cities in Bosnia and Herzegovina and other states in the Balkans region, in the context of local government delivery of efficient and effective service delivery.

Jasminka Šošić, Anela Lemeš, Nera Ćosić (Sarajevo, BiH): Healthcare Compliant Management in Federation of Bosnia and Herzegovina

In today’s business world, central figure is not company itself, but rather the clients. The Customer Relationship Management (CRM) is becoming crucial part of company’s primary business orientation and basic approach of the economy effectiveness. Well defined and properly implemented Compliant Management Procedure, as an important segment of CRM, stresses out the importance of our clients and gives them the opportunity to express their attitudes, suggestions and complaints all in purpose of service improvement.We have observed Complaint Management procedures within health-care system in Federation of B&H, their existence, functionality and their possible improvements. Different approaches to the clients in public and private health-care institutions were researched and will be presented as well. The main goal of this paper is to show, through the survey conducted amongst patients, that the existing Complaint Management procedures within healthcare practice in Federation of BiH are insufficient. Secondly, our goal was to show best practices in nearby countries such as Croatia, Slovenia etc. and suggest applicable practice for Federation of B&H. Finally, this paper should stress out the importance of CRM and Complaint Management procedures implementation within health-care institutions, considering the meaning and sensitivity of processes and activities themselves. On the other hand, enormous money allocations injected into the health care system in Federation of B&H are another, very important reason for proper Complaint Management procedure establishment. Health care practice is carrying huge responsibilities to be treated easily.Key words: Health-care system, Compliant Management, CRM, Clients

Rory Conces (Omaha, USA): Hammering Democratic (and Peacebuilding) Theory into Practice in the Balkans

INTERNACIONALNI SIMPOZIJUM IZ NEUROHIRURGIJE I SPINALNE HIRURGIJE, DAN I

Bruno Splavski (Osijek, HR/BHAAAS): Neurohirurgija - najstarija i najmodernija medicinska profesija

The aim of this introductory paper is to bring in mind some of the most important breakthroughs and personalities appearing during the long course of time in the history of neurosurgery that enabled the existence of such up to date profession we are seeing today. Neurosurgery is not only the most modern, but it is also considered as one of the most ancient medical specialties. Namely, skull trephination, as one of the most fascinating surgical practices in human history, probably started in Neolithic at least 7 000 years ago. It was mainly performed for spiritual reasons but also for therapeutic ones (headache, fracture, infection, seizures, insanity). The pioneers of human dissection carried out for medical research, as well as experimental (evidence-based) medicine during Antiquity were true predecessors of neuroscience. They were followed by the authors of some enormously important medical texts from the Middle Ages and Renaissance that swept away centuries of misconceptions about the relationship between structures and function of the human body and signaled the beginnings of scientific medicine. However, the entire knowledge of medicine changed little from ancient times to the Renaissance. Medicine only move ahead at a remarkable rate during the 19th century, which saw the genuine beginnings of modern medical professions due to innovation, experiments and methods ensuring the objectivity of scientific observations. The beginning of 20th century witnessed some essential medical discoveries such as radioactivity, but a dramatic change and progress in medicine and surgery occurred not before the second half of the 20th century. Currently, research in biomedical and neurosciences is entering the most exciting phase of its development. All of that enabled the progress of such a modern profession as neurosurgery is today. It is in fact one of the more recently advanced specialties, having a remarkable predecessor in Neolithic times.

TUMORI MOZGA 1

Jeffrey Sorenson (Memphis, USA/BHAAAS): Rhotonova 3D anatomija – prednja lobanjska jama i selarna regija.

Feridun Açar (Ankara, Turska): Supracerebelarni transtentorijalni pristup na temporomedijalnu regiju

Petar Vuleković, Igor Horvat, Sanja Vicković, Vedrana Karan, Mladen Karan, Đula Đilvesi (Novi Sad, SR): Awake – tumorska hirurgija mozga u Kliničkom centru Univerziteta u Vojvodini, Novi Sad

Introduction: Resection or even biopsy of intrinsic brain tumor in close relationship to eloquent cortex, carries a major risk of new neurological deficit. Aim: We have assessed the safety and effectiveness of awake craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving speech and motor cortex.Materials and Methods: We have performed a retrospective review of a consecutive series of 11 adult patients who underwent awake craniotomy under local anesthesia at Clinic of Neurosurgery, Clinical Center of Vojvodina during the year 2015. and 2016. All patients had tumors in close proximity to eloquent cortex, including speech and motor area and also fasciculus arcuatus stretched by peritumor edema. 6 patients had

motor aphasia and contralateral hemiparesis while the other 5 patients suffered from sensomotor aphasia with contralateral hemiparesis.Results: In all patients brain mapping was performed to identify eloquent areas such as Brocka, Wernicke and primary motor cortex. 9 patients cooperated completely during the procedure, while 2 patients had to be sedated by the end of the procedure due to subjective discomfort. Radiologically confirmed gross total resection was achieved in 7 patients despite the close relationship of tumor to the eloquent cortex. The other 4 patients had the maximum reduction performed which was mainly influenced by the position of the tumor.Conclusion: Awake craniotomy in tumor surgery is a safe and well tolerated procedure that allows maximal resection of lesion in close anatomical relationship to the eloquent cortex, with a low risk of developing a new neurological deficit.

Key words: Awake craniotomy, eloquent cortex, tumor resection.

