Do we need broad immunological work-up in all patients with CIS?

BACKGROUND: The aim of this study was to determine the prevalence of altered immunological tests and their clinical significance in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). ----- PATIENTS AND METHODS: The information was gathered from medical records of patients hospitalized in the Referral Center for Demyelinating Diseases in the 2008-2010 period. All patients had ANA, ENA profile, ANCA, aCl IgG and IgM, C3, C4, CH50, anti-TPO, AST and RF antibodies tested. ----- RESULTS: From 726 patients with CIS that were reviewed, the complete battery of immunological tests was performed in 418 of them (57.6%), representing our cohort. Altered tests were found in 235 patients (56.2%); 73 (17.4%) had positive antinuclear antibodies, 14 (3.3%) had positive ENA, 47 (11.2%) had positive aCl IgG, 83 (19.8%) had positive aCl IgM, and 13 (3.1%) had anti TPO antibodies. We found no correlation between ANA, aCl IgG or IgM positivity (ANA vs aCL IgG p=0.554; ANA vs aCL IgM p=0.19; aCL IgG vs aCL IgM, p=0.155). None of the patients had any clinical manifestations other than MS symptoms. ----- CONCLUSION: These results indicate that significant number of patients with CIS have altered immunological tests but nevertheless none of them had clinical expression of any other autoimmune disease making them clinically insignificant. In conclusion there is no need to perform extensive immunological work-up in all patients with CIS. Contrary, our results argue for more focused testing rather than a battery of screening tests

Sexual dysfunction and sexual life satisfaction among male students

Cilj: Istraživanje seksualnog zdravlja u adolescenata uglavnom se temelji na rizičnom ponašanju i zdravstvenim ishodima, dok se seksualna disfunkcija u adolescenciji rijetko ispituje. Glavni cilj ovoga istraživanja bio je utvrditi učestalost erektilne disfunkcije i prerane ejakulacije među seksualno aktivnim studentima prve godine visokih škola i fakulteta te povezanost s njihovim zadovoljstvom seksualnim životom. Metode: Ukupno je 174 studenata prve godine samostalno ispunilo anonimni anketni list o medicinskim podacima, rizičnim čimbenicima ponašanja i seksualnom životu. Rezultati: Ispitivanje je pokazalo učestalost erektilne disfunkcije od 17,8% i prerane ejakulacije od 9,8%. Samo je 4,6% ispitanika potvrdilo teškoće s erekcijom. Vjerojatnost nastupa erektilne disfunkcije sedam puta je veća kod mladića koji nisu zadovoljni svojim osobnim seksualnim životom (OR 6,75; CI 2,85-15,85; p<0,001). Zaključak: Ovo pitanje zahtijeva pragmatičan pristup imajući na umu specifi čnost populacije adolescenata, osjetljivost ovoga pitanja i često neprepoznavanje erektilne disfunkcije. Dokazano je da je nezadovoljstvo seksualnim životom snažno povezano s erektilnom disfunkcijom. Kako bi otkrili osobe s potencijalnim poremećajem, stručnjaci trebaju započeti s pitanjima o zadovoljstvu seksualnim životom, a ne ispitivati izravno o teškoćama s erekcijom.Purpose: Research on adolescent sexual health is mainly based on risky behaviour and health outcomes, whereas sexual functioning in adolescence is poorly investigated. The main aim of the study was to determine the prevalence of erectile dysfunction and premature ejaculation among sexually active fi rst-year male college and university students, and its association with sexual life satisfaction. Methods: A total of 174 fi rst-year male college students fi lled out an anonymous, self-administered questionnaire on medical information, behavioural risk factors, and sexual life. Results: The current study showed the prevalence of erectile dysfunction and premature ejaculation of 17.8% and 9.8%, respectively. Only 4.6% of the participants acknowledged erection diffi culties. Young men dissatisfi ed with personal sexual life had a seven-fold greater probability to experience erectile dysfunction (OR 6.75; CI 2.85-15.85; p<0.001). Conclusion: Bearing in mind the specifi city of adolescent population, sensitivity of the subject, and often unawareness of erectile dysfunction, approach should be pragmatic. Sexual life dissatisfaction proved to be strongly related to erectile dysfunction. In order to detect those with potential disorder, professionals should initially ask about sexual life satisfaction rather than enquire directly into erection diffi culties

Differences in oligoclonal bands and visual evoked potentials in patients with radiologically and clinically isolated syndrome

The aim of this study was to determine the prevalence of cerebrospinal fluid (CSF) and visual evoked potentials (VEP) abnormalities, and ANA titers in patients with either clinically or radiologically isolated syndrome (CIS and RIS). We gathered records from 330 hospitalized patients diagnosed with CIS/RIS within a 3-year period. Symptoms, CSF findings, VEP and ANA titers were analyzed. Incomplete transverse myelitis was the presenting symptom in 32.7 %, optic neuritis in 22.7 %, brainstem/cerebellar symptoms in 19.4 %, hemispheral symptoms in 2.7 % and multifocal symptoms in 15.2 % of patients in the CIS cohort. We identified 24 (7.3 %) patients with atypical or no symptoms-RIS cohort. Positive oligoclonal bands (OCB) were found in 75.5 % patients. When we divided the patients into CIS and RIS groups, the presence of OCB was 82.4 and 44 %, respectively. VEP were performed in 87.3 % patients and prolonged latencies were found in 39.6 % of them (43.8 and 14.3 % in the CIS and RIS cohort, respectively). ANA were positive in 15.2 % (14.7 and 16 % in the CIS and RIS cohort, respectively) of patients. RIS patients had statistically significant lower percentages of positive OCB and positive VEP (P = 0.002 and 0.001, respectively). Detection of OCB and VEP still has an important role for satisfying the "no better explanation for the clinical presentation" criteria when presented with a patient with a first "radiological" demyelinating episode

