Razlike u čimbenicima rizika i ishodu između ishemijskog i hemoragijskog moždanog udara

The aim of the study was to justify the hypothesis that risk factors do not differ between ischemic and hemorrhagic stroke. This retrospective study included 1066 stroke patients. The prevalence of risk factors and hospital-based survival were compared between patients with ischemic and hemorrhagic stroke. Data were retrieved from patient records. Statistical analysis was done by use of χ-test and t-test for dependent samples. The group of hemorrhagic stroke consisted of 70 (47.9%) female and 76 (52.1%) male patients. The group of ischemic stroke included 450 (48.9%) female and 470 (51.1%) male patients. Ischemic stroke patients had a higher prevalence of hypertension (79% vs. 72%), atherosclerotic diseases (50% vs. 34%) and atrial fibrillation (15.5% vs. 4.2%), and were statistically significantly older (72.5±10.4 VS. 65.7±12.8) than those with hemorrhagic stroke, however, fatal outcome was more common in the latter (26% vs. 17%). In conclusion, data analysis pointed to differences between hemorrhagic and ischemic stroke according to both risk factors and stroke outcome.Cilj studije bio je provjeriti opravdanost hipoteze kako se čimbenici rizika ne razlikuju između ishemijskog i hemoragijskog moždanog udara. Ova retrospektivna studija uključila je 1066 bolesnika s moždanim udarom. Učestalost rizičnih čimbenika i bolničko preživljenje uspoređeni su između bolesnika s ishemijskim i hemoragijskim moždanim udarom. Podatci su izvedeni iz bolesničkih kartona. Statistička analiza je provedena pomoću χ2-testa i t-testa za zavisne uzorke. Skupina bolesnika s hemoragijskim moždanim udarom imala je 70 (47,9%) žena i 76 (52,1%) muškaraca, a skupina s ishemijskim moždanim udarom 450 (48,9%) žena i 470 (51,1%) muškaraca. Bolesnici s ishemijskim moždanim udarom imali su veću učestalost hipertenzije (79% prema 72%), aterosklerotske bolesti (50% prema 34%) i atrijske fibrilacije (15,5% prema 4,2%) i bili su statistički značajno stariji (72,5±10,4 prema 65,7±12,8) od bolesnika s hemoragijskim moždanim udarom, ali je smrtni ishod bio češći kod ovih potonjih (26% prema 17%). Dakle, analiza prikupljenih podataka ukazala je na razlike između hemoragijskog i ishemijskog moždanog udara u rizičnim čimbenicima i ishodu bolesti

Razlike u čimbenicima rizika i ishodu između ishemijskog i hemoragijskog moždanog udara

The aim of the study was to justify the hypothesis that risk factors do not differ between ischemic and hemorrhagic stroke. This retrospective study included 1066 stroke patients. The prevalence of risk factors and hospital-based survival were compared between patients with ischemic and hemorrhagic stroke. Data were retrieved from patient records. Statistical analysis was done by use of χ-test and t-test for dependent samples. The group of hemorrhagic stroke consisted of 70 (47.9%) female and 76 (52.1%) male patients. The group of ischemic stroke included 450 (48.9%) female and 470 (51.1%) male patients. Ischemic stroke patients had a higher prevalence of hypertension (79% vs. 72%), atherosclerotic diseases (50% vs. 34%) and atrial fibrillation (15.5% vs. 4.2%), and were statistically significantly older (72.5±10.4 VS. 65.7±12.8) than those with hemorrhagic stroke, however, fatal outcome was more common in the latter (26% vs. 17%). In conclusion, data analysis pointed to differences between hemorrhagic and ischemic stroke according to both risk factors and stroke outcome.Cilj studije bio je provjeriti opravdanost hipoteze kako se čimbenici rizika ne razlikuju između ishemijskog i hemoragijskog moždanog udara. Ova retrospektivna studija uključila je 1066 bolesnika s moždanim udarom. Učestalost rizičnih čimbenika i bolničko preživljenje uspoređeni su između bolesnika s ishemijskim i hemoragijskim moždanim udarom. Podatci su izvedeni iz bolesničkih kartona. Statistička analiza je provedena pomoću χ2-testa i t-testa za zavisne uzorke. Skupina bolesnika s hemoragijskim moždanim udarom imala je 70 (47,9%) žena i 76 (52,1%) muškaraca, a skupina s ishemijskim moždanim udarom 450 (48,9%) žena i 470 (51,1%) muškaraca. Bolesnici s ishemijskim moždanim udarom imali su veću učestalost hipertenzije (79% prema 72%), aterosklerotske bolesti (50% prema 34%) i atrijske fibrilacije (15,5% prema 4,2%) i bili su statistički značajno stariji (72,5±10,4 prema 65,7±12,8) od bolesnika s hemoragijskim moždanim udarom, ali je smrtni ishod bio češći kod ovih potonjih (26% prema 17%). Dakle, analiza prikupljenih podataka ukazala je na razlike između hemoragijskog i ishemijskog moždanog udara u rizičnim čimbenicima i ishodu bolesti

Regresija asimetričnog tremora gornjih udova nakon transplantacije jetre u bolesnika s hepatalnom encefalopatijom: prikaz slučaja

