Smartphone-Based Voice Wellness Index Application for Dysphonia Screening and Assessment: Development and Reliability.

OBJECTIVE: This study aimed to develop a Voice Wellness Index (VWI) application combining the acoustic voice quality index (AVQI) and glottal function index (GFI) data and to evaluate its reliability in quantitative voice assessment and normal versus pathological voice differentiation. STUDY DESIGN: Cross-sectional study. METHODS: A total of 135 adult participants (86 patients with voice disorders and 49 patients with normal voices) were included in this study. Five iOS and Android smartphones with the "Voice Wellness Index" app installed were used to estimate VWI. The VWI data obtained using smartphones were compared with VWI measurements computed from voice recordings collected from a reference studio microphone. The diagnostic efficacy of VWI in differentiating between normal and disordered voices was assessed using receiver operating characteristics (ROC). RESULTS: With a Cronbach's alpha of 0.972 and an ICC of 0.972 (0.964-0.979), the VWI scores of the individual smartphones demonstrated remarkable inter-smartphone agreement and reliability. The VWI data obtained from different smartphones and a studio microphone showed nearly perfect direct linear correlations (r = 0.993-0.998). Depending on the individual smartphone device used, the cutoff scores of VWI related to differentiating between normal and pathological voice groups were calculated as 5.6-6.0 with the best balance between sensitivity (94.10-95.15%) and specificity (93.68-95.72%), The diagnostic accuracy was excellent in all cases, with an area under the curve (AUC) of 0.970-0.974. CONCLUSION: The "Voice Wellness Index" application is an accurate and reliable tool for voice quality measurement and normal versus pathological voice screening and has considerable potential to be used by healthcare professionals and patients for voice assessment.

Role of SIRT1 Gene Polymorphisms and Serum Levels in Patients with Multiple Sclerosis.

AIM: The purpose of this work was to investigate the prevalence of SIRT1 rs3818292, rs3758391, and rs7895833 single nucleotide polymorphisms and SIRT1 serum levels associated with multiple sclerosis (MS) in the Lithuanian population. METHODS: A total of 250 MS patients and 250 healthy controls were included in the study. Genotyping was performed using the RT-PCR method. Statistical analysis was performed using "IBM SPSS version 29.0". The serum SIRT1 level was determined by the ELISA method. RESULTS: We found that rs3818292 was associated with increased odds of developing MS under the dominant (p = 0.007) and allelic genetic (p = 0.004) models. rs3758391 was associated with increased odds of developing under the co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p = 0.002) genetic models. rs7895833 was associated with increased odds of developing MS under co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p < 0.001) genetic models. Additional sex-differentiated analysis within females revealed that the rs3758391 was associated with an increased odds ratio for the occurrence of MS among the co-dominant (p = 0.006), dominant (p = 0.002), and allelic (p = 0.001). rs7895833 was associated with an increased odds ratio for the development of MS under the co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p < 0.001) genetic models. Age-differentiated analysis showed that rs3758391 was associated with an increased odds ratio for the development of MS in younger patients under the codominant (p = 0.002), overdominant (p = 0.003), and dominant (p = 0.004) genetic models. rs7895833 was associated with an increased odds ratio for the occurrence of MS under the overdominant genetic model (p = 0.013). In elderly patients, rs3818292 was associated with an increased odds ratio for the occurrence of MS under the dominant (p = 0.008) and allelic (p = 0.009) genetic models. rs7895833 was associated with an increased odds ratio for the occurrence of MS under the codominant (p = 0.011 and p = 0.012), dominant (p = 0.001), and allelic (p < 0.001) genetic models. We also found that serum SIRT1 levels were statistically significantly different between MS patients and control group subjects (p < 0.001). In addition, comparison of SIRT1 levels between study groups and genotypes showed that rs3818292 AA (p = 0.001), rs3758391 CT (p < 0.001), and rs7895833 AA (p = 0.002) and AG (p = 0.004) had higher SIRT1 levels in the control group than in the MS group. All results were provided after strict Bonferroni correction. CONCLUSIONS: Genetic variations in SIRT1 rs3818292, rs3758391, and rs7895833 are associated with multiple sclerosis, with possible differences in gender and age, as well as lower serum SIRT1 levels.

Oligoclonal Band Status and Features of Radiological and Clinical Findings in Patients with Multiple Sclerosis in Lithuania.

