Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by obstructions of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen ...desaturation and arousal from sleep. OSA can be successfully treated with continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, hypoglossal nerve stimulation, and surgical procedures. It has been observed that untreated OSA is related to chronic disorders including hypertension, arrhythmias, congestive heart failure, coronary heart disease, diabetes mellitus, hyperlipidemia, stroke, depression, and cognitive decline. Event-related potentials (ERPs) is the procedure that has been widely used for evaluating cognitive brain functions. Using auditory event-related potentials (P300), this study aimed to examine the effect of CPAP therapy on cognitive functions in patients with moderate and severe OSA. The results of the study showed improvement in P300 latency and amplitude after 3 months of CPAP therapy, indicating a positive effect of CPAP therapy in the prevention of cognitive decline in patients with OSA.
Epilepsy is one of the most prevalent chronic neurological diseases, affecting about 70 million people worldwide. Patients with epilepsy often encounter cognitive dysfunction, which is influenced by ...different factors including age at the onset of epilepsy, etiology of epilepsy, type of seizures, seizure frequency and duration, psychiatric comorbidity, and antiepileptic drug (AED) therapy. Event-related potentials are useful, noninvasive, objective clinical and research instrument for evaluation of cognitive functions in patients. The aim of this study was to investigate and determine the effect of AED monotherapy and polytherapy on cognitive changes in patients with epilepsy, detected with P300 event-related potentials and compared with age- and gender-matched healthy individuals. The study was conducted in 82 patients with generalized and focal epilepsy and 82 healthy individuals aged 18-65 years. Cognitive evoked P300 potentials were recorded in all study subjects using auditory ‘oddball’ paradigm. The results showed the patients taking AED polytherapy to have a significantly longer P300 latency and significantly lower N200-P300 amplitude. These results indicate that AED polytherapy might worsen cognitive impairment in patients with epilepsy.
Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in ...the prevalence of risk factors in urban and rural areas of eastern Croatia.
The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests.
The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001).
In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.
A 46-year-old female patient with a large slow-growing craniocervical junction tumor is presented. Her complaints began 6 months before with sensory and painful sensations, sphincter impairment, and ...motor events (spastic tetraparesis, more pronounced on the left extremities). Magnetic resonance of the head revealed a rounded tumor of 2.5 cm in diameter, by its characteristics corresponding to meningioma, at the level of C1 vertebra and craniocervical junction, with the base at spinal canal anterior wall, occupying most of the craniocervical junction, compressing spinal cord and medulla oblongata. Intracerebral computed tomography angiography showed spared lumen and a satisfactory image of vertebral arteries bypassing the expansive growth at the occipital foramen, confirming slow tumor growth. Antiedematous therapy led to transient improvement in extremity strength and partial recovery of neurologic deficit, which resolved completely upon neurosurgical operation and rehabilitation. This case report exemplifies brain adaptability to slowly growing expansive neoplasms, based on its volume reduction up to the moment when further adaptation is not possible anymore, i.e. breaking of the mechanism of adaptation. Because of brain adaptability, such slowly growing tumors may stay asymptomatic for a long time. Brain plasticity also includes adaptation and autoregulation of the circulation, thus ensuring stable blood flow.
Razvoj medicine produžio je ljudski životni vijek, ali povećanjem udjela starogstanovništva raste i incidencija neurodegenerativnih bolesti kao što je Alzheimerova bolest. Donedavno je jedina opcija ...za liječenje Alzheimerove bolesti bila simptomatska terapija u obliku inhibitora kolinesteraze (rivastigmin, donepezil, galantamin) ili antagonista NMDA receptora (memantin). Pokušaji pronalaska potencijalne terapije koja ne ublažava samo kliničku sliku, već može i usporiti ili potpuno zaustaviti progresiju neurološkog i kognitivnog propadanja, usmjereni su na dvije osnovne morfološke karakteristike bolesti – amiloidne plakove i hiperfosforilirane tau neurofibrilarne snopiće, zbog čega se naziva antiamiloidnom i antitau terapijom. Taj se terapijski pristup temelji na inhibiciji sinteze beta-amiloida ili proteina tau, sprječavanju njihova taloženja u agregate ili uklanjanju nastalih patoloških oblika primjenom specifičnih protutijela. Jedan takav lijek, aducunumab (originalno ime Aduhelm), nedavno je odobrio FDA za liječenje blage Alzheimerove bolesti.
