Early onset Alzheimer's disease - a case study. / Choroba Alzheimera o wczesnym poczatku ­ opis przypadku.

Dementia syndromes constitute problem not only for the elderly. Early-onset dementia (EOD) starts below the age of 65 years. It accounts for 4-10% of all cases of dementia. EOD has significant psychosocial consequences because it affects people in their most productive years of life, with numerous family, professional and social responsibilities. There are many diseases that have been identified as the cause of the EOD. Among them, the most common are Alzheimer's disease, vascular dementia, fronto-temporal dementia, Lewy body dementia, traumatic brain injury, alcohol related dementia, Huntington's disease, Parkinson's disease, mixed dementia, Creutzfeldt-Jakob disease and Down's syndrome. Most studies have demonstrated Alzheimer's disease as the most common etiology of EOD. The article presents the case of a 33-year-old patient hospitalized in the Department of Neurology in Zabrze, with cognitive dysfunction, speech disordersand featuresof Parkinson's extrapyramidal syndrome that have been progressing for about 15 months. The MR of the head revealed cortical and subcortical atrophy, especially in parietal and temporal lobes. The cerebrospinal fluid examination showed decreased level of ß-amyloid and significantly elevated level of H-tau. The patient was diagnosed with early-onset Alzheimer's disease, which was confirmed by genetic testing - the sequence change was identified in the gene for presenilin 1 in a heterozygous system.

Sexual Satisfaction in Fully Ambulatory People with Multiple Sclerosis: Does Disability Matter?

Primary sexual dysfunctions (SD) are a direct result of neurological changes that affect the sexual response. Secondary SD result from the symptoms that do not directly involve nervous pathways to the genital system, such as bladder and bowel problems, fatigue, spasticity, or muscle weakness. Tertiary SD are the result of disability-related psychosocial and cultural issues that can interfere with sexual feelings and experiences. The aim of this study was to assess the sexual satisfaction (SS) in people with multiple sclerosis (PwMS) without significant mobility impairment and to estimate the influence of SD, the score on the Kurtzke Expanded Disability Status Scale (EDSS), lowered mood, and stress coping strategies on SS. Methods. 76 PwMS with the EDSS score < 5.0 points were enrolled in the study. The subjects completed the Montgomery-Asberg Depression Scale (MADRS), the Coping Inventory for Stressful Situations (CISS), the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19), and the Sexual Satisfaction Questionnaire (SSQ). Results. The level of SS in PwMS was not significantly lower compared to that of the general population. It correlated with the primary, secondary, and tertiary SD and lowered mood. However, it did not correlate with disability measured by the EDSS. Conclusions. The level of SS in PwMS with the EDSS score below 5.0 points was not significantly lower. SS depended on SD, lowered mood, and stress coping style, and it was not significantly related to the level of disability in patients with the EDDS score below 5.0.

Multiple sclerosis: oral health, behaviours and limitations of daily oral hygiene - a questionnaire study.

CLINICAL RATIONALE FOR THE STUDY: Neurological deficits and progressing disability in patients with multiple sclerosis (MS) may hamper daily oral hygiene, but their relations with oral problems have not yet been clearly determined. AIM OF THE STUDY: The aim of this study was to identify the most significant dental problems and limitations of daily oral hygiene in Polish patients with MS. MATERIAL AND METHODS: 199 patients with diagnosed MS (median age 37 years) treated in the neurological outpatient clinic were interviewed using a paper-based questionnaire. They provided answers on oral health, behaviours and the limitations of their daily oral hygiene. Clinical information regarding symptoms, MS phenotype, relapses, medication and degrees of disability was based on medical records. RESULTS: The most frequent symptoms were dry mouth (43.2%) and bleeding from gums (28.1%). Dry mouth was more frequent in patients with secondary-progressive MS (SPMS) than relapsing-remitting MS (65.4% vs 41.3%, p = 0.023). Patients with bleeding from gums had had MS for a longer duration (median 6 vs 4 years, p = 0.002). Difficulties in daily oral hygiene were more frequent in patients with SPMS (24.0% vs 8.1%; p = 0.016). Greater proportions of patients with muscle weakness of limbs, imbalance or pain brushed their teeth irregularly. Frequent (i.e. at least every six months) visits to the dentist's surgery were uncommon in patients with SPMS (12.0% vs 39.7%, p = 0.010). CONCLUSIONS AND CLINICAL IMPLICATIONS: Dry mouth and bleeding from gums are more frequent in patients with longer lasting and more advanced types of MS. Daily oral hygiene and oral health self-control is limited in patients with MS, mainly due to motor deficits, balance problems and pain, and this becomes worse with disease duration. To minimise the burden of the disease, patients with MS require better education and improvement in their awareness regarding proper oral health control, such as the use of electric toothbrushes. In addition, patients with chronic and progressive disability from multiple sclerosis may benefit from better organised access to dental care.

