Comorbidity of epilepsy and migraines epidemiological and clinical aspects

In patients with migraines, epilepsy occurs in 5.9% (1-17%) of cases compared to a prevalence of 0.5-1% in the general population. Comorbidity of migraines and epilepsy can be explained by neuronal hyperexcitability, while cortical spreading depression is considered to be a pathophysiological mechanism that lies in the basis of the migraine aura. The study included 259 patients with epilepsy and 40 patients with both epilepsy and migraines. The aim of the investigation was to determine the prevalence of migraines, the existence of a temporal association between epileptic and migraine attacks, to determine the clinical characteristics of joint epileptic and migraine attacks, the existence of a significant connection between a certain type of epileptic seizure and type of headache, and finally to determine heredity for epilepsy and migraines in patients who have these conditions associated. Patients were diagnosed clinically, neurophysiologically and neuroradiologically. The research results show that the frequency of associated epilepsy and migraines occurred in 15.44%. The results of this investigation point to a significantly higher frequency of epilepsy and migraines in female patients (ratio 5 : 1), which is different from the data we found in existing studies. Temporally connected attacks of epilepsy and migraines were observed in 48% of patients. Preictal headaches appeared in 20% of patients, postictal in 28% of patients. There was no significant association between migraines and the particular type of epileptic attack. Heredity for migraines was present in 35% of patients with both epilepsy and migraines. This data is significantly lower than the data found in other studies

INTRACYTOPLASMIC SPERM INJECTION: REVIEW OF TECHNIQUE AND ITS SUCCESSFUL IN TREATMENT OF INFERTILITY WITH FOLLOW UP CHILDREN CONCEIVED WITH THIS METHOD

SAŽETAK Intracitoplazmatsko injiciranje spermija (ICSI) predmet je rasprava s obzirom na indikacije za postupak, način provođenja postupka, te utjecaj na potomstvo. Namjera ovog članka je iznijeti novine u tehnici provođenja postupka ICSI, literaturne podatke o uspješnosti postupka, te podatke o praćenju razvoja djece začete u postupku IVF/ICSI.ABSTRACT Intracytoplasmic sperm injection (ICSI) has been the subject of ongoing debate regarding its indication, techniques and impact on offspring. The intention of this article is to review newer progress in the field of performing ICSI technique, presentation of literature outcome data as well as data of follow up studies children conceived after IVF/ICSI procedure

Javna svijest, razumijevanje i stavovi prema epilepsiji u Crnoj Gori

Stigma remains a distressing consequence of epilepsy worldwide. We assessed stigma markers among citizens of Montenegro. Randomly selected adults aged 18 to 65 were interviewed using a 10-item questionnaire, which had been used in similar settings. Descriptive statistics, χ2-test and Fisher exact test were used in order to identify factors associated with negative attitudes. After exclusions and refusals, the questionnaire was administered to 1000 people, 91% of whom had heard about epilepsy. Less than half knew someone with epilepsy and 31.5% had witnessed a seizure. One-fifth would object if their child played with a person who had epilepsy and three-quarters would object if their child married a person with epilepsy. Forty percent believed people with epilepsy should be employed in the same way as everybody else. Fewer than 8% of respondents thought epilepsy was a form of insanity. Over 80% favored brain disease as a cause of epilepsy and 95% chose convulsions to be a major feature of an epileptic attack. General awareness of epilepsy in Montenegro is similar to that in other countries. Understanding epilepsy is relatively good but the results suggest that there still are negative attitudes towards people with epilepsy.Stigma ostaje uznemiravajuća posljedica epilepsije diljem svijeta. Procijenili smo čimbenike koji utječu na stigmatizaciju među građanima Crne Gore. Skupinu su činile slučajno odabrane osobe u dobi od 18 do 65 godina. Ispitanici su intervjuirani upitnikom od 10 stavki, koji je bio korišten u sličnim ispitivanjima. Korištena je deskriptivna statistika, χ2-test i Fisherov egzaktni test kako bi se utvrdili čimbenici povezani s negativnim stavovima. Nakon isključivanja i odbijanja sudjelovanja u studiji upitnik je popunilo 1000 ljudi od kojih je 91 posto čulo za epilepsiju. Manje od polovice je znalo nekog s epilepsijom, a 31,5 posto su bili svjedoci napadaja. Jedna petina bi se protivila da se njihovo dijete igra s osobom s epilepsijom, a tri četvrtine bi se protivilo takvom braku. Četrdeset posto ispitanika smatra da ljudi s epilepsijom trebaju biti zaposleni kao i drugi. Manje od 8% ispitanika smatra da je epilepsija jedan oblik ludila. Preko 80% vjeruju da su bolesti mozga uzrok epilepsije, a 95% misli da je glavna osobina epileptički napadaj. Opća svijest o epilepsiji u Crnoj Gori je slična onoj u drugim zemljama. Razumijevanje epilepsije je relativno dobro, ali rezultati ukazuju na to da još uvijek postoje negativni stavovi prema osobama s epilepsijom

