Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.121.122
D. Sengul, I. Sengul, H. Ustun
Introduction: Liposarcoma is generally classified into four subtypes: a) well-differentiated liposarcoma/atypical lipomatous tumor, b) dedifferentiated liposarcoma, c) myxoid/round cell liposarcoma, and d) pleomorphic liposarcoma. Dedifferentiated liposarcoma is mostly seen in the region of retroperitoneum. Aim: To present a case of dedifferentiated liposarcoma in a rare site of location: the lower extremity. Case Report: A 24-year-old woman presented with a firm painful mass, 3x2 cm in diameter on the medial side of left thigh. MRI demonstrated a lesion on that location showing low signal intensity on T1-wieghted and high signal intensity on T2A-wieghted sequences. After an excisional biopsy the histopathological examination via Haematoxylin and Eosin firstly revealed the diagnosis of malign undifferentiated tumor. The results of immunohistochemical evaluations were as follows: SMA (-), HMB45 (-), S100 (+, focally), Desmin (-), Vimentin (+, focally), CD68 (+, focally), CD34 (-), LCA (-), and Inhibin (-). The final histopathological diagnosis was dedifferentiated liposarcoma. Conclusions: In English-language literature data for dedifferentiated liposarcoma of the lower extremities are very restricted. Although imaging with CT and MRI, the final and distinct diagnosis is made immunohistochemically. A clinician should be aware of the presence of a dedifferentiated liposarcoma within a mass on the lower extremities.
{"title":"Dedifferentiated Liposarcoma of the Left Thigh: a Rare Case","authors":"D. Sengul, I. Sengul, H. Ustun","doi":"10.5455/medarh.2019.73.121.122","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.121.122","url":null,"abstract":"Introduction: Liposarcoma is generally classified into four subtypes: a) well-differentiated liposarcoma/atypical lipomatous tumor, b) dedifferentiated liposarcoma, c) myxoid/round cell liposarcoma, and d) pleomorphic liposarcoma. Dedifferentiated liposarcoma is mostly seen in the region of retroperitoneum. Aim: To present a case of dedifferentiated liposarcoma in a rare site of location: the lower extremity. Case Report: A 24-year-old woman presented with a firm painful mass, 3x2 cm in diameter on the medial side of left thigh. MRI demonstrated a lesion on that location showing low signal intensity on T1-wieghted and high signal intensity on T2A-wieghted sequences. After an excisional biopsy the histopathological examination via Haematoxylin and Eosin firstly revealed the diagnosis of malign undifferentiated tumor. The results of immunohistochemical evaluations were as follows: SMA (-), HMB45 (-), S100 (+, focally), Desmin (-), Vimentin (+, focally), CD68 (+, focally), CD34 (-), LCA (-), and Inhibin (-). The final histopathological diagnosis was dedifferentiated liposarcoma. Conclusions: In English-language literature data for dedifferentiated liposarcoma of the lower extremities are very restricted. Although imaging with CT and MRI, the final and distinct diagnosis is made immunohistochemically. A clinician should be aware of the presence of a dedifferentiated liposarcoma within a mass on the lower extremities.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"1996 1","pages":"121 - 122"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90451409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.72-75
F. Zvizdić, E. Begić, A. Mujaković, E. Hodžić, B. Prnjavorac, O. Bedak, F. Čustović, Haris Bradaric, A. Durak-Nalbantić
Introduction: The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients. Aim: To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages. Patients and methods: The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration. Results: Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs a
{"title":"Beta-blocker Use in Moderate and Severe Chronic Obstructive Pulmonary Disease","authors":"F. Zvizdić, E. Begić, A. Mujaković, E. Hodžić, B. Prnjavorac, O. Bedak, F. Čustović, Haris Bradaric, A. Durak-Nalbantić","doi":"10.5455/medarh.2019.73.72-75","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.72-75","url":null,"abstract":"Introduction: The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients. Aim: To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages. Patients and methods: The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration. Results: Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs a","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"13 1","pages":"72 - 75"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78104585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.118-120
B. Al-abadi, Mansour Al-hiary, Rami Khasawneh, Asim Al-momani, A. Bani-Salameh, Sanaa Al-Saeidat, Alia Al-khlaifat, Omaima Aboalsondos
