University Clinical Center Tuzla Research Articles

Analysis of Clinical and Laboratory Characteristics of Patients with Leptospirosis in Five-year Period.

Introduction:Leptospirosis is an infection caused by spiral bacteria from the family Leptospiraceae, and is considered to be the most widespread zoonosis in the world.Aim:To analyze the clinical and laboratory characteristics of patients with Leptospirosis over five years.Methods:The study included 160 patients aged 17-79 years, who in the period 01.01.2014. to 21.12.2018. were hospitalized at the Clinic for Infectious Diseases of the University Clinical Center Tuzla. They were diagnosed based on medical history, clinical examination, laboratory and microbiological results. The definitive diagnosis was confirmed by serological testing from the patients’ blood.Results:In the observed period, the highest number of patients were in 2014 80/160, and the lowest in 2015 15/160. Male patients were more likely to suffer from 118 (73.8%) than female 42 (26,3%). The mean age was ±56.5 years. The most common symptoms in patients were: fever (95,6%), headache (93,8%), malaise (87,5%) and myalgia (85,6%). In all patients, 160/160 (100%) accelerated erythrocyte sedimentation and elevated C-reactive protein was observed. The following findings were reported from white blood cell findings: leukocytosis in 81/160 (50,6%), neutrophilia in 103/160 (64,4%) and lymphopenia in 128/160 (80%) patients. Liver findings had the following values: elevated AST in 142/160 (88%) and ALT in 130/160 (81,3%) patients. Total bilirubin was elevated in 105/160 (65,6%) and direct in 107/160 (66,9%). Thrombocytopenia was in 142/160 (88%) patients. Urea was elevated in 103/160 (64,4%) and creatinine in 101/160 (61,3%) patients.Conclusion:it is very important that physicians in their day to day practice, especially in ambiguous febrile conditions, differentially diagnose leptospirosis and establish a timely diagnosis, this is ley to adequate and timely therapy, and therefore to reducing to development of complications and mortality.

Antenatal Care and Weight Gain in Adolescent Compared to Adult Pregnancy.

Background:The aim of this study is to compare the antenatal care, body weight, and weight gain in pregnancy between the adolescent and adult pregnancies and, thus, examine the impact of adolescence on the studied parameters.Methods:This prospective study includes 300 pregnant women who were the patients of University Clinical Center Tuzla, Clinic for Gynecology and Obstetrics from January 2011 to December 2014. The women were divided into two groups: an experimental group consisted of 150 adolescent pregnant women aged 13–19 years and a control group consisted of 150 adult pregnant women aged 20–35 years. The following parameters were analyzed: age of pregnant women, number of antenatal controls in pregnancy, prepregnancy body weight, weight gain in pregnancy, parity, and obstetric history data.Results:A significantly higher number of adolescent pregnant women belongs to a subgroup from one to two examinations during pregnancy (P < 0.000013) and to subgroups from three to five examinations (P < 0.000001). A significantly smaller number of adolescent pregnant women performed their first antenatal control in the first 2 lunar months (P < 0.01). A subgroup with optimal body weight (from 51 to 69 kg) are the most prevalent among adolescent pregnant women (P < 0.000001). A significantly larger number of adolescent pregnant women had an optimal weight gain of 7.8 to 12.99 kg (P < 0.001).Conclusions:The adolescent pregnant women have suboptimal antenatal care, which could lead to adverse maternal and birth outcomes, but have optimal body weight and weight gain during pregnancy.

Pentraxin 3 might be better prognostic serum marker than IL-6, IL-10, and high-sensitivity C-reactive protein for major adverse cardiovascular events in patients with ST-elevation myocardial infarction after bare-metal stent implantation.