The developments in the field of medicine have led to an increase in humanlifespan, but with it comes the growth of older population which is followed by an increase in incidence of neurodegenerative diseases such as Alzheimer’s disease. Until recently, the only available therapy for Alzheimer’s disease was symptomatic in nature, such as the cholinesteraze inhibitors (rivastigmine, donepezil, galantamine) and the NMDA receptor antagonist memantine. Current attempts to find the potential disease-modifying therapy are targeting two typical morphological features of the disease, amyloid plaques and tau protein neurofibrillary tangles, which is why they are classified as anti-amyloid and anti-tau therapy. This approach is based on inhibition of beta-amyloid or tau protein synthesis,prevention of their aggregation or promotion of their clearence through use of specific antibodies. One such drug, aducunumab (brand name Aduhelm), has recently been approved by the FDA for treatment of mild Alzheimer’s disease.
SAŽETAK
Međunarodne smjernice za farmakološko liječenje epilepsija općenite su, sveobuhvatne i ne prepoznaju lokalne specifičnosti poput ekonomskih i tehničkih mogućnosti u pojedinim državama, ...dostupnosti pojedinih antiepileptika ili drugih metoda liječenja i slično. Stoga se nameće potreba izrade nacionalnih smjernica, čiji su zapravo temelj međunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakološko liječenje epilepsija plod su suradnje svih relevantnih stručnih društava i referentnih centara u RH, na čelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neurološkim društvom i Hrvatskim društvom za dječju neurologiju Hrvatskoga liječničkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifičnosti u našoj zemlji, najnovije spoznaje farmakoloških profila i učinkovitosti pojedinih antiepileptika kao i ekspertna mišljenja. Antiepileptička terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktička primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, mogućnostima liječenja i samopomoći, životnim ograničenjima te mogućim neželjenim događajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljšanje kvalitete života. Zlatni standard liječenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za liječenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifičnim čimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestičkih i dijagnostičkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika različitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, različitog profila nuspojava i sinergističkog ili aditivnog djelovanja. Zamjena generičkih ili originalnog i generičkog oblika lijeka nije preporučljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptičke terapije treba biti postupno i sporo, u slučaju politerapije jedan po jedan lijek, a u donošenju odluke o ukidanju, kao i o uvođenju antiepileptika, mora biti uključen bolesnik i njegova obitelj.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by obstructions of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen ...desaturation and arousal from sleep. OSA can be successfully treated with continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, hypoglossal nerve stimulation, and surgical procedures. It has been observed that untreated OSA is related to chronic disorders including hypertension, arrhythmias, congestive heart failure, coronary heart disease, diabetes mellitus, hyperlipidemia, stroke, depression, and cognitive decline. Event-related potentials (ERPs) is the procedure that has been widely used for evaluating cognitive brain functions. Using auditory event-related potentials (P300), this study aimed to examine the effect of CPAP therapy on cognitive functions in patients with moderate and severe OSA. The results of the study showed improvement in P300 latency and amplitude after 3 months of CPAP therapy, indicating a positive effect of CPAP therapy in the prevention of cognitive decline in patients with OSA. Key words: obstructive sleep apnea; continuous positive airway pressure; auditory event-related potentials; P300 Opstruktivna apneja u spavanju (OSA) je poremecaj disanja u spavanju karakteriziran opstrukcijom gornjih disnih puteva tijekom spavanja koji dovodi do prestanka disanja u