BIOMEDICINSKA ISTRAŽIVANJA

Volume 11, No 1, June 2020


ORIGINAL SCIENTIFIC ARTICLES

Differentiation plasticity of human monocytes in culture

Bojan Joksimović, Sergej Tomić, Marina Bekić, Miloš Vasiljević, Dragana Vučević, Miodrag Čolić

Biomedicinska istraživanja 2020; 11(1):1-10 doi:10.7251/BII2001001J

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Differentiation plasticity of human monocytes in culture

Bojan Joksimović1, Sergej Tomić2, Marina Bekić2, Miloš Vasiljević1, Dragana Vučević3, Miodrag Čolić1,2


1University of East Sarajevo, Faculty of Medicine Foca, Center for Biomedical Sciences, The Republic of Srpska, Bosnia and Herzegovina
2University of Belgrade, Institute for Application of Nuclear Energy, Belgrade, Serbia
3Military Medical Academy, Institute for Medical Research, Belgrade, Serbia

Introduction. Human monocytes are heterogeneous and plastic cell population with the ability to undergo phenotypic and functional changes as a response to a stimulus from a local microenvironment. Our aim was to determine the potential of human monocytes to differentiate into different cell populations depending on two different cytokines (IL-4 and IL-6) added to cultures as well as to compare their phenotypical and functional characteristics.
Methods. Peripheral blood mononuclear cells (PBMNC) were isolated from buffy coats of healthy donors. Monocytes, which were separated from PBMNC by plastic adherence, had been cultivated in Dendritic cell (DC), serum free medium for 5 days, either with granulocyte/macrophage colony-stimulating factor (GM-CSF) alone or with GM-CSF, with addition of interleukin 4 (IL-4) or interleukin 6 (IL-6), respectively. After cultivation, phenotypic characteristics of these cells were analyzed by flow cytometry, whereas the levels of produced cytokines in culture supernatants were quantified by ELISA. The potential of differentiated cells to modulate the proliferation of allogeneic T cells was examined by co-cultivation of these cells with PBMNC.
Results. GM-CSF differentiated monocytes into M0/M1 macrophages (MØ). The combination of GM-CSF and IL-4 favoured differentiation of immature DC, whereas GM-CSF and IL-6 transformed monocytes into monocytic myeloid derived suppressor cells (M-MDSC). All cell populations expressed typical monocyte/macrophage markers such as CD14, CD11b, CD16 and CD33, HLA-DR, CD209 and CD86, a co-stimulatory marker. DC and M-MDSC expressed CD1a and CD11c, in contrast to M0/M1 MØ. The expression of HLA-DR, CD1a, CD209 and CD86 was highest on DC. The expression of CD33 and CD16 was highest on M-MDSC, followed by lowest expression of HLA-DR. The potential of promoting T-cell proliferation was highest in cultures of PBMNC with DC, whereas M-MDSC had the opposite, suppressive, effect. These differences correlated with highest production of immunosuppressive cytokines such as IL-10, IL-27 and TGF-β by M-MDSC.
Conclusion. This study confirmed the differentiation plasticity of human monocytes, which are influenced by cytokines added in cultures. Phenotypic characteristics of these cells correlated with the production of cytokines involved in modulation of T-cell proliferation.
Key words: plasticity, differentiation, monocytes, culture, cytokines, T cell proliferation

Cellulose nanocrystals induce a dose-dependent effect on cytotoxicity and proliferative activity of human peripheral blood mononuclear cells

Miloš Vasiljević, Sergej Tomić, Marina Bekić, Bojan Joksimović, Dragana Vučević, Miodrag Čolić

Biomedicinska istraživanja 2020; 11(1):11-19 doi:10.7251/BII2001011V

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Cellulose nanocrystals induce a dose-dependent effect on cytotoxicity and proliferative activity of human peripheral blood mononuclear cells

Miloš Vasiljević1, Sergej Tomić2, Marina Bekić2, Bojan Joksimović1, Dragana Vučević3, Miodrag Čolić1,2


1University of East Sarajevo, Faculty of Medicine Foca, Center for Biomedical Sciences, Foca, The Republic of Srpska, Bosnia and Herzegovina
2University of Belgrade, Institute for Application of Nuclear Energy, Belgrade, Serbia
3Military Medical Academy, Institute for Medical Research, Belgrade, Serbia

