Biomedical subjects

M Gavranović

Publications and source records attributed to M Gavranović.

At least 19 recordsLinked to original sources

PubMed2000

[Ictal automatisms during partial complex seizures in 36 children].

Partial complex seizures are relatively frequent type of epileptic seizures. These attacks are having aura in 60% of cases, that can be vegetative, motor, sensor or psychological one. Important is aura in the form of uncinatus seizures (unpleasant odor), because we must exclude tumor of temporal region in these patients. Altered consciousness comes after aura, patient has opened eyes, face can be pale or red, and automatism appear, in the form of different movements. These automatisms are often considered insignificant by parents or eyewitnesses. There is often misdiagnosis of this type of seizures, because only about 20% of standard EEG recordings find specific epileptic grapho-elements. Therapy of these seizures is difficult, with the success in only 50% of cases. Ictal automatisms were tested in the group of 36 children with partial complex seizures aged 4 to 17 years. Duration of epilepsy was 1 to 5 years. All patients had proved diagnosis of partial complex seizures, clinically and on electroencephalography, CT scan and MRI in medically intractable seizures. Eleven patients were videotaped during the attack. All patients had questionnaire filled by parents, about automatisms. Thirty-four patients (94.4%) had ictal automatisms, and 2 with epileptic focus in frontal region did not. Some patients had different types of automatisms. Most frequent ones were mimicking (15.19%), sitting-standing up (10.76%), swinging (8.23%), swallowing (7.59%) etc. It can be concluded that automatisms are almost obligatory part of partial complex seizure, and their registration is essential for correct diagnosis and treatment of these seizures.

Adolescent↗

PubMed2000

[Hypochromic anemia in children with affective breath-holding spells].

Breath holding attacks are most common in children aged 6 months to 6 years, in 76% of cases between 6 and 18 months of age. Very often they are misinterpreted as tonic epileptic seizures. They are provoked by frustration, anger or sudden injury. Child starts to cry, then holds the breath at the end of expirium. After a few seconds it becomes cyanotic, and losses consciousness. It is usually floppy, but sometimes stiffness, and clonic seizures can be present, and child can be diagnosed as having epilepsy. The form in which child is pale is less frequent, and crying is usually brief or even absent in this type. Breath holding attacks usually do not last more then one to three minutes. Good heteroanamnesis is essential for diagnosis, revealing provoking factors for each attack. Interictal EEG registration is usually normal. Attacks often spontaneously cease after 5 or 6 years of age, and do not require any medical treatment. In more severe cases behavioral therapy has shown good results. It has been noticed that those children in adolescence have syncope more frequent then rest of population. Seventeen children (12 male and 5 female) were investigated at Pediatric Hospital in Sarajevo as breath holding attacks in period from June 1997 to June 2000. Age of patients was between 5 months and 5.5 years (median was 11 months). Hypochromic anemia was present in 12 patients (76%), with average hemoglobin value of 8.2 g/dl (5.9-11.0 g/dl). All children had normal EEG recording. Iron therapy gave positive response in 8 out of 9 patients that were followed (88.9%). Three patients had not come for follow up. It is concluded that hypochromic anemia is often a part of clinical presentation of breath holding attacks in children, and iron therapy can stop them.

Anemia, Hypochromic↗

PubMed1999

[Vigabatrin in childhood epilepsy--personal experience].

Vigabatrin has been in clinical use for 18 years. It has not been used widely in our country because of unavailability and costs of therapy. After the end of war in Bosnia and Herzegovina we started to use it in treatment of childhood epilepsies. We studied 19 patients that received vigabatrin as add on therapy and monotherapy. Follow up period was 6 months to 2 years. Nine of those patients were diagnosed as West syndrome, three had tuberous sclerosis, seven had intractable partial epilepsies. In the group with West syndrome 7 patients (5 as add on therapy and 2 as monotherapy) responded with complete control of seizures and disappearing of hypsarrhythmia in electroencephalographic recordings. One patient responded with reduction of seizures for 50%, one did not respond. In the group with tuberous sclerosis 1 was completely seizure free, one had reduction of seizures for 75%, one did not respond. Out of 7 patients with intractable partial epilepsies 3 responded with reduction of seizures between 75%-100%, 1 with reduction of seizures of 25%-50%, and 3 did not respond. Vigabatrin was well tolerated, we did not experience any serous adverse reactions. This antiepileptic drug can be a major improvement in treatment of some of the epileptic syndromes and needs further investigation.

Adolescent↗

PubMed1999

[Clinical algorithms in the treatment of status epilepticus in children].

The clinical algorithm is a text format that is specially suited for presenting a sequence of clinical decisions, for teaching clinical decision making, and for guiding patient care. Clinical algorithms are compared as to their clinical usefulness with decision analysis. We have tried to make clinical algorithm for managing status epilepticus in children that can be applicable to our conditions. Most of the algorithms that are made on this subject include drugs and procedures that are not available at our hospital. We identified performance requirement, defined the set of problems to be solved as well as who would solve them, developed drafts in several versions and put them in the discussion with experts in this field. Algorithm was tested and revised and graphical acceptability was achieved. In the algorithm we tried to clearly define how the clinician should make the decision and to be provided with appropriate feedback. In one year period of experience in working we found this algorithm very useful in managing status epilepticus in children, as well as in teaching young doctors the specifities of algorithms and this specific issue. Their feedback is that they find that it provides the framework for facilitating thinking about clinical problems. Sometimes we hear objection that algorithms may not apply to a specific patient. This objection is based on misunderstanding how algorithms are used and should be corrected by a proper explanation of their use. We conclude that methods should be sought for writing clinical algorithms that represent expert consensus. A clinical algorithm can then be written for many areas of medical decision making that can be standardized. Medical practice would then be presented to students more effectively, accurately and understood better.