Tomislav Sajko, I. Mladić –Batinica, M. Zmajević Schoenwald, S. salkičević, Krešimir Rotim (Zagreb, HR): Awake hirurgija za tumore u elokventnim zonama mozga

Aim. Authors present their experience with awake surgery of lesions in the eloquent brain region.Patients and methods. Twelve patients had tumor lesion in close proximity to eloquent cortex, including primary motor and sensory cortex in either hemisphere and language cortex in dominant hemisphere. Patients underwent a thorough neuropsychological evaluation prior to surgery. Patients were kept fully awake during the whole surgical procedure. Brain mapping was performed by direct cortical stimulation using the Ojemann stimulator to identify a safe corridor for surgical approach to the tumor. Intraoperative physiological monitoring was carried out by assessment of speech, motor and sensory functions during the process of surgical resection. All resections were evaluated and verified by postoperative imaging. Postoperative complications and neurological deficits, as well as extent of tumor resection, were evaluated.Results. Thirteen patients (7M:6F, median age 50,38) were operated due to tumor lesion in the eloquent regions. Seven patients had a lesion at or near the primary motor cortex and six patients a lesion near the language cortex of the dominant hemisphere. Patients were fully collaborative during the cortical mapping, but two patients experienced loss of collaboration during tumor surgery. Gross total resection was carried out in two patients and complete tumor removal (Simpson 1) in meningioma patient. Three patients deteriorated neurologically after the surgery, but improved in the early postoperative period.. Conclusion. Awake surgery with intraoperative functional mapping is a safe approach to maximize the extent of tumor removal and to minimize the resultant neurological deficits in the treatment of intracranial lesions involving the eloquent cortex. Authors have performed an awake surgical procedure in patients with brain tumors for the first time in Croatia and feel encouraged with the results.

Živko Gnjidić, Ante Subašić (Zagreb, HR): Mikrohirurgija nefunkcionalnih ekspanzivnih procesa selarne regije - za i protiv

Mirsad Hodžić, Selma Jakupović, Dželil Korkut, Mirza Moranjkić, Zlatko Ercegović, Harun Brkić, Mirsad Zornić, Goran Mehmedović (Tuzla, BiH): Tretman pedijatrijskih tumora mozga – iskustva iz jedne institucije

Introduction: Tumors of the brain and spine make up about 20 percent of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children.

Patients and methods: This study was done with the aim to anylize clinico-pathological caracteristics, treatment, complications and outcome in children with brain tumors. This study is a retrospective analysis of 15 consecutive patients younger than 16 years and hospitalized for surgical treatment of brain tumors. The intracranial hypertension, neurological status, radiological CT or MRI findings, tumour localization, type of resection, hydrocephalus treatment, histopathology, complications and outcome were analyzed. Results: Sixteen surgeries were performed in 15 patients for the brain tumors in the period of five years. According to the patient sex there were five females and ten males. An average age in patients was 7.8 years. There were 6 (40%) of children with astrocytoma among the brain tumors. Out of this number, there were 5 (83%) of pilocytic astrocytomas and 1 (17%) of ordinary histopathological subtype of high grade tumor. Conclusion: As with any cancer, prognosis and long-term survival vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor.Key words: pediatric brain tumors, treatment

Hakija Bečulić1, Harun Brkić2, Mirsad Hodžić2, Rasim Skomorac1, Aldin Jusić1, Fahrudin Alić1, Alma Mekić-Abazović1 (1Zenica, BiH; 2Tuzla, BiH): Pedijatrijski neuroepitelijalni tumori

Objective – To analyze the clinical and histological characteristics, as well as to evaluate the results of surgical treatment of pediatric neuroepithelial tumors. Patients and methods – A retrospective study was conducted, including 40 pediatric patients surgically treated at the Clinic of Neurosurgery, University Clinical Hospital Tuzla in the period 2002-2012. During the study we formed groups and the analysis was conducted by age, gender, clinical signs, histopathologic types and type of surgical treatment. The results are presented in tables and expressed by relative values. Results – Neuroepithlial tumors are more common in male patients. There was no statistically significant difference in distribution of neuroepithelial tumors (χ2=0.400; p=0.527) related to supratentorial and infratentorial localization. Infratentorial neuroepithelial tumors are most common at a younger age (F=6.516; p=0.015). Increased intracranial pressure and seizures are the most common initial presentation of neuroepithelial tumors (χ2=0.022; p=0.882). There was no statistically significant difference between types of surgical resection and localization of the tumor. Usually we performed total resection (χ2=0.246; p=0.620). There was a statistically significant difference in tumor grade regarding supratentorial and infratentorial localizations (p=0.013). Infratentorial tumors are higher grade (χ2=5.495; p=0.019). Conclusion – The most common initial presentations of neuroepithelial tumors are increased intracranial pressure and seizures. Infratentorial tumors are higher grade. The most common initial treatment of neuroepithelial tumors is radical surgical resection.

TUMORI MOZGA 2

Kenan Arnautović (Memphis, USA/BHAAAS): Meningeomi prednje lobanjske jame - olfactory groove, tuberculum sellae i prednji klinoid

Rosanda Ilić (Beograd, SR): Hirurška dilema – kada reoperisati rekurentni GBM

Marko Kovačević1, Kenan Arnautović2 (1Zagreb, Hrvatska; 2Memphis, USA/BHAAAS): Kombinovana mikrohirurška, endoskopska i neuronavigacijski-asistirana resekcija tumora hipofize - naše iskustvo

The trans-sphenoidal microsurgical resection has been long established as a “gold standard” treatment for pituitary tumors. It provides the magnification, the illumination, the 3-dimensional visualization, the communication among operation room personal and the education tool for trainees via a real-time direct observation of the screen or viewing the operation after recording it. More recently, endoscopic assisted trans-sphenoidal pituitary tumor resection has been gaining popularity claiming to be “less invasive,” able to see around different angles (“around the corner view)”and providing shorter patient length of stay (LOS) in the hospital. In addition, neuro-navigation has well established role in improving preciseness and radicality in resection of brain tumors. In an attempt to gain advantages of all three techniques, we have combined them in one in an attempt to achieve a radical and safe resection of pituitary tumors. Utilizing this combined technique, we have operated 56 patients. The details of demographics, clinical presentations, histology, radiological appearances, LOS, and outcomes will be analyzed. The combined benefits yielded using this 3 techniques will be highlighted.