Prevalence of pain in patients with multiple sclerosis and its association with anxiety, depressive symptoms and quality of life. / Wystepowanie bólu u chorych na stwardnienie rozsiane i jego zwiazek z objawami depresyjnymi, lekiem i jakoscia zycia.

OBJECTIVES: Pain is one of the most frequently reported symptoms of multiple sclerosis (MS). It affects the daily functioning of patients, limits the ability to work and reduces the joy of life. The aim of the study was to analyze the impact of pain on quality of life as well as symptoms of anxiety and depression in patients with MS. METHODS: The study included 144 patients with diagnosed MS (mean age 41±12 years, mean illness duration 10.3±8.6 years). The study was carried out on the basis of the author's survey on current and previous pain - the Quality of Life Self-esteem Questionnaire (EuroQol5D) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Among all respondents, 117 (81.3%) reported current pain, and 120 (83.3%) declared the occurrence of pain in the past. Currently, patients have reported: pain in one or more extremities - 79 people (54.9%), headache and facial pain - 72 (50%), back pain - 72 (50%), painful muscle spasms - 54 (38.6%), ocular pain - 37 (25.7%), Lhermitte's sign - 32 (22.2%). Patients reporting pain experienced significantly more severe symptoms of anxiety and depression (HADS-L: 8.0±4.3 vs. 5.1±4.3; p< 0.01; HADS-D: 6.0±4.2 vs. 3.4±3.7; p< 0.01), and had significantly worse quality of life (EQ 5D: 8.1±1.9 vs. 6.3±1.4; p< 0.0001). An association between presence of pain and gender (p< 0.01), age (p< 0.05), the degree of disability (p< 0.05), education (p< 0.001), and the professional activity (p< 0.01) was found. CONCLUSIONS: Pain in MS is associated with more severe symptoms of anxiety and depression, and worse quality of life. Female sex, older age, lower level of education, greater disability, and lack of occupational work predispose to the occurrence of pain in MS.

Assessment of Biochemical and Densitometric Markers of Calcium-Phosphate Metabolism in the Groups of Patients with Multiple Sclerosis Selected due to the Serum Level of Vitamin D3.

BACKGROUND: In addition to the widely known effect of vitamin D3 (vitD3) on the skeleton, its role in the regulation of the immune response was also confirmed. AIM: The assessment of biochemical and densitometric markers of calcium-phosphate metabolism in the groups of patients with relapsing-remitting multiple sclerosis (RRMS) selected due to the serum level of vitamin D3. METHODS: The concentrations of biochemical markers and indices of lumbar spine bone densitometry (DXA) were determined in 82 patients divided into vitamin D3 deficiency (VitDd), insufficiency (VitDi), and normal vitamin D3 level (VitDn) subgroups. RESULTS: The highest level of the parathyroid hormone (PTH) and the highest prevalence of hypophosphatemia and osteopenia were demonstrated in VitDd group compared to VitDi and VitDn. However, in VitDd, VitDi, and VitDn subgroups no significant differences were observed in the levels of alkaline phosphatase (ALP) and ionized calcium (Ca2+) and in DXA indices. A negative correlation was observed between the level of vitamin D3 and the Expanded Disability Status Scale (EDSS) in the whole MS group. The subgroups were significantly different with respect to the EDSS scores and the frequency of complaints related to walking according to the EQ-5D. CONCLUSIONS: It is necessary to assess calcium-phosphate metabolism and supplementation of vitamin D3 in RRMS patients. The higher the clinical stage of the disease assessed with the EDSS, the lower the level of vitamin D3 in blood serum. Subjectively reported complaints related to difficulties with walking were reflected in the EDSS in VitDd patients.

Hypoglossal nerve palsy in the course of dissection of the internal carotid arteries - Case reports.