Introduction: Cystic fibrosis (CF) is a genetic multisystem disorder that affects mostly the lungs, but other organs such as liver, pancreas and intestine also affected. CF is inherited in an autosomal recessive manner and occurs in males and females equally. Cystic fibrosis Transmembrane Conductance Regulator (CFTR) mutations are classified into five classes. Class 1 (non-functional protein), class 2 (near-absence of mature CFTR protein at the apical cell membrane), class 3 (full-length CFTR protein incorporated into the cell membrane), class 4 (reduced conductance CFTR mutation), and class 5 (reduced amount of CFTR protein with normal function). Globally F508 mutation is the most common. Aim: The aim of this study was to determine the frequency of CFTR gene mutation in Jordanian populations attending a major hospital (KHMC). Material and Methods: This is a retrospective study was conducted on 777 sera samples for patients clinically suspected to have cystic fibrosis over a six year period 1/1/2013-1/10/2018. The patient’s age range between 1year and 33 years, of which 59.2% (460) were male and 40.8% (317) female. Blood samples were analyzed at Princess Iman Centre for Research and Laboratory Sciences at King Hussein Medical Centre. The samples were tested for 34 mutations of CFTR gene using CF Strip Assay VIENNA LAB Diagnostics GmbH, Austria by polymerase chain reaction (PCR). Results: A total of 777 patients samples were analyzed for cystic gene mutations. Twelve (12) mutations were identified. In 49 patients (6.3%) were heterozygous genotype mutant and 28 (3.6%) were homozygous. The most frequent mutation F508del was found in 32/77 (41.5%). 20 (25.9%) of them were heterozygous genotype mutant and 12 (15.6%) were homozygous genotype mutant. The second frequent mutation was N1303K with frequency rate 15.6% (12/77), 9 (11.7%) of them were heterozygous and 3 (3.9%) were homozygous. Regarding frequency of cystic fibrosis gene mutation depending on sex, 55.8% (43/77) of mutations were found in male, whereas 44.2% (34/77) in female. Conclusion: Our findings suggest that cystic fibrosis in Jordan is not a rare disease, and found that the most frequent CFTR gene mutation was F508del, which is in keeping with results from other Mediterranean countries.
{"title":"Cystic Fibrosis Gene Mutation Frequency Among a Group of Suspected Children in King Hussein Medical Center","authors":"B. Al-abadi, Mansour Al-hiary, Rami Khasawneh, Asim Al-momani, A. Bani-Salameh, Sanaa Al-Saeidat, Alia Al-khlaifat, Omaima Aboalsondos","doi":"10.5455/medarh.2019.73.118-120","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.118-120","url":null,"abstract":"Introduction: Cystic fibrosis (CF) is a genetic multisystem disorder that affects mostly the lungs, but other organs such as liver, pancreas and intestine also affected. CF is inherited in an autosomal recessive manner and occurs in males and females equally. Cystic fibrosis Transmembrane Conductance Regulator (CFTR) mutations are classified into five classes. Class 1 (non-functional protein), class 2 (near-absence of mature CFTR protein at the apical cell membrane), class 3 (full-length CFTR protein incorporated into the cell membrane), class 4 (reduced conductance CFTR mutation), and class 5 (reduced amount of CFTR protein with normal function). Globally F508 mutation is the most common. Aim: The aim of this study was to determine the frequency of CFTR gene mutation in Jordanian populations attending a major hospital (KHMC). Material and Methods: This is a retrospective study was conducted on 777 sera samples for patients clinically suspected to have cystic fibrosis over a six year period 1/1/2013-1/10/2018. The patient’s age range between 1year and 33 years, of which 59.2% (460) were male and 40.8% (317) female. Blood samples were analyzed at Princess Iman Centre for Research and Laboratory Sciences at King Hussein Medical Centre. The samples were tested for 34 mutations of CFTR gene using CF Strip Assay VIENNA LAB Diagnostics GmbH, Austria by polymerase chain reaction (PCR). Results: A total of 777 patients samples were analyzed for cystic gene mutations. Twelve (12) mutations were identified. In 49 patients (6.3%) were heterozygous genotype mutant and 28 (3.6%) were homozygous. The most frequent mutation F508del was found in 32/77 (41.5%). 20 (25.9%) of them were heterozygous genotype mutant and 12 (15.6%) were homozygous genotype mutant. The second frequent mutation was N1303K with frequency rate 15.6% (12/77), 9 (11.7%) of them were heterozygous and 3 (3.9%) were homozygous. Regarding frequency of cystic fibrosis gene mutation depending on sex, 55.8% (43/77) of mutations were found in male, whereas 44.2% (34/77) in female. Conclusion: Our findings suggest that cystic fibrosis in Jordan is not a rare disease, and found that the most frequent CFTR gene mutation was F508del, which is in keeping with results from other Mediterranean countries.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"1 1","pages":"118 - 120"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89836130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.126-130
A. Cerovac, Adnan Šerak, Haris Zukić, Enida Nevačinović, D. Ljuca, Alma Brigic, D. Habek
Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board’s ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn–birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.