Psihijatrijski komorbiditeti u bolesnika s epilepsijom u Crnoj Gori

The aim of this study was to evaluate the prevalence of psychiatric comorbidities, depression and anxiety, among patients with epilepsy in the outpatient Clinic for Epilepsy, Clinical Centre of Montenegro. Patients aged 18 and above with a diagnosis of epilepsy for at least one year were consecutively enrolled during a six-month period. Patients anonymously filled out a questionnaire which included data on the gender, age, education, marital status and degree of seizure control. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to evaluate the presence or absence of anxiety and depression. Total number of study patients was 70, including 52 patients with partial seizures and 18 patients with generalized tonic-clonic seizures. The mean patient age was 37}7.92 years. The prevalence of depression in our sample was 32.8%, whereas the prevalence of anxiety was 21.4%. Patients with partial seizures were more depressed, while those with idiopathic generalized seizures were more anxious (p<0.01). Depression was associated with a lower educational level, unemployment and poor seizure control (p<0.05). The number of antiepileptic drugs showed a trend towards negative association with depression (p=0.005). Anxiety was associated with the level of education and uncontrolled seizures (p<0.01). Neither depression nor anxiety was associated with age, gender, marital status, age at onset and duration of epilepsy. Psychiatric disorders among patients with epilepsy are quite common but yet under-recognized. Therefore, appropriate recognition and efficient treatment of these disorders in patients with epilepsy might improve their quality of life and could consequently lead to better treatment success.Cilj ovoga istraživanja bio je ispitati učestalost psihijatrijskih bolesti, depresije i anksioznosti, u bolesnika s epilepsijom u Dispanzeru za epilepsije Kliničkog centra Crne Gore. Bolesnici u dobi od 18 godina i više s dijagnozom epilepsije od najmanje jedne godine uključivani su u studiju kroz šest mjeseci. Bolesnici su ispunjavali upitnik koji je uključivao podatke o spolu, dobi, obrazovanju, bračnom stanju i stupnju kontrole napadaja. Ljestvice Hamilton Depression Rating Scale (HAM-D) i Hamilton Anxiety Rating Scale (HAM-A) su korištene za procjenu prisutnosti ili odsutnosti depresije i tjeskobe. Ukupno je bilo uključeno 70 bolesnika: 52 bolesnika s parcijalnim napadajima i 18 bolesnika s generaliziranim toničko-kloničkim napadajima. Prosječna dob bolesnika je bila 37}7,92 godine. Učestalost depresije u našem uzorku je bila 32,8%, dok je učestalost anksioznosti bila 21,4%. Bolesnici s parcijalnim napadajima su bili više depresivni u odnosu na bolesnike s idiopatskim generaliziranim napadajima, koji su bili anksiozniji (p<0,01). Depresija u bolesnika s epilepsijom je bila povezana s niskim stupnjem obrazovanja, nezaposlenošću i lošom kontrolom napadaja (p<0,05). Uporaba antiepileptika je pokazala trend ka negativoj povezanosti s depresijom (p=0,005). Anksioznost je bila povezana s razinom obrazovanja i nekontroliranim napadajima (p<0,01). Nijedan od ovih psihijatrijskih poremećaja u bolesnika s epilepsijom nije bio povezan s dobi, spolom, bračnim stanjem, dobi nastupa i trajanjem epilepsije. Psihijatrijski poremećaji u bolesnika s epilepsijom su veoma česti, ali se još uvijek slabo prepoznaju. Odgovarajuće prepoznavanje i učinkovito liječenje ovih bolesti u bolesnika s epilepsijom moglo bi značajno poboljšati kvalitetu njihova života i posljedično bi moglo dovesti do bolje uspješnosti liječenja

