25 research outputs found
Autoimmune Encephalitis
The purpose of this paper is to provide a comprehensive review of recent literature data for autoimmune encephalitis (AIE). AIE refers to inflammatory, non-infectious, immune-mediated encephalitis characterised by neuroinflammation, synthesis of neuronal autoantibodies (NAAs), directed against surface, synaptic and intracellular antigens, with subsequent neuronal dysfunction. It is characterised by heterogeneous anatomic-clinical syndromes and prominent neuropsychiatric symptoms. Due to overlapping of different clinical and diagnostic biomarkers, AIE is often considered diagnosis of exclusion and requires an extensive work-up. Systematic search of the term Ā«autoimmune encephalitisĀ» in the PubMed database was performed, with limitation set for systematic review in papers English, published from 2004- 2022. Further analysis was performed by the search of the authorās reference list and Autoimmune Encephalitis Alliance (AEA) website. The analysis was conducted according to PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Outcomes that were sought included: AIE classification and presentation; diagnostic processing; treatment. Preset search of published systematic reviews in PubMed database, derived eighty six papers. Further screening of derived data, authorās reference list and AEA website was performed, according to previously defined out- comes. Finally, sixteen papers were independently selected and thoroughly analysed, with relevant conclusions present- ed in this paper. AIE is a severe inflammatory central nervous system (CNS) disorder with a complex differential diagnosis that often remains unrecognised. AIE research has established a wide range of new autoimmune antibodies syndromes, clinical and diagnostic biomarkers, which have improved diagnostic approach and treatment. Initial application of immunotherapy improves the outcome of disease
LAPAROSCOPIC TREATMENT OF POST-TRAU- MATIC SPLENIC CYST
Post-traumatic splenic cysts are classified as secondary cysts. It is possible diagnosis in patient with lump in the left upper quadrant with or without
other symptoms. After diagnosis is established, surgery should be performed early due to possible complications such as rupture and abscess formation
COGNITIVE ASPECTS IN MULTIPLE SCLEROSIS
Background: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive
impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive
course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised
word fluency, complex attention deficit and executive dysfunction.
Methods: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of
cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the
recently published literature on cognitive decline in MS.
Results: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive
decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging
parameters of the disease.
Conclusions: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely,
irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection
of cognitive relapse in MS patient
Medical students\u27 attitudes towards terminology of obesity
Introduction:
Obesity, one of the most common health problems encountered in medicine with implications in various other health issues, is nowadays omnipresent. Terminology describing diagnosis of obesity might be considered rude or offensive. Since perception of obese people is sometimes associated with negative attitudes and stereotypes, proper terminology used by physicians is crucial
COGNITIVE ASPECTS IN MULTIPLE SCLEROSIS
Background: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive
impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive
course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised
word fluency, complex attention deficit and executive dysfunction.
Methods: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of
cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the
recently published literature on cognitive decline in MS.
Results: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive
decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging
parameters of the disease.
Conclusions: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely,
irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection
of cognitive relapse in MS patient
SEXUAL DYSFUNCTION AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA
Background: Both depression and sexual dysfunction (SD) may be present in patients with multiple sclerosis (MS).
Objective: The aim of this study was to evaluate a possible association between SD and depression in patients with MS in Croatia.
Subjects and methods: This was a prospective cross-sectional study carried out in tertiary healthcare centre over 10 months,
which included 101 consecutive pwMS (mean age 42.09 (range 19-77) years, 75 female, 26 male, EDSS score 3.1 (range 0.0-7.0)).
SD was assessed using Multiple Sclerosis Intimacy and Sexuality Ques tionnaire (MSISQ), which was for this purpose successfully
translated and validated into Croatian. Information on treatment for depression was obtained during the medical interview. Data
were analysed and interpreted using parametric statistics (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version
23.0. Armonk, NY: IBM Corp.).
Results: 89 patients completed MSISQ. 25 patients were in treatment for depression, while 75 did not have depressive symptoms.