关于严重胎儿畸形的终止妊娠(TOP)存在许多伦理和道德困境。目的:我们的目的是提出一个严重的胎儿脑积水(HCP)， aperida脊柱裂和脑膜脊髓空洞(MMC)的病例。病例报告:一位妇科医生检查了一位23岁的孕妇，孕24/25周(WG)，胎儿异常。在围产期医学咨询委员会上，考虑到怀孕超出了围产期法律框架，决定继续怀孕并对其进行监测。医学顾问委员会的超声检查显示:严重脑积水，腹裂，肠高氧，马蹄内翻。通过多学科咨询，我们决定采用选择性剖腹产(CS)分娩，尽可能减少对胎儿的创伤，由于骨盆表现和胎儿异常，37个WG完成了分娩。经CS分娩一名活产女婴，出生体重3920克，身长56 cm，头围48 cm, Apgar评分8/8。头部积水，缝线间隔。胸腰椎缺损为腹裂、脑膜脊膜膨出(MMC)，大小为10x12cm。一个紧急的外科手术-外脑室衍生液，然后成功切除和整形脑膜脊髓膨出是由一组神经和整形外科医生进行的。术后第4天，由于怀疑有脓肿积存及产妇发热，行剖腹手术，发现瑞兹尤斯间隙脓肿积存。由于血细胞计数下降，给予总剂量580 ml的输血。由于患者有常规的一般和局部状态，患者出院后接受家庭治疗。手术后，尽管采取了各种措施，新生儿的病情还是恶化，HCP进展，头部伤口和胸腰椎开裂。当时作出了提供姑息治疗的决定，并将这一决定传达给了母亲。这孩子出现了长时间的呼吸暂停，没有复苏。这名婴儿在产后存活两个月后死于医院。结论:基于胎儿异常的TOP指征可能是一种医学决定，但也可能是母亲个人的道德选择，与法律规则、社会文化价值观和宗教信仰有关。
{"title":"Ethical and Legal Dilemmas Around Termination of Pregnancy for Severe Fetal Hydrocephalus, Spina Bifida Aperta and Meningomyelocoella","authors":"A. Cerovac, Adnan Šerak, Haris Zukić, Enida Nevačinović, D. Ljuca, Alma Brigic, D. Habek","doi":"10.5455/medarh.2019.73.126-130","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.126-130","url":null,"abstract":"Introduction: There are many ethical and moral dilemmas regarding the termination of pregnancy(TOP) with severe fetal anomalies. Aim: Our aim is to present a case of severe fetal hydrocephalus (HCP), spina bifida aperta and, meningomyelocoella (MMC). Case report: A gynecologist examined a 23-year-old patient with vital pregnancy of 24/25 week of gestation (WG) with the anomaly of the fetus. At the Perinatological Medical Advisory Board, a decision was made that the pregnancy should be continued and monitored bearing in mind that pregnancy exceeded the legal framework for TOP. Medical Advisory Board’s ultrasound examination showed the following: severe hydrocephalus (HCP), spina bifida aperta, hyperehogen intestine, pes equinovarus. Via multidisciplinary consultation it was decided to make a delivery with the elective caesarian section (CS) causing as little trauma to the fetus as possible, with 37 WG completed due to the pelvic presentation and fetal anomalies. The patient gave birth via CS to a live female newborn–birth weight 3920 grams, birth length 56 cm, head circumference 48 cm, and Apgar score 8/8. The head was hydrocephalic with spaced suture. There was thoracolumbar defect of spina bifida aperta and meningomyelocele (MMC) 10x12 cm in size. An urgent surgical procedure - the external ventricular derivation of the liquor, and then the successful resection and plastic meningomyelocele was performed by a team of neuro and plastic surgeons. During the fourth postoperative day due to a suspicion of abscess collection and febrility of the mother a relaparotomy is performed and the abscess collection of Retzius space was found. Due to the fall in blood count, blood transfusion in a total dose of 580 ml was given. The patient was discharged on a home treatment as she had a regular general and local status. After the surgery, the condition of the newborn resulted in deterioration, the progression of HCP and dehiscence of head wounds and the thoracolumbar region, in spite of all the measures taken. At that time a decision was made to provide palliative care and this decision was conveyed to the mother. The child had a prolonged apnoeic episode and was not resuscitated. The child died in hospital after surviving for two months postpartum. Conclusion: Indication of TOP based on fetal anomalies could be a medical decision but also a personal moral choice of the mother related to legal rules, socio-cultural values and religious beliefs.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"40 1","pages":"126 - 130"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81491334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.92-96
