Fatigue and depression in multiple sclerosis: Correlation with quality of life

The aim of this work was to examine the relationship between fatigue and depression, common features of multiple sclerosis (MS), and the quality of life (QOL). The study was comprised of 120 patients with clinical manifestations of definite MS. Relapsing-remitting MS was present in 76.7% patients and secondary progressive MS was present in 23.3% patients. Mean disease duration was 8.1 ± 5.6 years and the mean Expanded Disability Status Score (EDSS) was 3.5 ± 1.8 (range 1-8). Fatigue was measured with the Fatigue Severity Scale (FSS), depression was measured by the Beck Depression Inventory (BDI) and QOL was assessed using the health-related quality of life questionnaire SF-36. We observed that the global FSS score was 4.6 ± 1.8 (range 1-7) and BDI was 10.7 ± 10.3 (range 0-39). The FSS significantly and positively correlated with the BDI scores (r = 0.572; p = 0.000). The severity of fatigue had a significant impact on the quality of life (r = -0.743; p = 0.000), in particular on mental health (r = -0.749; p = 0.000). We observed a significant correlation between the severity of depression and impaired quality of life (r = -0.684; p = 0.000). This study shows that fatigue and depression are associated with impaired QOL in MS

Melas syndrome - Case report

Syndrome that includes mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes is briefly called MELAS. It is a rare (estimated prevalence is 16/100 000), progressive, neurodegenerative and incurable disease. It is a result of mutation of mitochondrial DNA. We report herein a case of 24-year-old woman who suffers from MELAS. First simptoms occurred in the age of 13 in the manner of headache and vomiting. Later on seizures have been registered, in the beginning as atypical apsans like, and than in the way of complex partial and generalised tonic-clonic seizures. They were often refractory with the applied antiepileptic therapy. In the course of illness speech disorder, memory loss, sight and hearing disorder occured with psychiatric changes. Motor weakness appeared as a result of repeated brain ischaemia and ecephalomalacia. Previously mentioned signs of the disease had their correlation in the diagnostic procedures. Endocranial MR showed signs of continuous deterioration of the disease with necrosis in numerous parts of the brain. Elevated lactate level has been found, marked with press sequences that matches sequelaes of oxidative metabolism. EEG showed signs of epileptiform dysfunction. Genetic investigation was positive. Since there is no causal therapy, early recognition and symptomatic treatment may be of certain benefit

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Prevalence of Asymptomatic Abdominal Aortic Aneurysm in Patients with Carotid Stenosis

The aim of this study was to demonstrate the prevalence of abdominal aortic aneurysm in patients with carotid disease and to analyse the influence of cardiovascular risk factors for abdominal aortic aneurysm. Methods: Ultrasound for abdominal aortic aneurysm was performed in 200 patients (112 men and 88 women, mean age 65.72±7.71 years) with known carotid disease. The primary cardiovascular risk factors (age, sex, hypertension, diabetes, dyslipidaemia and smoking) were analysed. Results: We found that 15.5% of patients with carotid stenosis also had abdominal aortic aneurysm. The prevalence of abdominal aortic aneurysm was higher in men (22.23%) than in women (6.81%). There was no correlation between the severity of carotid disease and the diameter of the abdominal aortic aneurysm (p>0.05). Advanced age and smoking were independent risk factors for abdominal aortic aneurysm. Conclusion: These results demonstrate that the prevalence of abdominal aortic aneurysm is higher in patients with carotid disease than in the general population. Patients with known carotid disease may be candidates for selective screening for abdominal aortic aneurysm detection

Temporal variations of stroke occurence

© 2017, University of Kragujevac, Faculty of Science. All rights reserved. Stroke is one of leading causes of death worldwide. Different frequency of stroke occurence is observed in days of the week and months in the year, and incidence of stroke has irregular time pattern. We analyzed 516 patients who had acute stroke and were treated in Clinic of Neurology, Clinical Center Kragujevac from January 1, 2013 to January 1, 2014, mean age 72,11 ± 11,52. Statistical analysis is conducted out using the SPSS software version 20.0. We used descriptive statistic, student T-test, chi-square or Fisher exact test. Friday is day we found the most IS and all stroke types occurences, and Wednesday is day we found the most IS in men. We found the most strokes in women younger than 65 years on Wednesday, but in women older than 65 years on Friday. Monday is day with the most admissions to hospital for patients wiThis, and we observed that there is average delay in the refering to the doctor for 1.80 ± 1.44 days. Friday is the day with the most ICH symptom beginings and the most admissions to the hospital, and Saturday is the day with the least symptom beginings and admissions to the hospital in the case of IS and ICH. The most IS occured in winter (in Decembar), and the least in summer (in August). The most ICH occured in May, and the least in July and October. We confirmed that there is a significant weekly variability in the IS symptom onset day

How does a mobile network infrastructure incumbent vendor use BMI in the context of 5G & 6G technological disruption? : A case study

Abstract Background The major mobile infrastructure incumbent vendors form an oligopoly of mobile technology leaders that have not changed their business models significantly as new mobile technology generations have been introduced since 1980. The introduction of 5G and research in 6G have created uncertainty calling for openness, disaggregation of software from hardware, and variety of industrial customers. The incumbent vendors need to innovate technology and business model (BM) to increase their chances of survival. Objectives This thesis aims to investigate how mobile network infrastructure incumbent vendors use business model innovation (BMI) in context of uncertainties related to 5G & 6G disruptive innovation. The purpose of the thesis is to refine the extant theory of BMI and to provide practitioners with recommendations on how to use BMI in the nascent phase of disruptive innovation. Methodology The grounded theory research process based on an exploratory qualitative single-case holistic study is used. The primary data is collected from thirteen semi-structured interviews while supportive secondary data is publicly available and collected via the Internet. Using inductive reasoning the study data analysis process produced first-order concepts, second-order themes and aggregate dimensions used to refine and extend the initial theoretical framework for BMI process usage. Findings When faced with uncertainty of disruptive innovation, the industry incumbents use the scenario-driven thinking to simultaneously develop a portfolio of BMs both by in-house diversification and by mergers and acquisitions. The management of BMI process leads to foreseeing and leveraging of both the internal resources and external resources. The internal resources are developed using BM ambidexterity, double ambidexterity, and intra-organizational learning, The external resources are developed via business ecosystems development and open BM innovation. Development of the resources creates unique managerial challenges related to ambidexterity, coopetition, and cultural transformation. Conclusions Our study provides the empirical grounds for a model of BMI usage by industry incumbents. Our model extends the scope of the extant theoretical discussions and provides details supported with rich empirical evidence from the nascent phase of technological disruption. The emphasis is on the firm’s dynamics that deal with multiple BMs and their innovation. We argue that while studying the process of single BMI is beneficial, the full understanding of BMI can be achieved only by covering the management of interactions and interdependencies among multiple simultaneous BMIs. Recommendations for future research Multiple-case studies to cover other industries would be beneficial to achieve generalization. Also, the longitudinal approach should be used in future studies to understand the impact of the BMI process management choices in the nascent phase on the survival and performance of the incumbents