Nutritional Assessment of Patients with Primary Progressive Dementia at the Time of Diagnosis.

BACKGROUND: patients with different types of dementia may experience changes in nutritional status, which are manifested by specific eating habits. The aim of this study was to determine the nutritional status and eating habits of patients at the time of confirmed diagnosis of primary progressive dementia. SUBJECTS AND METHODS: The study included 40 outpatients (63% women) diagnosed with either form of dementia. The mean age at diagnosis was 77±6 years and the mean time between the onset of first symptoms of the disease and diagnosis was 3-36 months. Nutritional assessment was determined at the time of confirmed diagnoses and included dietary habits (non-quantitative modified food frequency questionnaire (FFQ)), anthropometric (body weight and height and body mass index-BMI) and biochemical parameters (serum concentrations of vitamin B12, folic acid and 25-hydroxy vitamin D). Dietary habits were collected over a 12-month period with the help of a spouse or close family member. RESULTS: The results showed that none of the outpatients were malnourished, the largest number of outpatients (43%) were in the normal body mass category followed by 33% in the overweight category. The results of this study confirmed previous findings of higher preference for sweet foods observed in 53% of patients with dementia. Low status of vitamin B12 was observed in 57% of outpatients, folic acid in 24% and 25 (OH) D in 75% of outpatients. Lower frequency of consumption of dark green leafy vegetables and lower consumption of poultry meat, fish and eggs could have an impact on nutrient deficiency. CONCLUSIONS: The poor nutritional status of outpatients with primary progressive dementia is associated with unhealthy dietary habits that may lead to micronutrient deficiencies. Dietary monitoring and intervention should be initiated immediately after the diagnosis of primary progressive dementia with the goal of reducing nutritional deficiencies and preventing further and more severe impairment of cognitive function.

RANKL/RANK/OPG Axis Is Deregulated in the Cerebrospinal Fluid of Multiple Sclerosis Patients at Clinical Onset.

OBJECTIVES: Our study focused on the RANKL (receptor activator of nuclear factor-κB ligand)/RANK/OPG (osteoprotegerin) axis and selected proinflammatory/immunoregulatory upstream mediators in the peripheral blood (PBL) and cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients. METHODS: PBL and CSF were collected from healthy controls (n = 35) and MS patients at the clinical onset of the disease (n = 33). In addition, PBL samples were obtained from relapse-remitting (RR)-MS patients (n = 30). Patients were assessed by means of the expanded disability status scale (EDSS) and routine laboratory parameters. Soluble (s)RANKL and OPG were measured in the CSF and plasma; gene expression was detected for RANKL, RANK, OPG, and selected cytokines/chemokines (interleukin [IL]-4, IL-10, IL-17, CCL2, and CXCL12) in PBL mononuclear cells. RESULTS: The OPG level in the CSF was lower in MS patients at clinical onset than in controls. Moreover, the sRANKL/OPG ratio was higher in the CSF of MS patients at clinical onset and in the plasma of RR-MS patients than in controls. Gene expression of RANKL/RANK/OPG in PBL mononuclear cells was higher only in RR-MS patients. IL-4, CCL2, and CXCL12 were positively correlated and IL-10 was negatively correlated with RANKL/RANK expression. OPG was negatively correlated with EDSS and alkaline phosphatase level. CONCLUSION: Our study revealed that changes of RANKL/RANK/OPG axis are associated with MS, particularly the decreased OPG level in the CSF at disease onset. Therefore, these factors may serve as disease biomarkers and molecular targets of novel therapeutic approaches.

Cranial nerve lesion in diabetic patients.

The retrospective investigation was done about relationships between diabetes and cranial nerve lesions (CNL) on the sample of hospitalized neurological patients in Clinical Hospital Dubrava (CHD) in 6 yrs. period (2001-2006). The goal was to expand the cognition about CNL as a complication of diabetes, to investigate possibility of better therapy models as well as to investigate the prevention possibilities. The results show that CNL are significantly more present by the diabetic patients vrs. the other hospitalized neurological patients. The main risk factors for CNL development are the duration of diabetes, patient's age and diabetes per se. No significant differences between masculine and feminine patients were registered nor by diabetics neither by other patients. For CNL are also not from significant importance the successfully treatment of diabetes, as well as type of antidiabetic and other medication. This investigation can not confirm the suspicion that some of antidiabetic medicaments are responsible for CNL due to their neurotoxic side effects.

Qualitative analysis of dermatoglyphics of the digito-palmar complex in children with severe recessive perceptively impaired hearing.

The possible hereditary indicated differences in the ascending family tree was investigated in children with severe recessive perceptively impaired hearing, their parents, and healthy controls, using qualitative analysis of dermatoglyphics of the digito-palmar complex. The chi2 test was performed and biological distance was investigated by means according to Hiernaux Ag methods, and presented using Ward's method for the examined groups. The results show that the healthy control group differs from the groups of boys and girls with impaired hearing and also from their fathers mostly in palmar variables. The mothers were biologically more distant from the examined groups of patients, and more similar to the control group of randomly selected healthy female controls. The results indicate polygenic inheritance of sporadic sensoneurial hearing loss.

Missing risks in opportunistic screening for type 2 diabetes - CroDiabGP study.

Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record(EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients' data using Wonca International Classification Committee(WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients(aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM's assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p<.001). Conclusion Two methods of extraction could not detect data for episodes of the disease. In the list of personal information, FMs could not assess overweight for one in six patients and family history for every other patient. The study can stimulate improving coded and structured data in EMR.

A thin line between Meniere's disease and spontaneous intracranial hypotension syndrome.

AIM: To point out the similarity of Meniere disease and spontaneous intracranial hypotension and difference of their treatment. METHODS: A case of a 54-year-old male patient with previously diagnosed Meniere's disease and newly diagnosed spontaneous intracranial hypotension syndrome is presented. Additional neuroradiological examination, Brain contrast-enhanced MRI and MR myelography were used for diagnosis. RESULTS: Due to deterioration of vertigo, hearing loss and tinnitus in the right ear the patient was referred to the additional neuroradiological examination which confirmed the diagnosis of spontaneous intracranial hypotension syndrome. Brain contrast-enhanced MRI showed increased pachymeningeal contrast enhancement, and MR myelography identified the location of CSF leak. The patient was successfully treated conservatively. CONCLUSION: According to our knowledge this is the fifth case report of Meniere's disease and spontaneous intracranial hypotension coexistence. Both diseases have similar clinical presentation and initial treatment. We suggest procedures of additional examination when the treatment fails and initial diagnosis becomes questionable.

Sensation and spinal tumors.

Sensory disorders were investigated in a retrospective study of 131 patients operated on for tumors of the spine. The most common sign of sensory disorder was pain, followed by hypoesthesia and anesthesia. In case of intramedullary tumors, the most frequent signs were anesthesia and pain. There were no significant sex differences in the incidence of spinal tumors or sensory disorders. Moreover, sensory disorders did not significantly differentiate benign from malignant tumors. The study suggested the importance of sensory disorders in the possible development of spinal tumors, particularly if sensory disorders are frequent, long-term, and react poorly to therapy. Scanning of the axial skeleton and spinal cord is the technique of choice in the diagnosis and differential diagnosis of spinal cord tumors.