Ređi humoralni faktori rizika za ishemijski moždani udar i njihov prognostički značaj

Abstract: Introduction. Ischemic stroke (IS) is the third leading mortality cause in the world and the most common cause of disability. Knowing the risk factors and prognostic factors of ischemic stroke is very important. Patients and methods. We studied 50 consecutive patients with IS to assess levels of humoral rare vascular risk factors: vitamins B12 and D, homocysteine and thyroid hormones after IMU and functional status of patients using Brthel Index, modified Rankin Score, the National Institutes of Health Stroke Scale and cognitive status through the Mini Mental State Examination, a test of frontal function "Go-No Go" as well as the Geriatric Depression Scale, 3 and 6 months after IS. Results. In the study, there were more women than men with IS what can be seen as artifact of the small groups, whereas age was consistent with other studies, where the women were older than men. Blood pressure, blood glucose, lipids and C-reactive protein (CRP) showed a statistically significant reduction, and calcium elevation after the IS. Homocysteine significantly positively correlated with depression and unfavorable outcome, and negatively with executive functions and functional outcome. Vitamin B12 showed a statistically significant increase in the monitoring period, which positivly correlated with the outcome and functionality, cognition, and negatively with depression. Vitamin D positively correlated with executive functions and functional status. Folic acid and thyroid hormones are difficult to interpret because of the unreliability of the methods of determination. D dimer negatively correlated with cognitive measures, and positively with depression. CRP negatively correlated with outcome measures and functions. Conclusion. There is a significant association of vascular risk factors. Our research has shown the importance of influence of rarer humoral risk factors but also an association of more frequent and "rarer" factors. In each case, there is a need to assess multiple risk factors and their combined impact on the occurrence of IS.Sažetak: Uvod. Ishemijski moždani udar (IMU) je treći vodeći uzrok smrtnosti u svetu, a najzastupljeniji uzrok invaliditeta. Poznavanje uzroka IMU i prognostičkih faktora je veoma značajno. Bolesnici i metode. Ispitivano je 50 konsekutivnih bolesnika sa IMU kod kojih su određivani ređi humoralni faktori rizika: vitamini B12 i D, homocistein i tireoidni hormoni) posle IMU) i funkcionalni status bolesnika pomoću BI, modifikovani Rankinov skor, National Institutes of Health Stroke Scale (NIHSS) kao i kognitivni status putem Mini Mental testa (Mini Mental State Examination - MMSE), Testa frontalnih funkcija „Idi-ne idi“ kao i Gerijatrijske skale depresivnosti, 3 do 6 meseci posle ishemijskog možda udara. Rezultati. U studiji je bilo više žena nego muškaraca sa IMU što se može posmatrati kao artefakt male grupe, dok je životno doba bilo u skladu sa drugim studijama, odnosno žene su bile starije od muškaraca. Vrednosti krvnog pritiska, glikemija, lipida i C-reaktivnog proteina (CRP) su pokazala statistički značajno sniženje, a kalcijuma povišenje posle IMU. Viši nivoi homocisteina značajno pozitivno korelišu sa depresivnošću i nepovoljnijim ishodom, a negativno sa egzekutivnim funkcijama funkcionalnim ishodom. Vrednosti vitamina B12 su pokazale statistički značajan porast u periodu praćenja što je pozitivno korelisalo sa ishodom i funkcionalnošću, kognicijom, a negativno sa depresijom. Vitamin D je pozitivno korelisao sa egzekutivnim funkcijama i funkicionalnošću. Nalaze folne kiseline i tireoidnih hormona je teško tumačiti zbog nepouzdanosti metoda određivanja. D dimer je negativno korelisao sa kognitivnim merama, a pozitivno sa deprrsivnošću. CRP je negativno korelisao sa merama ishoda i funcije. Zaključak. Veoma je značajna veza odnosno udruženost više vaskulnih faktora rizika. U našem istraživanju je pokazan značaj uticaja ređih humoralnih faktora rizika ali i udruženosti češćih i „ređih“ faktora. U svakom pojedinačnom slučaju, nameće se potreba procene multiplih faktora rizika i njihovog udruženog uticaja na pojavu IMU

The Impact of Homocysteine, Vitamin B12, and Vitamin D Levels on Functional Outcome after First-Ever Ischaemic Stroke

We explored the relationship between acute ischaemic stroke (IS) early functional outcome and serum levels of homocysteine, vitamin B12, and D in a noninterventional prospective clinical study. We enrolled 50 patients with first-ever IS and performed laboratory tests and functional assessment at three time points: on admission and three and six months after stroke. Modified Rankin Scale (mRS), NIHSS scale, and Barthel index (BI) scores were assessed in all participants by trained examiner blinded to laboratory data. Patients did not receive treatment that might alter laboratory data. Admission NIHSS correlated with homocysteine levels (r = 0.304, p lt 0.05), B12 level (r = -0.410, p lt 0.01), and vitamin D levels (r = -0.465, p lt 0.01). Functional outcome measures (BI and mRS) did not significantly correlate with homocysteine and vitamin D3 levels at 3 and 6 months. However, a positive correlation with vitamin B12 levels was detected for BI both at 3 and 6 months and mRS at 6 months. Higher serum vitamin B12 levels were associated with better functional outcome at follow-up

