COMORBIDITIES IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA

Background: Comorbidities in multiple sclerosis (MS) have a big role in management of this chronic demyelinating neurodegenerative disorder. The aim of this study was to evaluate comorbidities in patients with MS in Croatia. Subjects and methods: This was a prospective cross-sectional study carried out in an out-patient setting at a tertiary healthcare centre over 10 months, which included 101 consecutive patients with MS (mean age 42.09 (range 19-77) years, 75 female, 26 male, EDSS score 3.1 (range 0.0- -42) years. Thirty-six patients were treated with disease modifying therapies (DMTs). Information on comorbidities was obtained during the medical interview. Data was analysed using software package IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Results: 33% (n=34) patients did not have any comorbidities, and there is an equal number of patients (n=34, 33%) that just had one comorbidity. 17.6% (n=18) of patients had two comorbidities, and 15.7% (n=16) three or more comorbidities. The most frequent comorbidity was depression found in 25 (24.75%) patients (19 (18.8%) women, 6 (5.9%) men), followed by the hypertension in 12.87% (n=13). Hyperlipidemia and migraine were each found in 6.93% (n=7), and hypothyreosis and arrhythmia each in 3.96% (n=4). The number of the comorbidities was found to significantly increase with the duration of MS (r=0.232, p=0.037). Women were found to have significantly bigger numbers of comorbidities than men (t=-2.59, df=74, p<0.05). Older patients with MS were found to have significantly more comorbidities (r=0.335, p<0.01). Conclusions: This study gives insight into the presence of comorbidities in Croatian patients with MS. Connection with comorbidities must be considered when managing patients with MS. Any other comorbidity in MS may also affect the condition of the patient in general, and also their quality of life, and requires a tailored approach in management

SEXUAL DYSFUNCTION AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA

Background: Both depression and sexual dysfunction (SD) may be present in patients with multiple sclerosis (MS). Objective: The aim of this study was to evaluate a possible association between SD and depression in patients with MS in Croatia. Subjects and methods: This was a prospective cross-sectional study carried out in tertiary healthcare centre over 10 months, which included 101 consecutive pwMS (mean age 42.09 (range 19-77) years, 75 female, 26 male, EDSS score 3.1 (range 0.0-7.0)). SD was assessed using Multiple Sclerosis Intimacy and Sexuality Ques tionnaire (MSISQ), which was for this purpose successfully translated and validated into Croatian. Information on treatment for depression was obtained during the medical interview. Data were analysed and interpreted using parametric statistics (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Results: 89 patients completed MSISQ. 25 patients were in treatment for depression, while 75 did not have depressive symptoms. On MSISQ 57 (43women, 14 men) patients had responded with ‘almost always/ always’ suggestive of SD. Majority of patients reported primary SD, followed by secondary and tertiary SD. Most difficulties were found regarding difficulty in getting or keeping a satisfactory erection (34.6% (N=9) men), followed by 32.9% (N=27) reporting that it takes too long to orgasm or climax, followe d with bladder or urinary symptoms in 32.6% (N=29). There were no significant differences between female and male patients re- garding treatment for depression ( Ȥ2=0.018, df=1, p>0.05). Results in all subcategories on t-test found that depressive patients had higher impact on SD when compared to non-depressive: overall (t=-2.691, df=87, p<0.01) and in regards to primary (t=-2,086, df=87, p<0.05), secondary (t=-2.608, df=87, p<0.05) and tertiary (t=-2.460, df=86, p<0.05) SD. Depressive patients on 7 questio ns showed significantly (p<0.05) higher SD symptoms: Muscle tightness or spasms in my arms, legs, or body; Tremors or shaking in hands or body; Pain, burning, or discomfort in their body; Feeling less attractive; Fear of being rejected sexually because of MS; Lack of sexual interest or desire; Less intense or pleasurable orgasms or climaxes. Conclusions: This study gives insight into the presence of depression and SD in Croatian patients with MS for which purpose valid questionnaire for the assessment of SD in MS patients MSISQ was with permission successfully translated and validated int o Croatian. The connection between depression and SD must be considered when managing patients with MS

