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We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2-L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery. [ABSTRACT FROM AUTHOR]

In recent years, cyberspace has emerged as a prominent realm for young people, perceived by them as at least as important as real life. Cyberspace has become a field for the satisfaction of many psychological needs and has brought to life novel factors that influence development among children and youth. As a consequence, the educational sphere has been dramatically affected by the changes in the psychological functions, behaviors, and habits of students, who are becoming increasingly different from what educators were trained for only a few decades ago. Causal connections are yet to be examined experimentally, and longitudinal research takes more time. In the meantime, based on theoretical assumptions in psychology and educational sciences, some of the changes that affect the motivation and behavior of students in the classroom can be assumed. With this being said, the following article, using the perspective of self-determination theory, is aimed at understanding changes in students’ motivation, engagement, and behavior caused by cyber-psychological factors. How are the attention and habits of new generations different? How does this affect their involvement and motivation to learn in the classroom? How do students’ emotional experiences that potentially permeate classrooms reflect their increased immersion in the digital world? What are the most important lessons from cyberpsychology that educational professionals need to be aware of to maximize the benefits of their teaching to students? This article attempts to provide some answers and recommendations regarding these vital issues.

This paper presents two spheres of public engagement of women in the contemporary society of Bosnia and Herzegovina (BiH): politics and the academic community. An insight into the first sphere, the political one, provides an introductory, succinct overview of the development of societal roles and positions of women during the period of Jugloslawia (1945-1992). Afterward, it focuses on the current position of women in another public sphere, the academic community. The applied method was a test (questionnaire). The first challenge was to determine the exact number of women engaged in the teaching process at the chosen public university in BiH (University of Zenica) since it was not possible to obtain data through the official internet websites or from the relevant published documents. According to these official documents, the total number of employees based on contracts for full-time or piece-work engagements in 2017 was 520. But, these documents did not contain data on the number of men and women who are engaged as teachers. Based on data available on the internet websites of faculties of this University, there were 65 women engaged as teachers; all were full-time employees since these websites did not present persons engaged as teachers on other legal bases. Results confirmed, while women were not taking the managing positions, men were undoubtedly dominant in higher education institutions managing positions. Although women fairly successfully graduate from all three university study cycles, afterward they face the so-called „glass ceiling“, disabling them or making it very hard to officially enter the education institutions as employees, which limits any future advancement. Women who managed to become faculty members were very often faced with gender-based stigmatization and/or segregation. Further analyses should establish why women, as employees of HEIs, hesitate and decline to accept managing positions. Also, it is necessary to enhance the higher education institution’s methodology of reporting, for HEIs to provide clear data on the number of women engaged in the teaching process, and data on their status (assistants or senior assistants, and assistant, associate or full professors). When a total number of women employed as teaching, administrative and technical staff in an HEI is given, the actual state of gender equality in any of the mentioned three segments is presented. The importance of women’s participation in politics becomes also clear in this point since it is extremely important to have political awareness and readiness for solving problems and creating relevant policies for the above issues.

The hospice movement was launched by the Croatian Society of Hospice and Palliative Care, Croatian Medical Association, founded and headed by the author until 2009. In this article, the author describes the development of the hospice movement in four periods, as follows: first period 1994-1999, the beginnings; second period 2000-2005, a period of great hopes and initial achievement of first goals; third period 2006-2008, a period of stagnation, the 'burn-out' syndrome, looking for new ways and people; and fourth period 2009-? Let us hope it will bring true finding way out, a new period of struggling for acceptable solutions, which has already been accomplished in many countries. The hope dies last, the hope in positive powers among the citizens of Croatia. Only the most important facts are presented, whereas citations from numerous lectures, events held all over Croatia and publications in many books and newspapers are omitted. Descriptions of numerous trips for training, education, for one month, two weeks, one week or several days in the USA, Canada, UK, Poland, Hungary, Austria, Switzerland, Norway, etc., and of visits paid by many guests from the UK, USA, Canada, Italy, Germany, Switzerland, Poland, Hungary, Romania, Bulgaria, Israel, Bosnia and Herzegovina, Serbia, Macedonia, etc. are also omitted. All these facts will be presented in the monograph that has been prepared for publication.