Introduction. Cellulose nanocrystals (CNCs) as attractive natural materials, have numerous applications in the biomedical field. Their unique biomechanical characteristics, surface chemistry, low cost and sustainable nature make them an engaging alternative to conventional materials and potentiate their use as progressive material. Therefore, it is critical to evaluate the cytocompatibility and immunomodulatory properties of nCNCs, which have not been completely explored. The objective of this study was to examine a dose-dependent effect of native (n)CNCs on cytotoxicity and proliferative activity of human peripheral blood mononuclear cells (PBMNCs) in vitro.
Methods. PBMNCs, obtained from the healthy blood donors, were cultivated with nCNCs. Cell viability was analyzed by flow cytometry assay, while proliferative activity was determined by MTT, [3H]-thymidine uptake assay and detection of IL-2 production.
Results. The cytotoxicity results suggested that no concentration of nCNCs (50-400 μg/ml) affected necrosis of PBMNCs, whereas apoptosis was induced by the highest concentration of nCNCs compared to control (p<0.05). Unexpectedly, the highest concentration of nCNCs increased the metabolic activity of PHA-stimulated cells compared to control (p<0.05). In contrast to these findings, lower concentrations of nCNCs (50 μg/ml and 100 μg/ml) stimulated proliferation of PBMNCs (p<0.05 and p<0.001). It was followed by increased production of IL-2 (100 μg/ml) (p<0.001).
Conclusion. The results suggest that non-cytotoxic concentrations of nCNCs modulate the proliferative activity of human PBMNCs, a phenomenon which has not been published up to now and which is relevant for further studies.
Keywords: cellulose nanocrystals, peripheral blood mononuclear cells, culture, cytotoxicity, proliferative activity

Efficacy of two different antibiotic solutions in preservation of fresh amniotic membrane

Vesna Ljubojević, Sanja Jovičić, Milka Mavija, Zoran Vujković

Biomedicinska istraživanja 2020; 11(1):20-28 doi:10.7251/BII2001020L

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Efficacy of two different antibiotic solutions in preservation of fresh amniotic membrane

Vesna Ljubojević1, Sanja Jovičić1, Milka Mavija2, Zoran Vujković3


1University of Banja Luka, Faculty of Medicine, Department of Histology and Embryology, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2University Clinical Centre of the Republic Srpska, Clinic of Ophthalmology, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
3University Clinical Centre of the Republic Srpska, Clinic of Neurology, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina

Introduction. The amniotic membrane is used in transplant surgery, ophthalmology and dermatology. Various methods have been developed to preserve amniotic membrane: hypothermic storage, cryopreservation, lyophilization. Transplantation of fresh amniotic membrane showed low inflammatory response. The efficient antibiotic solutions are carefully chosen for the hypothermic storage of amniotic membranes. The aim of this study was to compare the efficacy of two antibiotic solutions for the hypothermic amniotic membrane preservation and the structure of the amniotic membrane after the preservation process.
Methods. Fifteen amniotic membranes were prepared and hypothermically stored in penicillin solution in BSS (2000 IU/ml) while the remaining fifteen in an antibiotic solution containing: benzylpenicillin (50 µg/ml), gentamicin (100 µg/ml), ciprofloxacin (200 µg/ml) and fluconazole (100 µg/ml). All amniotic membranes were microbiologically tested after preparation and after hypothermic storage for two weeks. Histological analysis of thirty amniotic membranes was performed after the process of preservation.
Results. Fifteen amniotic membranes were sterile after hypothermic preservation in the penicillin solution. Also, fifteen amniotic membranes were sterile after hypothermic preservation in the solution of antibacterial agents (penicillin, gentamicin, ciprofloxacin) and antifungal agent fluconazole. The amniotic membrane had a normal structure and thickness of 35.33±11.03 μm.
Conclusion. Both antibiotic solutions, one that contains only penicillin and one that contains multiple antibacterial agents and fluconazole, provide sterility of fresh hypothermically stored amniotic membranes for two weeks. In the preparation of fresh hypothermically stored amniotic membrane, a solution with multiple antibiotics is preferred. The normal tissue structure of the amniotic membrane was histologically confirmed after the process of preservation.
Keywords: amniotic membrane, preservation, tissue, histological characteristics

Expression of matrix metalloproteinase-9 in acquired middle ear cholesteatoma

Dalibor Vranješ, Slobodan Spremo, Siniša Šolaja

Biomedicinska istraživanja 2020; 11(1):29–36 doi:10.7251/BII2001029V

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Expression of matrix metalloproteinase-9 in acquired middle ear cholesteatoma