Background and Objectives: Multiple sclerosis (MS) is a widely spread and debilitating disease with 2.8 million people worldwide currently affected. However, the exact pathogenesis of the disease and its progression remains incompletely understood. According to the revised McDonald criteria, cerebrospinal fluid oligoclonal bands (CSF OCBs) magnetic resonance imaging (MRI) results, in conjunction with clinical presentation, remain the gold standard of MS diagnostics. Therefore, this study aims to evaluate the association between CSF OCB status and features of radiological and clinical findings in patients with multiple sclerosis in Lithuania. Materials and Methods: The selection of 200 MS patients was performed in order to find associations between CSF OCB status, MRI data and various disease features. The data were acquired from outpatient records and a retrospective analysis was performed. Results: OCB positive patients were diagnosed with MS earlier and had spinal cord lesions more frequently than OCB negative patients. Patients with lesions in the corpus callosum had a greater increase in the Expanded Disability Status Scale (EDSS) score between their first and last visit. Patients with brainstem lesions had higher EDSS scores during their first and last visit. Even so, the progression of the EDSS score was not greater. The time between the first symptoms and diagnosis was shorter for patients who had juxtacortical lesions than patients who did not. Conclusions: CSF OCBs and MRI data remain irreplaceable tools when diagnosing multiple sclerosis as well as prognosing the development of the disease and disability.

Oropharyngeal Dysphagia as the Main Expression of Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease. Only about 10% of ALS patients survive more than 10 years. Clinical studies show that multidisciplinary care statistically significantly improves survival compared to neurological care. ALS tends to manifest as limb weakness, but some patients present with bulbar symptoms, such as dysphagia and dysarthria. In rarer cases, the main symptom of ALS is oropharyngeal dysphagia. Respiratory muscle weakness is a relatively rare symptom at the onset of this disease and may lead to a fatal outcome due to aspiration pneumonia within about 1.4 years. These reasons led to a particularly complicated diagnosis of ALS in a 66-year-old Caucasian female patient complaining of dyspnoea and coughing while drinking water. Notably, dyspnoea is only present in one out of four treatment-seeking patients, and the course of ALS is non-specific. For these reasons, the diagnosis took an entire year while the patient underwent many tests and visited many specialists. However, the diagnosis was only made at a late stage of the disease. At present, the patient is almost unable to swallow food, water, or saliva, and is at a very high risk of aspiration, but refuses to have a percutaneous endoscopic gastrostomy performed. The objective of this case report is to highlight the fact that a symptom as simple as difficulty swallowing may be the result of severe disease, a frequent outcome of which is death.

Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls.

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults >65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p < 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p < 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

Laryngeal carcinoma experimental model suggests the possibility of tumor seeding to gastrostomy site.

Some studies state that laryngeal squamous cell carcinoma (LSCC) is associated with possible direct tumor cell seeding to percutaneous endoscopic gastrostomy (PEG) site. However, there is a lack of experimental proof that LSCC tumor tissue can adhere and grow in distant sites. Therefore, we aimed to investigate the growth pattern of LSCC implants on chicken embryo chorioallantoic membrane (CAM) and evaluate possible associations between clinical course of the disease and behavior of experimentally implanted LSCC tumors. Our results show that implanted LSCC tissue survives on CAMs in 95% of cases while retaining essential morphologic characteristics and proliferative capacity of the original tumor. We identified the increased CAM vascularization, an infiltrative growth pattern of the implant and formation of distant isolated metastatic nodes on the CAMs. LSCC tumors with worse differentiation degree (G2 or G3) adhered to the experimental CAMs significantly better than G1. These results facilitate the understanding of tumor biology and allow hypothetisezing that dissemination and direct implantation of LSCC cells into the stomal wall during the pull PEG procedure might be possible.

An Experimental Model of Human Recurrent Respiratory Papillomatosis: A Bridge to Clinical Insights.