Algorithms↗

PubMed1995

[History of the neuropsychiatric health service in Bosnia-Herzegovina].

During the Turkish rule, there was no organized medical protection of population, and the mentally ill people have been in especially difficult circumstances, since not a single institution has existed before 1640, when in Sinan [symbol: see text]s Tekija in Sarajevo some kind of haven for mental patients was established. More severe cases were sent to the uncertainty of Hospital for Mentally ill in Jedren, deep in the heart of Turkish Empire. Mental patients of Christian religion were treated in churches, monasteries. The Francistiens Order, that has been active in the region since 13th century, was especially involved. After occupying Bosnia and Herzegovina, Austro-Hungarian Monarchy found only "Vakuf Hospital" and Turkish Military Hospital, in 1866. After establishing state Hospital, ex "Vakuf Hospital" was turned into the first Psychiatric institution, which was conducted by Health Counselor, dr Carly Bayer. In 1908, he became the first Head of newly-built Department for mentally ill persons within the State Hospital. By the end of the First World War, there was 113 beds and one doctor in change, Chief of staff dr Egon Zahratka, who was succeeded by dr Salvator Karabaji. In 1947, Neuro-Psychiatric Clinic within the Medical Department of Sarajevo University was established, and its founder and the first Head was prof. dr Nedo Zec. One year later, a Psychiatric Hospital was opened in Jagomir, in vicinity of Sarajevo. Since then neuropsychiatric health services have been constantly expanding, and that is shown in the tables within the paper. Independent development of neurology, psychiatry, psycho-therapy, pharmacological-biological psychiatry and other branches enabled foundation of independent specialized psychiatric and neurological institutions. The expansion of scientific research and educational activities was direct consequence of that. This expansion has been extremely successful during last several decades, that the experts from our Republic were very highly appreciated within the former Yugoslavia, as well as abroad.

Bosnia and Herzegovina↗

PubMed1994

[A doctrinaire approach to evaluation of sequelae of craniocerebral injuries].

The consequences of the severe head injuries should be estimated 1-2 years following the injury. The evaluation must be based upon certain postulates which are to be obligatory for the team of experts (neuropsychiatrist, otologist, ophthalmologist, neuro-radiologist, clinical psychologist). They must work simultaneously as a team for it is the only way to establish the precise qualification of the damage in question. The clinical work up to now has shown many weak points. The first postulate is the information on the state of health prior to the injury: previous injuries and their sequelae, psychopathological manifestations, alcohol abuse, disturbances of the consciousness, vertigo, disturbances of the sight and hearing etc. The second postulate is the review of the case history regarding the acute period of the injury: the qualification of the injury, the duration of the state of unconsciousness and post-traumatic amnesia, focal neurological signs, psychological disturbances, EEG, CT etc. The third postulate is a detailed clinical examination including paraclinical parameters neurological examination (focal neurological signs, hemicerebral syndrome and very seldom-parkinsonism) with consultation of otologist (vestibularis, audiogram) and ophthalmologist (visus, fundus, campus, intraocular pressure), EEG (longitudinal follow-up), possible evoked cerebral potentials. The epilepsy syndrome must be based upon clinical and EEG criteria, while the selection must be very strict. In there are structural brain changes the collaboration with the neuroradiologist is important. Psychological disorders: neurasthenic neurosis, personality disorders, and rarely dementia. It should be clinically confirmed accompanied by psychological tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Craniocerebral Trauma↗

PubMed1991

[Specifics in the treatment of epilepsy in children with mental retardation].

Authors discuss some specifics in treating epilepsies in children with mental retardation that have to be considered. First is the problem of precise diagnosis, because of certain phenomena in mentally retarded children, and a possibility of the so called pseudoretardation that can be caused by epileptic seizures or inadequate medication. A specific problem is vulnerability of these patients regarding antiepileptic drugs, especially phenytoin and phenobarbiton. Usage of psychopharmacs should be minimized and drugs interaction has to be considered permanently. A general trend in treatment should go towards increase in usage of carbamazepine and valproic acid, preferring monotherapy.

Child↗

PubMed1989

[The importance of beginning antiepileptic therapy and aspects for its prognosis].

Before we start the medical treatment of epilepsy, we have to examine the diagnostic again as well the factors significant for prognosis (etiology, type of seizure, cerebral structural changes, neurology deficiency, psychic changes, social handicap, etc.) The possibility of accidental seizure must be eliminated, the care of possible precipitating factors taken too. On principle the first seizure shouldn't be treated but if we decide to cure it, we have to make careful selection. The medical treatment must be done with one anticonvulsant.

Anticonvulsants↗

PubMed1988