Vitamin a and the nervous system

Vitamin A is essential for the early development and normal functioning of the brain throughout life. A deficiency of vitamin A is one of the leading causes of morbidity and mortality in developing countries, and subclinical deficiency is probably present worldwide. The main active molecule in vitamin A is retinoic acid, which is involved in vision, the immune system, skin health, olfaction and cognition (learning, memory, spatial functions, olfaction, etc.) through processes of neuroplasticity and neurogenesis. Vitamin A is involved in the regulation of about one-sixth of the human genome. It has non-genomic actions in protein translation and paracrine actions. Retinal vitamin A aldehyde is crucial for day and night vision. The best-known manifestation of hypovitaminosis A is night blindness but in more severe cases, it causes blindness. In the hypothalamus, vitamin A, with information from the retina, acts in circadian and seasonal regulation. Increased retinoic acid levels in the blood are associated with increased risk of depression, and lower levels have been connected with Alzheimer's disease, Parkinson's disease, cerebral ischemia, autistic spectrum disorders and schizophrenia. Higher doses and longer periods of treatment pose the threat of hypervitaminosis A. Vitamin A and its analogs are a promising new class of therapeutic agents in a wide spectrum of disorders, albeit with a narrow therapeutic window

Post-COVID-19 and Mental Health

Beginning with its emergence in Wuhan, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic that causes COVID-19, has spread and left profound consequences on the lives and health of people around the world. Although most patients who have COVID-19 recover after two to six weeks, research shows that 10–30% of people who have had COVID-19, even with a mild clinical picture, remain with persistent symptoms that have a devastating effect on their quality of life. These symptoms, which most often include fatigue, shortness of breath, chest pain, headache, and cognitive dysfunction, but also others that generally have an impact on everyday functioning, are recognized as a clinical condition called post-COVID syndrome (long COVID). In addition to physical disabilities in people recovering from COVID-19, mental health problems have also been observed, including problems with concentration (“brain fog”), anxiety, depression, sleep disorders, and symptoms of post-traumatic stress disorder (PTSD). In this chapter, we provide a comprehensive review of the current scientific findings identifying post-COVID conditions and their relationship with mental health status

Ređi humoralni faktori rizika za ishemijski moždani udar i njihov prognostički značaj

Abstract: Introduction. Ischemic stroke (IS) is the third leading mortality cause in the world and the most common cause of disability. Knowing the risk factors and prognostic factors of ischemic stroke is very important. Patients and methods. We studied 50 consecutive patients with IS to assess levels of humoral rare vascular risk factors: vitamins B12 and D, homocysteine and thyroid hormones after IMU and functional status of patients using Brthel Index, modified Rankin Score, the National Institutes of Health Stroke Scale and cognitive status through the Mini Mental State Examination, a test of frontal function "Go-No Go" as well as the Geriatric Depression Scale, 3 and 6 months after IS. Results. In the study, there were more women than men with IS what can be seen as artifact of the small groups, whereas age was consistent with other studies, where the women were older than men. Blood pressure, blood glucose, lipids and C-reactive protein (CRP) showed a statistically significant reduction, and calcium elevation after the IS. Homocysteine significantly positively correlated with depression and unfavorable outcome, and negatively with executive functions and functional outcome. Vitamin B12 showed a statistically significant increase in the monitoring period, which positivly correlated with the outcome and functionality, cognition, and negatively with depression. Vitamin D positively correlated with executive functions and functional status. Folic acid and thyroid hormones are difficult to interpret because of the unreliability of the methods of determination. D dimer negatively correlated with cognitive measures, and positively with depression. CRP negatively correlated with outcome measures and functions. Conclusion. There is a significant association of vascular risk factors. Our research has shown the importance of influence of rarer humoral risk factors but also an association of more frequent and "rarer" factors. In each case, there is a need to assess multiple risk factors and their combined impact on the occurrence of IS.Sažetak: Uvod. Ishemijski moždani udar (IMU) je treći vodeći uzrok smrtnosti u svetu, a najzastupljeniji uzrok invaliditeta. Poznavanje uzroka IMU i prognostičkih faktora je veoma značajno. Bolesnici i metode. Ispitivano je 50 konsekutivnih bolesnika sa IMU kod kojih su određivani ređi humoralni faktori rizika: vitamini B12 i D, homocistein i tireoidni hormoni) posle IMU) i funkcionalni status bolesnika pomoću BI, modifikovani Rankinov skor, National Institutes of Health Stroke Scale (NIHSS) kao i kognitivni status putem Mini Mental testa (Mini Mental State Examination - MMSE), Testa frontalnih funkcija „Idi-ne idi“ kao i Gerijatrijske skale depresivnosti, 3 do 6 meseci posle ishemijskog možda udara. Rezultati. U studiji je bilo više žena nego muškaraca sa IMU što se može posmatrati kao artefakt male grupe, dok je životno doba bilo u skladu sa drugim studijama, odnosno žene su bile starije od muškaraca. Vrednosti krvnog pritiska, glikemija, lipida i C-reaktivnog proteina (CRP) su pokazala statistički značajno sniženje, a kalcijuma povišenje posle IMU. Viši nivoi homocisteina značajno pozitivno korelišu sa depresivnošću i nepovoljnijim ishodom, a negativno sa egzekutivnim funkcijama funkcionalnim ishodom. Vrednosti vitamina B12 su pokazale statistički značajan porast u periodu praćenja što je pozitivno korelisalo sa ishodom i funkcionalnošću, kognicijom, a negativno sa depresijom. Vitamin D je pozitivno korelisao sa egzekutivnim funkcijama i funkicionalnošću. Nalaze folne kiseline i tireoidnih hormona je teško tumačiti zbog nepouzdanosti metoda određivanja. D dimer je negativno korelisao sa kognitivnim merama, a pozitivno sa deprrsivnošću. CRP je negativno korelisao sa merama ishoda i funcije. Zaključak. Veoma je značajna veza odnosno udruženost više vaskulnih faktora rizika. U našem istraživanju je pokazan značaj uticaja ređih humoralnih faktora rizika ali i udruženosti češćih i „ređih“ faktora. U svakom pojedinačnom slučaju, nameće se potreba procene multiplih faktora rizika i njihovog udruženog uticaja na pojavu IMU