OBJECTIVES/HYPOTHESIS: To investigate the growth pattern of recurrent respiratory papilloma (RRP) implants on chicken embryo chorioallantoic membranes (CAMs) and to evaluate possible associations between the clinical course of the disease and the behavior of experimentally implanted RRP tumors. STUDY DESIGN: Experimental study. METHODS: Fresh 172 RRP tissue samples from 12 patients were implanted onto chick embryo CAMs. Morphological and morphometric analysis of the experimental CAM and chorionic epithelium was performed. The microvascular network of the CAM with the RRP implant was investigated under the effect of fluoresceinated anionic dextran. The peculiarities of the clinical course of the disease were evaluated. RESULTS: The implanted RRP tissue samples survived on CAMs in 86% of cases, retaining their essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM and the chorionic epithelium, but none of the RRP implants crossed the basement membrane of the hosting CAM. A "crawling film" of acellular material with newly formed papilloma sprouts located on the outer chorionic epithelium of the CAM was detected. Direct association between a recurrence rate of RRP and the number of newly formed papilloma sprouts around the implanted tumor on CAMs was revealed. CONCLUSION: The chicken embryo CAM-based model is appropriate for investigations of RRP and facilitates the understanding of tumor biology and the clinical course of the disease, thus providing the basis for further research and acceleration of the identification and development of new specific therapeutic compounds that limit the spread and recurrence of RRP. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:E914-E920, 2021.

Validation and Factor Analysis of the Lithuanian Version of the Dizziness Handicap Inventory.

OBJECTIVES: This study aimed to validate the Lithuanian version of the Dizziness Handicap Inventory (DHI-L), investigate its reliability, and perform factor analysis. MATERIALS AND METHODS: A standard protocol of translation was followed for psychometric instruments. A total of 108 patients (75.9% women), mean age 51.9 years, with peripheral or central dizziness and vertigo participated in our cross-sectional study. The internal consistency was measured by Cronbach's alpha coefficient and corrected item-total correlations (CI-TCs). After a week, 65 of the recruited patients were again asked to fill out Dizziness Handicap Inventory (DHI)-L to ascertain test-retest reliability (intraclass correlation, ICC). Concurrent validation was performed using Pearson correlation between the total score and subscales of DHI-L and the eight scales of Short Form-36 Health Survey (SF-36). Finally, the factor structure of the DHI was assessed by principal component analysis (PCA). RESULTS: The Cronbach's alpha coefficient was very high (0.91). CI-TCs for DHI-L total scale ranged from 0.33 to 0.67. The correlations between DHI and SF-36 were high to weak. The ICC was excellent for the total score and its subscales. Our proposed two-factor model explained 44.5% of the variance. The first factor indicated disability in daily activities and psychological effect of handicap. The second factor comprised of items that pertained to postural instability. CONCLUSION: The DHI-L has shown good reliability and validity. Results did not support the original subscale structure of the DHI. As more studies need to be done to restructure DHI, we recommend only using the total DHI score as a measure of dizziness handicap.

Model of human recurrent respiratory papilloma on chicken embryo chorioallantoic membrane for tumor angiogenesis research.

We aimed to develop a chick embryo chorioallantoic membrane (CAM) model of recurrent respiratory papilloma (RPP) and to evaluate its morphological and morphometric characteristics, together with angiogenic features. Fresh RRP tissue samples obtained from 13 patients were implanted in 174 chick embryo CAMs. Morphological, morphometric, and angiogenic changes in the CAM and chorionic epithelium were evaluated up until 7 days after the implantation. Immunohistochemical analysis (34ßE12, Ki-67, MMP-9, PCNA, and Sambucus nigra staining) was performed to detect cytokeratins and endothelial cells and to evaluate proliferative capacity of the RRP before and after implantation on the CAM. The implanted RRP tissue samples survived on CAM in 73% of cases while retaining their essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM (241-560%, p=0.001) and the chorionic epithelium (107-151%, p=0.001), while the number of blood vessels (37-85%, p=0.001) in the CAM increased. The results of the present study confirmed that chick embryo CAM is a relevant host for serving as a medium for RRP fresh tissue implantation. The CAM assay demonstrated the specific RRP tumor growth pattern after implantation and provided the first morphological and morphometric characterization of the RRP CAM model that opens new horizons in studying this disease.

Subjective visual vertical assessment with mobile virtual reality system.