The goal of palliative care is to provide the best possible quality of life for patients and their families in the process of dying as well as before, during the course of illness. Emphasis is on the role of team approach in every aspect of patient care. The moral principles of sacredness of life and the right of personal autonomy may occasionally come in conflict. The basic principle of the respect of life prohibits killing, which has been accepted in one way or another by all societies - for the reasons of survival. Similar to this, modern morality supports the principle of respecting autonomy and self-management based on informed, conscious personality of an individual. Still, if the needs of another person appear to be more important or desirable than reaching certain individual goals, then the right of an individual regarding autonomy may be legitimately limited. Decisions on not applying or terminating certain procedures must be based on thorough discussion and consideration of the nature and expected result of treatment. If the patient is not competent, then the discussion should involve a team providing care for the patient and a representative of the patient. When the physician and the team can clearly see that unfavorable effects of treatment will outweigh therapeutic benefits, then, according to medical ethics of the respecting beneficiary, the team is not obliged to provide that form of treatment. Except for palliative care, there is no medical treatment that is always obligatory. A physician that does not accept the patient's request to be killed does not limit the patient's autonomy. Autonomy is self-management and capability of the patient to kill him/herself is not limited by the physician's refusal to do so. Even in those cases when patients for various reasons say that death will be a relief, it does not mean that the physician is obliged to terminate life. The superior obligation of physicians is to alleviate pain. If euthanasia would be legal, it would discourage those that work in the field of medical education and search for new ways to diminish pain. The progress in the development of palliative care would be stopped worldwide. Supporting the belief that killing is forbidden could increase the benefits for the society, whereas forbidding the concept of "allowing to die" despite the use of all-powerful technologies does not seem to maximize beneficial effects. In fact, if the latter be valid, then all patients at intensive care units with all the possible life sustaining facilities would have to die. Yet, members of the unit health care team would be accused of a deed considered equivalent to murder. For autonomy to be accomplished, competence is required, and that is something that varies, passing through different stages. In medical context, a person is competent when he/she is able to understand the basic information about the illness, including prognosis, if she/he is able to understand the treatment suggested, differentiate between the risk and benefit, and come to a rational decision. A partially competent person can, if he/she wants and is able to, reach joint decisions with the rest of the team. If the person is not competent and has not delegated a proxy (representative) and has not provided written instructions for the future, the health care team does not know what the patient would want if competent. Then the team handles according to the principles of doing good and no harm. The role of the "directive for the future" and proxy-decision-makers becomes problematic for the following reasons. By the time when the directives should be implemented many forms of medical treatment have been further developed, so that the illness may have become curable or treatment easier. Older and weak people that need care and feel they pose a burden could feel forced to sign directives for the future if they are legally obligatory.

We are used to speak about the organic pain origin. Meanwhile in actual and old definitions of pain the other determinants, besides the organic one, are included. They are changing the pain threshold and the pain tolerance. Dame Cicely Saunders, who started the modern hospice movement of care for those in advanced stage of disease, describes the concept of "total pain" as involving organic, emotional, spiritual and social determinants. Such pain concept fits into the classical division of pain pathogenesis. The basic forms are: nociceptive, neuropathic and according to the old nomenclature psychogenic. The first one is defense reaction, the second one is due to pathology. The third one is very complex and this article is dealing with it. The patient's emotional reactions, especially the fear and anxiousness producing tension increase the pain. Therefore, different kinds of relaxation or attention distraction can help a lot in relieving the pain. Spiritual pain can be a very difficult symptom increasing the physical pain significantly. Everybody has spiritual needs and they are independent of religious orientation. The experience of life's and suffering's senslessness, personal valulessness and situational hopelessness lowers significantly pain tolerance. The selfconfidence, the confidence in other persons, in somebody over us has the opposite effect. And finally the pain is often easier to cope with in the presence of a friendly person. To be able to complain and to describe one's own fears, especially in connection with the significance of the actual pain, helps a lot. The support of the wider community also helps. We ought to approach the patient holistically, that means also observe the person, the human being suffering, hoping and wishing to be heard, and not to be left alone.