ANXIETY AND DEPRESSION AS COMORBIDITIES OF MULTIPLE SCLEROSIS

Multiple Sclerosis (MS), a chronic inflammatory neurodegenerative disease, is accompanied by a number of comorbidities. Among the psychiatric ones, depression and anxiety occupy a special place. It is estimated that the prevalence of anxiety in the MS population is 22.1% verus 13% in the general population; whereas the prevalence of anxiety levels, as determined by various questionnaires, reaches even 34.2%. Systematic literature reviews (SPL) show considerable data variations due to differences in study design, sample size, diagnostic criteria and extremely high heterogeneity (I2). Among the more conspicuous factors associated with anxiety disorder in MS are demographic factors (age and gender), nonsomatic depressive symptoms, higher levels of disability, immunotherapy treatments, MS type, and unemployment. Depression is the most common psychiatric commorbidity in MS and the lifetime risk of developing depression in MS patients is >50%. According to some research, the prevalence of depression in MS vary between 4.98% and 58.9%, with an average of 23.7% (I2=97.3%). Brain versus spinal cord lesions, as well as temporal lobe, fasciculus arcuatus, superior frontal and superior parietal lobe lesions in addition to the cerebral atrophy have been shown to be the anatomical predictors of depressive disorder in MS. Hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA) and the consequent dexamethasone-insupressible hypercortisolemia, in addition to cytokine storm (IL-6, TNF--4) present the endocrine and inflammatory basis for development of depression. Fatigue, insomnia, cognitive dysfunction, spasticity, neurogenic bladder, pain, and sexual dysfunction have shown to be additional precipitating factors in development of anxiety and depression in MS patients

LOWER URINARY TRACT SYMPTOMS AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS

Background: Both depression and lower urinary tract symptoms (LUTS) may be present in patients with multiple sclerosis (MS). The objective of this study was to give an insight on depression and LUTS in patients with MS in Croatia and to determine the possible association between LUTS and depression in patients with MS. Subjects and methods: This was a prospective cross-sectional study conducted in a tertiary healthcare center in Croatia. Hundred and one consecutive patients with MS (75 female, 26 male, mean age 42.09 (range 19-77) years, mean Expanded Disability Status Scale (EDSS) score 3.1 (range 0.0-7.0)) participated in this study. We evaluated LUTS and related quality of life (QoL) using three International Consultation on Incontinence Questionnaires (ICIQ) enquiring about overactive bladder (ICIQ-OAB), urinary incontinence short form (ICIQ-UI SF) and lower urinary tract symptoms related quality of life (ICIQLUTS-QoL). ICIQ-OAB and ICIQLUTS-QoL were for this purpose with permission successfully translated and validated into Croatian, while ICIQ-UI SF was already previously validated for the Croatian language. Information regarding treatment for depression was obtained during the medical interview. Data were analyzed and interpreted using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). Results: 89.10% (N=90) patients with MS reported urgency with urge urinary incontinence (UUI) present in 70.29% (N=71). 81.18% (N=82) patients reported nocturia, and 90.09% (N=91) reported feeling drowsy or sleepy during the day due to bladder symptoms. Neurological deficit measured by EDSS was found to positively correlate with LUTS on all three questionnaires: ICIQOAB (r=0.390, p<0.05), ICIQ-UI SF (r=0.477, p<0.01) and ICIQ-LUTSQoL (r=0.317, p<0.05). 25 patients were in treatment for depression. There were no significant differences between female and male patients regarding treatment for depression (2=0.018, df=1, p>0.05). Results on ICIQ-UI SF showed that depressive patients had more pronounced LUTS (t=2.067, df=99, p<0.05), which was also true for the ICIQ-LUTSQoL (t=-2.193, df=99, p<0.05). Positive correlations were found between depression and LUTS on ICIQ-UI SF (r=0.203, p<0.05) and ICIQ-LUTSQoL (r=0.215, p<0.05). Conclusion: This study gives insight into the presence of depression and LUTS in Croatian patients with MS for which purpose ICIQ-OAB and ICIQ-LUTSQoL were with permission successfully translated and validated into Croatian. The connection between depression and LUTS must be considered when managing patients with MS