Internal carotid artery dissection (ICAD) has become an increasingly recognized cause of cerebrovascular accidents in young and middle-aged patients. We report 2 cases of hypoglossal nerve palsy in the course of dissection of the internal carotid arteries. The first patient was admitted to the Department of Neurology due to swallowing difficulty, speech articulation disorders and numbness of the right half of the tongue for 4 weeks. Extracranial vessel ultrasound (US) and transcranial colour Doppler (TCD) visualized thrombus causing occlusion of the right internal carotid artery (RICA). Angio-CT revealed a compression on right XII nerve and a dissection of the RICA. The second patient was referred to the Department of Neurology due to articulation disorders and swallowing difficulties. On admission, neurological examination revealed tongue deviation towards the right side with evidence of atrophy of the right half of the tongue, deviation of the uvula to the right side, absence of palatal and pharyngeal reflexes, rhinolalia and dysphagia. Vessel imaging was taken using angio-MR showing mural thrombus of the RICA. CONCLUSION: The diagnosis of spontaneous non-traumatic dissection of the carotid arteries is a major challenge for clinicians. ICAD must be considered for young and middle-aged patients when severe headache is preceded by the co-existence of focal neurological symptoms. The probability of ICAD increases in the presence of predisposing diseases. The final diagnosis is based on imaging studies: color duplex ultrasound, CT angiography or MR angiography.

Antiplatelet and anticoagulant therapy in elderly people with type 2 diabetes mellitus in Poland (based on the PolSenior Study).

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is an important and common cardiovascular risk factor. The purpose of the study was to evaluate the frequency of use of oral antiplatelet drugs (OAPs) and oral anticoagulant drugs (OACs) among the elderly with T2DM in Poland. MATERIAL AND METHODS: The study was based on the data collected in the Polish national PolSenior study. RESULTS: Among 4979 PolSenior participants aged 65 and over, 883 (17.8%) had previously diagnosed T2DM. Among them, 441 (49.9%) used at least one drug in pharmacological cardiovascular prevention, i.e. OAPs (mostly ASA) in 405 (45.9%) cases and OACs in 38 (4.3%). The use of these drugs significantly depended on the sex (p = 0.02) and personal income (p = 0.05). Age, place of residence and level of education did not affect the prevalence of pharmacological prevention. Previous stroke and myocardial infarction were mostly associated with OAPs, whereas a history of atrial fibrillation (AF) was related to OAC treatment. Among participants treated with OAPs, therapy was applied as secondary cardiovascular prevention in 211 (52.1%) subjects, and as primary prevention in 194 (47.9%) subjects. Among participants treated with OACs, 24 (64.9%) persons had a history of AF. Secondary cardiovascular pharmacological prevention should be considered in 45 untreated participants (12.5%), and primary cardiovascular pharmacological prevention (SCORE ≥ 10 and/or AF) in 154 participants (42.7%). CONCLUSIONS: Cardiovascular pharmacological prevention in the elderly with T2DM in Poland seems to be unsatisfactory. Educational programmes concerning current recommendations for pharmacological cardiovascular prevention should be developed among general practitioners.

Pharmacological stroke prevention in the elderly with atrial fibrillation in Poland - Results of PolSenior study.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. OBJECTIVES: The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors. PATIENTS AND METHODS: The analysis included elderly (≥65 years) participants of the PolSenior study performed in years 2008-2012. RESULTS: The study group consisted of 4979 people (mean age: 79.3±8.7 years). Among them, there were 875 patients (18.7%) with documented history of AF. Pharmacological prevention with the use of vitamin K antagonists (VKA) was applied by 117 (13.4%) of the elderly with AF, including 15 (1.7%) on dual therapy. Additionally, 386 (45.3%) subjects with AF were using oral antiplatelet therapy (OAPs), mostly aspirin. Acenocoumarol was much more often used than warfarin. New oral anticoagulant drugs (NOACs) were not used at all. Only personal income was associated with the use of VKA. No significant correlation was found for the age, sex, place of residence and level of education. CONCLUSIONS: The study was unique to determine the frequency of pharmacological stroke prevention among elderly people with AF in Poland. It occurred that oral anticoagulant drugs were applied too rarely in this group of patients. Educational programs should be developed among general practitioners concerning current recommendations for patients with AF.

Validity and reliability of the Polish version of myasthenia gravis - Quality of life questionnaire - 15 item.

