EEG ANALYSIS AND SPECT IMAGING IN ALZHEIMER’S DISEASE, VASCULAR DEMENTIA AND MILD COGNITIVE IMPAIRMENT

Background: Alzheimer’s disease (AD) and vascular dementia (VaD) represent a leading public-health problem given the rising age of the population. Early diagnosis of dementia, especially at the stage of mild cognitive impairment (MCI) has become an important goal of the modern patient work-up. Brain perfusion single-photon emission computed tomography (SPECT) has become a mainstay of diagnostic algorithms in patients with dementia showing specific patterns of hypoperfusion in temporal and parietal lobes. Clinical electroencephalography (EEG) is a relatively simple and inexpensive diagnostic tool showing potential in assessing cortical thinning and lower perfusion in temporoparoetal regions. Subjects and methods: Our study was a cross sectional and included retrospective analysis of the group of patients diagnosed with AD, VaD and MCI. The study group consisted of 50 patients - 29 females and 21 males. All patients underwent EEG and SPECT analysis as part of regular work-up. Result: Patients with AD exhibit EEG changes mostly in the form of theta waves, focal abnormalities and spike-and-wave complexes in frontotemporal regions with the reduction in the amplitude of alpha waves. SPECT in most patients exhibited hypoperfusion in temporoparietal regions with occasional unilateral abnormalities in frontotemporal region. EEG changes in patients with VaD are predominantly in the form of theta waves while SPECT findings show mostly “patchy” abnormalities. EEG readings are normal or exhibit minimal changes in the group of patients with MCI, while SPECT imaging exhibits mostly normal CBF. Conclusion: EEG and SPECT are diagnostic methods which show specific changes, especially in AD. EEG can be used to monitor the therapeutic effect and progression of AD as well as the possible transition from MCI to early stage AD. SPECT on the other hand, being a more expensive and less available method, can be utilized as an add-on method to increase the specificity and sensitivity of the diagnostic algorithm

IMPACT OF INVASIVE EEG MONITORING AND RESECTIVE NEUROSURGICAL TREATMENT ON THE QUALITY OF LIFE IN PATIENTS WITH DRUG RESISTANT EPILEPSY - PRELIMINARY RESULTS

Background: Neurosurgical treatment is one of important way to cure drug resistant epilepsy. After invasive EEG monitoring and the invasive neurosurgical treatment (resective surgery) there are possible complications (intracranial haemorrhage, cortic al lesions and infections), however there are possible neuropsyhologic outcomes such as memory outcomes, language outcomes and psychiatric outcomes. The quality of life in epilepsy (QOLIE-31) scale is a self-completed questionnaire which contains seven subscales which address the following aspects: emotional well-being, social functioning, energy/fatigue, cognitive functioning, seizure worry, medication effects and overall quality of life. Our study aimed to examine the quality of life in patients with drug resistant epilepsy who had undergone invasive EEG monitoring and resective neurosurgical treatment through the application of t he QOLIE-31 scale. Subjects and methods: The study included 9 patients with drug resistant epilepsy who had undergone invasive EEG monitoring followed by resective neurosurgical treatment in the period from 2010 to 2016, and the control group of 15 patients with drug resistant epilepsy who had not undergone neurosurgical procedures. Clinical variables of interest for this study were obtained through phone contact, and the QOLIE-31 scale was applied. Results: In the domaine of seizure worry, patients in the examined group were more concerned about the seizures (54.7) compared to the examined group (80), as well as in the overal quality of life (examined group 57.5; control group 77.5). Patien ts in the control group complained more in the domain of antiepileptic therapy (score 70.7) than patients in the examined group (scor e 100). In the other domains: emotional well-being, energy/fatigue, cognitive functioning, and social functioning there were mino r deviations between the examined and control groups. Conclusion: There was no statistically significant difference between individual QOLIE-31 questionnaires, as well as between the two groups of respondents

SOCIAL FUNCTIONING OF PATIENTS WITH PSYCHOTIC DISORDERS IN LONG-TERM PSYCHODYNAMIC GROUP PSYCHOTHERAPY: PRELIMINARY RESEARCH

Background: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. Subject and methods: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. Results: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. Conclusion: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders

Epilepsy due to malformations of cortical development: correlation of clinical, MRI and Tc-99mECD SPECT findings

