SCRIPTA MEDICA

An Advice for Young Researchers

2018-12-21T11:11:31+01:00

For a young researcher, the best way to improve his skills and develop his research capabilities is to work in established research laboratories where he is enabled to learn modern techniques and how to attack the scientific problems. Today, we have easy communications, including computers and the internet, but direct interactions with the most experienced scientists are the best way for young scientist to advance his research capabilities. Ulf Svante von Euler, Swedish pharmacologist and physiologist presents the best example that illustrates how interaction of a young researcher with established scientists develop his research capabilities and become a well-known scientist1.
When Ulf was seventeen (1922), he came in Stockholm to study medicine. As a student, he became interested in research, and in 1926 he attended the Twelfth International Congress of Physiologists in Stockholm where he heard lectures by I. P. Pavlov, E. H. Starling and other great scientists of the time. He also observed a historic demonstration by Otto Loewi on the existence of Vagusstoff in the frog’s heart, which would stimulate his own interest and research on mediators of nerve transmission. Prior to this demonstration, Loewi had published several papers on the nature of this chemical substance that slowed the heart, but not all of his research contemporaries were convinced. However, a successful demonstration at the Congress (repeated eighteen times) convinced all critics. Von Euler recalled that these experiments inspired his enduring interest in neurohumoral transmission.
Initially, von Euler was influenced by several well-known Swedish scientists: G. Liljestrand (pharmacologist/physiologist), R. Fåraeus (a hematologist) and H. Theorell (a biochemist, who received the Nobel Prize for Medicine and Physiology in 1955). Ulf defended his doctoral dissertation in 1930 and became a professor of pharmacology. Then, he received a two-year scholarship for postdoctoral studies abroad that enabled him to improve his skills by working with several famous foreign researchers.
The young Ulf von Euler made the most of this opportunity. He spent six months in Hampstead at Sir Henry Dale’s laboratory, two months in Birmingham with I. de Burgh Daly, eight months in Ghent with C. Heymans, and three months in Frankfurt with G. Embden. Later, in 1934, he returned to London for six months to work with A. Hill, primarily because Liljestrand advised him instead of pharmacology, rather to devote to physiology because at that time in Sweden this scientific discipline was more appreciated. Towards the end of 1937, he went back to Hampstead for five months to work again with Sir Henry Dale.

The Importance of Rehabilitation Treatment in Patients with Parkinson’s Disease

2018-12-21T11:11:44+01:00

Parkinson’s disease (PD) is a chronic neurodegenerative disease with a slowly progressive course, having an average duration of about 15 years. It is characterized by akinesia/ bradykinesia, tremor, rigidity and postural instability. For the diagnosis of PD at least two of these four characteristics are required. There is a whole spectrum of non-motor symptoms (mood disorders, different levels of cognitive deficit, sleep disorders, fatigue, autonomic dysfunction). The patomorphologic base of PD is a disorder of the nigrostriatal dopaminergic mechanisms, metabolic damages, structural changes (hydrocephalus, tumors) or degenerative processes of presynaptic nigrostriatal dopaminergic projections or the striatum. Although the pharmacological approach is still essential, more systematic reviews and meta-analysis support the hypothesis on the positive effects of physiotherapy and intensive kinesiotherapy in PD patients. The main rehabilitation method for these patients is kinesiotherapy in its various forms, related to the individual therapeutic target, based on functional limits. Rehabilitation programs contain kinesiotherapeutic procedures for balance, posture, the range of motions- especially rotation of the trunk, strength, elongation, as well as exercise for functionally reduced motion types. The greatest emphasis in the rehabilitation process should be on the re-education of gait, which involves the optimization of initiation, speed, and length of steps. The aim of kinesiotherapy and occupational therapy is to bring the maximum functional independence of the patient and the occurrence of complications to a minimum.
In neurodegenerative disorders, all modalities for improving the gait function are essentially a lifelong activity. Therapeutic strategy comes down to the combination of pharmacotherapy and neurorehabilitation methods.

