Vascular comorbidities in patients with multiple sclerosis and their impact on physical disability.

Aim Given the impact of vascular comorbidities (VC) on the diagnosis, treatment, and outcome of multiple sclerosis (MS), we examined the incidence and correlation of VC and risk factors for vascular disease in people with MS (PwMS) compared to the general population, and the impact on the physical disability of patients. Methods Cross-sectional study involved 100 patients with MS and 50 healthy people from the general population, matched by sex and age. The values of demographic, biochemical, and anthropometric parameters, the presence of VC and risk factors for vascular diseases in both groups, and clinical parameters in PwMS were analysed. Statistical analysis included methods of descriptive statistics, χ2 test, Student's t-test, analysis of variance, correlation and regression analysis. Results Groups differed by a higher frequency of transient ischemic attack in the control group (p=0.024), and the treatment of hypertension (p=0.038) and smoking frequency (p=0.044) in the MS group. Normal triglycerides levels were statistically significantly more prevalent in the MS group (p=0.000). Total body weight and BMI were statistically significantly higher in the control group (p=0.000). The increase in Expanded Disability Status Scale (EDSS) score was associated with higher levels of total (p=0.001) and low-density lipoprotein (LDL) cholesterol (p=0.003), and activated partial thromboplastin time APTT (p=0.002). Conclusion In PwMS it is necessary to pay attention to the higher frequency of smoking than in general population, and the impact of total cholesterol, LDL and APTT levels as significant parameters that affect physical disability.

Memory efficiency in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate memory in patients with drug-resistant epilepsy. METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). CONCLUSION: Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

Entropy Analysis of COVID-19 Cardiovascular Signals.

The world has faced a coronavirus outbreak, which, in addition to lung complications, has caused other serious problems, including cardiovascular. There is still no explanation for the mechanisms of coronavirus that trigger dysfunction of the cardiac autonomic nervous system (ANS). We believe that the complex mechanisms that change the status of ANS could only be solved by advanced multidimensional analysis of many variables, obtained both from the original cardiovascular signals and from laboratory analysis and detailed patient history. The aim of this paper is to analyze different measures of entropy as potential dimensions of the multidimensional space of cardiovascular data. The measures were applied to heart rate and systolic blood pressure signals collected from 116 patients with COVID-19 and 77 healthy controls. Methods that indicate a statistically significant difference between patients with different levels of infection and healthy controls will be used for further multivariate research. As a result, it was shown that a statistically significant difference between healthy controls and patients with COVID-19 was shown by sample entropy applied to integrated transformed probability signals, common symbolic dynamics entropy, and copula parameters. Statistical significance between serious and mild patients with COVID-19 can only be achieved by cross-entropies of heart rate signals and systolic pressure. This result contributes to the hypothesis that the severity of COVID-19 disease is associated with ANS disorder and encourages further research.

PREDICTORS OF EARLY-ONSET DEPRESSION AFTER FIRST-EVER STROKE.

Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.

Ego Defence Mechanisms in Patients with Epilepsy.

BACKGROUND: In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS: We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS: Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION: Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

Quality of life in patients with multiple sclerosis in Republic of Srpska.

AIM: To estimate health-related quality of life (HRQoL) in patients with multiple sclerosis (MS), and to investigate relationship between HRQoL and selected demographic and clinical parameters. METHODS: In this cross-sectional study HRQoL was measured using the MS-specific MSQoL-54 questionnaire. Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS), and presence of depression and anxiety using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Statistical analysis included descriptive statistics and correlation analysis. RESULTS: The results confirmed that physical disability had a significant impact on HRQoL. Correlations were the strongest for the domains of physical health (PH) (r=-0.718), overall quality of life (QL) (r=-0.528), satisfaction with sexual function (r=-0.493) and role limitations due to emotional problems (r=-0.493) of MSQoL- 54 scales. It was found that there were statistically significant correlations between composite score of PH of MSQoL-54 scale and duration of MS ( r=-0.381), employment status (r=-0.624), educational level (r=0.384), occupation (r= 0.552), and age at disease onset (r=-0.434). There were statistically significant correlations between anxiety and depression and low scores on a majority of MSQoL-54 subscales. Correlations were the strongest for the subscales of QL (r=-0.674), energy (r=-0.629), sexual function (r=-0.579) and PH (r=-0.573) for HARS and QL (r=-0.751), PH (r=-0.629) and satisfaction with sexual function (r=-0.612) for HDRS. CONCLUSION: Our results indicate that HRQoL is influenced not only by disability itself, but rather by interactions of a range of physical, psychological and social factors.

Hemorrhagic complications of thrombolytic therapy.

Stroke is the most frequent neurological disorder, and the most common cause of severe disability compared to other diseases. Recombinant tissue plasminogen activator (rt-PA) is the only approved specific therapy for acute ischemic stroke. Hemorrhage is a significant complication of thrombolytic treatment. This study, which included a hundred patients (52 male and 48 female), was aimed at assessing the safety according to our experience with 100 thrombolytic treatments for stroke. The death rate related to hemorrhage after thrombolysis was 3%. The frequency of hemorrhagic events (hemorrhagic infarctions type 1 and 2, parenchymal hematomas type 1 and 2) was 16%. The study results have shown that the intravenous recombinant tissue plasminogen activator (rt-PA) therapy is safe.

Vascular dementia: clinical and neuroradiological correlation.

All stroke patients admitted to Banjaluka Clinical Centre during one year were evaluated by the standard protocol during the hospitalization and three months after the stroke. It included clinical, functional and neuropsychological examination and neuroimaging. Dementia was diagnosed according to the criteria of National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences. Demographic and clinical variables were examined. After the exclusion of the patients who died (n = 139) and those who refused to be interviewed during the 3-month follow up (n = 52) and those with pre-stroke dementia (n = 22), a total of 273 (58.8%) patients underwent neuropsychological examination 3 months after the stroke. Forty-nine (19.52%) of them met the criteria for vascular dementia. The predictors of vascular dementia were age, atrial fibrillation, cognitive and functional impairment on admission and functional outcome, subcortical lacunar infarctions, leukoaraiosis, multiple and bilateral brain lesions. Dementia is frequent after stroke and it cannot be determined by a single factor. A combination of several factors increases the critical threshold for cognitive decline.

Functional outcome after thrombolytic therapy.

In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score > or=90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score < or =2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a 'door-to-needle' time of less than 60 minutes and emphasize that 'time is brain'.