Ibrahim Omerhodžić, Salko Zahirović, Almir Džurlić, Adi Ahmetspahić, Dino Lisica, Anes Mašović (Sarajevo, BiH): Bilateralni falksni meningeomi

Falcine meningioma arising from the falx cerebri and is usually concealed by the overlying cortex. Mostly tends to grow predominately into one cerebral hemisphere but sometime is bilateral, and in some patients the tumor grows into the inferior edge of the sagittal sinus. However, although much information is available regarding meningiomas, little is known about falcine meningiomas. Falx meningioma constituted 10% of the meningiomas treated in our institution, but there is only 1% bilateral which are usually large or huge in size.Several techniques are described for the treatment of falcine meningiomas, aiming for total and gross total resection considering the size of the tumor, vascular supply, tumor locations, degrees of sagittal sinus involvement etc. The interhemispheric approach through a midline crossing craniotomy was used most frequently to treat falcine meningiomas. An anterior or middle third tumor type with a dumbbell shape required a bicoronal or linear incision, whereas for posterior third tumors, a U-shaped flap based inferiorly which was wide enough to allow for bilateral occipital craniotomy should suffice.Histologicaly, the transitional subtype was the most common and accounted for 40% patients.Some meningioma histotypes are associated with an aggressive behavior, but much more recurrence depends on incomplete removal rather than on an intrinsic malignancy. With regards to the prognosis, the extent of surgical resection was found to be significantly related to tumor recurrence, and thus gross total tumor resection is presumed to be the single most important predictor of an improved surgical outcome.In this report, cases of large bilateral falcine meningiomas are reviewed with respect to their clinical characteristics, the surgical techniques used, their histological subtypes, and surgical outcomes. Also, our experience with total and gross total tumor resection (Simpson grade I-III), postoperative results and pitfalls and tricks for complication avoidance are accentuated.

Adi Ahmetspahić, Ibrahim Omerhodžić, Eldin Burazerović, Avdulah Hasanagić, Alija Čeljo, Mersad Baručija, Almir Džurlić, Salko Zahirović, Dino Lisica, Anes Mašović (Sarajevo, BiH): Menadžment meningeoma baze lobanje u UKC Sarajevo

CEREBROVASKULARNA NEUROHIRURGIJA

Krešimir Rotim, Vladimir Kalousek, Vili Beroš, Marta Borić (Zagreb, HR): Mikrohirurško-endovaskularno-kombinovani tretman intrakranijalnih vaskularnih lezija

Introduction: Intracranial vascular lesions treatment includes, nowadays, several options, and requires careful evaluation when deciding which modality to choose. The goals remain simple – permanent occlusion and optimal preservation or even restoration of patient’s neurological function. There are two main groups of treatment, microsurgery and endovascular. With development of multidisciplinary approach there are cases that require, and are eligible for combined treatment. Varieties of factors have to be considered when deciding on treatment modality. Those include whether vascular lesion has ruptured or not, it’s size and location, patient’s age and medical condition and associated factors such as intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) or presence of vasospasm.Aim: We present several cases treated microsurgical, endovascular or with combined approach considering latest recommendations, multidisciplinary decisions making (neurologist, radiologist, neurosurgeon) and availability of an interventional option that had an acceptable risk.Material and methods: The cases have been chosen regarding the presentation, treatment option and outcome.Results: On the basis on several cases presented, we have considered indications and so far published several studies results and recommendations regarding treatment options for intracranial vascular lesions, focusing on combined approach.Conclusion: With development of endovascular treatment techniques, which are approaching the phase of acceptance and appropriate use, the patients with intracranial vascular lesions have gained a therapy option that can be primary, secondary or combined with surgical treatment. The decision on treatment option has to be individually based considering patient/lesion factors and institutional availability of each technique experts.

Daniel Hoit (Memphis, USA): Rhotonova trodimenzionalna anatomija mozga – prednja lobanjska jama i selarna regija

Eldin Burazerović (Sarajevo, BiH): Izbor hirurškog pristupa kod moždanih aneurizmi

Background: Multiple intracranial aneurysms are common. Although clipping of multiple aneurysms during a single surgical procedure has been reported, there has still been controversy concerning the use of multiple craniotomies in one-stage procedure, multiple-stage surgeries or one-stage ipsilateral craniotomy and contralateral approach. We present our experience describing the strategy and choice of surgical approach for multiple aneurysms in the same setting.Methods: Retrospective review of our patients from 2007 to 2016 was conducted. A total of 617 patients harboring 683 aneurysms underwent surgical treatment.

Results: We will be presenting our cumulative experience in surgical treatment of multiple intracranial aneurysms. The choice of surgical approach, results, operative strategy will be discussed based on personal experience. Ruptured aneurysms were treated first. There were no surgery-related mortality.Conclusion: In good clinical grade patients clipping of multiple aneurysms in the same procedure is safe and effective, spearing the patients from another surgery. Utilizing this treatment strategy cost savings should be expected as well

Adisa Kuršumović (Degendorf, GER): Mehanička trombektomija kod akutnog ishemijskog moždanog udara

Harun Brkić (Tuzla, BiH): Tumor karotidnog glomusa – prikaz slučaja i pregled literature

Mirza Moranjkić, Haris Husejnagić, Harun Brkić, Mirsad Hodžić, Dželil Korkut, Zlatko Ercegović, Selma Jakupović, Mirsad Zornić, Gordan Mehmedović (Tuzla, BiH): Endovaskularni tretman mozdanih AV malformacija – neurohirurška perspektiva

Cerebral arteriovenous malformations (AVMs) and dural AV fistulas (dAVFs) are complex high-flow lesions that can result in devastating neurological injury when they cause hemorrhage. Endovascular embolization is a critical component in the management of many patients with cerebral AVMs. Embolization may be used as an independent curative therapy or in an adjuvant fashion prior to either micro- or radiosurgery. Even though recent randomized trials have shed some light on natural history and treatment morbidity for patients with unruptured AVMs, treatment protocols for these patients continue to vary considerably between institutions. We present a single-center experience with endovascular AVM treatment.

