Cerebrovascular Insult Hospital Cases in West Hercegovina Canton from 1998 to 2002

Analysis of a cerebro-vascular insult hospitalised cases from West Herzegovina Canton as a retrospective epidemiological study was done in Clinical hospital Mostar for the period from  to . Th e major source of data was medical documentation of this hospital, the only hospital for the treatment of , inhabitants from this Canton. Th e study included a total of  cerebro-vascular insult cases from this Canton treated in the Clinical hospital Mostar. Among them  (.) were male patients, while  (.) cases were female. Th e majority of the cases were above  years of life. Majority of treated female patients were older then , while among male patients the majority were between  and  years old. Th e least number of cases was under  years in both groups. During the same period risk factors research for entire FBiH was performed on the sample of , national insurance holders. Out of them . was found to suff er of cerebro vascular insult.


Introduction
Cerebro-vascular (brain) insult is defi ned as sudden focal neurological defi cit, caused by a cerebro-vascular disease lasting more then  hours.Cerebro-vascular insult in general is divided as ischemic and hemorrhagic (bleeding brain insult).Ischemic insult is more often, while around  of all brain insults are manifested as brain bleeding ().Together with cardiac and malignant diseases, cerebrovascular diseases are the most common mortality and invalidity cause of modern humans.Each year about . millions of people all around the Globe suff er from brain insult.Because of that fact, this disease is the leading cause of disability (, , ).Complications are occurred among - of the cases; the most common are pneumonia, hearth decompesation, and pulmonary embolia ().Brain insult occurs because of brain blood circulation problems, which results in insuffi ciency in oxygen supply for some parts of the brain.Th at leads to partial brain damages resulted in functional disability for the function performed by that part of the brain (, , ).It is estimated worldwide that as much as  of brain insult cases is among people between  and  years of life, while from  to  years the incidence is about .Major cause in etiology of brain insult is blood vessels damaging due to atherosclerotic processes by mechanical (blood pressure) and/or chemical (hypercholesterolemia) factors; infl ammation process of blood vessels; or within some immune diseases (lupus erithematodes) (,,).In literature major risk factors for developing of brain insult are: arterial hypertension, cardiac diseases, diabetes mellitus, adiposity, smoking, stress, high cholesterol, and rare hyper-uric diathesis (,).Together with treatment, preventing the risk factor (except for the unchangeable) is the best way to avoid insult.

Objective
Th e objective of this paper was to analyse the frequency of cerebrovascular insult in West Hercegovina Canton from  to  as well as research on hospitalised cases according to the sex and age distribution, by demografic and epidemiological characteristics.

Patients and Methods
Retrospective epidemiological study of hospitalized brain insult patients from West Herzegovina Canton was conducted in Clinical hospital Mostar.This hospital is the only hospital for , inhabitants of West Hercegovina Canton.Municipalities in this Canton are: Ljubuški, Grude, Široki Brijeg and Posušje.This population lives there for years -there were no recent migrations.As a source of data we used medicinal documentation of Neurology department.For each of the cases we needed: age, sex, place of living and clinically confi rmed cerebro-vascular insult diagnosis.From  January  until  December  a total of  insult cases were hospitalized.Among them,  were male and  were female patients.Th e cases were divided in three age groups: -, - and  and more years of life by sex.For the analysing of table data, standard methods of descriptive statistics were performed.

Results
Structure of cerebro-vascular insult treated cases in Clinical Hospital Mostar according to the age and sex was shown in Table .A total of  cases were treated of brain insult in the period from  through  in Clinical hospital Mostar.Out of that number  (.) were male patients, while  (.) were female patients.Among both sexes a total of  cases (.) were between  and  years old,  patients (.) were from  through  years old, and waste majority of patients treated because of the brain insult were  and over.Among all male and female patients observing separately by gender as a cluster, majority of the treated male cases were in the oldest group of cases . ( patients) as well as it was observed among female patients where registered percent in this group was even higher -. or  patients.Th e lowest number of cases according to the age structure was treated among younger patients -- years old among either sexes -. (or  cases) of male cohort, and only . (or  cases) of female cohort.

Discussion
During the previous, recent period, population of Bosnia and Herzegovina was exposed to certain level of exposure to diff erent risk factors infl uencing health status of individuals.Th is was particularly the case with the chronic non-communicable diseases, gastrointestinal problems as well as viral diseases.Psychosocial factors and changed life styles, dietary regime, psycho stresses and social and economic factors have linked with greater number of brain insult cases ().Cardiovascular diseases are the leading cause of mortality Worldwide.Cerebro-vascular diseases are the leading cause of mortality among female population in neighbor countries in transition (Croatia), while the same diseases are in the second place among male population, just follow-IVAN VASILJ ET AL.: CEREBROVASCULAR INSULT HOSPITAL CASES IN WEST HERCEGOVINA CANTON FROM 1998TO 2002 ing cardiovascular diseases ().Th e same is characteristic for Bosnia and Herzegovina, and particularly for Federation of BiH ().In West Herzegovina Canton from  until  total of  cerebro-vascular/brain insult patients were registered.Among those cases  (or . of total) were hospital treated patients.Th at percent is understandable because one percent of patients die before even reaching a hospital, one part is out-patient facility treated because as a part of primary health care exist centers for mental health and physical medicine and rehabilitation (e.g. in Ljubuški) () and the rest of the cases are going to a hospital.According to the available literature the greater part of hospital treated patients according to the age is after  year of life.Th at is confi rmed in our study where . of patients were in that age group.We observed . patients senior then  years.If we look to the sex distribution, . were male, and . were female patients among hospitalized.Th is data is similar to other authors' fi ndings ().Our fi ndings show that greater number of treated women were older then  -. comparing to . of men among all our hospitalized patients.According to the same fi ndings, looking to the younger patients, that ratio is slightly diff erent -. of men vs. . of treated women.Th at is understandable having in mind that women have some hormone protection until the after of menopause, and this fi nding is matching the other authors' fi ndings ().Some authors' estimation considering age and brain insult is that in between  and  years of life should be about . of all brain insult cases ().Brain insult incidence according to the literature until  years of life is  (), while we found . in that age group among all our observed hospitalized patients.Calculated as an incidence rate per existing Canton population and per  population it would be much lesser that the mentioned literature incidence rate -./.If we bear in minds that this patients were only hospital treated patients, without above mentioned out-patient clinics treated ones and lethal ones, that rate will be higher.Cerebro-vascular/brain insult as a last stage of cerebrovascular diseases is among top leading mortality cause Worldwide, so research on risk factors for developing that disease is of the highest importance.Such a research study was done among , insured in FBiH using questionnaires and measurements.Among that population  (or .) were found to have brain insult.Regarding standard risk factors . were found to have hypertension, . hypercholesterolemia, and . diabetes.Similar results were found among  insured participants in this study from West Herzegovina Canton ().

Conclusions
In this retrospective epidemiological study from  -,  brain insult patients were hospitalized from West Herzegovina Canton.Th e greater part of hospitalized patients age  and more were women; in the age group from  to  years majority were men, same as among patients from  to  which was the smallest patient cohort.Regarding objective of this study on frequency of hospitalization of cerebro-vascular insult cases West Herzegovina follows other neighboring countries in transition.More attention must be given to the prevention programs and activities.