 

Dalibor Vranješ1,2, Slobodan Spremo1,2, Siniša Šolaja3


1University of Banja Luka, Faculty of Medicine, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
2University Clinical Center of the Republic of Srpska, The Ear, Nose and Throat Department, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
3University Hospital Foca, The Republic of Srpska, Bosnia and Herzegovina

Introduction. Matrix metalloproteinase-9 (MMP-9) plays one of the key roles in the migration of inflammatory cells and the destructive behavior of acquired middle ear cholesteatoma. The aim of the study was to determine the expression levels of MMP-9 in chronic otitis media, with and without acquired cholesteatoma, as well as to determine the correlation between them and the pathomorphological changes in the tympanic membrane (TM).
Methods. Immunohistochemical study included 178 patients of both sexes, aged 5-75 years, who underwent microsurgical treatment of chronic otitis media (COM) at the Ear, Nose and Throat Department of the University Clinical Center of the Republic of Srpska in Banja Luka from 2015 to 2018. Patients were divided into two groups on the basis of the presence or absence of acquired cholesteatoma: 97 (CCOM) and 81 (COMWC). The samples of the perimatrix of acquired cholesteatoma (n=97) and inflamed middle ear mucosa (n=81) were taken intraoperatively. The presence of retraction and certain types and subtypes of TM perforations were examined by intraoperative exploration. MMP-9 expression levels were determined by immunohistochemical analysis.
Results. In the presence of cholesteatoma and highly positive expression of MMP-9, the marginal type of TM perforation was more likely to occur (p<0.01) while in negative expression of MMP-9 in the COMWC group, the central type was more likely to occur (p<0.01). There was a higher probability of the presence of attic subtype of TM perforation in patients with cholesteatoma and moderate positive expression of MMP-9 (p<0.01). There was not a statistically significant contribution of any of the factors in the prediction of the influence on the occurrence of TM retraction.
Conclusion. The presence of acquired middle ear cholesteatoma and highly positive expression of MMP-9 are statistically significant predictors of the presence of marginal type and attic subtype of TM perforation. Expression levels of MMP-9 may have potential clinical significance in the development of irreversible pathomorphological changes on TM in middle ear cholesteatoma.
Keywords: cholesteatoma, matrix metalloproteinase-9, tympanic membrane

Burnout Syndrome in Nurses/Technicians in Intensive Care Units of Clinical Center of Montenegro

Dragana Backović, Dragana Jovanović, Ljubica Pejakov

Biomedicinska istraživanja 2020; 11(1):37–43 doi:10.7251/BII2001037B

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Burnout Syndrome in Nurses/Technicians in Intensive Care Units of Clinical Center of Montenegro

Dragana Backović, Dragana Jovanović, Ljubica Pejakov


Clinical Center of Montenegro, Podgorica, Montenegro


Introduction. The Burnout syndrom is a health issue that greatly disables a person. It includes emotional exhaustion, depersonalization and reduced efficiency in the workplace. So far, this issue has not been addressed where medical staff is concerned.
Methods. The Maslach Burnout Inventory – Human Service Survey and Demografic Questionnaire were used. Emotional exhaustion is taken to be the most important aspect of the syndrome.
Results. The sample consisted of data acquired from 59 nurses/technicians, out of which 45 were female and 14 male. 12% of them possessed all of the characteristics belonging to the syndrome, 27% of them were overextended (whereby the majority of them were inefficient), while the additional 10% were ineffective. There was a correlation between the chronic disease, on the one hand, and emotional exhaustion (p<0.000) and average ranks of exhaustion scale, on the other hand (p=0.006). Furthermore, there was a significant correlation between reduced efficiency in the workplace and chronic problems (p=0.006).
Conclusion. The Burnout syndrome is a multidimensional issue. The method of perceiving the measured dimensions influence the obtained results. The data have shown that the majority of the respondents have some kind of problem concerning their job (burnout, being overextended or ineffective). Significant correlation between chronic disesases and emotional exhaustion underlines the need for further research to benefit the medical staff, as well as health system.
Keywords: Burnout syndrome, intensive care unit, nurses/technicians, Montenegro, chronic diseases

 

 

REVIEWS

 

Nutrition as risk factor for development of chronic non-communicable diseases

Vesna Lazić, Biljana Mijović, Miloš Maksimović

Biomedicinska istraživanja 2020; 11(1):44–53 doi:10.7251/BII2001044L

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Nutrition as risk factor for development of chronic non-communicable diseases