Malformations of cortical development (MCD) have been increasingly recognized as an important cause of intractable epilepsy. The aim of our study was to define epileptogenicity of MCDs by correlating MRI, EEG and semiology of epileptic attacks, and to determine the effect of MCD on drug resistant epilepsy. We also intended to reveal the utility of interictal single photo emission computed tomography (SPECT) in verification of MCD lesions and relative prevalence of different MCDs. Based on interictal EEG finding, semiology of the epileptic attacks and brain magnetic resonance imaging (MRI) "electroclinical epileptogenicity" of MCD was defined. Brain MRI revealed cortical dysplasia (CD) in nine patients, polymicrogyria in four patients, lissencephaly and schizencephaly in one patient each. Three patients had a combination of malformations. The localization of SPECT hypoperfusion corresponded to MCD lesion in ten (66.67%) patients. Electroclinically confirmed epileptogenicity of MCD overlapped with MR and interictal SPECT findings in fourteen (93.3%) and nine (60.0%) patients, respectively. Our study results demonstrated the MCD lesions to be highly epileptogenic and a frequent cause of intractability

SOCIAL FUNCTIONING OF PATIENTS WITH PSYCHOTIC DISORDERS IN LONG-TERM PSYCHODYNAMIC GROUP PSYCHOTHERAPY: PRELIMINARY RESEARCH

Background: In recent years, social functioning of patients has increasingly been used as a criterion for assessing therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. Subject and methods: The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. Results: The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. Conclusion: Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders

Characteristics of the group process in long-term psychodynamic group psychotherapy for patients with psychosis

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie’s Group Climate Questionnaire-Short Form (GCQ-S) that was completed bythe therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis

Acase report of brucellosis and sacroiliitis with clinical and epidemiological overview

Bruceloza je zoonoza rasprostranjena u nekih domaćih i divljih životinja koja se u rijetkim slučajevima može prenijeti i na ljude. Bolesnik iz Bosne i Hercegovine zaprimljen je u našu Kliniku zbog razjašnjenja etiologije rekurirajućeg intermitentnog febriliteta u trajanju od skoro dva mjeseca praćenog bolovima u križima i donjim ekstremitetima zbog čega je postao nepokretan. Bolesnik je najprije hospitaliziran u kirurškoj klinici gdje su mu učinjeni radiogram kralježnice s kukovima, višeslojna kompjutorizirana tomografija i MR kralježnice na kojima je nađena protruzija diska L5/S1, ali ne i osnovni uzrok bolesti. Stoga je premješten u Kliniku radi dalje obrade i liječenja. Nadopunom anamneze doznali smo da bolesnik živi na seoskom domaćinstvu gdje se bavi uzgojem ovaca zbog čega se postavila sumnja na brucelozu. Dijagnoza bruceloze postavljena je serološkim metodama, PCR-om i izolacijom Brucella mellitensis iz krvi bolesnika, a scintigrafija skeleta pokazala je patološko nakupljanje radiofarmaka u sakroilijakalnim zglobovima. Provedeno je kombinirano antimikrobno liječenje kroz osam tjedana: kombinacijom doksiciklina i rifampicina šest tjedana, a potom još dva tjedna doksiciklinom i ciprofloksacinom. Bolesnik je iz Klinike otpušten u dobrom općem stanju, afebrilan, pokretan i bez simptoma bolesti. Ovim prikazom htjeli smo istaknuti važnost uzimanja epidemiološke anamneze kao i pomišljanja na brucelozu u bolesnika koji dolaze iz susjednih zemalja u kojima je bruceloza česta. Veterinarske mjere kontrole i nadzora bruceloze u životinja kao i nadzor nad stokom koja se importira iz susjednih zemalja najvažnije su preventivne mjere u sprječavanju ove bolesti i u ljudi.Brucellosis is a zoonotic infectious disease found in some domestic and wild animals that in rare cases may be transmitted to humans as well. A patient from Bosnia and Herzegovina was admitted to our hospital for unclear etiology of recurrent intermittend fever lasting for almost two months accompanied by pain in the back and lower extremities causing his inability to move. The patient was at first hospitalized in a surgical clinic where spine and hip radiogram was performed as well as multislice computer tomography and magnetic resonance imaging of the spine that showed disc protrusion at L5/S1, but not the underlying cause of disease. Therefore, he was transferred to our hospital for further examination and treatment. Additional patient history revealed that the patient lived on a homestead where he raised sheep which is why brucellosis was suspected. Brucellosis diagnosis was confirmed by serological testing, PCR and isolation of Brucella mellitensis from the patient’s bood sample, and skeletal scintigraphy showed a pathological accumulation of radioactive agents in the sacroiliac joints. Acombined antimicrobial therapy lasting for eight weeks was administered: a combination of doxycycline and rifampicin for six weeks, then additional two weeks of doxycycline and ciprofloxacin. The patient was discharged from hospital in good general condition, without fever, able to move and without disease symptoms. This case report underlines the importance of collecting epidemiological data as well as considering brucellosis in patients coming from neighbouring countries where brucellosis is common. Veterinary measures for brucellosis control and surveillance in animals as well as surveillance of cattle imported from neighbouring countries are most important preventive measures for disease transmission among humans