AIM: The myasthenia gravis-quality of life questionnaire 15 item (MG-QOL15) is a short, and easy to use disease-specific quality of life (QOL) tool in myasthenia gravis. The aim of this study was to validate and adapt the Polish version of the MG-QOL15. MATERIALS AND METHODS: The total number of 50 patients with MG were qualified for the examination. Each patient underwent neurological examination and completed the quality of life evaluation questionnaire MQ-QOL 15 after translation and back-translation. Additionally, each patient was asked to evaluate the quality of his/her life by means of questionnaire SF-36 in Polish language version. RESULTS: The MG-QOL15 was found to have high internal consistency, test-retest reliability, and concurrent validity. CONCLUSION: The MG-QOL15 is accepted to be a valid, reliable, valuable tool for measuring disease-specific QOL in Polish patients with MG.

Association between carotid plaque score and microvascular complications of type 2 diabetes.

INTRODUCTION: According to the "common soil" hypothesis, diabetic microangiopathy and macroangiopathy have a similar pathophysiological background. It has been well documented that carotid artery atherosclerosis in patients with type 2 diabetes is associated with cardiovascular complications; however, it remains unclear whether there is a similar association for microvascular complications. OBJECTIVES: We investigated whether the carotid plaque score and the carotid intima-media thickness (IMT) are associated with macroangiopathic and microangiopathic complications of type 2 diabetes. PATIENTS AND METHODS: We enrolled patients with type 2 diabetes and microvascular complications or overt macroangiopathy. A B­mode carotid ultrasound was performed in all participants, and anthropometric parameters, hemoglobin A1c (HbA1c) levels, lipid profile, and smoking status were assessed. RESULTS: The study included 73 patients (mean [SD] age, 63.6 [7.5] years; 36 men [49%]). The mean (SD) diabetes duration was 11.7 (8.1) years. Microvascular complications were observed in 32 patients (43.8%), and overt macroangiopathy, in 42 (57.5%). Hypertension was reported for 60 patients (82%); dyslipidemia, for 56 (77%); obesity, for 37 (51%); and smoking, for 10 (14%). A multivariate regression analysis showed that the carotid plaque score, but not carotid IMT, was significantly associated with dyslipidemia (P = 0.03) and microangiopathy (P = 0.01). CONCLUSIONS: Our results indicate that, unlike carotid IMT, the carotid plaque score is independently associated with microangiopathic complications in type 2 diabetes. Patients with a high plaque score should receive special care and the most intensive treatment to stop progression of these complications.

Multimodal evoked potentials in patients with multiple sclerosis in assessment of the course of the disease.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system with a multifocal damage. THE AIM: The assessment of the MS course by multimodal evoked potentials (EP). MATERIAL AND METHODS: We evaluated 95 patients (63 female, 32 male) with relapsing-remitting MS in the average age of 36.4±10.4. The average disease duration was 4.6±7.4 year. Among them, 48 patients (50.5%) were treated with immunomodulatory drugs. All patients underwent neurological examination and EP testing: VEP (visual evoked potentials), SEP (somatosensory evoked potentials), endogenous potential P300. The latencies of following waves were evaluated: P100 (VEP), N4 , N9 , N13, N20, P22 (SEP) and P300, with the reference values of the Neurophysiological Research Laboratory of the Department of Neurology in Zabrze. RESULTS: Abnormal VEP(I) was found in 80 patients (84.2%), SEP(I) in 9 patients (9.5%), P300(I) in 15 patients (15.8%). Abnormal result of the control research VEP (II) was found in 23 patients (82.1%), SEP(II) in 1 patient (3.6%), P300(II) in 4 patients (14.3%). The average values of the waves latencies in the control study were higher, however the statistical significance was not found. The correlation was observed between EDSS, and N20 and P22. No relationship was found between EP and age, disease duration, number of relapses and treatment. CONCLUSIONS: In the era of neuroimaging, usage of EP in the diagnosis and assessment of MS is limited. Electrophysiological studies may be used in addition to the clinical examination to confirm the multifocal damage.

Interictal heart rate in patients with epilepsy.

INTRODUCTION: Electrocardiographic abnormalities in patients with epilepsy are related to the presence of discharges in central autonomic structures and the effect of antiepileptic drugs. These patients are at risk for sudden unexpected death, and cardiac arrhythmias are one of the most probable causes related to it. THE AIM: The heart rate (HR) assessment recorded on electrocardiography (ECG) in the interictal period in patients with newly diagnosed and previously treated epilepsy, depending on the type of changes in electroencephalography (EEG) and the treatment option. MATERIAL AND METHODS: Fifty patients with epilepsy were enrolled in the study: 22 comprised a non-treated patient (NTP) group with newly diagnosed epilepsy and 28 comprised a treated patient (TP) group that had been treated for more than 2 years. Resting ECG and EEG were performed in all patients. RESULTS: A significantly higher HR was recorded in the TP group compared to the NTP group (80±13 vs 67±15 bpm, p=0.00006). The tendency to higher HR was observed in polytherapy patients, carbamazepine patients and in patients with a focus in the right hemisphere. CONCLUSIONS: There is a relationship between the presence of the disorders related to bioelectric activities of the brain and the heart, therefore the ECG should be periodically monitored in epileptic patients.