M. A. Alsammani, Athar Mohieldin Jafer, Sumeya A. Khieri, A. Ali, Mohamed Abdelgadir Shaaeldin
Introduction: It is known for many years, that grand multiparity is associated with poor pregnancy outcome with or without considering increasing maternal age. Aim: To examine the impact of grand multiparity on pregnancy outcome in young women aged 18–34 years (Young grand multiparas). Material and Methods: A prospective comparative cross-sectional study conducted at Omdurman Maternity Hospital, Sudan from January to September 2018. A standard questionnaire was used to gather data on pregnancy outcome in the low-risk group, grand multiparas age < 35 years and grand multiparas age ≥ 35 years. The association between variables was tested with Chi-square test. Results: Young grand multiparas have a significant risk of PPH and increased length of hospital stay => 3 days and babies born to young grand multiparas women were more likely of low birth weight and have a higher rate of admission to NICU. Young grand multiparas were similar in their maternal and fetal complication to low-risk pregnancies and significantly less in several complications when compared to older grand multiparas women. Conclusion: Young grand multiparas are less likely to develop several pregnancy complications compared to older grand multiparas women. The occurrences of intra-partum complications match that in low-risk pregnancy.
导言:多年来我们都知道，无论是否考虑增加产妇年龄，多胎产与妊娠结局不良有关。目的:探讨18-34岁年轻女性(young grand multiparas)大胎数对妊娠结局的影响。材料和方法:2018年1月至9月在苏丹恩图曼妇产医院进行的前瞻性比较横断面研究。采用标准问卷收集低危组、高龄产妇< 35岁和高龄产妇≥35岁的妊娠结局数据。变量间的相关性采用卡方检验。结果:年轻大多产产妇发生PPH的风险显著，住院时间增加=> 3天，年轻大多产产妇所生婴儿低出生体重的可能性更大，新生儿重症监护病房的入院率更高。年轻的大多产妇女的产妇和胎儿并发症与低风险妊娠相似，与年长的大多产妇女相比，一些并发症明显减少。结论:年轻的大多产妇女与年长的大多产妇女相比，不太可能发生几种妊娠并发症。产后并发症发生率与低危妊娠相当。
{"title":"Effect of Grand Multiparity on Pregnancy Outcomes in Women Under 35 Years of Age: a Comparative Study","authors":"M. A. Alsammani, Athar Mohieldin Jafer, Sumeya A. Khieri, A. Ali, Mohamed Abdelgadir Shaaeldin","doi":"10.5455/medarh.2019.73.92-96","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.92-96","url":null,"abstract":"Introduction: It is known for many years, that grand multiparity is associated with poor pregnancy outcome with or without considering increasing maternal age. Aim: To examine the impact of grand multiparity on pregnancy outcome in young women aged 18–34 years (Young grand multiparas). Material and Methods: A prospective comparative cross-sectional study conducted at Omdurman Maternity Hospital, Sudan from January to September 2018. A standard questionnaire was used to gather data on pregnancy outcome in the low-risk group, grand multiparas age < 35 years and grand multiparas age ≥ 35 years. The association between variables was tested with Chi-square test. Results: Young grand multiparas have a significant risk of PPH and increased length of hospital stay => 3 days and babies born to young grand multiparas women were more likely of low birth weight and have a higher rate of admission to NICU. Young grand multiparas were similar in their maternal and fetal complication to low-risk pregnancies and significantly less in several complications when compared to older grand multiparas women. Conclusion: Young grand multiparas are less likely to develop several pregnancy complications compared to older grand multiparas women. The occurrences of intra-partum complications match that in low-risk pregnancy.