Recidivantna neuroborelioza - prikaz slučaja

We present a case of a young woman, age 34, who presented with recurrent Lyme neuroborreliosis (LNB). Her clinical profile consisted of a rare combination of two thirdstage manifestations, namely, progressive encephalomyelitis and peripheral neuritis, in both bouts of the disease. The epidemiological data were controversial, as she reported a tick bite only two months prior to the onset of symptoms. Negative magnetic resonance imaging (MRI) results excluded multiple sclerosis, vascular causes and tumours. Serological tests confirmed the Bb infection in the recommended twostep serological approach consisting of an enzyme-linked immunosorbent assay (ELISA) test for Borrelia burgdorferi (Bb) immunoglobulin G (IgG) and immunoglobulin M (IgM) and a Western blot (WB) as confirmatory analysis in the blood. Another controversial issue is the lack of pleocytosis. Atypical findings in our patient can be explained by a possible rare genotype of Bb. After treatment with oral doxycycline, she made an apparent remission, but after three months, she had another episode with signs of central and peripheral nervous system involvement, increased Bb antibodies and white matter changes on the MRI. This time, she was treated with intravenous ceftriaxone, 2 grams daily for four weeks. She showed no signs of LNB, both clinically and serologically, during a follow up lasting about a year. This case emphasises the importance of the clinical and serological findings and the use of ceftriaxone as the first line of treatment in LNB.Mi predstavljamo slučaj mlade žene starosti 34 godine sa rekurentnom Lajmskom neuroboreliozom (LNB). Njena klinička slika se sastojala od retke kombinacije dve manifestacije treće faze, naime, progresivnog encefalomijelitisa i perifernog neuritisa u obe epizode bolesti. Epidemiološki podaci su kontroverzni jer se ubod krpelja desio samo dva meseca ranije. Magnetna rezonanca (MR) mozga je isključila multiplu sklerozu, vaskularne uzroke i tumor. Serološki testovi su potvrdili Bb infekcije u preporučenoj serologiji u dva koraka, sa enzyme-linked immunosorbent assay (ELISA) testom za Borrelia burgdorferi (Bb) specifične imunoglobuline G (IgG) i imunoglobulina M (IgM) i Vestern Blot (VB) testom za konfirmaciju. Drugo kontroverzno pitanje je nedostatak pleocitoze u likvoru. Atipični nalazi u naše bolesnice mogu se objasniti retkim genotipom Bb. Nakon tretmana sa oralnim doksiciklinom, bolesnica je postigla remisiju, ali je posle tri meseca imala još jednu epizodu sa znacima zahvaćenosti centralnog i perifernog nervnog sistema, povećanim titrom specifičnih Bb antitela kao i promenama bele mase na MR mozga. Ovaj put, ona je tretirana ceftriaksonom intravenski, dva grama dnevno tokom četiri nedelje. Bolesnica je ponovo ušla u remisiju LNB koja se održavala i klinički i serološki tokom praćenja u trajanju od oko godinu dana. Ovaj slučaj naglašava značaj kliničkih i seroloških nalaza u dijagnostici kao i opravdanost ceftriaksona, kao prve linije lečenja u LNB