A REPORT OF SEVERE OVARIAN HYPERSTIMULATION SYNDROME CASE IN THE ASSISTED REPRODUCTION PROCEDURE

Prikazana je primarno neplodna pacijentica s dijagnosticiranim sindromom policističnih jajnika, koja je u postupku potpomognute oplodnje stimulirana GnRh agonistom i gonadotropinima, te koja je razvila teški oblik sindroma hiperstimulacije jajnika. Stanje pacijentice se dodatno pogoršalo nakon što je nastupila trudnoća. Na odjelu intenzivne njege provela je 21 dan, u bolnici ukupno 55 dana. Trudnoća je završila porodom zdravog djeteta carskim rezom u 38. tjednu trudnoće.We present a case of a primary infertile patient with diagnosed polycystic ovary syndrome, who in an assisted reproduction procedure was stimulated with GnRh agonists and gonadotropins, and who subsequently developed a severe ovarian hyperstimulation syndrome. The patient’s condition was further worsened after the pregnancy was confirmed. She spent 21 day at the intensive care unit and 55 days in the hospital. The pregnancy resulted in the birth of the healthy child, delivered by caesarean section at 38th week of pregnancy

CONSERVATIVE TREATMENT OF CERVICAL PREGNANCY Review and case report

Cervikalna trudnoća je najrjeđi, ali i najopasniji oblik ektopične trudnoće. U prošlosti se cervikalna trudnoća liječila kirurškim metodama koje su često završavale histerektomijom. Danas se u terapiji cervikalne trudnoće primjenjuju konzervativne medikamentozne metode. Najčešće korišten lijek je metotreksat. Prikazana je 33-godišnja nulipara koja je primljena u Kliniku zbog klinički i ultrazvučno dijagnosticirane cervikalne trudnoće u 6. tjednu amenoreje. Unutar cerviksa nađen je embrionalni odjek od 4 mm, s pozitivnom srčanom akcijom, a betahCG bio je 9970 IU/L. Započeta je terapija metotreksatom 75 mg iv u infuziji na koju se nadovezala terapija Leukovorinom. Ista terapija je ponavljana 8. i 17. dan. Nakon prve doze betahCG je porastao na 12650 IU/L i potom je kontinuirano padao do 33. dana kada je bio 52,6 IU/L. Pacijentica je 36. dan otpuštena iz bolnice, dva tjedna kasnije je klinički i ultrazvučni nalaz uredan, a betahCG negativiziran.Cervical pregnancy is a rare but very dangerous site of ectopic pregnancy. In the past cervical pregnancy was treated by various surgical methods that often ended with hysterectomy. Today cervical pregnancy is treated conservatively, mainly with local or systemic application of methotrexate. We present a case of 33 years old nullipara who was admitted to our department with clinical and ultrasonographic finding of cervical pregnancy in 6 weeks of gestation. Inside the cervix we found the gestational sac with the embryonic echo 4 mm with positive heart beats. The betaHCG level was 9970 IU/L and we started with administration of methotrexate, 75 mg iv in infusion followed by Leucovorin. The same therapy was given on Day 8 and Day 17. After the first dose of methotrexate betaHCG was higher (12650 IU/L) followed by a continious drop until Day 33 when was 52,6 IU/L. The patient was discharged from the hospital on day 36 and two weeks thereafter had normal clinical and ultrasonographic findings and negative betaHCG