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"17 1","pages":"92 - 96"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75539198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.101-103
Fariba Naderi, Zahra Soheilirad, Z. Haghshenas
Introduction: In recent years, the treatment of idiopathic central precocious puberty using gonadotropin-releasing hormone agonist (GnRH) agonist has been considered as a common treatment. To date, there is not much information about the effect of GnRH agonist treatment on pediatric thyroid function. Aim: The aim of this study was to evaluate the influence of GnRH treatment on thyroid function tests in children with central idiopathic precocious puberty. Material and Methods: This cross-sectional study investigated 50 children with idiopathic precocious puberty treated with GnRH agonist, who were referred to Bahrami pediatric hospital, Tehran, Iran. Patients` height, weight, and symptoms of hypothyroidism were evaluated every two months. Thyroid function tests, T4 and thyroid-stimulating hormone (TSH), were reviewed every 6 months. Data were analyzed using SPSS Statistics, Version 18. Results: The majority of the children who participate in this study were female. 72% of children with central idiopathic precocious puberty had a significant increase in TSH level (P=0.002). In this group of patients, 66% and 6% had subclinical and clinical increases in thyroid function tests, respectively. The estimated time to thyroid dysfunction was 12.37 months. It is found that only 2% of patients showed thyroid dysfunction during the first 6 months of the treatment. Conclusion: The results of this study showed that more than 70% of children who were undergoing GnRH agonist treatment for central precocious puberty had impaired thyroid function (especially subclinical hypothyroidism). Therefore, evaluating thyroid function in children with precocious puberty who are under treating with GnRH agonist, would be reasonable; especially one year after initiating the treatment.
近年来，使用促性腺激素释放激素激动剂(GnRH)激动剂治疗特发性中枢性性早熟被认为是一种常用的治疗方法。迄今为止，关于GnRH激动剂治疗对儿童甲状腺功能的影响的信息并不多。目的:本研究的目的是评估GnRH治疗对中枢性特发性性早熟儿童甲状腺功能检查的影响。材料和方法:这项横断面研究调查了50名接受GnRH激动剂治疗的特发性性早熟儿童，他们被转介到伊朗德黑兰的Bahrami儿科医院。每两个月评估患者的身高、体重和甲状腺功能减退症状。甲状腺功能检查，T4和促甲状腺激素(TSH)每6个月复查一次。数据分析使用SPSS Statistics, Version 18。结果:参与本研究的儿童以女性为主。72%的中枢性特发性性早熟患儿TSH水平显著升高(P=0.002)。在这组患者中，分别有66%和6%的甲状腺功能测试出现亚临床和临床增加。到甲状腺功能障碍的估计时间为12.37个月。发现只有2%的患者在治疗的前6个月出现甲状腺功能障碍。结论:本研究结果显示，在接受GnRH激动剂治疗的中枢性性性早熟儿童中，超过70%的患者甲状腺功能受损(尤其是亚临床甲状腺功能减退)。因此，评估接受GnRH激动剂治疗的性早熟儿童的甲状腺功能是合理的;尤其是在开始治疗一年后。