On MSISQ 57 (43women, 14 men) patients had responded with āalmost always/ alwaysā suggestive of SD. Majority of patients
reported primary SD, followed by secondary and tertiary SD. Most difficulties were found regarding difficulty in getting or keeping a
satisfactory erection (34.6% (N=9) men), followed by 32.9% (N=27) reporting that it takes too long to orgasm or climax, followe d
with bladder or urinary symptoms in 32.6% (N=29). There were no significant differences between female and male patients re-
garding treatment for depression ( Ȥ2=0.018, df=1, p>0.05). Results in all subcategories on t-test found that depressive patients had
higher impact on SD when compared to non-depressive: overall (t=-2.691, df=87, p<0.01) and in regards to primary (t=-2,086,
df=87, p<0.05), secondary (t=-2.608, df=87, p<0.05) and tertiary (t=-2.460, df=86, p<0.05) SD. Depressive patients on 7 questio ns
showed significantly (p<0.05) higher SD symptoms: Muscle tightness or spasms in my arms, legs, or body; Tremors or shaking in
hands or body; Pain, burning, or discomfort in their body; Feeling less attractive; Fear of being rejected sexually because of MS;
Lack of sexual interest or desire; Less intense or pleasurable orgasms or climaxes.
Conclusions: This study gives insight into the presence of depression and SD in Croatian patients with MS for which purpose
valid questionnaire for the assessment of SD in MS patients MSISQ was with permission successfully translated and validated int o
Croatian. The connection between depression and SD must be considered when managing patients with MS
COMORBIDITIES IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA
Background: Comorbidities in multiple sclerosis (MS) have a big role in management of this chronic demyelinating neurodegenerative
disorder. The aim of this study was to evaluate comorbidities in patients with MS in Croatia.
Subjects and methods: This was a prospective cross-sectional study carried out in an out-patient setting at a tertiary
healthcare centre over 10 months, which included 101 consecutive patients with MS (mean age 42.09 (range 19-77) years, 75
female, 26 male, EDSS score 3.1 (range 0.0- -42) years.
Thirty-six patients were treated with disease modifying therapies (DMTs). Information on comorbidities was obtained during the
medical interview. Data was analysed using software package IBM Corp. Released 2015. IBM SPSS Statistics for Windows,
Version 23.0. Armonk, NY: IBM Corp.
Results: 33% (n=34) patients did not have any comorbidities, and there is an equal number of patients (n=34, 33%) that just had
one comorbidity. 17.6% (n=18) of patients had two comorbidities, and 15.7% (n=16) three or more comorbidities. The most frequent
comorbidity was depression found in 25 (24.75%) patients (19 (18.8%) women, 6 (5.9%) men), followed by the hypertension in
12.87% (n=13). Hyperlipidemia and migraine were each found in 6.93% (n=7), and hypothyreosis and arrhythmia each in 3.96%
(n=4). The number of the comorbidities was found to significantly increase with the duration of MS (r=0.232, p=0.037). Women
were found to have significantly bigger numbers of comorbidities than men (t=-2.59, df=74, p<0.05). Older patients with MS were
found to have significantly more comorbidities (r=0.335, p<0.01).
Conclusions: This study gives insight into the presence of comorbidities in Croatian patients with MS. Connection with
comorbidities must be considered when managing patients with MS. Any other comorbidity in MS may also affect the condition of the
patient in general, and also their quality of life, and requires a tailored approach in management
Effectiveness of electroconvulsive therapy
Electroconvulsive therapy (ECT) is a medical treatment in which the patientās brain is briefly electrically stimulated under anesthesia to induce a
brief seizure. ECT is usually used when other treatments havenāt worked. Although it is primarily used to treat patients with major depression, patients with other disorders may also benefit
ANXIETY AND DEPRESSION AS COMORBIDITIES OF MULTIPLE SCLEROSIS
Multiple Sclerosis (MS), a chronic inflammatory neurodegenerative disease, is accompanied by a number of comorbidities.