Morbidly Obese are Ghrelin and Leptin Hyporesponders with Lesser Intragastric Balloon Treatment Efficiency: Ghrelin and Leptin Changes in Relation to Obesity Treatment

Background: Ghrelin and leptin recently emerged as the most influential neuroendocrine factors in the pathophysiology of obesity. The said peptides act in reciprocity and are responsible for regulation of appetite and energy metabolism. Intragastric balloons acquired worldwide popularity for obesity treatment. However, the roles of ghrelin and leptin in intragastric balloon treatment were still not systematically studied. Methods: A prospective single-center study included 43 Caucasians treated with BioEnterics intragastric balloon, with age range of 18–60, and divided to non-morbid (body mass index cutoff 40 kg/m2) or morbid type of obesity, with 12 months follow-up. Serum hormonal samples were taken from fasting patients and kept frozen until analyses. Results: Significant differences were observed in anthropometrics and there were no differences between genders or comorbidities. The baseline weight for non-morbid vs. morbid was 104 kg (90–135) vs. 128.5 kg (104–197). Weight loss was statistically different between the studied groups during the study course with a median control weight at 6 months of 92 kg (72–121) vs. 107 kg (84–163), p<0.001. Treatment was successful for 18 (94.7%) vs. 16 (66.7%) patients, p= 0.026. Ghrelin varied from 333.3 to 3,416.8 pg/ml and leptin from 1.7 to 61.2 ng/ml, with a statistically significant time dependent relationship. A significant difference (p=0.04) with emphasized ghrelin peak was found in the 3rd month of treatment for non-morbidly obese subjects. Conclusions: The importance of ghrelin and leptin in treatment-induced changes was reaffirmed. Ghrelin hyperresponse in non-morbidly obese subjects characterized greater short-term treatment efficiency and landmarked an inclination to weight regain. The results suggest a potential pattern of individualization between obese patients according to body mass index towards intragastric balloon or bariatric surgery. Further studies are needed in order to get better insights in the pathophysiologic mechanisms of obesity

Surveillance of Tahyna Orthobunyavirus in Urban Areas in Croatia—The “One Health” Approach

Background: Tahyna orthobunyavirus (TAHV) is a neglected mosquito-borne bunyavirus. Although the virus is widespread in continental Europe, TAHV infections are rarely reported. We analyzed the prevalence of TAHV in humans and different animal species as well as mosquitoes collected in urban areas of Zagreb and its surroundings in the period from 2020 to 2022. Methods: The study included 32 patients with neuroinvasive disease (NID), 218 asymptomatic individuals, 98 horses, 94 pet animals (dogs and cats), and 4456 Aedes vexans mosquitoes. Cerebrospinal fluid (CSF) and urine samples of patients with NID were tested for the TAHV RNA using a real-time reverse transcription-polymerase chain reaction (RT-qPCR). Human and animal serum samples were tested for TAHV-neutralizing (NT) antibodies using a virus-neutralization test (VNT). Mosquito pools were tested for TAHV RNA using an RT-qPCR. Results: TAHV NT antibodies were detected in 3/9.4% of patients with NID, 8/3.7% of asymptomatic individuals, 29/29.6% of horses, and 11/11.7% of pet animals. There was no difference in the seroprevalence according to age, sex, and area of residence in asymptomatic individuals. In addition, TAHV seropositivity did not differ according to age and sex in pet animals. None of the tested mosquito pools was TAHV RNA-positive. Conclusions: The presented results highlight the importance of interdisciplinary surveillance (“One Health”) of this neglected viral zoonosis

Do we need broad immunological work-up in all patients with CIS?

BACKGROUND: The aim of this study was to determine the prevalence of altered immunological tests and their clinical significance in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). ----- PATIENTS AND METHODS: The information was gathered from medical records of patients hospitalized in the Referral Center for Demyelinating Diseases in the 2008-2010 period. All patients had ANA, ENA profile, ANCA, aCl IgG and IgM, C3, C4, CH50, anti-TPO, AST and RF antibodies tested. ----- RESULTS: From 726 patients with CIS that were reviewed, the complete battery of immunological tests was performed in 418 of them (57.6%), representing our cohort. Altered tests were found in 235 patients (56.2%); 73 (17.4%) had positive antinuclear antibodies, 14 (3.3%) had positive ENA, 47 (11.2%) had positive aCl IgG, 83 (19.8%) had positive aCl IgM, and 13 (3.1%) had anti TPO antibodies. We found no correlation between ANA, aCl IgG or IgM positivity (ANA vs aCL IgG p=0.554; ANA vs aCL IgM p=0.19; aCL IgG vs aCL IgM, p=0.155). None of the patients had any clinical manifestations other than MS symptoms. ----- CONCLUSION: These results indicate that significant number of patients with CIS have altered immunological tests but nevertheless none of them had clinical expression of any other autoimmune disease making them clinically insignificant. In conclusion there is no need to perform extensive immunological work-up in all patients with CIS. Contrary, our results argue for more focused testing rather than a battery of screening tests