{"title":"The Influence of Gonadotropin-Releasing Hormone Agonist Treatment on Thyroid Function Tests in Children with Central Idiopathic Precocious Puberty","authors":"Fariba Naderi, Zahra Soheilirad, Z. Haghshenas","doi":"10.5455/medarh.2019.73.101-103","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.101-103","url":null,"abstract":"Introduction: In recent years, the treatment of idiopathic central precocious puberty using gonadotropin-releasing hormone agonist (GnRH) agonist has been considered as a common treatment. To date, there is not much information about the effect of GnRH agonist treatment on pediatric thyroid function. Aim: The aim of this study was to evaluate the influence of GnRH treatment on thyroid function tests in children with central idiopathic precocious puberty. Material and Methods: This cross-sectional study investigated 50 children with idiopathic precocious puberty treated with GnRH agonist, who were referred to Bahrami pediatric hospital, Tehran, Iran. Patients` height, weight, and symptoms of hypothyroidism were evaluated every two months. Thyroid function tests, T4 and thyroid-stimulating hormone (TSH), were reviewed every 6 months. Data were analyzed using SPSS Statistics, Version 18. Results: The majority of the children who participate in this study were female. 72% of children with central idiopathic precocious puberty had a significant increase in TSH level (P=0.002). In this group of patients, 66% and 6% had subclinical and clinical increases in thyroid function tests, respectively. The estimated time to thyroid dysfunction was 12.37 months. It is found that only 2% of patients showed thyroid dysfunction during the first 6 months of the treatment. Conclusion: The results of this study showed that more than 70% of children who were undergoing GnRH agonist treatment for central precocious puberty had impaired thyroid function (especially subclinical hypothyroidism). Therefore, evaluating thyroid function in children with precocious puberty who are under treating with GnRH agonist, would be reasonable; especially one year after initiating the treatment.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"29 1","pages":"101 - 103"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83859562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.113-117
Kenan Demirovic, Jasmin Habibović, V. Džemidžić, A. Tiro, E. Nakaš
Introduction: Malocclusion as an oral disorder can cause negative impact on individuals oral conditions, social interactions and self-esteem. Aim: The aim of this study was to compare oral health-related quality of life (OHQoL) of patients who had received fixed orthodontic treatment and patients who had not received fixed orthodontic treatment. Materials and Methods: Data were collected from 178 participants attended at professional dental office (mean age 22.71 years) in two groups (experimental and control). The experimental group comprised of 90 subjects who were in the retention phase, after their orthodontic treatment, and the control group comprised of 88 untreated subjects. Oral Health Impact Profile (OHIP-14) was used to assess the patients oral health related quality of life (OHQoL). Results: The control group had significantly higher OHIP-14 scores than experimental group (p < 0.001). Participants with treatment need reported a significantly greater negative impact on the overall OHRQoL score. Conclusion: Subjects with no history of orthodontic treatment had more negative oral health related quality (OHRQoL), than subjects who had completed orthodontic treatment. Dental malocclusion has significant negative impact on OHRQoL.