KIČMA 1 – DEGENERATIVNA PATOLOGIJA

Dario Mužević1, Bruno Splavski1, Kenan Arnautović2 (1Osijek, HR, 2Memphis, USA): Prednja cervikalna discektomija sa parcijalnom resekcijom endplate-a i instrumentiziranom fuzijom alografta - uticaj na obnovu cervikalne lordoze i klinički ishod

Introduction. The most important biomechanical consequence of cervical spondylosis is the loss of cervical lordosis and progression into kyphosis. Restoration of cervical lordosis is one of the key objectives of the anterior cervical discectomy and fusion. The aim of this study is to investigate the impact of anterior cervical discetomy and fusion with partial endplate resection onto cervical lordosis restoration and surgical outcome.Patients and Methods. Patients with degenerative disease of the cervical spine, treated by anterior cervical discectomy with partial endplate resection and instrumented allograft fusion during a three-year period were included in study. In all patients preoperative and postoperative configuration of the cervical spine was assessed by Benzel’s criteria. The posterior tangent angles according to Harrison were measured on plain lateral radiographs of the cervical spine. Treatment outcomes were assessed using Odom’s criteria.Results. The study included 154 patients, 100 females and 54 males. The mean age of the patients was 50.62

years. Patients were postoperatively followed-up for a median period of 12 months. Using Benzel’s criteria, 89 (57.8%) patients had kyphotic or straight cervical spine, and 65 (42.2%) patients had an adequate lordotic configuration preoperatively. Postoperatively, lordotic configuration was noted in 94 (61.0%) patients. This difference in cervical spine configuration was found to be statistically significant (p<0.01). A statistically significant difference between preoperative (mean 12.23 degrees) and postoperative (mean 17.36 degrees) posterior tangent angles according to Harrison was observed (p<0.01). Excellent treatment outcomes (Odom scores 3 and 4) were achieved in 127 (82.5 %) patients. Conclusion. Anterior cervical discectomy and fusion with partial endplate resection is a reliable surgical method that significantly improves cervical spine configuration, resulting in a favorable treatment outcome.

Mirza Bišćević (Sarajevo, BiH): Revizija instrumentizirane hirurgije kičme

Revisions in surgery are unpleasant, risky, complicated, more extensive and expensive, higher failure rate, sometime impossible. Good plan for prime surgery is best prevention of revision surgery. 394 instrumented spine surgeries in 01.01.2010.-01.01.2016. (without decompresions, lumbal disk surgeries, needle procedures): 32 anterior cervical (trauma, herniations), 9 posterior cervical (stenosis, trauma), 81 pediatric spine deformities (AIS, cong. scoliosis), 36 senior adult spine deformities (degenerative scoliosis, stenosis, etc.), 54 lystesis (all types), 83 thoracolumbal fractures, 21 spondylodyscitis, 27 vertebral tumors, and 34 other surgeries. 17 revisions were consisted of: 8 deep wound infections, 5 decompensations (“adding on”), 2 sterile dehiscences, 2 “loosenings”, and 0 neurodeficits.Preoperatively we have to clinically assess: subjective complaints, neurological exam (deficit, claudicating), imbalance (coronal/sagittal), DEXA, scan, patient’s and pt’s family expectations (high rate of complications); especially comorbidities. Further, X-ray assessment (bending, supine, standing, traction images; CT, MR scans), analyse a interaction between structural curve, compensatory mechanism, and biology of the patient (harmony among the physiologic spine curves), will define the minimum that needs to be done. Surgeon and patient have to have realistic expectations, and to be aware that there is no “undo” button in surgery, or “unfusing” is impossible. Challenge in trying to achieve the greatest benefit with the least intervention.

Zlatko Kolić, Marijana Karlović Vidaković, Duje Vukas (Rijeka, HR): Pregled komplikacija minimalno invazivne hirurgije kičme sa naglaskom na infekcije

The goal of minimally invasive spine surgery (MISS) is to stabilize the vertebral bones and spinal joints and relieve the spinal roots compression, faster and safer with less recovery time, then with open procedures. MISS reduces trauma to the muscles and soft tissues. It has better cosmetic results,

reduced risk of infection and decreased blood loss. The use of pain medications after surgery is reduced as is rehabilitation time.MISS techniques include: radiofrequency neuroablation, radiofrequncy disc biacuplasty, percutaneous disc decompression (PLDD, coblation, discogel), spine surgery with tubular retractor, percutaneous spinal decompression, percutaneous placement of screws and rods, PLIF, TLIF and AxiaLIF, and spinal endoscopy. As with any surgical procedure, there are certain risks in MISS procedures that include possible adverse reaction to the anesthetic, unexpected blood loss during the procedure, and infections. A described complication of MISS are infections with an occult cause. Incidence of post-procedural infections is 5.5/1000, with a mortality of 11.7%. In less than 50% Staphylococcus aureus was revealed as cause. Some types of infections such as spinal arachnoiditis, epidural and paravertebral abscess, and vertebral osteomyelitis are very rare. The treatment depends on stage and cause of infection, with long term antimicrobial administration of an average of three months. After completion of antimicrobial therapy, each case can be re-evaluated and re-operated.

Key word: minimally invasive spine surgery, complications, infection

Goran Lakičević (Mostar, BiH): Procjena funkcionalnog kapaciteta cervikalne kičme nakon prednje cervikalne discektomije i međupršljenske fuzije

Aim of the study: To assess cervical spine functional capacity after the anterior cervicaldiscectomy and cage interbody fusion by examining global and segmental pre and postoperative curvature of the cervical spine using two methods of radiographic cervical vertebral-dynamic measurements. Subjects and methods: A prospective study of 60 consecutive patients diagnosed with cervical spine degenerative disease operated on at one cervical level during a four-year period. Analyzed parameters were: age, gender, level of intervertebral disc herniation, and functional cervical spine capacity that was assessed by measuring the Cobb and posterior vertebral body angles on a standard cervical spineradiographs prior to and after surgery. The patients who were operated on due to cervical spondylosis/compressive myelopathy and/or at more than one cervical level were excluded.Results: The average values of Cobb’s angle and of the posterior vertebral body angle after surgery were significantly higher than before surgery, showing the most significant increase in angle valueat C5/C6 and C6/C7 levels respectfully. Conclusion: The improvement of radiographic status of the cervical spine and parameters of physiologic lordosis after the anterior cervical discectomy and interbody fusion may be identified by thepostoperative increase in average values of Cobb’s and posterior vertebral body angle. As a consequence, a physiologic, lordotic cervical spine curvature is re-established decreasing the risk ofcervical vertebral-dynamic segment instability. The method of measuring such angles is valuable in the assessment of cervical spine functional capacity after the anterior cervical discectomy and cagefusion. The best restitution of postoperative cervical lordosis is achieved using the carbon allograft with premeditated adequate constant angle of inclination.