Hepatic encephalopathy (HE) is a brain dysfunction caused by liver failure. Clinically, it can manifests as a wide spectrum of neurological or psychiatric abnormalities. This report presents a case of a 43-year-old male with HE and asymmetric kinetic, postural and resting tremor of upper extremities. Magnetic resonance imaging (MRI) of the brain showed signal abnormalities in numerous areas. The patient underwent liver transplantation and six months after normalization of liver function, tremor as well as brain MRI abnormalities almost completely regressed. This case report presents the asymmetric and reversible kinetic, postural and resting tremor of upper extremities as part of the spectrum of neurological abnormalities in HE.Hepatalna encefalopatija poremećaj je funkcije mozga uzrokovan jetrenom insuficijencijom. Klinički se može očitovati širokim spektrom neuroloških i psihijatrijskih poremećaja. Ovdje prikazujemo 43-godišnjeg muškarca s hepatalnom encefalopatijom i asimetričnim akcijskim, posturalnim i tremorom u mirovanju gornjih udova. Magnetska rezonancija (MR) mozga pokazala je promjene signala u brojnim arejama. Bolesnik je podvrgnut transplantaciji jetre i šest mjeseci nakon normalizacije jetrene funkcije tremor i MR promjene mozga gotovo su se potpuno povukle. Ovaj prikaz slučaja predočuje asimetričan i reverzibilan akcijski, posturalni i tremor u mirovanju gornjih udova kao dio spektra neuroloških poremećaja u hepatalnoj encefalopatiji

Progression of Optic Neuritis to Multiple Sclerosis in the County of Split-Dalmatia, Croatia

The aim of this study was to determine the incidence of monosymptomatic optic neuritis (MON) and progression of MON to multiple sclerosis (MS) from the Mediterranean region of southern Europe in the County of Split-Dalmatia, Croatia during the 11 years period from 1991 to 2001. This study was made retrospectively on the 87 cases (59 female, aged 25.9±11.3 and 28 male aged 29.9±9.2) of MON, which were treated at the Department of Ophthalmology and Department of Neurology, Split, University Hospital, from January 1991 to December 2001. In each case the diagnosis was confirmed by a chart review and cases were ascribed to the data of admittance at hospital. The annual incidence of MON was 1.9 per 100,000 (95% CI, 0.4–3.5). The incidence among males was 1.2 (95% CI, 0–2.9) cases / 100,000 per year and 2.5 (95% CI, 0.1–4.9) among females. A significant seasonal variations in the incidence of MON was not found (c 2=6.81, p=0.08). MS developed in 20 of 87 patients (22.9%) and median time was 25 (SE 8) months, (95% CI, 9–41) after the MON onset. After two years 12.6% of patients with MON developed MS, 20.6% after 5 years and 22.9% after 10 years. MS was slightly but not significantly more frequent in women than in men (c 2 =0.72, p=0.3). In conclusion, the progression of MON to MS in the County of Split-Dalmatia, Croatia was at a relatively moderate frequency

Neurotoxicity that May Mimic Progressive Multifocal Leukoencephalopathy in Patient with Transplanted Kidney

We present the 55-year old woman who has had kidney transplantation three times. She has been treated with immunosuppressive therapy and lamivudine for hepatitis B and C. Nine years after the last transplantation she showed neurological symptoms that presented in the form of confusion and epileptic seizures of the grand mal type. A brain MRI showed large oval zones of hyperintense MR signal in T2- weighted image and hypointense in T1- weighted image around the frontal horns of the lateral ventricles, bilaterally and in both cerebellar hemispheres. After reduction in immunosuppression and the exclusion of lamivudine from therapy, the patient was stable with normal neurological status during the course of next five years. We start from the assumption that the concomitant use of cyclosporin with mycophenolate mofetil and lamivudine, despite normal concentrations of cyclosporin, might cause the accumulation of toxic metabolites and lead to neurotoxicity that mimics PML in a chronic viral environment

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 našim saznanjima nema studije koja je istraživala nastaju li umor i depresija kao najučestaliji simptomi kod bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili iz sekundarnih povezanih stanja kao što je OSA kod bolesnika s MS. Cilj naše anketne studije bio je utvrditi jesu li depresija i umor u bolesnika s MS povezani s kliničkim obilježjima OSA ili MS. Proveli smo anketu pomoću četiri validirana upitnika (STOP-BANG, Epworthova ljestvica pospanosti, ljestvica težine umora i revidirana ljestvica depresije Centra za epidemiološke studije) u 28 uzastopnih ambulantnih bolesnika s klinički i paraklinički dokazanom MS. Učestalost bolesnika s MS s povećanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna od kliničkih značajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuća terapija, drugi lijekovi) nije bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilježje OSA bila je značajno i pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). Također, depresija je značajno i pozitivno korelirala s povećanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). Konačno, utvrđena je značajna pozitivna korelacija između težine umora i simptoma depresije (p=0,003). OSA je čest poremećaj kod bolesnika s MS. Kliničke značajke i čimbenici rizika za OSA u bolesnika s MS povezani su s dva najčešće prijavljivana simptoma depresije i umora, podupirući tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

Kliničko značenje imunokompleksa u multiploj sklerozi : doktorska disertacija

Sažetak disertacije "Kliničko značenje imunokompleksa u multiploj sklerozi" nije dostupan

Kliničko značenje imunokompleksa u multiploj sklerozi : doktorska disertacija

Sažetak disertacije "Kliničko značenje imunokompleksa u multiploj sklerozi" nije dostupan