The bioethical problems related to the dying person might be classified in four groups: 1) those of the society the person is involved in, 2) those of physicians and other health professionals, 3) those of the nursing staff in the broadest sense and 4) those connected with the dying person himself. The society must consider the death as a part and natural end of life. One of the most delicate problems related to patient-physician relationship is adequate information concerning the diagnosis and prognosis of the condition. A very complex problem is stopping or not introducing the treatment which cannot influence significantly the quality and length of life. Palliative therapy, although risky, should be introduced if suffering is great. The duty to alleviate suffering is more important than life prolongation. The nursing staff and family should honour the wishes of the dying. Active euthanasia legalization is too risky, especially for nonautonomous persons unable to express their will. In autonomous persons even the possibility of its realization could be the cause of extreme disturbances in patient/physician relationship. Active euthanasia, due to the involvement of public opinion, is already becoming a sociopolitical problem.

L-carnitine is essential in fatty acids metabolism, it is synthetized endogenically and supplied by nurishment as well. Ninety eight percent of it is stored in skeletal muscles. Its importance in primary deficiency, either systemic encephalomyopathies or isolated myopathies, is out of discussion. In deficiency states, life itself may be threatened. Numerous investigations point to secondary carnitine deficiencies. Favorable substitution effects are published, first of all, in organic acidurias in children, in ischemic heart diseases of adults, in hyperlipoproteinemias, in peripheral vascular disease, in patients on hemodialysis, and in muscle dystrophy. Favorable results are published also in total parenteral nourishment of newborns and adults. L-carnitine may prevent toxic effects of valoproates and antracyclins. The substance is not toxic and is well tolerated. LD50 values are almost like those of amino acids. Meanwhile, inspite of many reports on favorable results in secondary carnitne deficiencies the additional controlled clinical trials should be done, especially in children.

Twenty-nine patients with myasthenia gravis in pregnancy have been presented. These patients represent a total of 31 deliveries and 33 newborns. Despite that myasthenia gravis is an illness that poses potentially grave complications for both mother and infant, there were no maternal and neonatal deaths. Only two patients experienced significant exacerbation of their disease during pregnancy. Most of patients underwent vaginal delivery. Cesarean section is not indicated unless there are obstetrical reasons. Incidence of cesarean section delivery was 16.1%. Vacuum extractor has been used to shorten the second stage of labor and its incidence was 16.1%. In the seven (22.6%) patients myasthenic signs and symptoms got worse during the postpartal period. Neonatal myasthenia gravis was observed in 13 (39.4%) newborns. Inverse relationship was found between neonatal myasthenia and duration of disease in mothers. Incidence of neonatal myasthenia was higher in newborns born by mothers with short duration of myasthenia gravis.

In our investigation 119 patients suffering from carpal tunnel syndrome, and 45 suffering from cubital tunnel syndrome have been analyzed. The above mentioned syndromes belong to compressive mononeuropathies and are the result of the narrowing of the anatomical channel, through which the nerve passes, causing direct or indirect pressure on the nerve and difficulties in the flow of particles and nerve impulses towards the periphery. The aim of our work was to study the influence of the compressive lesion, primarily on the distal motor and sensory latencies. To achieve a better precision, the distal motor latency is expressed as a quotient of terminal latency. It is obtained by dividing the distance between the stimulation and the recording point in centimeters with the latency of response expressed in miliseconds. Sensory latencies are obtained by orthodromic stimulation of the finger and the detection of the neural potential at the wrist. According to our results, the proximal pathological process, besides causing the localized slowing down of conduction velocity, affects the conduction velocity of the distal sensory fibers in a higher degree than of the distal motor fibers. In any case the distal motor latencies are in a higher percentage prolonged by the distal lesion, such as carpal channel syndrome, in comparison with the proximal lesion (cubital tunnel syndrome). The less pronounced prolongation of the distal latencies, especially of sensory ones, must not be proclaimed as a consequence of a local compression without additional plurisegmental analysis.