6 research outputs found
The role of vitamin D in multiple sclerosis
Multipla skleroza (MS) je kroniÄna idiopatska upalna bolest srediÅ”njeg Å£ivÄanog sustava
obiljeÅ£ena demijelinizacijskim oÅ”teÄenjima u mozgu i kraljeÅ£niÄnoj moÅ£dini. NajÄeÅ”Äe
zahvaÄa mlaÄu populaciju, s vrhuncem incidencije izmeÄu 25. i 45. godine Å£ivota te
predstavlja znaÄajan uzrok invaliditeta u mlaÄoj dobi. Uzrok bolesti je nepoznat, ali
dosadaŔnja saznanja govore najviŔe u prilog autoimunoj patogenezi. Brojne epidemioloŔke i
eksperimentalne studije pokazuju da i geni i okoliÅ”ni Äimbenici imaju ulogu u etiologiji MS-a.
Od okoliÅ”nih Äimbenika najviÅ”e se spominju infekcija, puÅ”enje i manjak vitmina D. Vitamin D
spada u skupinu vitamnina topivih u mastima, a u tijelu igra nekoliko uloga od kojih je
najpoznatija odrţavanje zdravlja koŔtanog sustava i utjecaj na metabolizam minerala. Pored
ovog, vitamin D moÅ£e modificirati imunoloÅ”ki odgovor, staniÄnu proliferaciju, diferencijaciju
i apoptozu. Manjak vitamina D povezan je s brojnim bolestima, ukljuÄujuÄi MS. Na ulogu
vitamina D u MS-u upuÄuje u prvom redu geografska distribucija bolesti, zatim brojna
istraţivanja koja pokazuju da je nedvojbena njegova uloga u nastanku i tijeku bolesti, a
temeljena su na prouÄavanju njegovih imunomodulatornih svojstava, utjecaja na ekspresiju
odreÄenih gena i na prouÄavanju njegove uloge u Å£ivotinjskom modelu MS-a. Neka su
istraţivanja pokazala da vitamin D ima ulogu u prevenciji MS-a, ali velike studije koje trebaju
potvrditi moţe li i koliko uzimanje suplemenata vitamina D moţe prevenirati bolest, tek su
zapoÄele. Rezultati studija koje su se bavile pitanjem uloge vitamina D u terapiji bolesnika
koji su veÄ razvili MS nisu jednozanÄni, ali ipak viÅ”e govore u prilog pozitivnom uÄinku i
vitamin D danas je dio standradne terapije MS-a Äemu pridonosi Äinjenica da je prirodan,
siguran i jeftin. BuduÄe studije Äe razjasniti ima li uzimanje vitamina D direktan uÄinak na
tijek bolesti i odgovoriti na pitanje koliko je vitamina D potrebno u lijeÄenju, kao i koja je
optimalna razina vitamina D u krvi kod bolesnika sa MS-om.Multiple sclerosis (MS) is a chronic idiopathic inflammatory disease of the central nervous
system characterized by demyelinating lesions in the brain and the spinal cord. It most
commonly affects young adults, with a peak incidence between the age of 25 and 35 years and
is a significant cause of disability in this age group.The cause of the disease is unknown but
the current findings argue in favor of autoimmune pathogenesis. Numerous epidemiological
and experimental studies have shown that both genes and environmental factors play a role in
the etiology of MS. Of the environmental factors the most investigated are infection, smoking
and lack of vitamin D. Vitamin D belongs to fat-soluble group of vitamins and plays several
roles, of which the maintenance of bone health and influence on metabolism of minerals is the
best known. In addition, vitamin D can modify the immune response, cell proliferation,
differentiation and apoptosis. Vitamin D deficiency is associated with numerous diseases,
including MS. Geographical distribution of the disease refers to the role of the vitamin D in
the first place. Also numerous studies, which are based on the study of its immunomodulatory
properties, influences on the expression of certain genes and the study of its role in the animal
model of MS, have shown that it undoubtedly plays the role in the onset and course of the
disease. Some studies have shown that vitamin D has a role in preventing MS. However, large
studies which should confirm whether and how taking vitamin D supplements can prevent the
disease, have only just begun. Results of the studies that have dealt with the issue of the role
of vitamin D in the treatment of patients who have developed MS are rather ambiguous, but
they still speak in favor of its positive effects. Furthermore, vitamin D is now part of the
standard therapy for MS to which contributes the fact that it is natural, safe and inexpensive.