BACKGROUND AND OBJECTIVE: The subjective visual vertical (SVV) is a measure of a subject's perceived verticality, and a sensitive test of vestibular dysfunction. Despite this, and consequent upon technical and logistical limitations, SVV has not entered mainstream clinical practice. The aim of the study was to develop a mobile virtual reality based system for SVV test, evaluate the suitability of different controllers and assess the system's usability in practical settings. MATERIALS AND METHODS: In this study, we describe a novel virtual reality based system that has been developed to test SVV using integrated software and hardware, and report normative values across healthy population. Participants wore a mobile virtual reality headset in order to observe a 3D stimulus presented across separate conditions - static, dynamic and an immersive real-world ("boat in the sea") SVV tests. The virtual reality environment was controlled by the tester using a Bluetooth connected controllers. Participants controlled the movement of a vertical arrow using either a gesture control armband or a general-purpose gamepad, to indicate perceived verticality. We wanted to compare 2 different methods for object control in the system, determine normal values and compare them with literature data, to evaluate the developed system with the help of the system usability scale questionnaire and evaluate possible virtually induced dizziness with the help of subjective visual analog scale. RESULTS: There were no statistically significant differences in SVV values during static, dynamic and virtual reality stimulus conditions, obtained using the two different controllers and the results are compared to those previously reported in the literature using alternative methodologies. The SUS scores for the system were high, with a median of 82.5 for the Myo controller and of 95.0 for the Gamepad controller, representing a statistically significant difference between the two controllers (P<0.01). The median of virtual reality-induced dizziness for both devices was 0.7. CONCLUSIONS: The mobile virtual reality based system for implementation of subjective visual vertical test, is accurate and applicable in the clinical environment. The gamepad-based virtual object control method was preferred by the users. The tests were well tolerated with low dizziness scores in the majority of patients.

Reliability and validity of the Lithuanian Tinnitus Handicap Inventory.

OBJECTIVE: The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap. MATERIALS AND METHODS: A cross-sectional psychometric validation study was performed in the University Hospital. A total of 248 subjects reporting chronic tinnitus as their primary complaint or secondary to hearing loss were encluded in the study and filled in the Lithuanian version of THI. For assessment of construct validity a subgroup of 55 participants completed the Lithuanian version of the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. Test-retest and internal consistency reliability as well as construct validity were calculated. RESULTS: The Lithuanian version of the THI and its subscales showed a robust internal consistency reliability (Cronbach's alpha=0.93) comparable to the original version. Statistically significant correlations were observed between the Lithuanian translation of the THI and the measures of self-perceived levels of anxiety and depression using HADS. Confirmatory factor analysis demonstrated that the three subscales of the THI Lithuanian version corresponded to three different factors, which strongly correlated between themselves. CONCLUSIONS: The results suggest that the Lithuanian version of THI maintains its original validity and may serve as reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living.

Associations of HLA DRB1 alleles with IgG oligoclonal bands and their influence on multiple sclerosis course and disability status.

BACKGROUND AND AIM: Oligoclonal bands (OCB) may be associated with the genes of HLA complex, which allows to consider the possible interaction of genetic and immunological factors and its importance in the development and progression of multiple sclerosis (MS). The aim of this study was to evaluate the associations between HLA DRB1 alleles and oligoclonal bands (OCBs) in the disease course and disability of multiple sclerosis (MS) patients. MATERIALS AND METHODS: This was a prospective study of 120 patients with MS. HLA DRB1 alleles were genotyped using the polymerase chain reaction. Matched cerebrospinal fluid (CSF) and plasma samples were analyzed using isoelectric focusing and IgG specific immunofixation to test for the presence of intrathecal specific OCB. RESULTS: HLA DRB1*08 allele was related to a lower degree of disability. Oligoclonal bands were an independent and significant factor that influenced disability status irrespective of HLA DRB1* 04, *07, *08, *13, *15 and *16 alleles. Age at the onset and duration of the disease were independent and significant factors for MS progression in all logistic regression models with each newly added HLA DRB1 allele. HLA DRB1*08 allele was related to 75% lower odds that relapsing remitting (RR) MS will change to a progressive course MS irrespective of the other factors investigated. Detection of OCBs in the CSF was associated with the higher possibility of RR MS progression in all cases, except when the *08 allele was present. CONCLUSIONS: OCBs had an influence on disability status, while HLA DRB1*08 allele was significantly associated with lower possibility that RR MS will change to progressive course MS.

Global Genomic Diversity of Human Papillomavirus 11 Based on 433 Isolates and 78 Complete Genome Sequences.