IMPACT OF INVASIVE EEG MONITORING AND RESECTIVE NEUROSURGICAL TREATMENT ON THE QUALITY OF LIFE IN PATIENTS WITH DRUG RESISTANT EPILEPSY - PRELIMINARY RESULTS

Background: Neurosurgical treatment is one of important way to cure drug resistant epilepsy. After invasive EEG monitoring and the invasive neurosurgical treatment (resective surgery) there are possible complications (intracranial haemorrhage, cortic al lesions and infections), however there are possible neuropsyhologic outcomes such as memory outcomes, language outcomes and psychiatric outcomes. The quality of life in epilepsy (QOLIE-31) scale is a self-completed questionnaire which contains seven subscales which address the following aspects: emotional well-being, social functioning, energy/fatigue, cognitive functioning, seizure worry, medication effects and overall quality of life. Our study aimed to examine the quality of life in patients with drug resistant epilepsy who had undergone invasive EEG monitoring and resective neurosurgical treatment through the application of t he QOLIE-31 scale. Subjects and methods: The study included 9 patients with drug resistant epilepsy who had undergone invasive EEG monitoring followed by resective neurosurgical treatment in the period from 2010 to 2016, and the control group of 15 patients with drug resistant epilepsy who had not undergone neurosurgical procedures. Clinical variables of interest for this study were obtained through phone contact, and the QOLIE-31 scale was applied. Results: In the domaine of seizure worry, patients in the examined group were more concerned about the seizures (54.7) compared to the examined group (80), as well as in the overal quality of life (examined group 57.5; control group 77.5). Patien ts in the control group complained more in the domain of antiepileptic therapy (score 70.7) than patients in the examined group (scor e 100). In the other domains: emotional well-being, energy/fatigue, cognitive functioning, and social functioning there were mino r deviations between the examined and control groups. Conclusion: There was no statistically significant difference between individual QOLIE-31 questionnaires, as well as between the two groups of respondents

Rano odlučivanje blizanaca kao moguć činilac u povećanju proizvodnje jagnjećeg mesa

Increase of the production of lamb meat can be achieved by increasing the number of twin lambs which is popular practice in the world today - forcing of the multiple fertility. However, the issue of early weaning of Iambs is also present in many cases. It is known that twins are more difficult to maintain during first period and they are slower in growth in future development, which indicates the production of early weaned twin lambs. In domestic, and especially international, literature the issue of early weaning of twin lambs from the aspect of production of lamb meat was discussed however there are no literature references regarding the effect of early weaning on future development of twins after weaning. The objective of this paper was to determine the effect of early weaning of twins on their future development and production, and breeding. Based on presented analysis regarding the effect of early weaning of twin lambs on their future development and production, the following can be concluded: Early weaned twins (age of 2 months) have slower growth and body development compared to single offspring but these differences weren't statistically significant. However, although technically more complicated, weaning of twins only several days after birth was proved to be most efficient in regard to future development and production since these twins were the only ones which have realized same results as single lambs during the investigation period. In case of early weaning, growth of twin lambs depends on their initial body mass which is almost always below the body mass of single lambs. The wool production was higher in case of those animals whose body was more developed, that is the skin surface larger, also the nutrition during first two months was unified and regular as in case of single lambs and lambs from group I.Povećanje proizvodnje jagnjećeg mesa moguće je postići povećanjem broja jaganjaca bližnjenjem, pa se danas u svetu sve više forsira gajenje rasa sa izraženijom mnogoplodnošću. Međutim, u mnogim se slučajevima, paralelno s tim postavlja i pitanje što ranijeg odlučivanja jaganjaca. Poznato je da se blizanci teže održavaju u prvim danima i sporije napreduju u daljem razvoju što upućuje na proizvodnju rano odlučenih blizanaca. U našoj. a naročito stranoj literaturi obrađivano je pitanje ranog odlučivanja blizanaca s gledišta proizvodnje jagnjećeg mesa, ali se do soda nije obrađivao njegov uticaj na razvoj blizanaca posle odlučivanja. Cilj ovog ispiti van/a je bio da utvrdi uticaj ranog odlučivanja blizanaca na njihov dalji razvoj i proizvodnju, odnosno uzgoja blizanaca koji se ostavljaju za dalji priplod