Future studies will clarify whether taking supplements of vitamin D has a direct effect on the
disease course and will answer the question of how much vitamin D is required for the
treatment, as well as its optimal level in the blood of patients with MS
Korea uzrokovana arteriovenskom malformacijom: prikaz sluÄaja i pregled literature
Chorea is a movement disorder that can be caused by a large range of degenerative, vascular, metabolic and toxic disorders in basal ganglia. Arteriovenous malformations are rare vascular malformations the clinical presentation of which depends on the malformation characteristics and
localization. Th ey are most commonly presented with intracranial hemorrhage, while focal neurological deficit is the rarest presentation. A case is reported of a 64-year-old female patient presented with hemichorea. Magnetic resonance imaging and digital subtraction angiography revealed the presence of arteriovenous malformation in the right temporal lobe.Korea je poremeÄaj pokreta koji može biti uzrokovan velikim rasponom degenerativnih, vaskularnih, metaboliÄkih i toksiÄnih poremeÄaja u bazalnim ganglijima. Arteriovenske malformacije su rijetke vaskularne malformacije kliniÄka prezentacija kojih ovisi o karakteristikama i lokalizaciji malformacije. NajÄeÅ”Äe se prezentiraju intrakranijskom hemoragijom, a najrjeÄe fokalnim neuroloÅ”kim defi citom. Prikazujemo sluÄaj 64-godiÅ”nje bolesnice koja se prezentirala hemikoreom. UÄinjena
magnetska rezonanca i digitalna subtrakcijska angiografi ja otkrila je prisutnost arteriovenske malformacije u medijalnom dijelu desnog temporalnog režnja
UspjeÅ”no lijeÄenje akutnog diseminiranog encefalomijelitisa (ADEM) pravodobnom primjenom imunoglobulina ā prikaz sluÄaja i pregled literature
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease
includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.Akutni diseminirani encefalomijelitis (ADEM) je upalna demijelinizirajuÄa bolest srediÅ”njega živÄanog sustava koja obiÄno pogaÄa djecu i mlade odrasle osobe. NajÄeÅ”Äe ima monofazni tijek, iako su zabilježeni i relapsi bolesti. KliniÄka prezentacija bolesti ukljuÄuje encefalopatiju i multifokalne neuroloÅ”ke deficite. Pouzdani kriteriji za dijagnozu ADEM-a nisu utvrÄeni i ponekad ga je teÅ”ko razlikovati od prve atake multiple skleroze, osobito kod odraslih. Dijagnoza ADEM-a temelji se na kliniÄkim, radioloÅ”kim i laboratorijskim nalazima. U lijeÄenju ADEM-a primjenjuju se visoke doze kortikosteroida, plazmafereza i imunoglobulini. Prikazujemo sluÄaj mlade odrasle bolesnice kod koje je potpun oporavak uslijedio nakon pravodobne primjene visoke doze metilprednizolona i imunoglobulina
Depresija i umor uzrokovani opstrukcijskom apnejom tijekom spavanja u multiploj sklerozi
To our knowledge, there is no study investigating whether fatigue and depression
as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea
(OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions
such as OSA in MS patients. The aim of our survey study was to determine whether depression and
fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted
a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness
Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised)
in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of
OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features
of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was
correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark
of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004)
and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the
increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive
correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is
a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are
associated with the two most commonly reported symptoms of depression and fatigue, thus supporting
the hypothesis that both symptoms are due to a secondary condition in MS.Sukladno naÅ”im saznanjima nema studije koja je istraživala nastaju li umor i depresija kao najuÄestaliji simptomi kod
bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili
iz sekundarnih povezanih stanja kao Ŕto je OSA kod bolesnika s MS. Cilj naŔe anketne studije bio je utvrditi jesu li depresija
i umor u bolesnika s MS povezani s kliniÄkim obilježjima OSA ili MS. Proveli smo anketu pomoÄu Äetiri validirana upitnika
(STOP-BANG, Epworthova ljestvica pospanosti, ljestvica težine umora i revidirana ljestvica depresije Centra za epidemioloŔke
studije) u 28 uzastopnih ambulantnih bolesnika s kliniÄki i parakliniÄki dokazanom MS. UÄestalost bolesnika s MS
s poveÄanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna
od kliniÄkih znaÄajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuÄa terapija, drugi lijekovi) nije
bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilježje OSA bila je znaÄajno i
pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). TakoÄer, depresija je znaÄajno i
pozitivno korelirala s poveÄanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). KonaÄno, utvrÄena je znaÄajna
pozitivna korelacija izmeÄu težine umora i simptoma depresije (p=0,003). OSA je Äest poremeÄaj kod bolesnika s MS.
KliniÄke znaÄajke i Äimbenici rizika za OSA u bolesnika s MS povezani su s dva najÄeÅ”Äe prijavljivana simptoma depresije i
umora, podupiruÄi tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS
The role of vitamin D in multiple sclerosis
Multipla skleroza (MS) je kroniÄna idiopatska upalna bolest srediÅ”njeg Å£ivÄanog sustava
obiljeÅ£ena demijelinizacijskim oÅ”teÄenjima u mozgu i kraljeÅ£niÄnoj moÅ£dini. NajÄeÅ”Äe
zahvaÄa mlaÄu populaciju, s vrhuncem incidencije izmeÄu 25. i 45. godine Å£ivota te
predstavlja znaÄajan uzrok invaliditeta u mlaÄoj dobi. Uzrok bolesti je nepoznat, ali
dosadaŔnja saznanja govore najviŔe u prilog autoimunoj patogenezi. Brojne epidemioloŔke i
eksperimentalne studije pokazuju da i geni i okoliÅ”ni Äimbenici imaju ulogu u etiologiji MS-a.