UNLABELLED: Human papillomavirus 11 (HPV11) is an etiological agent of anogenital warts and laryngeal papillomas and is included in the 4-valent and 9-valent prophylactic HPV vaccines. We established the largest collection of globally circulating HPV11 isolates to date and examined the genomic diversity of 433 isolates and 78 complete genomes (CGs) from six continents. The genomic variation within the 2,800-bp E5a-E5b-L1-upstream regulatory region was initially studied in 181/207 (87.4%) HPV11 isolates collected for this study. Of these, the CGs of 30 HPV11 variants containing unique single nucleotide polymorphisms (SNPs), indels (insertions or deletions), or amino acid changes were fully sequenced. A maximum likelihood tree based on the global alignment of 78 HPV11 CGs (30 CGs from our study and 48 CGs from GenBank) revealed two HPV11 lineages (lineages A and B) and four sublineages (sublineages A1, A2, A3, and A4). HPV11 (sub)lineage-specific SNPs within the CG were identified, as well as the 208-bp representative region for CG-based phylogenetic clustering within the partial E2 open reading frame and noncoding region 2. Globally, sublineage A2 was the most prevalent, followed by sublineages A1, A3, and A4 and lineage B. IMPORTANCE: This collaborative international study defined the global heterogeneity of HPV11 and established the largest collection of globally circulating HPV11 genomic variants to date. Thirty novel complete HPV11 genomes were determined and submitted to the available sequence repositories. Global phylogenetic analysis revealed two HPV11 variant lineages and four sublineages. The HPV11 (sub)lineage-specific SNPs and the representative region identified within the partial genomic region E2/noncoding region 2 (NCR2) will enable the simpler identification and comparison of HPV11 variants worldwide. This study provides an important knowledge base for HPV11 for future studies in HPV epidemiology, evolution, pathogenicity, prevention, and molecular assay development.

Effect of Laryngeal Squamous Cell Carcinoma Tissue Implantation on the Chick Embryo Chorioallantoic Membrane: Morphometric Measurements and Vascularity.

BACKGROUND: The aim of this study was to develop chick embryo chorioallantoic membrane (CAM) model of laryngeal squamous cell carcinoma (LSCC) and to evaluate the morphological and morphometric characteristics and angiogenic features of it. METHODS: Fresh LSCC tissue samples obtained from 6 patients were implanted onto 15 chick embryo CAMs. Morphological, morphometric, and angiogenic changes in the CAM and chorionic epithelium were evaluated up to 4 days after the tumor implantation. Immunohistochemical analysis (34ßE12, CD31, and Ki67 staining) was performed to detect cytokeratins and tumor endothelial cells and to evaluate the proliferative capacity of the tumor before and after implantation on the CAM. RESULTS: The implanted LSCC tissue samples survived on the CAM in all the experiments and retained the essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM (103-417%, p = 0.0001) and the chorionic epithelium (70-140%, p = 0.0001) and increase in number of blood vessels (75-148%, p = 0.0001) in the CAM. CONCLUSIONS: This study clarifies that chick embryo CAM is a relevant assay for implanting LSCC tissue and provides the first morphological and morphometric characterization of the LSCC CAM model that opens new perspectives to study this disease.

Combined Use of Standard and Throat Microphones for Measurement of Acoustic Voice Parameters and Voice Categorization.

OBJECTIVE: The aim of the present study was to evaluate the reliability of the measurements of acoustic voice parameters obtained simultaneously using oral and contact (throat) microphones and to investigate utility of combined use of these microphones for voice categorization. MATERIALS AND METHODS: Voice samples of sustained vowel /a/ obtained from 157 subjects (105 healthy and 52 pathological voices) were recorded in a soundproof booth simultaneously through two microphones: oral AKG Perception 220 microphone (AKG Acoustics, Vienna, Austria) and contact (throat) Triumph PC microphone (Clearer Communications, Inc, Burnaby, Canada) placed on the lamina of thyroid cartilage. Acoustic voice signal data were measured for fundamental frequency, percent of jitter and shimmer, normalized noise energy, signal-to-noise ratio, and harmonic-to-noise ratio using Dr. Speech software (Tiger Electronics, Seattle, WA). RESULTS: The correlations of acoustic voice parameters in vocal performance were statistically significant and strong (r = 0.71-1.0) for the entire functional measurements obtained for the two microphones. When classifying into healthy-pathological voice classes, the oral-shimmer revealed the correct classification rate (CCR) of 75.2% and the throat-jitter revealed CCR of 70.7%. However, combination of both throat and oral microphones allowed identifying a set of three voice parameters: throat-signal-to-noise ratio, oral-shimmer, and oral-normalized noise energy, which provided the CCR of 80.3%. CONCLUSIONS: The measurements of acoustic voice parameters using a combination of oral and throat microphones showed to be reliable in clinical settings and demonstrated high CCRs when distinguishing the healthy and pathological voice patient groups. Our study validates the suitability of the throat microphone signal for the task of automatic voice analysis for the purpose of voice screening.