Objectives:To assess the prognostic value of pentraxin 3 (PTX3) in patients with ST-elevation myocardial infarction (STEMI) after bare-metal stent (BMS) implantation.Methods:In this prospective study, PTX3, interleukin (IL-6), IL-10, high-sensitivity c-reactive protein (hsCRP), and cardiac troponin I (cTnI) plasma values were determined before and 24hours after BMS implantation in 97 consecutively enrolled patients with STEMI who were admitted to University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina between February 2016 and February 2017. Patients were followed for 24 months to assess major adverse cardiovascular events (MACEs).Results:At 24 hours after percutaneous coronary intervention (PCI), plasma values of PTX3, IL-6, hsCRP, and cTnI were significantly increased; and IL-10 levels were significantly decreased compared with the values determined before PCI. Patients with MACEs had significantly higher plasma PTX3 levels at 24 hours after BMS-PCI than in patients without MACEs. Patients with PTX3 plasma values ≥5042 ng/ml had a significantly higher risk of MACEs than patients with PTX3 levels <5.042 ng/mL. Pentraxin 3 levels exhibited strong and significant correlations with IL-6 and IL-10 levels. Pentraxin 3, cTnI, and IL-6, but not hsCRP levels have showed independent association with MACEs, according to the multivariate Cox regression analysis.Conclusion:Pentraxin 3 might be better serum prognostic marker than IL-6, IL-10 or high sensitivity CRP for MACEs after BMS-PCI. It might help to make better risk stratification of those patients who are undergoing BMS-PCI.

Importance of screening in the prevention of emergence and spread of MDR bacteria

Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.

JUSTIFICATION OF RADIOLOGICAL PROCEDURES ALGORITHM ADJUSTMENT IN DIAGNOSIS OF LOWER BACK PAIN CAUSE AT UNIVERSITY CLINICAL CENTER TUZLA

Introduction: Lower Back Pain (LBP) is one of the most frequent reasons for visiting physican. Authors of guidelines scrutinizing use of radiography and Computed tomography (CT) or Magnetic resonance imaging (MRI) in LBP diagnostic. Method of choice in the LBP diagnostic should be MRI except in cases where we should get diagnostic informations as soon as possible (traumas etc.) and in strict indications in bone structures where CT should be a method of choice. Increase of CT use and following icrease CT derived radiation dose in patients are very serious problems of last decades. Aim: To show the nessesary of procedure algorithm adjusment in LBP diagnostic. Reasons are: danger of overdiagnosis leading to chronifications, loosing time and money to get exact diagnose and leading to cumulate very high ionizing doses (10 mSv per person with average body weight from lumbar spine CT) that could couse a cancer if it is over 100 mSv (in some studies if it is over 50 mSv). Patients and methods: Sixty-nine patients, average age of 51.35 years, were included in the study. Lumbar spine CT was performed and repeated procedure at MRI in a very short time in Clinic for Radiology and Nuclear Medicine of University Clinical Centre Tuzla from January 1 2017 to February 9 2018. The sample of patients was formed consecutively. Referral diagnosis for CT procedures were: M51 in 36 patients (52.17%), N/A in 13 (18.84%), M05 in 4 (5.8%), G83.4 in 3 (4.35%) and other in 13 (18.84%). Results: 30 (83.33%) of patients were referred from CT to MRI procedure in time under 42 days (during acute phase). Relation of justified and unjustified undertaken CT procedures were: 71% unjustified, 10% justified and 19% N/A.Conclusion: Performed study showed unjustified undertaken CT procedures and high unnecessary radiation dose in 71% patients. There are justified reasons for procedure algorithm adjusment in LBP diagnostic. Key words: lower back pain, diagnostic procedure algorithm, CT, MRI

Efficacy and Safety of Lysozyme, Cetylpyridinium and Lidocaine Fixed Combination for Treatment of Chemotherapy- and Radiotherapy-Induced Oral Mucositis: a Pilot Study.