Ermin Hadžić (Mostar, BiH): Uticaj dužine preoperativnog išijasa i hroniciteta bola na efekat lumbalne discektomije – preliminarni rezultati

Background. The upper limit of nonoperative treatment duration for patients with lumbar discherniation remains controversial. The evaluation of chronic pain in such patients is a methodological problem, since it is only defined with aspect of duration of the chronic pain syndrome. Nonetheless, preoperative sciatica duration does not adequately reflect the complex bio-psychosocial associations involved in chronic pain disorders. Objective. To evaluate the influence of preoperative sciatica duration and multidimensional aspect of pain chronicity on the effect of lumbar discectomy. Methods. A cohort of 63 adult patients were surgically treated due to lumbar disc herniation and prospectively evaluated. They were divided into two groups according to the duration of preoperative sciatica of more or less than 6 months, and into three groups according to chronicity of pain assessed by Mainz Pain Staging System. The preoperative percentage of disability was computed by OswestryDisability Index, while the intensity of pain was measured by Visual Analogue Scale in low back and legs, and Sciatica Botherssome Index. The same disability and pain assessment was performed at least 6months after surgery too. Wilcoxon test and Mann-Whitney U test, ANOVA and Fishers exact test were used for statistical analysis with the significance sat at p< 0.05.Results. The patients in whom duration of sciatica was less than 6 months had significantly better outcome when compared to those whose symptoms lasted longer (p<0.001). The patients with the lowest levels of pain chronicity showed significantly better effect of lumbar discectomy, as well as better surgical outcome, when compared to those with a higher degree of pain chronicity (p=0,024). Conclusion. Assessing preoperative duration of herniated lumbar disk sciatica, as well as chronicity of pain is a significant predictor of surgical management outcome. Such measurement tools may considerably contribute to better planning of further therapeutic procedures, as well

KIČMA 2 – TUMORI

Zulejha Merhemić (Sarajevo,BiH): Intraduralni ekstramedularni spinalni tumori

Intradural extramedullarz tumors are relatively rare, but if left untreated, can cause serious neurological deficits and disability. Early-stage intradural extramedullary tumors are difficult to detect. They are not easily differentiated from lower lumbar disc diseases, such as herniation of the intervertebral disc and spinal stenosis. These tumors lack obvious clinical symptoms until compression or neurological deficit occurs. An accurate diagnosis is therefore crucial in determining prognosis and directing therapy. Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) comprise the overwhelming majority this subset of spinal tumors. Meningiomas arise from covering cells of arachnoid layer and are most common in middle aged and elderly women. Schwannomas and neurofibromas arise from the nerve roots which come off the spinal cord. Meningiomas and nerve sheath tumors are usually benign. Less common tumors are hemangiopericytoma, metastases, benign tumors (lipoma, dermoid, epidermoidand) cystic lesions (perineural or Tarlov cysts). Characteristic magnetic resonance imaging findings are helpful for localization and characterization of these lesions before treatment, as well as for follow-up after treatment.

Fahrudin Alić, Rasim Skomorac, Aldin Jusić, Hakija Bečulić (Zenica, BiH): Hirurški tretman i ishod tumora kičmene moždine: 10 godina iskustva Službe za neurohirurgiju Kantonalne bolnice Zenica.

Introduction: Although not so common, oncology of the spine takes an important place in neurosurgical practice. Primary spinal cord tumors constitute 10% to 15% of all primary CNS lesions. The most common extradural spinal lesions are metastatic tumors from another primary site. Intradural lesions are divided into two categories, depending on whether they involve the substance of the spinal cord (intramedullary) or are outside the spinal cord but within the dura (extramedullary). Aim: We will present our overview of 10 years’ experience with spinal cord oncologyMaterial and methods: Retrospectively we have used our hospital data from patients and sorted cases by gender, age, symptomatology, localization and level of lesion, surgical treatment. Results: From 2006 to 2015 we have operated 343 tumors of central nervous system. The tumor of spinal cord were present in 24 cases of which 14,58% were female and 10,42% were male. In 20,83% cases the tumor was removed totally, and the most frequent level of the tumor was in the thoracic region of the spine. Results of pathohistological analysis showed that the majority of them were intradural extramedullary tumors. Conclusion: Surgery of spinal cord tumors is associated with significant risk of neurological deterioration, spine instability and even mortality. For this reason we need to continue working on this pathology in goal to provide safer approaches and to introduce new techniques. Key words: Spinal tumors, surgical outcome, results

Almir Džurlić, Ibrahim Omerhodžić, Eldin Burazerović, Avdulah Hasanagić, Adi Ahmetspahić, Salko Zahirović, Dino Lisica, Anes Mašović, Mersad Baručija, Edin Hajdarpašić (Sarajevo, BiH): Hirurški tretman intraduralnih spinalnih tumora