spavanju, desaturacije krvi kisikom i budenja. OSA se uspjesno lijeci uredajima za potpomognuto disanje s neprekinutim pozitivnim tlakom (CPAP), gubitkom tjelesne tezine, pozicijskom terapijom, oralnim udlagama, stimulacijom zivca hipoglosusa i operativnim lijecenjem. Opazeno je da je nelijecena OSA povezana s kronicnim poremecajima, ukljucujuci arterijsku hiperteziju, aritmije, kongestivno zatajenje srca, koronarnu srcanu bolest, secernu bolest, hiperlipidemiju, mozdani udar, depresiju i kognitivno propadanje. Kognitivni evocirani potencijali se koriste za proucavanje kognitivnih funkcija. Cilj ovog rada je ispitati ucinak terapije CPAP-om na kognitivne funkcije bolesnika s umjerenom i teskom OSA--om koristeci slusne kognitivne evocirane potencijale. Rezultati ove studije su pokazali poboljsanje P300 latencija i amplituda, ukazujuci na pozitivni ucinak terapije CPAP--om u prevenciji kognitivnog poremecaja u bolesnika s OSA--om. Kljucne rijeci: opstruktivna apneja u spavanju; disanje s neprekinuitim pozitivnim tlakom; slusni kognitivni evocirani potencijali; P300
Cervical dystonia and quality of life Tomic, Svetlana; Petkovic, Ivana; Pucic, Tomislav ...
Acta neurologica Belgica,
12/2016, Letnik:
116, Številka:
4
Journal Article
Recenzirano
Cervical dystonia is focal dystonia characterized by involuntary movement of the neck muscle, which leads to abnormal head posture. It can be accompanied with pain and tremor. In this study, we ...evaluated the presence of depression and anxiety in patients with cervical dystonia and the influence of dystonia symptoms on the quality of life. Psychiatric symptoms were evaluated by use of the Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to evaluate the cervical dystonia symptoms. Quality of life was assessed by the craniocervical dystonia questionnaire (CDQ-24) and short form 36 health survey (SF-36). Nineteen patients were analyzed. Most of the patients had mild cervical dystonia (mean TWSTRS 23.89). Depression was present in 42.1 % and anxiety in 57.9 % of the patients. Disability due to cervical dystonia correlated with the occurrence of depression (
ρ
= 0.534) and anxiety (
r
= 0.652). Disability was found to significantly influence the stigma, emotional state, pain, daily activity, social life, physical function, and physical and mental disability. Pain influenced some aspects of body pain, physical function, and physical and mental disability. Being associated with disability and pain, cervical dystonia decreases the quality of life in many aspects. Disability also influenced depression and anxiety, which were present in half of study patients. In addition to follow up for cervical dystonia symptoms, patients with cervical dystonia should also be assessed for psychiatric symptoms on routine clinical check-ups. In addition to botulinum toxin, psychopharmaceuticals should be considered as a treatment option in these patients.
BPPV is generally the most common cause of vertigo, caused by a pinch-off of tiny calcium carbonate crystals (called the otoconia or the otoliths) from the macula utriculi, most frequently due to the ...degenerative processes or a trauma, whereby the crystals, under the action of gravity in certain head positions coinciding with its direction, arrive to some of the semicircular canals, usually the posterior one, due to the existent anatomical circumstances and relationships, thus creating an inadequate stimulus of the cupular senses while floating through the endolymph and provoking symptoms of a strong and short-term dizziness. Two main clinical forms can be distinguished: canalolythiasis, with an accommodation of otolithic debris in the semicircular canal, and cupulolythiasis, with their location immediately next to the cupular sense. The diagnosis is established by a positive positioning test, Dix-Hallpike for the posterior and the supine roll for the lateral canal. Although one can expect a spontaneous recovery subsequent to few weeks or months, various methods of otolith repositioning to a less sensitive place lead to a prompt improvement while reducing or withdrawing the symptoms completely. These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method.
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