Introduction:Beneficial effect of local administration of lysozyme in patients with recurrent aphthous stomatitis was demonstrated, but there are no published studies focused on treatment of chemotherapy or radiotherapy induced oral mucositis with lysozyme.Aim:The aim of this study was to compare efficacy and safety of Lysobact Complete spray (lysozyme, cetylpyridinium, and lidocaine) and compounded medication for local use in the treatment of radio- and chemo-therapy induced oral mucositis.Patients and Methods:This observational, phase IV study was designed as prospective cohort investigation, and conducted at two sites, Clinical Hospital Zenica and University Clinical Center Tuzla, Bosnia & Herzegovina, from August to November, 2018. The patients with oral mucositis after radio- or chemo-therapy were treated by either registered lysozyme-based or compounded medication (standardized and bicarbonate-based) for 21 days.Results:Both lysozyme-based (Lysobact Complete Spray) spray (lysozyme, cetylpyridinium and lidocaine) and compounded medication for local use were effective in local treatment of chemotherapy and radiotherapy-induced oral mucositis. However, lysozyme-based preparation was more effective, since signs of inflammation, number of oral ulcers and intensity of pain during eating and speaking withdrew to a greater extent than with highly variable compounded medication for local use. No adverse events were recorded in both treatment arms.Conclusions:Locally administered spray with fixed combination of lysozyme, cetylpyridinium and lidocaine (Lysobact Complete Spray) is very efficient and completely safe treatment of both radiotherapy and chemotherapy-induced oral mucositis.

Clinical Characteristics and Outcome of Malignant Eyelid Tumors: A Five-Year Retrospective Study.

Introduction:To the best of our knowledge, this is the first study about malignant eyelid tumors in the region of Tuzla, Bosnia and Herzegovina, and it shows similar results comparing with other countries (the annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population). Malignant eyelid tumors are relatively uncommon, but potentially fatal disease. However, if detected early and treated adequately, the prognosis is generally excellent.Aim:The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of surgical treatment and reconstructive methods of eyelid tumors.Methods:This retrospective study included 60 patients surgically treated at the University Clinical Center Tuzla from January 2012 to December 2016, who were initially diagnosed with malignant eyelid tumors in accordance to the final results obtained by histological examination of excised lesions.Results:In the group of malignant tumors, the most common tumors were BCC (85%), which were predominantly found on the lower eyelids (92.16%) and showed female predominance (51.06%). SCC was the second most common eyelid malignancy (15%) and showed a predilection for the lower eyelid involvement and male predominance (55.56%). Tumors up to 2 cm in diameter (clinical stage T1) were found in 78.33% of cases, 95.74% of which with radical excision, while 4.26% with non-radical excision.Conclusion:Treatment by complete excision with histological confirmation of tumor clearance is recommended. Perineural spread is an adverse prognostic sign, which may require postoperative radiotherapy. Orbital invasion is a rare complication but, if recognized early, it can be treated effectively with exenteration. Because presentation varies and histological examination is required for accurate diagnosis, any suspicious lesion occurring on the eyelids should be excised or biopsied. All patients with malignant tumors should be advised of the risk of recurrent or new tumors and encouraged to attend lifelong follow up.

Depression in Patients with Epilepsy

Depression is the most common psychiatric co morbidity in people with epilepsy, but often remains unrecognized. The aims of the study were to investigate differences in level and severity of depression between patients with epilepsy and healthy control group. We explored knowledge about specific socio economic factors that might contribute to depression and compare differences among patients with epilepsy and control group. The sample consisted of 100 adult patients with epilepsy from University Clinical Centre Tuzla, Bosnia and Herzegovina and 100 adult volunteers without any diagnosis. Level of depression was measured by Beck depression inventory (BDI). The questionnaire about demographic and specific socio economic data (gender, employment, education, marital status) was used. Patients with epilepsy showed significantly higher Beck’s depression inventory than controls. The minimal depression was less frequent, but mild, moderate and severe depression was more frequent in subjects with epilepsy. In both group females and males showed similar distribution of Beck’s depression inventory. Females and males with epilepsy showed significantly higher Beck’s depression inventory than in control group. Patients with epilepsy showed similar distribution among subject regarding education. Employed and unemployed subjects among patients with epilepsy showed similar distribution of Beck’s depression inventory. In control group, unemployed subjects showed significantly higher Beck’s depression inventory. Beck’s depression inventory had similar distribution regarding marital status in both groups. The subjects that are married, in relationship or without relationship showed significantly lower Beck’s depression inventory. There are statistically significant difference in level and severity of depression between epileptic patients and healthy subjects in control group. Hypothesis that there are statistically significant differences in specific socio economic factors that are related to depression among patients with epilepsy and control group is partially confirmed.