Bone Metabolism Markers and their Correlation with Body Mass Index in Aerobic Physical Activity

2018-12-21T11:12:02+01:00

Introduction: Bone formation marker osteocalcin (OC) and bone resorption marker C-terminal telopeptide of type 1 collagen (CTX) can be used to detect or to monitor the early responses of the skeleton to physical activity. Literature suggests that it is likely that higher body mass index (BMI) has positive effect on bones and can postpone onset of osteoporosis.
Aim of the Study: The aim of this study is to:
1.
Determine the effect of aerobic physical acitivity on OC and CTX in young women
2.
Investigate correlation of OC, CTX and BMI in young women engaged into structured aerobic excercise
Material and methods: Study included 64 healthy young women, aged 19 to 25 years, devided into two groups: intervention group (n=32) and control group (n=32). The study duration was six weeks with follow-up period of four weeks. The intervention group underwent structured aerobic physical activity program for six weeks, but the control group did not receive such program. Level of OC, CTX and BMI were measured at baseline, after 6-week aerobic program, and after 4-week follow up (only intervention group).
Results: There was significant increase of OC level after 6-week aerobic program, while level of CTX did not changed. OC level was at its maximum immediately after finishing the program in the participants with normal BMI (p<0.001). There was no statistically significant interaction of BMI and CTX level.
Conclusion: Aerobic physical activity increases level of osteocalcin, suggesting that it has positive influence on bone formation in young women, primarily in women with normal BMI.

Importance of Selection a Method of Reconstruction of Digestive Continuity After Gastrectomy

2018-12-21T11:12:20+01:00

Introduction: Gastrectomy is one of the most common surgical methods for the treatment of gastric cancer, which basically destroys the mechanism and digestion chemistry. Reconstruction after gastrectomy attempts to optimize the antireflux and nutritive component of the postgastrectomic syndrome.
Objective: To determine which reconstructive method after gastrectomy has the optimal synthesis of antireflux and nutritional components.
Patients and Methods: 111 patients were treated for gastric malignancies at the Surgical Clinic of the University Clinical Center in Banja Luka, which were operated with the intention of achieving curability.
Results: Based on Fisher’s exact probability test there is no statistically significant difference (p> 0.05) in mortality compared to the restoration of digestive continuity after gastrectomy. Reflux oesophagitis is the dominant modality of morbidity in omega-loop reconstruction (p <0.05). There is no statistically significant difference (p> 0.05) in late dumping syndrome in patients relative to individual gastric substitution options. In the Hunt-Lawrence-Rodino pouch reconstruction option, there is no statistically significant difference (p> 0.05) in the participation of individual modalities of meal quantity in relation to the condition before the disease or the modality of the nutritional status. .
Conclusion: The results indicate the antireflux component of reconstruction Roux en Y and the advantage of the nutritive component in the loop modification (the creation of the Hunt-Lawrence-Rodino pouch).

Complications of Diabetes Mellitus on Muscles and Joints of Lower Extremities

2018-12-21T11:12:35+01:00

Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy.
Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and first metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes.
Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in “Primary Health Care Centre Banjaluka” in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer.
Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000).
Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes.

The Value Assessment of Clinical Trials Based on Electrophysiologically Verified Lumboischialgia