Vesna Lazić1, Biljana Mijović2, Miloš Maksimović3


1PHI Public Health Institute of the Republic of Srpska, Regional Center Zvornik, The Republic of Srpska,
Bosnia and Herzegovina
2University of East Sarajevo, Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina
3University of Belgrade, Faculty of Medicine, Belgrade, Institute of Hygiene with Medical Ecology, Serbia

Chronic non-communicable diseases are diseases that arise as a response of the human body to a number of factors, the most important of which are ecological and socio-economic factors. According to the World Health Organization, their classification is based on mortality and morbidity statistics. The top four leading causes of death are as follows: cardiovascular diseases, malignancies, chronic respiratory diseases and diabetes. Non-communicable diseases (NCDs) present a global public health problem, leading to over 40 million deaths a year, whereby the population aged 30 to 69 years account for one third of the total number of deaths. Risk factors for the development of chronic NCDs can be divided into metabolic and environmental ones. Metabolic risk factors include hypertension, hyperglycemia, hyperlipidemia and obesity. Environmental risk factors include: alcohol and tobacco consumption, followed by physical inactivity and unhealthy diet. Unhealthy diet, apart from posing a risk for the development of NCDs, is also the cause of metabolic risk factor development, namely hypertension and obesity. The world nutritional authorities are focused on making dietary recommendations to prevent the rising trend and subsequently reduce morbidity from NCDs.
Keywords: chronic non-communicable diseases, risk factors, unhealthy diet

Maladaptive behavior in people with intellectual disabilities

Bojana Mastilo, Slađana Ćalasan

Biomedicinska istraživanja 2020; 11(1):54-63 doi:10.7251/BII2001054M

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Maladaptive behavior in people with intellectual disabilities

Bojana Mastilo, Slađana Ćalasan


University of East Sarajevo, Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina

The aim of the study is to provide better understanding of the prevalence and forms of maladaptive behavior, as well as of the factors associated with this behavior in people with intellectual disability, by reviewing the available literature.
Maladaptive behavior is behavior that is common enough and/or severe enough to limit a person’s ability to function properly in everyday life, learn new skills, and gain access to social resources. It covers a whole range of behaviors such as: physical aggression towards things or people, self-harm, stereotypical behavior, sexually inappropriate behavior, abusive behavior, etc. Studies highlight considerable variations in the prevalence of maladaptive behavior in individuals with IO ranging from 5.7% to 63.9%. The appearance of maladaptive behavior can be influenced by several factors, the most significiant of which are the following: gender, age, severity of IO, additional impairments, residential environment, cognitive-emotional factors, communication dysfunction, etc. A common feature of all these behaviors is the negative effect on the quality of life of the person and the staff caring for them.
In addition to psychotropic drugs and behavioral methods, various psychotherapy methods, cognitive and emotional training, creative therapeutic methods and functional behavior analysis are used in the treatment of maladaptive behavior. The condition is that they are tailored to the individual’s developmental level and his or her way of communication.
Keywords: maladaptive behavior, intellectual disability, prevalence, risk factors

 

FOR PRACTICE

 

Cognitive niche

Djordje Petronić, Igor Vujović

Biomedicinska istraživanja 2020; 11(1):64–70 doi:10.7251/BII2001064P

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Cognitive niche

Djordje Petronić, Igor Vujović


University of East Sarajevo, Faculty of Philosophy, Department of Psychology, Pale, The Republic of Srpska, Bosnia and Herzegovina


In a joint publication with Alfred Russell Wallace, Charles Darwin presented the theory which stated that all life forms were developed by natural selection in which the fight for survival had the effect similar to artificial intelligence applied to selective breeding. Despite a coincidence of views concerning the origin of life, these two scientists had their disagreements. Wallace argued that intelligence could have never arisen through the process of natural adaptation, but rather as a consequence of intelligent design. On the other hand, Darwin insisted that human intelligence could only be explained by the theory of evolution. This difference in point of views on the matter is a manifestation of the difference in the efforts to answer the question: “Why are people so intelligent?”
In this context, the main aim of the study is to present a literature review concerning evolutionary psychology and to provide an explanation of the evolution of human intelligence. In other words, the study seeks to explain why people are able to accomplish such intellectual exploits as the ones found in mathematics, science, philosophy, law, etc., bearing in mind that such abilities or talents cannot be found in the original human habitat. The results have showed that evolutionary psychologists consider humans to be so intelligent due to the fact that they have evolved to fill the “cognitive niche”. The cognitive niche is a survival mode characterized by managing the environment through mediating cognition and social cooperation.
Keywords: intelligence, cognitive niche, evolution, adaptation