The efficiency of electrocardioversion-induced rhythm restoration performed in University Clinical Center Tuzla

The efficiency of electrocardioversion-induced rhythm restoration performed in University Clinical Center Tuzla

Corneal astigmatism in cataract surgery patients from Bosnia and Herzegovina.

To determine corneal astigmatism prevalence, its correlations with age and symmetry pattern in fellow eyes of patients undergoing cataract surgery. This is a clinical-based retrospective cross-sectional study. Keratometry measurements of patients undergoing cataract surgery assigned to University Clinical Center Tuzla, Bosnia and Herzegovina, between January 2011 and June 2012 were recorded and analyzed retrospectively. The study consisted of 4080 eyes of 2205 consecutive cataract surgery patients with a mean age of 68.24years ± 9.25 (SD) (range 32-84years), and 54.0% of the patients were women. Mean corneal astigmatism was 0.72 ± 0.61D (range 0-6.5D). The prevalence of corneal astigmatism 1.0D or more was in 1291 eyes (31.64%), 1.5D or more in 736 eyes (18.03%), 2.0D or more in 396 eyes (9.71%) and 3.0D or more in 108 eyes (2.65%). There was no significant difference in the magnitude of astigmatism between age groups (p = 0.10), male and female (p = 0.29) or right and left (p = 0.75) eyes. The prevalence and amount of astigmatism increased with age (p < 0.05). Gradual shift from with-the-rule astigmatism toward against-the-rule astigmatism was observed (p = 0.03). Patients with higher amount of astigmatism in one eye are more likely to have significant astigmatism in fellow eye (p < 0.01). Symmetry in pairs of eyes is present in eyes with astigmatism greater than 2.5D (p < 0.01). This study provides useful reference data for cataract surgeons and patients from Bosnia and Herzegovina.

Frequency and type of eyelid neoplasia in Tuzla region, Bosnia and Herzegovina

Introduction: Benign and malignant tumors can arise from each of the eyelid layers. Our aim was to investigate the frequency and distribution of the eyelid tumors in tertiary health institution in Tuzla Region in Bosnia and Herzegovina. Methods: We analyzed medical records for all the patients treated for eyelid malignancies in University Clinical Center Tuzla, from January 2012 to December 2016. Demographic, clinical and pathological data were collected and analyzed. Results: A total of 89 patients were treated during the 5 year period. Forty seven of the patients were male (52 %) and 42 (48 %) were female. Patient age ranged from 11 to 92 years, with the mean age of 66.6 years. The most common eyelid malignancy was basal cell carcinoma (80.95%), followed by squamous cell carcinoma (14.29%), merkel cell carcinoma (3.17%) and melanoma (1.59%).&#x0D; Conclusion: The annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population. Majority of the malignant tumors were basal cell carcinoma, while melanoma was the least frequent. Most frequent benign lesions were seborrheic keratosis and benign nevi.

Epidemiological Characteristics of the Accidental Exposures to Blood-Borne Pathogens Among Workers in the Hospital.

