Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

SAMOPROCIJENJENA SURADLJIVOST BOLESNIKA KORELIRA SA SERUMSKIM FOSFOROM, OSTATNOM DIUREZOM I STATUSOM UHRANJENOSTI BOLESNIKA NA HEMODIJALIZI: MEĐUNARODNO, MULTICENTRIČNO ISTRAŽIVANJE

Compliance is a major obstacle to achieving phosphorus control in the majority of patients with end-stage renal disease. We investigated self-reported medication adherence and its correlation with serum phosphate levels and nutritional status in hemodialysis patients. A total of 417 patients from Croatia, Montenegro and Bosnia and Herzegovina, mean age 63.82 (range, 21-92) years, were included in the study. There were 55.1% of male patients with the mean dialysis vintage of 68.67 (range, 3-456) months. A signifi cant positive correlation was found between self-reported adherence and serum phosphorus (0.192), and negative correlation with hemoglobin, prealbumin, albumin, Kt/V and residual diuresis (-0.187, -0.227, -0.100, 0.192, and -0.106, respectively). On the other hand, the number of pills taken daily correlated signifi cantly with residual diuresis, serum prealbumin, serum glucose, triglycerides, ferritin and ultrafi ltration volume (0.241, 0.154, 0.158, 0.112, 0.201 and 0.125, respectively). In conclusion, self-reported medication adherence correlates with serum phosphate levels, residual diuresis and nutritional status in hemodialysis patients.Suradljivost je glavna prepreka kontroli fosfora u većine bolesnika sa završnim stadijem kronične bubrežne bolesti. Istražili smo povezanost suradljivosti s uzimanjem lijekova, procijenjene od strane samih bolesnika, s koncentracijom fosfora u serumu i statusom uhranjenosti bolesnika na hemodijalizi. U istraživanje je uključeno 417 bolesnika iz Hrvatske, Crne Gore i Bosne i Hercegovine. Prosječna dob bila je 63,82 godine (raspon, 21-92), 55,1 % ih je bilo muškog spola, prosječno liječenih dijalizom 68,67 (raspon, 3-456) mjeseci. Nađena je statistički značajna pozitivna korelacija između suradljivosti i serumskog fosfora (0,192), a negativna s prealbuminom, albuminom, Kt/V i ostatnom diurezom (redom, -0,187, -0,227, -0,100, 0,192 i -0,106). S druge strane, broj dnevno unesenih tableta je statistički značajno korelirao s ostatnom diurezom, serumskim prealbuminom, glukozom, trigliceridima, feritinom i volumenom ultrafi ltracije (redom, 0,241, 0,154, 0,158, 0,112, 0,201 i 0,125). Zaključno, samoprocijenjena suradljivost bolesnika korelira sa serumskim fosforom, ostatnom diurezom i statusom uhranjenosti bolesnika na hemodijalizi

SAMOPROCIJENJENA SURADLJIVOST BOLESNIKA KORELIRA SA SERUMSKIM FOSFOROM, OSTATNOM DIUREZOM I STATUSOM UHRANJENOSTI BOLESNIKA NA HEMODIJALIZI: MEĐUNARODNO, MULTICENTRIČNO ISTRAŽIVANJE

Compliance is a major obstacle to achieving phosphorus control in the majority of patients with end-stage renal disease. We investigated self-reported medication adherence and its correlation with serum phosphate levels and nutritional status in hemodialysis patients. A total of 417 patients from Croatia, Montenegro and Bosnia and Herzegovina, mean age 63.82 (range, 21-92) years, were included in the study. There were 55.1% of male patients with the mean dialysis vintage of 68.67 (range, 3-456) months. A signifi cant positive correlation was found between self-reported adherence and serum phosphorus (0.192), and negative correlation with hemoglobin, prealbumin, albumin, Kt/V and residual diuresis (-0.187, -0.227, -0.100, 0.192, and -0.106, respectively). On the other hand, the number of pills taken daily correlated signifi cantly with residual diuresis, serum prealbumin, serum glucose, triglycerides, ferritin and ultrafi ltration volume (0.241, 0.154, 0.158, 0.112, 0.201 and 0.125, respectively). In conclusion, self-reported medication adherence correlates with serum phosphate levels, residual diuresis and nutritional status in hemodialysis patients.Suradljivost je glavna prepreka kontroli fosfora u većine bolesnika sa završnim stadijem kronične bubrežne bolesti. Istražili smo povezanost suradljivosti s uzimanjem lijekova, procijenjene od strane samih bolesnika, s koncentracijom fosfora u serumu i statusom uhranjenosti bolesnika na hemodijalizi. U istraživanje je uključeno 417 bolesnika iz Hrvatske, Crne Gore i Bosne i Hercegovine. Prosječna dob bila je 63,82 godine (raspon, 21-92), 55,1 % ih je bilo muškog spola, prosječno liječenih dijalizom 68,67 (raspon, 3-456) mjeseci. Nađena je statistički značajna pozitivna korelacija između suradljivosti i serumskog fosfora (0,192), a negativna s prealbuminom, albuminom, Kt/V i ostatnom diurezom (redom, -0,187, -0,227, -0,100, 0,192 i -0,106). S druge strane, broj dnevno unesenih tableta je statistički značajno korelirao s ostatnom diurezom, serumskim prealbuminom, glukozom, trigliceridima, feritinom i volumenom ultrafi ltracije (redom, 0,241, 0,154, 0,158, 0,112, 0,201 i 0,125). Zaključno, samoprocijenjena suradljivost bolesnika korelira sa serumskim fosforom, ostatnom diurezom i statusom uhranjenosti bolesnika na hemodijalizi

Association of multiple retinal nodular hamartomas and "confetti" skin lesions with end-stage renal disease in patients with tuberous sclerosis

Purpose: The main purpose of this study is to explore characteristics of patients with chronic kidney disease in tuberous sclerosis (TSC) and to underline differences in clinical characteristics between end-stage renal disease (ESRD) patients and patients in earlier stages of chronic kidney disease. Methods: This multicentric, retrospective study included data for 48 patients from seven South-Eastern European countries (Albania, Bosnia and Herzegovina, Croatia, Greece, Montenegro, Serbia, Slovenia) in the period from February to August 2020. Researchers collected data from local and national nephrological and neurological registries and offered clinical and laboratory results from medical histories in follow-up periods. Results: This study enrolled 48 patients with a median age of 32.3 years (range, 18-46 years), and predominant female gender (60.45%). The percentage of patients with chronic kidney disease (CKD) diagnosis of the total number of patients was 66.90%, with end-stage renal disease development in 39.6%. The most prevalent renal lesions leading to chronic kidney disease were angiomyolipomas (AMLs) in 76.6%, while multiple renal cysts were present in 42.6% of patients. Nephrectomy was performed in 43% of patients, while the mTOR inhibitors were used in 18 patients (37.5%). The majority of patients had cutaneous manifestations of tuberous sclerosis-83.30% had hypomelanotic cutaneous lesions, and 68.80% had angiofibromas. Multiple retinal nodular hamartomas and "confetti" skin lesions were more frequent in end-stage renal disease (ESRD) than in patients with earlier stages of chronic kidney disease (p-0.033 and 0.03, respectively). Conclusion: Our study has also shown that retinal hamartomas and "confetti" skin lesions are more frequent in end-stage renal diseases (ESRD) patients than in other chronic kidney disease (CKD) patients. Usage of mTOR inhibitors can also reduce the number of complications and associated with tuberous sclerosis, such as dermatological manifestations and retinal hamartoma, which are more common in the terminal stage of chronic kidney disease