Klinička istraživanja u zemljama u razvoju - etička promišljanja

When designing clinical trial or considering decision to take part in particular clinical trial as investigators, even before submission to responsible Central Ethic Committee, we always make certain private assessment about ethical justification of this clinical trial. When making assessment if any clinical trial is ethically justifiable, there should make no difference in which country this clinical trial will be executed. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial. There must be careful assessment of clinical protocols by various independent local advisory committees (e.g. hospital review boards, hospital drug committees, hospital administration and whatever is applicable) to exclude the possibility that only one person or one group of people has concentrated power to make decisions for entire country. Many times physicians/clinical researchers from developing countries are faced with the criticisms that they are not of the same quality as physicians from developed countries and that they can be easily bribed by sponsors, which are based on the prejudice that any clinical trial can be executed in developing countries, no matter of quality or risks for patients. Physicians coming from developing countries must ensure that patient population of developing countries is not misused in any ethically questionable clinical trial.Prilikom pripreme kliničkog istraživanja ili promišljanja o sudjelovanju u određenom kliničkom istraživanju kao istraživači, čak I prije centralnog etičkog odbora, uvijek osobno procijenimo etičku opravdanost tog kliničkog istraživanja. Prilikom procjene etičke opravdanosti kliničkog istraživanja, ne bi trebalo činiti nikakvu razliku to u kojoj se državi provodi kliničko istraživanje. Liječnici iz zemalja u razvoju moraju osigurati da pacijenti iz zemalja u razvoju nisu zloupotrebljeni u etički upitnom istraživanju. Mora postojati detaljna procjena kliničkih protokola od strane raznih lokalnih savjetodavnih odbora (kaon a primjer: bolnička uprava, administracija, odbor za lijekove i što je već prikladno ) tako da bi se isključila mogućnost da samo jedna osoba ili skupina ljudi ima svu moć u donošenju odluka za cijelu zemlju. Liječnici/klinički istraživači iz zemalja u razvoju često se suočavaju s kritikama da nisu dovoljno kvalitetni kao oni iz razvijenih zemalja te da ih sponzori lako podmite, temeljeno na predrasudama o tome da klinička istraživanja mogu biti provedena u zemljama u razvoju bez obzira na sigurnost pacijenata. Liječnici iz zemalja u razvoju moraju osigurati da pacijenti iz zemalja u razvoju nisu zloupotrebljeni u etički upitnom istraživanju

Application of Specific Judo Operators in the Preparatory Part of Athlete Training : Undergraduate Thesis

U ovom radu su opisani kineziološki operatori koji se primjenjuju u judo treningu, osobito s mlađim dobnim kategorijama, a mogu imati svoju primjenu u velikom broju drugih sportova, osobito u uvodno-pripremnom dijelu treninga. Svi navedeni operatori kategorizirani su u 4 skupine i više podskupina sukladno načinu izvedbe (individualno ili u parovima, te u kretanju ili u mjestu). Ovaj rad stoga može imati veliku praktičnu vrijednost trenerima u osmišljavanju i planiranju trenažnih jedinica.This final thesis describes kinesiological operators that are used in judo training, especially with younger age categories, and can have their application in a large number of other sports, especially in the introductory-preparatory part of training. All these operators are categorized into 4 groups and more subgroups according to the method of performance (individually or in pairs, and in motion or in place). This final thesis can therefore be of great practical value to trainers in designing and planning training units

Application of Specific Judo Operators in the Preparatory Part of Athlete Training : Undergraduate Thesis

U ovom radu su opisani kineziološki operatori koji se primjenjuju u judo treningu, osobito s mlađim dobnim kategorijama, a mogu imati svoju primjenu u velikom broju drugih sportova, osobito u uvodno-pripremnom dijelu treninga. Svi navedeni operatori kategorizirani su u 4 skupine i više podskupina sukladno načinu izvedbe (individualno ili u parovima, te u kretanju ili u mjestu). Ovaj rad stoga može imati veliku praktičnu vrijednost trenerima u osmišljavanju i planiranju trenažnih jedinica.This final thesis describes kinesiological operators that are used in judo training, especially with younger age categories, and can have their application in a large number of other sports, especially in the introductory-preparatory part of training. All these operators are categorized into 4 groups and more subgroups according to the method of performance (individually or in pairs, and in motion or in place). This final thesis can therefore be of great practical value to trainers in designing and planning training units