The importance of HLA DRB1 gene allele to clinical features and disability in patients with multiple sclerosis in Lithuania.

BACKGROUND: The association of HLA DRB1 alleles with susceptibility to multiple sclerosis (MS) has been consistently reported although its effect on the clinical features and disability is still unclear probably due to diversity in ethnicity and geographic location of the studied populations. The aim of the present study was to investigate the influence of HLA DRB1 alleles on the clinical features and disability of the patients with MS in Lithuania. METHODS: This was a prospective study of 120 patients with MS. HLA DRB1 alleles were genotyped using the polymerase chain reaction. RESULTS: The first symptoms of MS in patients with HLA DRB1*15 allele manifested at younger age than in those without this allele (28.32 +/- 5.49 yrs vs. 30.94 +/- 8.43 yrs, respectively, p = 0.043). HLA DRB1*08 allele was more prevalent among relapsing-remitting (RR) MS patients than among patients with progressive course of MS (25.0% vs. 8.3%, respectively, chi^2 = 6.000, p = 0.05). MS patients with this allele had lower relapse rate than those without this allele (1.00 +/- 0.97 and 1.44 +/- 0.85, respectively, p = 0.043). Degree of disability during the last visit was lower among the patients with HLA DRB1*08 allele (EDSS score 3.15 +/- 1.95 vs. 4.49 +/- 1.96, p = 0.006), and higher among those with HLA DRB1*15 allele (EDSS score 4.60 +/- 2.10 vs.4.05 +/- 1.94, p = 0.047) compared to patients without these alleles but there were no significant associations between these alleles and the duration of the disease to disability. HLA DRB1*08 allele (OR = 0.18, 95% CI 0,039-0,8, p = 0.029) was demonstradet to be independent factor to take a longer time to reach an EDSS of 6, while HLA DRB1*01 allele (OR = 5.92, 95% CI 1,30-26,8, p = 0.021) was related in a shorter time to reach and EDSS of 6. Patients with HLA DRB1*08 allele had lower IgG index compared to patients without this allele (0.58 +/- 0.17 and 0.73 +/- 0.31, respectively, p = 0.04), and HLA DRB1*15 allele was more often found among MS patients with oligoclonal bands (OCBs) in cerebrospinal fluid than among those without OCBs (OR 2.3, CI 95% 1.017-5.301; p = 0.043). CONCLUSIONS: HLA DRB1*15 allele was related with an earlier manifestation of the first MS symptoms, progressive course of the disease and higher degree of disability. HLA DRB1*08 allele was more prevalent among the RR MS patients and was associated with the lower rate of relapse, degree of disability and IgG index.

The significance of HLA DRB1*1501 and oligoclonal bands in multiple sclerosis: clinical features and disability.

UNLABELLED: The aim of the present study was to determine the value of immunogenetic risk factors and to estimate their relationship with the clinical features and disability status of patients with multiple sclerosis in a Lithuanian population. MATERIALS AND METHODS: This was a prospective study of 80 patients with multiple sclerosis. The diagnosis of multiple sclerosis was based on the revised McDonald criteria. Oligoclonal bands (OCBs) of immunoglobulin G (IgG) were tested using isoelectric focusing and IgG specific immunofixation. HLA DRB1 alleles were genotyped using polymerase chain reaction. RESULTS: Of all patients, 55% were positive for OCBs and 56% for HLA DRB1*1501. OCB-positive patients with multiple sclerosis had higher EDSS scores than their OCB-negative counterparts at onset of the disease (3.93±1.21 and 3.36±0.96 points, respectively; P=0.02) and during the last visit (4.31±2.06 and 3.09±1.98 points, respectively; P=0.009). The mean relapse rate was higher in the OCB-positive group compared with OCB-negative group (1.45±0.69 and 0.58±0.64, respectively; P=0.001). OCB-positive patients had higher IgG index compared with OCB-negative patients (P=0.0001). No relationship was found between HLA DRB1*1501 antigen status and the clinical features or EDSS score, and presence or absence of OCB in the present subset of patients with multiple sclerosis. CONCLUSIONS: The presence of oligoclonal bands in the cerebrospinal fluid of the patients with multiple sclerosis was associated with the greater number of exacerbations, higher degree of disability, and higher IgG index. There were no significant associations between the presence of HLA DRB1*1501 allele and the clinical symptoms, course of disease, or disability score.