INTRODUCTION : Spinal tumors are mass benign or malignant tissue in or around the spinal cord. They can be primary (those tumors originating in the spinal cord), and secondary tumors that are metastatic. They are divided into two groups, extradural and intradural tumors. Intradural tumors can be intramedullary and extramedullary. Intramedullary are ependymoma, astrocytomas, hemangioblastomas and metastasis. Extramedullary tumors are schwannoma, neurofibromas/neurinoma, and meningeoma. OBJECTIVES : The main objective of this study is to show the frequency and histopathologic characteristics of the analyzed intradural intramedullary and extramedullary tumors, the treatment and analysis of the types of used surgical approaches, and assessment of treatment results.SUBJECTS AND METHODS : The study was conducted at the Department of Neurosurgery, Clinical Centar University of Sarajevo. The study included 64 consecutive patients with diagnosed and surgically treated one of the intradural spinal tumors. The study covers period from 01.07.2008-31.12.2015. years (90 months). This is retrospective-descriptive study based on information obtained from pathhistological registry and patient histories.RESULTS : The results showed that these tumors are more frequently affect females. The most common tumor in the gropup of intramedullary tumors is ependymoma, and meningeoma in gruop of extramedullary tumors. Laminectomia, operative approach was performed in all 64 patients.CONCLUSION : Surgery is the gold standard in the treatment of intradural spinal tumors.MRI study in tree planes and careful preoperative planning with regard to the location and size of the tumor will dictate the moust appropriate surgical approach.The prognosis depends on the histological characteristics of the tumor and the severity of the disease.

Aida Šehić Kantardžić (Louisville, USA): Izbor modaliteta neuromonitoringa kod procedura na kičmenoj moždini

PERIFERNI NERVI I NEUROTRAUMA

Eldin Karaiković (Chicago,USA): Kratkosegmentna fiksacija kod torakolumbalnih fraktura

Lukas Rasulić (Beograd, SR): Hirurški tretman lezija perifernih nerava

Background: Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is high chance of combined injuries of these structures (23%).

Methods: The initial trauma recovery was followed by detailed evaluation, and if there were no signs of recovery or if only partial recovery occurred and the deficits were thought to be potentially reversible, secondary surgical treatment was performed jointly by the same neurosurgeon and vascular surgeon at Clinic of Neurosurgery in Belgrade.Results: The injuries were most frequently caused by a sharp object – in 47.22% of cases. The most common localization of the injury – in 50% of cases – was at the arm level. The most frequently injured nerve was the median nerve. The most commonly injured blood vessel was the brachial artery. All vascular injuries were primarily treated surgically in RMC. If the mechanism of the injury allowed, the treatment of choice for vascular repair was direct suture, whereas more complex vessel injuries were treated using graft interposition or bypass. During the secondary procedure at the Clinic of Neurosurgery in Belgrade, 52 nerve repairs were performed. The majority of patients (51.9%) were treated using nerve grafting, while complex nerve repair was performed in approximately 23% of cases. Good outcome was accomplished after 84.6% neurolysis, 85.2% nerve grafting and 75% of nerve transfers. Conclusions: Good overall results in our study may indicate that there is no significant difference in treatment outcome in patients with associated vascular injuries compared to isolated nerve injuries alone if they are diagnosed in time and treated appropriately. Furthermore, the revascularization of the injured extremity may be a significant factor for good recovery of nerve function. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.

Ante Subašić (Zagreb, HR): Invertebralna disk-hernijacija kao posljedica sportskih aktivnosti

Biomehanical events in spine during sport activity are very complex Biomehanical shape of vertebra is very complex and in normal function multiply unspecified. During transmission of load trough spine every vertebra is very complexly loaded. During sports activities spine is extreamly loaded. Level of centric and

excentric forces is in range of 800-1000N. Resault of that is rupture of external ring, anulusfibrosus and extrusion of discal masses in spinal canal.

Alem Kaplan, Haris Varupa (Sarajevo, BiH): Nužnost uspostavljanja helikopterske neurohirurške hitne službe u Bosni i Hercegovini

POSTER SESIJA

P1. Aldin Jusić, Mirza Pojskić, Rasim Skomorac, Hakija Bečulić, Fahrudin Alić: Traumatski induciran eozinofilni granulom kod djece sa tuberoznom sklerozom

Aim: To present an unusual case of trauma induced eosinophilic granuloma in a child with

previous history of tuberous sclerosis.Case report: This case reports a two-years old boy with previous history of tuberous sclerosis who developed eosinophilic granuloma after a mild head trauma first concidered as a subgaleatic hematoma. Previous existance of the granuloma has been excluded both clinically and neuroradiologically due to regular pediatric and MRI follow up of his main desease. Conclusion: Mild head trauma is possible cause of rapid progression of eosinophilic granuloma.Key words: eosinophilic granuloma, mild head trauma, tuberous sclerosis

P2. Bruno Splavski: Klinička povezanost Lhermitte-Duclosove bolesti i

Cowdenovog sindroma – prikaz slučaja

Dysplastic cerebellar gangliocytoma/Lhermitte-Duclos disease is an uncommon hamartomatous benign lesion responsible for producing a compressive effect in the posterior cranial fossa, usually affecting young adults. It is frequently related to other congenital malformations such as multiple hemangiomata, some cutaneous disorders and polydactyly. Multiple hamartoma-neoplasia syndrome or Cowden\'s syndrome is a rare autosomal dominant genetic disorder having a high incidence of systemic neoplasia in the breast, thyroid, colon, genitourinary organs, and central nervous system. Recent reports suggest that both entities may be clinically related. Their importance and scarcity in clinical practice are posing the necessity for meticulous inspection to detect probable associated malignancies of other organs and systems. Hereby, we present a case report of a 35-year-old female with dysplastic cerebellar gangliocytoma. History revealed that the patient was operated on due to polydactilty of both hands during her childhood. She was admitted due to long-standing occipital headaches. A pigmented scleral neoplasia on the left eye was observed. Magnetic resonance imaging (MRI) of the brain revealed a mass lesion in the left cerebellar hemisphere slightly compressing the fourth ventricle. The mass was hypointense having typical hypo-to-isointense striations on T1-weighted images, while T2-weighted images showed characteristic hyperintense mass with hyper-to-isointense striations. Surgical posterior fossa decompression was performed resulting in uneventful postoperative recovery. Following surgery, a methodical clinical inspection and supplementary diagnostics were carried out to recognize possible signs of Cowden\'s syndrome. Executing such a protocol, a breast fibroadenoma was diagnosed and the tumor was surgically removed two months later. At a one-year follow-up, the patient was doing well and postoperative brain MRI showed no disease progression. In conclusion, we have documented the clinical relationship between Cowden’s syndrome and Lhermitte-Duclos disease in our patient. Therefore, identifying affected patients and selecting them for further diagnostic screenings and procedures is essential to attain a favorable outcome.