Introduction:The main route of acquiring infectious blood and body fluids in hospital conditions is accidental exposure to stinging incidents.Aim:The aim of this study was to determine the epidemiological characteristics of accidental exposures to blood-borne pathogens among different professional groups of health care workers (HCWs).Materials and Methods:A cross-sectional study was conducted using the “Questionnaire on the HCWs exposure to blood and blood transmitted infections” at the University Clinical Centre Tuzla, Bosnia and Herzegovina, from the 1st of March to the 31st of December 2014. Study sample consisted of 1031 participants (65% of total employees) stratified into three occupational groups: doctors, nurses and support staff.Results and Discussion:Exposure incident was recorded in 1231 participants (54.8%) at least once in the last 12 months. An average number of exposure incidents per HCWs in total years of service was 7.07± 8.041. Out of total sample, 70% reported at least one type of exposure incident. Nurses had a higher frequency of multiple contacts compared to doctors and support staff (χ2=37.73; df=4; p<0.001). The frequency of reported incidents among nurses at the surgical departments was almost two times higher (1.7). 75.5% (778/1031) of the participants, reported not having been exposed to these incident. Doctors were significantly less likely to report exposure incidents than nurses and support staff. There were significant differences in reporting rate (χ2=32,66; df=4; p<0.001).Conclusion:HCWs in hospitals have a high prevalence of occupational exposure to blood-borne infections. Seventy percent of the HCWs is periodically or constantly exposed to or contact related to blood. Nurses are most frequently exposed occupational group among HCWs, while the lowest reporting rate on an exposure incident is among doctors.

Time Management of Tuzla University Clinical Center Health Managers.

Introduction:Time management is an important aspect of successful leadership and involves mastering your own work and time instead of allowing them to master you. Time management is a daily process that is applied in order to rationally use time, work schedules, lists of tasks, delegation of responsibilities and everything else that helps to efficiently use time.Material and methods:This research was prospective, descriptive, analytical and controlled. There was 100 medical worker involved, who have managing jobs of different levels and 100 medical workers who do not have managing jobs, who represented the control group. The questionnaire on „time stealers“ according to Sewert. Demographic data was gathered according to the questionnaire on self construction.Results and Conclusions:Based on conducted research, it was established that there were differences in frequencies of certain „time stealers“ in managers of different levels of University Clinical Center Tuzla; the „time stealers“ are more frequent among these with shorter length of service; These differences are significantly more frequent (p<0.05) for some questions e.g. being distracted by phone calls, meetings that are held just for the sake of having a meetings, insufficient, one-way or bad communication with superiors, and have negative effects on management of business hours.

Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report

We present chest wall reconstruction with titanium mesh in a patient who underwent sternal resection due to solitary plasmacytoma (SP). A 35 year old female was admitted to The Thoracic Surgery Department of University Clinical Center Tuzla with pain and tender upper-sternal swelling.

Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla.

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain-Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis(MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic's disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

Two year outcomes of poststroke writing and reading disorders

ABSTRACTPoststroke language disorders are frequent and include aphasia, alexia, agraphia, and acalculia. These disorders refer to an acquired inability to read, write and calculate. In this study, we evaluated the two year outcomes of writing and reading disorders in poststroke patients, the natural course, recovery and mortality. We evaluated all the patients with stroke who were admitted to the Department of Neurology, University Clinical Centre Tuzla in period of six months, who developed poststroke alexia, agraphia, acalculia, or different combinations of these language disorders. Outcome of these patients was evaluated again after 24 months. For clinical assessment of alexia, agraphia, and acalculia we used Minnesota Test for Differential Diagnosis of Aphasia. We investigated 59 (30.5%) of 193 stroke patients with alexia, agraphia, acalculia, and combinations. Outcome of these patients after 24 months was: 37 (62.7%) died, 13 (22%) fully recovered, and 9 (15.3%) of them retained the same disorder or developed dementia or blindness. Binary logistic regression analysis showed that patients with combined language disorders had significantly higher mortality. The main factors influencing language disorders recovery in this study are initial severity of reading, writing and calculation impairment, age, neglect, and level of education.

Risk factors for post-colectomy adhesive small bowel obstruction.