Flynn effect – generation growth of IQ

Igor Vujović, Djordje Petronić

Biomedicinska istraživanja 2020; 11(1):71–77 doi:10.7251/BII2001071V

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Flynn effect – generation growth of IQ

Igor Vujović, Djordje Petronić


University of East Sarajevo, Faculty of Philosophy, Department of Psychology, Pale, The Republic of Srpska, Bosnia and Herzegovina


In the 1980-s, the attention of the public was attracted by the research of James Flynn, who noticed something interesting – as the time went by, respondents achieved higher scores in the IQ tests. According to his research, as well as the researches of the authors who were engaged in the subject, the observed increase was 4.4 points per decade on average. These increases varied across different environments, however, in almost every country where research was conducted the point increases in IQ tests were observed. In addition to the observed increases in the IQ tests, it was also necessary to uncover the reasons for such results. The aim of the study is to present the results of the empirical research confirming this phenomenon, as well as to provide some possible explanations related to its occurrance. The relevant literature have singled out education, test exposure, nutrition and health care, reduction in the number of primary family members and heterosis as the possible reasons for the above-mentioned point increases.
Keywords: Flynn effect, intelligence, increase in IQ, neurophychological assessment

Cardio-Оncology – New Challenge in Clinical Practice

Sladjana Popović, Srdjan Popović, Nikolina Dukić, Jelena Vladičić-Mašić, Olivera Čančar 

Biomedicinska istraživanja 2020; 11(1):78–85 doi:10.7251/BII2001078P

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Cardio-Оncology – New Challenge in Clinical Practice

Sladjana Popović1,2, Srdjan Popović1,2, Nikolina Dukić1,2,
Jelena Vladičić-Mašić1, Olivera Čančar1,2


1University Hospital Foca, Center for Internal Medicine, The Republic of Srpska, Bosnia and Herzegovina
2University of East Sarajevo, Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina

There is a daily increase in the number of patients with malignant diseases, but with the advances in modern oncology research, the number of survivors treated with malignant diseases is becoming larger and larger. The survival rate after completing oncology therapy is increasing on a daily basis, so that malignant diseases belonging to the category of terminal diseases are now referred to as ‘chronic illnesses’. In this specific group of patients, the risk from cardiovascular diseases is increasing nowadays. A new challenge for the future cardiologists will certainly pose the treatment of this group of patients. A cardiological approach in oncological patient treatment is an important issue. The cardiologist focuses on risk stratification and prevention of cardiovascular complications in the oncological patient in relation to his or her pre-existing condition, and in relation to the type of specific oncology therapy applied, and on further follow-up during therapy and after its completion. This implies that it is necessary to create cardio-oncology teams in our institutions treating the oncological patients. There is a considerable need for education in a new field, which presents the intersection between two clinical disciplines, i.e. cardiology and oncology, and for special education of cardiologists concerning all types of chemotherapy and their potential cardiotoxic effects. The oncologist, on the other hand, must be trained to recognize any possible early signs and symptoms of cardiac complications concerning the therapy applied and to seek further cardiac care for the patients. The aim of this review article is to assist the doctors treating this group of patients in their daily practice and to highlight the need for a multidisciplinary approach, as well as the creation of a cardio-oncology team for a comprehensive and integrative approach to a cardio-oncological patient.
Keywords: cardio-oncology, cardiotoxicity, cancer, anthracyclines, trastuzumab, chemotherapy, radiotherapy, ultrasound


 

CASE REPORTS

 

Endodontic treatment of maxillary second molar with two roots – a case report

Dajana Nogo-Živanović, Dragan Ivanović, Tanja Ivanović, Ivana Simić

Biomedicinska istraživanja 2020; 11(1):86–89 doi:10.7251/BII2001086N

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Endodontic treatment of maxillary second molar with two roots – a case report

 

Dajana Nogo-Živanović, Dragan Ivanović, Tanja Ivanović,
Ivana Simić


University of East Sarajevo, Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina


Introduction. The success of endodontic treatment depends on the adequate biomechanical preparation and obturation of the entire root canal system. The untreated or poorly debrided/obturated root canals are among the most frequent causes of endodontic treatment failure. The endodontic treatment of maxillary molar has the highest failure rates due to the complexity of their root canal anatomy. The aim of the study is to present the endodontic treatment of maxillary second molar with two roots and two canals.
Case report. The clinical case report presents the endodontic treatment of maxillary second molar with two roots and two canals in a patient, aged 32 years. After the analysis of preoperative diagnostic radiograph, opening the pulp chamber and access cavity preparation, two canal orifices were localized. After the biomechanical preparation, root canals were obturated with the Gutta-percha points and sealer during the same visit.
Conclusion. Although maxillary second molar most commonly varies in terms of the number of root canals in the buccal roots, less common variations in anatomical and morphological traits, such as the presence of two roots and two canals, should be considered during endodontic treatment.
Keywords: endodontic treatment, root canal morphology, maxillary second molar

Déjà vu phenomenon as symptom of temporal lobe epilepsy in eight-year-old girl – a case report

Goran Popović, Ranka Mirković, Dejan Bokonjić, Biljana Milinković, Tatjana Gavrilović-Elez

Biomedicinska istraživanja 2020; 11(1):90–95 doi:10.7251/BII2001086N

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Déjà vu phenomenon as symptom of temporal lobe epilepsy in eight-year-old girl – a case report

 

Goran Popović1, Ranka Mirković2, Dejan Bokonjić2, Biljana Milinković1, Tatjana Gavrilović-Elez1


1University Hospital Foca, The Republic of Srpska, Bosnia and Herzegovina
2University of East Sarajevo, Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina


Introduction. Deja vu (franc. Déjà vu) is a phenomenon experienced by two thirds of all people. However, this phenomenon can follow aura during the temporal lobe epilepsy. It is believed that it originates from hippocampus, which plays a major role in generating epileptic discharges. Some authors emphasize that in these patients déjà vu phenomenon is not an aura but rather it sometimes refers to the attack itself.
Method. In this case report, an eight- year-old girl suffering from repeated crisis of consciousness is described.
Case report. The aim of the study was to present the case of an eight- year- old girl who underwent three crisis of consciousness, headache behind the forehead as well as the repeated déjà vu phenomenon. The girl was hospitalized, after which medical history was taken and physical examination, as well as other diagnostic tests, were performed. EEG recording revealed an increased electrocortical epileptic activity above the right frontotemporal region. An antiepileptic therapy (Karbapin) leading to attack control was introduced.
Conclusion. It is necessary to give temporal lobe epilepsy in children with déjà vu phenomenon serious consideration.
Keywords: crisis of consciousness, déjà vu, child, epilepsy, EEG

Orbital complications of acute rhinosinusitis in children – case study

Ljiljana Krsmanović, Siniša Šolaja, Vladimir Turuntaš

Biomedicinska istraživanja 2020; 11(1):96–101 doi:10.7251/BII2001086N

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Orbital complications of acute rhinosinusitis in children – case study

 

Ljiljana Krsmanović1,2, Siniša Šolaja1,2, Vladimir Turuntaš1,2


1University Hospital Foca, Bosnia and Herzegovina, The Republic of Srpska
2University of East Sarajevo, The Faculty of Medicine, Foca, The Republic of Srpska, Bosnia and Herzegovina


Introduction. Acute rhinosinusitis (ARS) encompasses a heterogeneous group of inflammatory disorders affecting nasal mucosa and paranasal sinuses. Rhinosinusitis is the most common condition in the United States. It is estimated that over 30 million people annually visit the doctor due to this condition, while every sixth adult suffers from ARS. Among all ARS complications, over 91% are orbital complications (OC) with an average prevalence of 6% and a higher incidence in children compared to adults.
Case report. Twelve-year-old boy, accompanied by his mother, was urgently referred to the Department of Otorhinolaryngology at the University Hospital in Foca due to a sudden red and painful left periorbital edema, pain in the left eye and a fever reaching 38.5ºC. After laboratory and CT scan diagnostics, an ophthalmologic examination and inpatient clinical findings after 36 hours of parenteral triple antibiotic therapy, the patient was referred to a tertiary-type institution for further treatment. The same procedure was performed conservatively during the hospitalization within 6 days.
Conclusion. The initial treatment of orbital complications in children is conservative. Treatment should be started empirically, using triple antibiotic therapy. The choice of antibiotics and treatment protocols among pediatric population have not been agreed yet. If 36-48 hours after the beginning of the conservative treatment, there is lack of the clinical response, surgical treatment is absolutely indicated, regardless of the stage of orbital complication.
Keywords: acute rhinosinusitis, orbital complications, children, treatment