Among the psychiatric ones, depression and anxiety occupy a special place. It is estimated that the prevalence of anxiety in the MS
population is 22.1% verus 13% in the general population; whereas the prevalence of anxiety levels, as determined by various
questionnaires, reaches even 34.2%. Systematic literature reviews (SPL) show considerable data variations due to differences in
study design, sample size, diagnostic criteria and extremely high heterogeneity (I2). Among the more conspicuous factors associated
with anxiety disorder in MS are demographic factors (age and gender), nonsomatic depressive symptoms, higher levels of disability,
immunotherapy treatments, MS type, and unemployment. Depression is the most common psychiatric commorbidity in MS and the
lifetime risk of developing depression in MS patients is >50%. According to some research, the prevalence of depression in MS vary
between 4.98% and 58.9%, with an average of 23.7% (I2=97.3%). Brain versus spinal cord lesions, as well as temporal lobe,
fasciculus arcuatus, superior frontal and superior parietal lobe lesions in addition to the cerebral atrophy have been shown to be the
anatomical predictors of depressive disorder in MS. Hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA) and the
consequent dexamethasone-insupressible hypercortisolemia, in addition to cytokine storm (IL-6, TNF--4) present
the endocrine and inflammatory basis for development of depression. Fatigue, insomnia, cognitive dysfunction, spasticity,
neurogenic bladder, pain, and sexual dysfunction have shown to be additional precipitating factors in development of anxiety and
depression in MS patients
LOWER URINARY TRACT SYMPTOMS AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS
Background: Both depression and lower urinary tract symptoms (LUTS) may be present in patients with multiple sclerosis (MS).
The objective of this study was to give an insight on depression and LUTS in patients with MS in Croatia and to determine the
possible association between LUTS and depression in patients with MS.
Subjects and methods: This was a prospective cross-sectional study conducted in a tertiary healthcare center in Croatia. Hundred
and one consecutive patients with MS (75 female, 26 male, mean age 42.09 (range 19-77) years, mean Expanded Disability Status
Scale (EDSS) score 3.1 (range 0.0-7.0)) participated in this study. We evaluated LUTS and related quality of life (QoL) using three International
Consultation on Incontinence Questionnaires (ICIQ) enquiring about overactive bladder (ICIQ-OAB), urinary incontinence
short form (ICIQ-UI SF) and lower urinary tract symptoms related quality of life (ICIQLUTS-QoL). ICIQ-OAB and ICIQLUTS-QoL
were for this purpose with permission successfully translated and validated into Croatian, while ICIQ-UI SF was already previously
validated for the Croatian language. Information regarding treatment for depression was obtained during the medical interview. Data
were analyzed and interpreted using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA).
Results: 89.10% (N=90) patients with MS reported urgency with urge urinary incontinence (UUI) present in 70.29% (N=71).
81.18% (N=82) patients reported nocturia, and 90.09% (N=91) reported feeling drowsy or sleepy during the day due to bladder
symptoms. Neurological deficit measured by EDSS was found to positively correlate with LUTS on all three questionnaires: ICIQOAB
(r=0.390, p<0.05), ICIQ-UI SF (r=0.477, p<0.01) and ICIQ-LUTSQoL (r=0.317, p<0.05). 25 patients were in treatment for
depression. There were no significant differences between female and male patients regarding treatment for depression (2=0.018, df=1, p>0.05). Results on ICIQ-UI SF showed that depressive patients had more pronounced LUTS (t=2.067, df=99, p<0.05), which was also true for the ICIQ-LUTSQoL (t=-2.193, df=99, p<0.05). Positive correlations were found between depression and LUTS on ICIQ-UI SF (r=0.203, p<0.05) and ICIQ-LUTSQoL (r=0.215, p<0.05).
Conclusion: This study gives insight into the presence of depression and LUTS in Croatian patients with MS for which purpose
ICIQ-OAB and ICIQ-LUTSQoL were with permission successfully translated and validated into Croatian. The connection between depression and LUTS must be considered when managing patients with MS