Improvement of quality of life after therapeutic plasma exchange in patients with myasthenic crisis.

INTRODUCTION: We sought to evaluate quality of life patients with myasthenic crisis before and after therapeutic plasma exchange. MATERIALS AND METHODS: In our study we conducted an assessment of the quality of life with the use of the questionnaire SF-36, when executed eleven therapeutic plasma exchange. The assessment was made on baseline and after 4 weeks. We also did neurological clinical evaluation before and after TPE. RESULTS: Patients in the study showed significant improvement in quality of life after performed therapeutic plasma exchange. The changes were observed in physical functioning, which confirmed the results of the statistical significance of p<0.05. In the analysis, the assessment of mental functioning not obtained the results of statistical significance, but the results also showed improvement in self-assessment. We observed high correlation between general health and physical mental functioning, between the role limitations due to physical health problems and role limitations due to emotional problems, and general health perception and bodily pain. CONCLUSIONS: Therapeutic plasma exchange significantly improves the quality of life of patients with myasthenia gravis during the crisis.

Changes in Serum Ceruloplasmin Levels Based on Immunomodulatory Treatments and Melatonin Supplementation in Multiple Sclerosis Patients.

BACKGROUND The cause of multiple sclerosis (MS) is currently unknown, but it is thought that oxidative damage and iron metabolism mechanisms are involved. The aim of this study was to examine ceruloplasmin concentration in MS patients based on various immunomodifying therapies and to test the effect of antioxidative melatonin on ceruloplasmin levels. MATERIAL AND METHODS This prospective study included 102 MS patients and 15 healthy controls. Patients were divided into groups according to different immunomodifying therapies: interferons beta 1a, interferons beta 1b, glatiramer acetate, mitoxantrone, and immunomodifying pre-treatment (A, B, G, Mx, and P groups, respectively), and the relapse R group. MS patients were supplemented with melatonin for 3 months. Serum ceruloplasmin concentrations, EDSS, brain MRI, serum C-reactive protein level, and white blood cell count were examined. RESULTS The results indicated significantly increased levels of ceruloplasmin in MS patients. No differences in ceruloplasmin concentrations between the relapse group and controls were observed. In A and G groups, ceruloplasmin levels before and after melatonin were similar to levels in controls. In group B, ceruloplasmin concentration was significantly higher vs. control and relapse groups. After melatonin administration in group B, ceruloplasmin levels decreased. Ceruloplasmin concentrations in the Mx group were significantly higher compared to controls. CONCLUSIONS We found for the first time that ceruloplasmin concentration in MS patients varies depending on different immunomodulatory treatment and decrease after 3 months of melatonin administration. Ceruloplasmin could be a valuable serum marker for the chronic demyelinating process participating in oxidative stress mechanisms, as well as a neurodegenerative marker, but not a marker of acute-phase MS.

[Neurosarcoidosis - clinical characteristics, diagnosis and treatment]. / Neurosarkoidoza - obraz kliniczny, diagnostyka i leczenie.

Neurosarcoidosis (NS) manifests itself clinically in approximately 8-13% of patients with sarcoidosis. Granulomas are localized in both the central and peripheral nervous system, mainly within the meninges and cranial nerves. Changes may spread interstitially, occupying different structures of the brain and spinal cord. Diagnosis of NS is made by characteristic clinical symptoms and the exclusion of other diseases, with the presence of specific changes in the magnetic resonance and cerebrospinal fluid, and it is mainly based on histopathological examination. The first choice treatment are corticosteroids. In case of failure or adverse events, methotrexate, azathioprine, cyclosporine, cyclophosphamide, mycophenolate mofetil and infliximab could be used.

What you cannot get from routine MRI of MS patient and why - The growing need for atrophy assessment and seeing beyond the plaque.

Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients' disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients' clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results.

Interictal heart rate in patients with epilepsy.