P3. Ivana Bulić, Goran Lakičević, Marko Bošnjak, Bruno Splavski, Andrej Kogler: Ponavljana cistična ehinokokoza mozga i jetre – prikaz slučaja

Human echinococcosis is a zoonosis caused by larval forms of Echinococcus tapeworms found in the small intestines of carnivores. Among the recognized species, E. granulosus is of particular

medical importance as a generator of a rare cystic brain disease caused by larvae hematogenic dissemination. It is characterized by slow growth of cerebral echinococcus cyst which is well tolerated until it causes intracranial pressure increase or neurological symptoms due to its site and/or size enlargement. Herby, we present a case report of a 10-year-old boy from sheep and dog raising household who was repeatedly operated on due to repetitive echinococcosis of the brain and liver confirmed by liver echography and brain MRI revealing a cyst of the right parietal lobe. He underwent surgery of the liver and brain and both cyst were incompletely removed. A silicon catether was used to instilate a warm saline between brain tissue and cyst wall to completely remove the cyst, but at a very end of the procedure the extremely thin cyst wall was ruptured. Recurrent brain and liver ecchinococcosis developed despite preoperative and postoperative proper combined antihelmintic therapy. Repetitive large cyst of the brain was confirmed by postoperative MRI and the patient was opted for repeated surgery. In spite of the cyst perioperative rupture, the proper mechanism of the cyst recurrence remains unclear. Nevertheless, we believe that radical surgery consisting of a meticulous complete cyst resection is the treatment of choice for cystic brain echinococcosis evading the cyst recurrence and resulting in a favorable outcome.

P4. Midhat Čizmić, Harun Đozić: Morfometrija lumbalnog kičmenog kanala pomoću kompjuterizovane tomografije na populaciji Bosne i Hercegovine

Aims and objectives: The aim of this study is using MSCT to determine normal dimensions of the spinal canal and vertebral body of the lumbar spine at the Bosnian-Herzegovina population and compare it with dimensions of other population in the world.Methods and materials: 200 patients were included in retrospective-prospective study aged 20 to 60 years, who made MSCT of lumbo-sacral spine in period of two year. We measured normal dimensions of the lumbar spinal canal for the Bosnian-Herzegovinian population and compared it with other populations in the world. The criteria for lumbar spinal stenosis were determined. We determined correlation between the diameters of the lumbar spinal canal (mediosagittal and interpedicular diameter).Results: The mediosagittal diameter of the lumbar spinal canal for men ranges from 11.70 mm to 30.80 mm, for women from 12.30 mm to 26.10 mm, while the interpedicular diameter for men ranged from 21.30 mm to 41.80 mm, and for women it is ranged from 20.10 mm to 42.80 mm, for Bosnian-Herzegovinian populations. MSAG is greater for women than for men and IPD is greater for men than for women. The mediosagittal and interpedicular diameters of lumbar spinal canal in the Bosnian-Herzegovinian population was significantly greater compared to other populations in the world (p<0.05).Dimensions of the lumbar spinal canal do not correlate with body weight and height.Conclusion: Dimensions of the lumbar spinal canal of the Bosnian-Herzegovinianpopulations are widest compared to other populations in the world anddo not follow anthropometric parameters.

P5. Bilal Imširović: Slike magnetne rezonanse kod neurosarkoidoze

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by presence of granulomas in affected tissues with variety in clinical presentations and presents a differential diagnostic and therapeutic dilemma. Clinical presentation of neurosarcoidosis is very variable. Diagnosis is based on clinical and radiological criteria; histological findings of disseminated non-necrotic granuloma and followed by negative cultures for bacteria and fungi. MRI plays a key role in detection of lesions located in

the brain parenchyma.

Keywords: Sarcoidosis, neurosarcoidosis, MRI

P6. Mirza Moranjkić, Haris Husejnagić, Harun Brkić, Mirsad Hodžić, Dželil Korkut, Zlatko Ercegović, Selma Jakupović, Mirsad Zornić, Gordan Mehmedović: Dvostruko trenirani vaskularni neurohirurg – paradigme

By the dawn of the 21st century endovascular techniques have assumed a significant role in treatment of cerebrovascular disorders. Supported by the results of recent randomized controlled trials and novel technological solutions, endovascular techniques are striving to assume dominant role in for intracranial aneurysm management. In many regions of the world (particularly North America and Japan), the bulk of endovascular procedures are performed by neurosurgeons, trained in both endovascular and neurosurgical techniques. Dualism and multidisciplinary integration of both microsurgical and endovascular strategies has become a hallmark of mature cerebrovascular programs. Reluctance of European neurosurgeons to embrace this new paradigm shift might lead to deleterious consequences, with interventional radiologist gaining a dominant role in aneurysm treatment in Europe. We present a single-center experience with a dual-trained neurosurgeon paradigm and we suggest that this is not only preferred, but also necessary path to follow.