2018-12-21T11:12:48+01:00

Introduction: Lumboischialgia is defined as pain in the distribution of ischemic nerve caused by a pathological change in the nerve itself, whereas lumbago is a localized spondylogenic pain that is not followed by a neurological deficit, and is a consequence of muscular bone dysfunction of the lumbosacral region. Previous studies which investigated the value of clinical trials in the diagnosis of lumboischialgia did not find a high sensitivity and specificity in those tests.
Objective: Our objective was to define clinical tests that indicate the existence of radiculopathy and to determine the value of the overall diagnostic finding in relation to the findings of the EMNG examination.
Methods: The sample consisted of 100 patients of both genders, aged 18-65. The inclusive criteria were: strong lower back pain propagating in one of both legs and lasting for 1-3 months and the medical history suggesting a radicula lesion. Non-inclusion criteria were the following: symptoms of cauda equine, acute febrile condition, existence of tumors, vertebral fractures, lesions of central motoneuron, inability to perform the EMNG examination, acute psychotic conditions, operations of the spine and pregnancy. Immediately before each EMNG examination, medical history was taken with defined questions on the existence of pain stronger in the leg than in the spine, dermatome deficit, pain during labor and weakness in the leg.
Results: Patients usually have a total of two (31%) and three (26%) positive clinical signs of lumboischialgia. By statistical analysis, three clinical trials proved to be discriminatory in terms of verification of radiculopathy: positive Lazarevic test, paresis of a particular muscle group, and absence or reduction of the patellar or Achilles reflex. After processing with logistic regression, the statistically predictive value is retained by a positive Lazarevic test. The analysis of the surface under ROC curve shows that the positivity of four or more clinical tests is statistically the best limit value, with a specificity of 67% and a sensitivity of 56%.
Conclusion: The conducted study indicates the statistical significance of the frequency of positive clinical trials: Lazarevic test, objective muscular weakness and absent reflex, in persons with electrophysiologically verified lumboischialgia.

Effects of Anxiety and Depressive Manifestations of Personality on Functional Recovery of Patients with Cervical Pain Syndrome

2018-12-21T11:13:02+01:00

Introduction: Cervical syndrome is a set of symptoms that are manifested by pain in the neck segment and shoulder blade region, with the feeling of tightness and tension, and limited movement of the neck segment of the spine. Because of the long-term duration of symptoms, we often find psychopathological manifestations in the form of anxiety and depression in these patients.
Objective: The goal was to detect the presence of anxiety and depressive manifestations of personality in patients with cervical syndrome at the beginning of rehabilitation treatment, to determine to what extent the presence of anxiety and depressive symptomatology affects the functional recovery of patients after a physical rehabilitation treatment.
Patients and Methods: The study was conducted as a prospective study involving 100 patients. Criteria for inclusion were the diagnosis of cervical syndrome and the age of patients between 20 and 60 years of age. Exclusion criteria were diagnosis of cervical radiculopathy, vertebrobasilar syndrome, diagnosis of anxiety and depressionconfirmed by psychiatrist, as well as use of psychotropic substances. On admission, each patient filled in Beck’s questionaire for anxiety and depression (BAI and BDI)and accordingly patients were divided into 3 groups.
Results: Out of total of 100 patients, 74% were female and 26% were male. In 77% of patients psychopathological manifestations of personality were found. A statistically significant association of gender and group placement was found (p=0,003). The women had a far greater percentage of anxiety and anxiety-depressive manifestations of the personality than men. In terms of BAI and BDI, there was a statistically significant difference between genders. All of the parameters ( VAS, Schober, CSS) monitored during rehabilitation treatment were improved at the end of treatment (p=0,0001). There was a positive correlation of BAI and BDI with CSS on admission and at discharge (p=0,05) in a group of anxiety-depressed patients.
Conclusion: The presence of anxiety and depressive manifestations of personality did not have a negative impact on the functional recovery of patients. Physical therapy has led to reduction of pain, increased mobility and better functional status of cervical spine for patients with cervical spine syndrome.

Analysis of Survival at Metastatic Melanoma Patients Treated with Vemurafenib - a Three Year Single Institution Study