INTRODUCTION: Electrocardiographic abnormalities in patients with epilepsy are related to the presence of discharges in central autonomic structures and the effect of antiepileptic drugs. These patients are at risk for sudden unexpected death, and cardiac arrhythmias are one of the most probable causes related to it. THE AIM: The heart rate (HR) assessment recorded on electrocardiography (ECG) in the interictal period in patients with newly diagnosed and previously treated epilepsy, depending on the type of changes in electroencephalography (EEG) and the treatment option. MATERIAL AND METHODS: Fifty patients with epilepsy were enrolled in the study: 22 comprised a non-treated patient (NTP) group with newly diagnosed epilepsy and 28 comprised a treated patient (TP) group that had been treated for more than 2 years. Resting ECG and EEG were performed in all patients. RESULTS: A significantly higher HR was recorded in the TP group compared to the NTP group (80±13 vs 67±15 bpm, p=0.00006). The tendency to higher HR was observed in polytherapy patients, carbamazepine patients and in patients with a focus in the right hemisphere. CONCLUSIONS: There is a relationship between the presence of the disorders related to bioelectric activities of the brain and the heart, therefore the ECG should be periodically monitored in epileptic patients.

Effect of intravenous versus subcutaneous insulin delivery on the intensity of neuropathic pain in diabetic subjects.

INTRODUCTION: The effectiveness of treatment of painful diabetic polyneuropathy remains unsatisfactory. The aim of this study was to compare effects of intravenous vs. subcutaneous insulin delivery in patients with diabetic symmetric sensorimotor polyneuropathy on pain relief, the quality of life, sleep disturbance, and the nerve conduction. MATERIAL AND METHODS: Thirty-four patients with diabetic polyneuropathy (mean age 62 ± 10 years, duration 17 ± 10 years), who reached a pain score over 40 mm on the VAS scale, HbA(1c) 7.5-10%, were randomly assigned to continuous intravenous insulin infusion (examined group) and multiple injections (control subjects). Before and after five days of the insulin treatment the effects on pain relief (SFMPQ-VAS), the quality of life improvement (EuroQol EQ-5D), and sleep disturbances (AIS) were assessed. RESULTS: Both groups experienced significant pain reduction, improvement of the quality of life, and reduction of sleep disturbances, i.e. a VAS in the study group of 69 ± 14 mm before treatment vs. 40 ± 19 mm after treatment (p < 0.001), and in control subjects 66 ± 16 mm vs. 47 ± 17 mm (p < 0.001). No difference in level of pain intensity reduction between the groups studied was found. CONCLUSIONS: Intensification of insulin treatment applied for five days results in improvement of the physical condition of patients with painful diabetic polyneuropathy, through pain relief, and improvement of the quality of life and sleep quality. The efficacy of insulin intravenous infusion and multiple injections is comparable.

[Evaluation of the nature and prevalence of risk factors for stroke in patients with known cerebral vascular disease, depending on the place of residence]. / Ocena rodzaju i czestosci wystepowania czynników ryzyka udaru mózgu u chorych z rozpoznana choroba naczyniowa mózgu w zaleznosci od miejsca zamieszkania.

INTRODUCTION: The aim of this study was to answer the question whether there are differences in the type and frequency of risk factors for stroke in patients coming from urban and suburban areas. MATERIAL AND METHODS: The study included patients with a diagnosis of cerebrovascular disease treated in the Department of Neurology, Provincial Hospital in Czestochowa in 2004-2005. Socio-demographic and risk factors for cerebrovascular diseases were determined based on a retrospective analysis of medical records of each patient. RESULTS: The study included 294 patients. 153 persons (52.0%) were from suburban environment, and 141 people (48.0%)--from the urban environment. There were no statistically significant difference in age and gender between the two groups, while the differences in education were significant (p < 0.00001). The most common riskfactorfor stroke was hypertension, more frequent among patients from the city (64.0%) than suburban areas (55.7%), but this difference was not statistically significant. The next most common riskfactorwas dyslipidemia. It was recorded more frequently among patients from the urban environment (30.2%), compared to suburban areas (19.5%) (p = 0.03). There were no differences in the prevalence of other risk factors between the two groups. CONCLUSIONS: Hypertension was the most frequently observed risk factor for stroke. The only risk factor significantly differentiating both environments was dyslipidemia. It was identified significantly more often in patients from the city. Prevention of cardiovascular disease should include more frequent occurrence of certain risk factors in patients living in the city, which may be associated with the promotion of an appropriate lifestyle.