P7. Vjeran Saratlić, S. Marić, V. Ivanišević, J. Ivanović, Z. Mirivić: Opcije tretmana gigantske ICA aneurizme kod pacijenta sa ozbiljnim komorbiditetom

P8. Edin Hajdarpašić, Almir Džurlic, Adi Ahmetspahić, Salko Zahirović: Misteriozna konverzija VP u VA šant

Introduction: Placement of a ventriculoperitoneal shunt is the most common form of treatment for hydrocephalus and one of the first operation that residents of neurosurgery perform by themselves. Many complications related to VP shunt were described including overdrainage, valve failure, catheter obstruction, infection and migration of distal catether into another body part (breast, colon, anus, liver, thoracic cavity, etc.). In this case report we present the first documented case in the East Europe of sepsis caused by migrated distal catheter into heart which was colonised with bacteria. Clinical presentation: We report an unusual complication of sepsis caused by bacterial colonisation of the previously confirmed extrathoracic and intraperitoneal distal catheter of VP shunt which had later migrated into the heart and pulmonary vasculature. Intracardiac position was confirmed by plain chest X-ray, CT and echocardiography. The patient was operated four years previously due to large Meningioma in posterior cranial fossa accompanied with internal hydrocephalus. After tumor resection hydrocephalus persisted and VP shunt was implanted seven days after first operation. One month ago patient was admitted because of fever and during clinical evaluation migration of the distal catheter into heart was confirmed. Operative finding:Surgical procedure was planned and performed together with the cardiac surgery team. Horisontal supraclavicular incision crossing the pathway of the distal catheter was made and the entry site

of the catheter in external jugular vein was verified. Catheter was devided and there was good SCF flow on the upper part of devided catheter. Simultaneously right parietal incision was made to access the ventricular catheter which was carefully pulled out together with the valve. Cardiac surgeon pulled out the rest of intracardiac part of catheter without any complication. Microbiology confirmed that catheter was colonised with Klebsiella pneumoniae. We didn’t place new VP shunt and seven days after surgery patient is with no signs of increased intracranial pressure and with no heart problems. Conclusion: Although extremely rare complication, migration of distal ventriculoperitoneal shunt catheter into the heart is a situation that could be lethal, causing sepsis, cardiac inssuficiency or pulmonary emboli. One should take into account this possibility when the patient with previously placed VP shunt has cardiopulmonary problems or fever. Plain chest X-ray could be very helpful as a very simple procedure in showing abnormal catheter position. Neurosurgeon should be consulted as soon as possible and catheter should be removed with the assistance of cardiac surgeon.

P9. Vjeran Saratlić, S. Marić, V. Ivanišević, J. Ivanović, Z. Mirvić: Hirurški tretman MCA aneurizme

PROJEKCIJA FILMA

 Projekcija filma: Destruction of Memory (Vast Productions USA, 2016), Movie by Tim Slade

THE WAR AGAINST CULTURE, AND THE BATTLE TO SAVE ITOver the past century, cultural destruction has wrought catastrophic results across the globe. This war against culture is not over - it's been steadily increasing.In Syria and Iraq, the ‘cradle of civilization’, millennia of culture are being destroyed. The push to protect, salvage and rebuild has moved in step with the destruction. Legislation and policy have played a role, but heroic individuals have fought back, risking and losing their lives to protect not just other human beings, but our cultural identity - to save the record of who we are. Based on the book of the same name by Robert Bevan, The Destruction of Memory tells the whole story - looking not just at the ongoing actions of Daesh (ISIS) and at other contemporary situations, but revealing the decisions of the past that allowed the issue to remain hidden in the shadows for so many years. Interviewees in the film include the Director-General of UNESCO, the Prosecutor of the International Criminal Court, as well as diverse and distinguished international experts, whose voices combine to address this urgent issue. 

RAT PROTIV KULTURNE ZAOSTAVŠTINE I BORBA DA SE ISTA SPASIU posljednjih stotinjak godina, uništavanje kulturne zaostavštine je nanijelo katastrofalne posljedice svuda po svijetu. Rat protiv kulture se nastavlja i u porastu je.U Sriji i Iraku, kolijevkama civilizacije, drevna kultura je dovedena do uništenja. Napori da se ona obnovi i u nekim slučajevima zaštiti prije destrukcije, je dio istog procesa. Zakoni i političke intervencije su pojačane na tom polju, ali uglavnom se spasenje oslanja na individualce i njihove herojske poteze da sačuvaju ono što je oko njih a što je važno za sve nas kao dokument naše zajedničke historije. Inspirisan knjigom Roberta Bevana pod istim naslovom, ovaj film prati pomenuta zbivanja, ne samo trenutna koja se pripisuju ISIL-u, nego iz sveobuhvatnije perspektive razmatra kako odluke i događaji iz prošlosti usmjeravaju odluke i tokove sadašnjosti po pitanju definicije i zaštite kulturne baštine. Osim Sirije, Iraka i Afganistana, film predstavlja događanja i u Bosni i Hercegovini u proteklom ratu, kao i pokušaje obnavljanja onog što je uništeno.  Film uključuje intervjue sa generalnim direktorom UNESCO-a, ekspertima, akademicima i očevicima, ispreplićući njihove poglede i apele da se ovo važno pitanje ne zapostavi iz javnog diskursa. 

ORGANIZACIONI PARTNERI

FABRIKA LOGO

KOORGANIZATORI INTERNACIONALNOG TRANSDISCILINARNOG SIMPOZIJA IZ

RANOG RASTA I RAZVOJA - PEDIJATRIJE: EDUS-Edukacija za Sve i UNICEF-BiH

KOORGANIZATORI INTERNACIONALNOG SIMPOZIJA IZ NEUROHIRURGIJE I

SPINALNE HIRURGIJE: Udruženje neurohirurga Jugoistočne Evrope (SeENS) i Udruženje

neurohirurga u Bosni i Hercegovini (UNUBIH)

KOORGANIZATORI INTERNACIONALNOG SIMPOZIJA IZ PSIHIJATRIJE DAN I:

Udruženje za biološku psihijatriju/psihofarmakologiju u FBiH i Udruženje psihijatara u Bosni i Hercegovini

Organizacioni odbor simpozijuma:Abdulah Kučukalić, PredsjednikAlma Džubur KulenovićAlma Bravo MehmedbašićGoran RačetovićSabina KučukalićTanja Cabrera

SPONZORI 8. DANA BHAAAS-a u BIH, Neum 2016

Enhancing Life for People Around the WorldTogether, Medtronic and Covidien are better able to improve global healthcare.