{"title":"Comparison of Oral Health-Related Quality of Life in Treated and Non-Treated Orthodontic Patients","authors":"Kenan Demirovic, Jasmin Habibović, V. Džemidžić, A. Tiro, E. Nakaš","doi":"10.5455/medarh.2019.73.113-117","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.113-117","url":null,"abstract":"Introduction: Malocclusion as an oral disorder can cause negative impact on individuals oral conditions, social interactions and self-esteem. Aim: The aim of this study was to compare oral health-related quality of life (OHQoL) of patients who had received fixed orthodontic treatment and patients who had not received fixed orthodontic treatment. Materials and Methods: Data were collected from 178 participants attended at professional dental office (mean age 22.71 years) in two groups (experimental and control). The experimental group comprised of 90 subjects who were in the retention phase, after their orthodontic treatment, and the control group comprised of 88 untreated subjects. Oral Health Impact Profile (OHIP-14) was used to assess the patients oral health related quality of life (OHQoL). Results: The control group had significantly higher OHIP-14 scores than experimental group (p < 0.001). Participants with treatment need reported a significantly greater negative impact on the overall OHRQoL score. Conclusion: Subjects with no history of orthodontic treatment had more negative oral health related quality (OHRQoL), than subjects who had completed orthodontic treatment. Dental malocclusion has significant negative impact on OHRQoL.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"19 1","pages":"113 - 117"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89307028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.123-125
Vahid Jusufović, Emir Čabrić, A. Vodenčarević
Introduction: It is known that simultaneous penetrating keratoplasty, cataract removal and intraocular lens implantation are always a big challenge to a surgeon, especially in developing countries such as Bosnia and Herzegovina. In these cases there is always a higher rate of different kind of intraoperative complications. Phacoemulsification after penetrating keratoplasty especially in older people may cause significant endothelial injury and also could affect long term graft survival. Aim: The aim of this report is to describe one of these challenging cases and the possible ways to manage them in developing countries. Case report: In this paper we report a case of a 46 year-old female patient, with a cataract on her right eye with a central corneal leukoma. She reported that when she was 6 years old, she had an eye injury with corn leaf. At the age of 10 year she reported that she had another injury of the same eye with a glass. She reported that she wasn’t seeing quite good after that. Three years ago she had a transplantation of amniotic membrane due ulcer on the same eye. She reported also that even after this procedure she wasn’t seeing quite good. Now she was admitted to hospital for a triple surgical procedure. At that moment patient has been ophthalmological examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found central corneal leukoma, occlusion of pupil and complicated cataract. Before surgery her Uncorrected distance visual acuity (UDVA) on her left eye was light perception. A combined procedure of penetrating keratoplasty (PKP), open-sky cataract extraction, and intraocular lens (IOL) implantation was planned. Thirty days after surgery her visual acuity was 0,5 without correction. It is concluded that cataract surgery in patients after keratoplasty is more complicated. Conclusion: Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.
{"title":"Simultaneous Penetrating Keratoplasty, Cataract Removal and Intraocular Lens Implantation in Tuzla, Bosnia and Herzegovina","authors":"Vahid Jusufović, Emir Čabrić, A. Vodenčarević","doi":"10.5455/medarh.2019.73.123-125","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.123-125","url":null,"abstract":"Introduction: It is known that simultaneous penetrating keratoplasty, cataract removal and intraocular lens implantation are always a big challenge to a surgeon, especially in developing countries such as Bosnia and Herzegovina. In these cases there is always a higher rate of different kind of intraoperative complications. Phacoemulsification after penetrating keratoplasty especially in older people may cause significant endothelial injury and also could affect long term graft survival. Aim: The aim of this report is to describe one of these challenging cases and the possible ways to manage them in developing countries. Case report: In this paper we report a case of a 46 year-old female patient, with a cataract on her right eye with a central corneal leukoma. She reported that when she was 6 years old, she had an eye injury with corn leaf. At the age of 10 year she reported that she had another injury of the same eye with a glass. She reported that she wasn’t seeing quite good after that. Three years ago she had a transplantation of amniotic membrane due ulcer on the same eye. She reported also that even after this procedure she wasn’t seeing quite good. Now she was admitted to hospital for a triple surgical procedure. At that moment patient has been ophthalmological examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found central corneal leukoma, occlusion of pupil and complicated cataract. Before surgery her Uncorrected distance visual acuity (UDVA) on her left eye was light perception. A combined procedure of penetrating keratoplasty (PKP), open-sky cataract extraction, and intraocular lens (IOL) implantation was planned. Thirty days after surgery her visual acuity was 0,5 without correction. It is concluded that cataract surgery in patients after keratoplasty is more complicated. Conclusion: Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"28 1","pages":"123 - 125"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87681621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/medarh.2019.73.87-91
Milorad Grujičić, Aleksandra Salapura, G. Basta-Jovanovic, Andreja Figurek, Dubravka Mićić-Zrnić, A. Grbić
Introduction: In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy. Aim: The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis. Material and Methods: From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence. Results: In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis. Conclusion: NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.