Od okoliÅ”nih Äimbenika najviÅ”e se spominju infekcija, puÅ”enje i manjak vitmina D. Vitamin D
spada u skupinu vitamnina topivih u mastima, a u tijelu igra nekoliko uloga od kojih je
najpoznatija odrţavanje zdravlja koŔtanog sustava i utjecaj na metabolizam minerala. Pored
ovog, vitamin D moÅ£e modificirati imunoloÅ”ki odgovor, staniÄnu proliferaciju, diferencijaciju
i apoptozu. Manjak vitamina D povezan je s brojnim bolestima, ukljuÄujuÄi MS. Na ulogu
vitamina D u MS-u upuÄuje u prvom redu geografska distribucija bolesti, zatim brojna
istraţivanja koja pokazuju da je nedvojbena njegova uloga u nastanku i tijeku bolesti, a
temeljena su na prouÄavanju njegovih imunomodulatornih svojstava, utjecaja na ekspresiju
odreÄenih gena i na prouÄavanju njegove uloge u Å£ivotinjskom modelu MS-a. Neka su
istraţivanja pokazala da vitamin D ima ulogu u prevenciji MS-a, ali velike studije koje trebaju
potvrditi moţe li i koliko uzimanje suplemenata vitamina D moţe prevenirati bolest, tek su
zapoÄele. Rezultati studija koje su se bavile pitanjem uloge vitamina D u terapiji bolesnika
koji su veÄ razvili MS nisu jednozanÄni, ali ipak viÅ”e govore u prilog pozitivnom uÄinku i
vitamin D danas je dio standradne terapije MS-a Äemu pridonosi Äinjenica da je prirodan,
siguran i jeftin. BuduÄe studije Äe razjasniti ima li uzimanje vitamina D direktan uÄinak na
tijek bolesti i odgovoriti na pitanje koliko je vitamina D potrebno u lijeÄenju, kao i koja je
optimalna razina vitamina D u krvi kod bolesnika sa MS-om.Multiple sclerosis (MS) is a chronic idiopathic inflammatory disease of the central nervous
system characterized by demyelinating lesions in the brain and the spinal cord. It most
commonly affects young adults, with a peak incidence between the age of 25 and 35 years and
is a significant cause of disability in this age group.The cause of the disease is unknown but
the current findings argue in favor of autoimmune pathogenesis. Numerous epidemiological
and experimental studies have shown that both genes and environmental factors play a role in
the etiology of MS. Of the environmental factors the most investigated are infection, smoking
and lack of vitamin D. Vitamin D belongs to fat-soluble group of vitamins and plays several
roles, of which the maintenance of bone health and influence on metabolism of minerals is the
best known. In addition, vitamin D can modify the immune response, cell proliferation,
differentiation and apoptosis. Vitamin D deficiency is associated with numerous diseases,
including MS. Geographical distribution of the disease refers to the role of the vitamin D in
the first place. Also numerous studies, which are based on the study of its immunomodulatory
properties, influences on the expression of certain genes and the study of its role in the animal
model of MS, have shown that it undoubtedly plays the role in the onset and course of the
disease. Some studies have shown that vitamin D has a role in preventing MS. However, large
studies which should confirm whether and how taking vitamin D supplements can prevent the
disease, have only just begun. Results of the studies that have dealt with the issue of the role
of vitamin D in the treatment of patients who have developed MS are rather ambiguous, but
they still speak in favor of its positive effects. Furthermore, vitamin D is now part of the
standard therapy for MS to which contributes the fact that it is natural, safe and inexpensive.
Future studies will clarify whether taking supplements of vitamin D has a direct effect on the
disease course and will answer the question of how much vitamin D is required for the
treatment, as well as its optimal level in the blood of patients with MS
Chorea Caused by Unruptured Arteriovenous Malformation: Case Report and Review of Literature
Chorea is a movement disorder that can be caused by a large range of degenerative, vascular, metabolic and toxic disorders in basal ganglia. Arteriovenous malformations are rare vascular malformations the clinical presentation of which depends on the malformation characteristics and
localization. Th ey are most commonly presented with intracranial hemorrhage, while focal neurological deficit is the rarest presentation. A case is reported of a 64-year-old female patient presented with hemichorea. Magnetic resonance imaging and digital subtraction angiography revealed the presence of arteriovenous malformation in the right temporal lobe