Diagnostic value of conventional visual evoked potentials applied to patients with multiple sclerosis.

OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of this classical technique employed at the Hospital of Lithuanian University of Health Sciences for the patients with multiple sclerosis and to assess its possible correlations with affected neurological systems. MATERIAL AND METHODS: Pattern shift visual evoked potentials were recorded in 63 patients with multiple sclerosis, 17 (27%) of whom had a history of optic neuritis, and in 63 control patients with other neurological diseases. The latencies and amplitudes of P100 were measured. In total, 126 patients were referred to the inpatient department of neurology for differential diagnosis of demyelinating disorders between January and December of 2007. RESULTS: Abnormalities of visual evoked potentials were observed by 73% more frequently in patients with multiple sclerosis than in control patients (α=0.05, ß<0.01). The combined monocular/interocular test showed a specificity of 90.5% and a sensitivity of 82.5%. The probability of an affection of the pyramidal system was 5 times greater (95% CI, 2.2-11.0; P<0.01) and the probability of the optic pathways involvement was 4.8 times greater (95% CI, 1.9-11.9; P<0.01) in patients with multiple sclerosis than in controls. CONCLUSION: Conventional visual evoked potentials must be reappraised in light of their diagnostic value in multiple sclerosis given their high diagnostic efficiency, relatively easy, short, and cheap implementation, and easy availability in everyday clinical practice.

A randomized cross-over study to evaluate the swallow-enhancing and taste-masking properties of a novel coating for oral tablets.

OBJECTIVE: To explore the swallowing-enhancing and taste-masking effects of MedCoat, a new disposable device used to apply a coating to tablets just before oral administration. SETTING: Kaunas Medical University Hospital in Lithuania. METHOD: The study was performed as a randomized cross-over study. In total 41 subjects (20 male and 21 female) were enrolled in the study. Subjects were healthy volunteers who at least sometimes experience difficulties swallowing tablets. Subjects were asked to swallow placebo tablets uncoated and coated with MedCoat in a randomized order, and indicate their preferences. Subjects were also asked to evaluate the taste-masking properties of MedCoat. RESULTS: Of the 41 subjects, 40 (97.6%) found it less difficult to swallow non-flavoured placebo tablets coated with MedCoat compared to identical uncoated tablets. Forty subjects (97.6%) found it less difficult to swallow divided non-flavoured placebo tablets coated with MedCoat compared to identical uncoated divided tablets. All 41 subjects (100.0%) found it less difficult to swallow bitter flavoured placebo tablets coated with MedCoat compared to identical uncoated tablets. All 41 (100.0%) of the subjects stated that MedCoat completely masked the bitter taste of a bitter flavoured tablet. CONCLUSION: The study showed that MedCoat made tablets easier to swallow for people with difficulties swallowing tablets and that it masked the taste of bitter tasting tablets. MedCoat could therefore be a valuable tool to aid the oral taking of tablets for patients who have difficulties swallowing tablets.

Effects of betahistine on patient-reported outcomes in routine practice in patients with vestibular vertigo and appraisal of tolerability: experience in the OSVaLD study.

This was a 3-month multicentre, open-label post-marketing surveillance study of betahistine (24 mg b.i.d. or 16 mg t.i.d.) in patients with vertigo of peripheral vestibular origin. Study endpoints comprised on-treatment changes in the Dizziness Handicap Index (DHI), Hospital Anxiety and Depression Score (HADS) and the Short-Form (SF)-36v2. Total DHI score improved 37.2 points (of a 100-point scale) following betahistine treatment. Corresponding improvements occurred in all three DHI scale domains (all p < 0.001 vs baseline). Betahistine therapy was also accompanied by progressive, significant improvements in both HADS-A and HADS-D scores (p < 0.001), and improvements in the distribution profiles of anxiety and depression scores. Significant improvements in the Physical Component Summary and Mental Component Summary scores of the SF-36v2 were recorded during betahistine treatment. Betahistine was generally well tolerated. A total of 76 adverse drug reactions (ADRs) were recorded in 49 patients (2.4%), of which 75 were classified as mild or moderate and 54 were possibly related to betahistine. ADRs led to study drug discontinuation in 17 patients. These data illustrate that treatment with betahistine 48 mg/day in patients with recurrent peripheral vestibular vertigo is associated with improvements in objective measures of health-related quality of life and satisfactory tolerability.