2018-12-21T11:13:16+01:00

Introduction: The introduction of BRAF inhibitor vemurafenib significantly improved
overall survival (OS) in metastatic melanoma patients.
Aim of the Study: The purpose of this study was to determine OS and progression
free survival (PFS) in patients with advanced metastatic melanoma treated with
vemurafenib in the Oncology Clinic, University Clinical Centre of the Republic of
Srpska (UKC RS). The secondary goal is to determine the effect of elevated serum
lactate dehydrogenase (LDH) on OS.
Patients and Methods: We analysed patients that received vemurafenib in the
April 2015. until March 2018. They had pathohistologically confirmed B-RAF positive
metastatic melanoma. LDH values were measured at the start of the treatment.
Results: A total of 16 patients were analyzed, with an average age of 53 years
(37-78). A large number of patients at the start had multiple sites of metastases.
Calculated OS in patients who received vemurafenib is 11.8 months (p=0,23), with
standard deviation (SD) 9.18. The calculated PFS is 9.5, SD 7,57. OS in patients with
normal LDH is 14.4 months, SD 10.73, and with elevated LDH is 8.4 months, SD
4.9 (p=0.079).
Conclusion: Use of vemurafenib resulted in an improvement in PFS, with improved
OS in patients with advanced BRAF-mutated melanoma. In patients with elevated
LDH OS was reduced. This shows that LDH is a good prognostic marker and that
we should do it routinely for all patients with melanoma. This study has indicated
the need for new diagnostic and therapeutic options for melanoma in Republic of
Srpska.

Open Surgical Biopsy in Diagnosis of Mammographically Detected Suspicious Microcalcifications

2018-12-21T11:13:29+01:00

Background: One of the earliest signs of breast cancer may be the presence of mammographically detected suspicious microcalcifications in the breast. The aim of the study was to present an open surgical biopsy of the mammographically detected suspicious microcalcifications in a breast, with preoperative wire marking of the lesions and intraoperative specimen radiography, as a reliable and valid procedure.
Material and Methods: The study included 80 female patients underwent surgery because of mammographically detected suspicious microcalcifications. The method of preoperative ultrasound-guided wire marking of a zone of microcalcification was performed in all patients.After wire marking, the control native mammography in ML and CC projections was performed, in order to locate the microcalcifications relative to the wire. In all patients, the extirpation of the suspicious microcalcifications was verified by the specimen radiography.
Results: In the definitive histopathological finding in situ component of ductal carcinoma of the breast was verified in nine (11,25%) examinees. High grade in situ component was verified in eight (10%) examinees and low grade in situ component in one examinee (1,25%). In 11 (13,75%) examinees, the invasive breast cancer with an extensive in situ component up to 50% was verified. In 46 (57,5%) of the examinees, benign, non-proliferative changes were verified, while proliferative changes characterized as premalignant condition (sclerosing adenosis, radial scar and atypical ductal hyperplasia) were verified in 14 (17,5%) examinees. Microcalcifications verified by specimen radiography are completely removed.
Conclusion: Presence of mammographically detected suspicious microcalcifications has a significant predictive value in the early detection of breast cancer. The method of an open surgical biopsy, as an alternative to stereotactic biopsy, is valid in diagnostic of the mammographically suspicious microcalcifications.

Advantages of Percutaneous Coronary Intervention in Relation to Medication Therapy in Patients with Stable Angina Pectoris (Three- Wessel Coronary Disease)

2018-12-21T11:13:41+01:00

Patient, a man, age of 66 years, was admitted to the Internal Department,
Interventional Cardiology Department for chest pains by type of stable angina
pectoris. CCS II. In ambulatory conditions he was made non-invasive diagnostics,
and after a positive ergometric test, a decision was made that the patient be
admitted to the catheterization hall for invasive diagnosis and possible percutaneous
coronary intervention.

Acute Poisoning with Herbicide Glyphosate

2018-12-21T11:13:50+01:00

Glyphosate is the most common used organophosphorus herbicide which most probably inhibits oxidative phosphorylation without leading to the inhibition of esterases. Glyphosate poisoning is mostly the consequence of the synergistic effect of an active substance and surfactant. There is a case of 42-year-old patient who worked on weed spraying with glyphosate, with hand sprinkler. Symptoms of the acute poisoning such as weakness, sweating, nausea, vomiting and stomach ache were visible right after the working period. With biochemical analysis increased activity of the enzymes AST, ALT and y-GT were diagnosed and sanated after aborting an expositions in the period of six months and treatment. In this shown case poisoning was caused during applying herbicides without proper handling with the herbicide and also because of non-compliance of measures in safety and health at work. It is very clear that this is a case of acute poisoning with pesticides which ended with no consequences and was declared as work injury.