Characteristics, outcome and predictors of one year mortality rate in patients with acute heart failure

Background/Aim. Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and longterm mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population. Methods. This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade) and were followed for one year after the discharge. Results. Mean age of the patients was 63.6 ± 12.6 years and 59.4% were males. Acute congestion (43.8%) and pulmonary edema (39.1%) were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF) was 39.7% ± 9.25%, while 44.4% of the patients had LVEF ≥ 50%. At discharge, 55.9% of the patients received therapy with β-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blokcers (ARB). The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS) and a higher tricuspid velocity. Conclusion. One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity

To Professor Petar Pfendt, In calidum, et plurium retributivus memoriae: FTIR-ATR analysis of post stamps of the Principality of Serbia issued in 1866 and 1868 and their forgeries

In order to further define the potential use of FTIR-ATR spectroscopy, as a non-destructive and reliable technique, for the analysis of the characteristics of post stamps, certified originals of the Principality of Serbia stamps (“Prince Michael issues”) issued in 1866 and 1868 as well as their forgeries were ana­lyzed. Spectra enabling the comparison of the paper, dye and glue of stamps of so-called “Vienna issues”, having denominations of 10 (orange-yellow), 20 (pink) and 40 para (blue) and “Belgrade issues” (1 para-green and 2 para-reddish brown), as well as 24 expert-certified forgeries, were taken. It was shown that the applied technology was, in most of the cases, a fast and suitable technique for establishing clear differences between the spectral characteristics of the paper and dye used for the original stamps, and forgeries that were most probably made decades after the printing of the genuine stamps. The differences between print­ings of the same issues of the genuine stamps were also elaborated. It is pro­posed, for the first time in philatelic history, the possibility that “Vienna issues” stamps may have been printed on two different papers, and, having in mind the technology of printing in the 19th century, potentially, not even at the same time or in the same printing house

Intracitoplazmatsko Injiciranje Spermija: Osvrt na Tehniku i Njenu Uspješnost u Liječenju Neplodnosti, te Praćenje Razvoja Djece Začete Ovom Metodom

Intracytoplasmic sperm injection (ICSI) has been the subject of ongoing debate regarding its indication, techniques and impact on offspring. The intention of this article is to review newer progress in the field of performing ICSI technique, presentation of literature outcome data as well as data of follow up studies children conceived after IVF/ICSI procedure.Intracitoplazmatsko injiciranje spermija (ICSI) predmet je rasprava s obzirom na indikacije za postupak, način provođenja postupka, te utjecaj na potomstvo. Namjera ovog članka je iznijeti novine u tehnici provođenja postupka ICSI, literaturne podatke o uspješnosti postupka, te podatke o praćenju razvoja djece začete u postupku IVF/ICSI

Public Awareness, Understanding and Attitudes Towards Epilepsy in Montenegro

Stigma remains a distressing consequence of epilepsy worldwide. We assessed stigma markers among citizens of Montenegro. Randomly selected adults aged 18 to 65 were interviewed using a 10-item questionnaire, which had been used in similar settings. Descriptive statistics, χ2-test and Fisher exact test were used in order to identify factors associated with negative attitudes. After exclusions and refusals, the questionnaire was administered to 1000 people, 91% of whom had heard about epilepsy. Less than half knew someone with epilepsy and 31.5% had witnessed a seizure. One-fifth would object if their child played with a person who had epilepsy and three-quarters would object if their child married a person with epilepsy. Forty percent believed people with epilepsy should be employed in the same way as everybody else. Fewer than 8% of respondents thought epilepsy was a form of insanity. Over 80% favored brain disease as a cause of epilepsy and 95% chose convulsions to be a major feature of an epileptic attack. General awareness of epilepsy in Montenegro is similar to that in other countries. Understanding epilepsy is relatively good but the results suggest that there still are negative attitudes towards people with epilepsy