{"title":"Non-Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus–11-Year Experience from a Single Center","authors":"Milorad Grujičić, Aleksandra Salapura, G. Basta-Jovanovic, Andreja Figurek, Dubravka Mićić-Zrnić, A. Grbić","doi":"10.5455/medarh.2019.73.87-91","DOIUrl":"https://doi.org/10.5455/medarh.2019.73.87-91","url":null,"abstract":"Introduction: In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy. Aim: The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis. Material and Methods: From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence. Results: In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis. Conclusion: NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"12 1","pages":"87 - 91"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81352466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.5455/MEDARH.2019.73.134-135
I. Masic
Dr. Bruno von Curinaldi, came to Mostar from Zadar (Croatia) and started to work as Director of Mostar hospital in 1879 (1-3). In that time in Mostar also worked Dr. Franjo Hus (died in Mostar 1940), Dr. Otto Weiss (came to Mostar in 1882 from Bilroth’s hospital in Vienna, and in 1894 he moved to State hospital in Sarajevo to chair Gynaecology-Obstretics department), Dr. William Tonner (from Prague, well known as physician who treated poor people in Mostar free of charge (written in journal "Novi hercegovacki bosiljak" in 1885) (4), Dr. Fakete Samule (from Hungary, died in Mostar due to infection when performing autopsy), Dr. Trepeljka and Dr. Kestner (worked in 1886, during epidemic of cholera in Mostar), Dr. Braun, Dr. Herman, Dr. Koralek, Dr. Tausig (all of them physicians in Military hospital in Mostar), Dr. Moritz Englander (surgeon), Dr. Drago Mesliger, Dr. Kohn, Dr. Goldfarb, Dr. Franjo Bulat (famous physician, but also musician, Director of “Hrvatska glazba” in Mostar which organized a lot of concerts in Mostar, died in 1947), Dr. Gotfrid Holer, Dr. Pollacek. From Vienna to Mostar sometime was coming famous ophtalmologist Dr. Dragutin Heinzel (worked at Clinic of professor Fuchs), Dr. Jerko Bulat, son of Franjo Bulat spent his work time in Mostar. Dr. Nikola Grazetic also was engaged in Mostar’s cultural manifestations with Franjo Bulat (4).
{"title":"The Most Influential Physicians in Bosnia and Herzegovina: Bruno Curinaldi (1854-1944)","authors":"I. Masic","doi":"10.5455/MEDARH.2019.73.134-135","DOIUrl":"https://doi.org/10.5455/MEDARH.2019.73.134-135","url":null,"abstract":"Dr. Bruno von Curinaldi, came to Mostar from Zadar (Croatia) and started to work as Director of Mostar hospital in 1879 (1-3). In that time in Mostar also worked Dr. Franjo Hus (died in Mostar 1940), Dr. Otto Weiss (came to Mostar in 1882 from Bilroth’s hospital in Vienna, and in 1894 he moved to State hospital in Sarajevo to chair Gynaecology-Obstretics department), Dr. William Tonner (from Prague, well known as physician who treated poor people in Mostar free of charge (written in journal \"Novi hercegovacki bosiljak\" in 1885) (4), Dr. Fakete Samule (from Hungary, died in Mostar due to infection when performing autopsy), Dr. Trepeljka and Dr. Kestner (worked in 1886, during epidemic of cholera in Mostar), Dr. Braun, Dr. Herman, Dr. Koralek, Dr. Tausig (all of them physicians in Military hospital in Mostar), Dr. Moritz Englander (surgeon), Dr. Drago Mesliger, Dr. Kohn, Dr. Goldfarb, Dr. Franjo Bulat (famous physician, but also musician, Director of “Hrvatska glazba” in Mostar which organized a lot of concerts in Mostar, died in 1947), Dr. Gotfrid Holer, Dr. Pollacek. From Vienna to Mostar sometime was coming famous ophtalmologist Dr. Dragutin Heinzel (worked at Clinic of professor Fuchs), Dr. Jerko Bulat, son of Franjo Bulat spent his work time in Mostar. Dr. Nikola Grazetic also was engaged in Mostar’s cultural manifestations with Franjo Bulat (4).","PeriodicalId":18414,"journal":{"name":"Medical Archives","volume":"2015 1","pages":"134 - 135"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86898413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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