The purpose of this study was to assess the risk factors for adhesive small bowel obstruction (SBO) following colectomy for colorectal cancer. In this retrospective study we analyzed 284 patients who underwent surgery for colorectal cancer at the Department of Surgery University Clinical Center Tuzla in the period from 1st January 2009 until 31st December 2014. All patients underwent open colectomy. The length of follow up was from 6 months to 6 years (median follow up 3 years and 6 months). The study included all patients who underwent surgery due to colon cancer. The study excluded patients with postoperative small bowel obstruction after colon cancer surgery with different comorbidities. In the analyzed sample of 284 patients, a small bowel obstruction occurred in 13.7% patients after surgery for colon cancer. The highest correlation of risk factors and the occurrence of postoperative small bowel obstruction after colectomy for colorectal cancer in multivariate regression analysis was found to be for Tumor-Node-Metastasis ≥3 (or =3.680), and postoperative complications (or =30.683). Postoperative SBO have many causes, but in this study the highest risk factors were the Tumor-Node-Metastasis ≥3, and postoperative complications.

Rehospitalization rate of first episode and chronic schizophrenia patients one year after discharge

IntroductionRelapse rate among patients with schizophrenia can determinate outcome of illness. Up to 40% of patients with first psychosis responds well to treatment. Despite this fact relapse rate is still high, in particular if treatment is discontinuated. Frequent use of first generation antipsychotics (FGA) in underdeveloped countries can be one of possible reasons for treatment discontinuation and consequent relapse.AimsTo analyse rehospitalisation rate in patients with first and multiple episodes of schizophrenia, and compare it with medication choice.MethodsRetrospective analysis of medical records of patients with schizophrenia hospitalised in Psychiatry Clinic of University Clinical Center Tuzla in period from year 2011 to 2013.ResultsDuring the two-year period, 37 patients with first episode of schizophrenia were hospitalised. Second generation antipsychotics (SGA) were used in 40.5%, and first generation in 13.5%, long acting injectibles - first generation (LAI) were used in 8.1%, and combination of FGA's and SGA's in 5.4% of cases. In the same period, 121 patients with multiple episodes of schizophrenia were hospitalised. SGA were used in 21.4%, FGA in 33%, LAI's in 47.1%, and combination FGA's and SGA's in 35.5% of cases. Relapse rate in the first year after discharge was 16.2% in group with first psychotic episode, and 33% in the group with multiple episodes of schizophrenia.ConclusionHigh relapse rate in group with multiple episodes can be explained with nonadherence regarding the side effects of too frequent use of FGA's.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Prevalence of Eyelid Myokymia in Medical Students

Aims: To determine the prevalence and factors associated with eyelid myokymia (EM) in students attending Medical faculty. Study Design: Cross sectional survey. Place and Duration of Study: Medical faculty University of Tuzla and Department of Ophthalmology University Clinical Centre Tuzla, between December 2015. and January 2016. Methodology: We included 100 medical students, randomly selected by staff employed in student service of Medical faculty, from the list of students registered for different exams in December 2015. Before the survey all participants were informed about the signs and presentations of eyelid twitching and its possible significance. The survey was performed before and after the exams with students of third, fourth and fifth study year. It consisted of 18 questions regarding the presence of eyelid twitch, and influence of various factors on its frequency and intensity. Short Research Article Hadžic et al.; BJMMR, 14(6): 1-6, 2016; Article no.BJMMR.24910 2 Results: Forty four percent of students had signs of eyelid myokimia (EM) during short period of 7 days before the exams. Female students were more likely to have EM than male students (OR 2.46:1). Students of fifth study year were at more risk for development of EM than students of fourth and third year respectively (OR 1:1.5:2.67). Energy drinks consuming was a significant predictor for EM occurrence (P=.046). Students who reported to have reduced sleep during exam preparation have significantly more often symptoms of EM (P=.014) as well as individuals who claim to have been exposed to a greater amount of stress (P=.042). Conclusion: Eyelid myokymia is relatively common phenomenon among students of Medical faculty. It has higher incidence before exams, during the period of intense studying.