Publications by authors named "Vladimira Vuletic"

19 Publications

  • Page 1 of 1

The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease.

J Neurol Surg A Cent Eur Neurosurg 2021 Feb 22. Epub 2021 Feb 22.

Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.

Introduction:  In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up.

Materials And Methods:  Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed.

Results:  The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (= 1), or unwanted side effects, such as emotional instability ( = 1).

Conclusion:  Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.
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http://dx.doi.org/10.1055/s-0040-1715826DOI Listing
February 2021

Effect of clonidine on the cutaneous silent period during spinal anesthesia.

World J Clin Cases 2018 Dec;6(16):1136-1145

Center for Clinical Research, Winston Salem, NC 27103, United States.

Aim: To investigate the effect of clonidine on the cutaneous silent period (CSP) during spinal anesthesia.

Methods: A total of 67 adult patients were included in this randomized, prospective, single-center, double-blind trial. They did not have neurological disorders and were scheduled for inguinal hernia repair surgery. This trial was registered on ClinicalTrials.gov (NTC03121261). The patients were randomized into two groups with regards to the intrathecally administered solution: (1) 15 mg of 0.5% levobupivacaine with 50 µg of 0.015% clonidine, or (2) 15 mg of 0.5% levobupivacaine alone. There were 34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group. CSP and its latency were measured four times: prior to the subarachnoid block (SAB), after motor block regression to the 0 level of the Bromage scale, with ongoing sensory blockade, and both 6 and 24 h after SAB.

Results: Only data from 30 patients in each group were analyzed. There were no significant differences between the groups investigated preoperatively and after 24 h. The CSP of the L group at the time point when the Bromage scale was 0 was 44.8 ± 8.1 ms, while in the LC group it measured 40.2 ± 3.8 ms ( = 0.007). The latency in the L group at the time point when the Bromage scale was 0 was 130.3 ± 10.2 ms, and in the LC group it was 144.7 ± 8.3 ms ( < 0.001). The CSP of the L group after 6 h was 59.6 ± 9.8 ms, while in the LC group it was 44.5 ± 5.0 ms ( < 0.001). The latency in the L group after 6 h was 110.4 ± 10.6 ms, while in LC group it was 132.3 ± 9.7 ms ( < 0.001).

Conclusion: Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone results in a diminished inhibitory tonus and shortened CSP.
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http://dx.doi.org/10.12998/wjcc.v6.i16.1136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306629PMC
December 2018

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

Neuroimmunomodulation 2018 19;25(1):23-33. Epub 2018 Jun 19.

Department of Physiology and Immunology, and Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.

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.
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http://dx.doi.org/10.1159/000488988DOI Listing
January 2019

Calcium-axonemal microtubuli interactions underlie mechanism(s) of primary cilia morphological changes.

J Biol Phys 2018 03 31;44(1):53-80. Epub 2017 Oct 31.

Brain Tumor Research Laboratories, Brain and Mind Center, Sydney Medical School and Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2050, Australia.

We have used cell culture of astrocytes aligned within microchannels to investigate calcium effects on primary cilia morphology. In the absence of calcium and in the presence of flow of media (10 μL.s) the majority (90%) of primary cilia showed reversible bending with an average curvature of 2.1 ± 0.9 × 10 nm. When 1.0 mM calcium was present, 90% of cilia underwent bending. Forty percent of these cilia demonstrated strong irreversible bending, resulting in a final average curvature of 3.9 ± 1 × 10 nm, while 50% of cilia underwent bending similar to that observed during calcium-free flow. The average length of cilia was shifted toward shorter values (3.67 ± 0.34 μm) when exposed to excess calcium (1.0 mM), compared to media devoid of calcium (3.96 ± 0.26 μm). The number of primary cilia that became curved after calcium application was reduced when the cell culture was pre-incubated with 15 μM of the microtubule stabilizer, taxol, for 60 min prior to calcium application. Calcium caused single microtubules to curve at a concentration ≈1.0 mM in vitro, but at higher concentration (≈1.5 mM) multiple microtubule curving occurred. Additionally, calcium causes microtubule-associated protein-2 conformational changes and its dislocation from the microtubule wall at the location of microtubule curvature. A very small amount of calcium, that is 1.45 × 10 times lower than the maximal capacity of TRPPs calcium channels, may cause gross morphological changes (curving) of primary cilia, while global cytosol calcium levels are expected to remain unchanged. These findings reflect the non-linear manner in which primary cilia may respond to calcium signaling, which in turn may influence the course of development of ciliopathies and cancer.
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http://dx.doi.org/10.1007/s10867-017-9475-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834999PMC
March 2018

Excellent outcome of pallidal deep brain stimulation in DYT6 dystonia: A case report.

J Neurol Sci 2016 Jul 19;366:18-19. Epub 2016 Apr 19.

Geriatric Department, Memory Clinic Bldg 20, University Hospital Oslo, Oslo University, Oslo, Norway.

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http://dx.doi.org/10.1016/j.jns.2016.04.032DOI Listing
July 2016

Thrombolysis for acute stroke in patient with systemic lupus erythematosus: A case report.

J Neurol Sci 2016 Feb 9;361:7-8. Epub 2015 Dec 9.

Department of Neurology, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia.

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http://dx.doi.org/10.1016/j.jns.2015.12.014DOI Listing
February 2016

Head trauma and posttraumatic epilepsy in Slavonski Brod, East Croatia, 1988-2008.

Coll Antropol 2014 Sep;38(3):1077-9

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989 to 2008, which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity.
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September 2014

Head trauma and posttraumatic epilepsy in Slavonski Brod, East Croatia, 1988-2008.

Coll Antropol 2014 Sep;38(3):1077-9

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989 to 2008, which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity.
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September 2014

Decreased level of sRAGE in the cerebrospinal fluid of multiple sclerosis patients at clinical onset.

Neuroimmunomodulation 2014 1;21(5):226-33. Epub 2014 Mar 1.

Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia.

Objectives: Receptor for advanced glycation end products (RAGE) ligands/RAGE interactions have been proposed to have a pathogenic role in neuroinflammatory disorders. Our study aimed to assess changes in high-mobility group box (HMGB)1 and its receptor RAGE in peripheral blood (PBL) and cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) at the disease onset compared with control subjects.

Methods: PBL and CSF were collected from control subjects (n = 30) and MS patients (n = 27) at clinical onset. Soluble RAGE (sRAGE), HMGB1, S100 calcium-binding protein A12 (S100A12), interleukin (IL)-1β and tumor necrosis factor (TNF)-α were measured in the CSF and plasma by enzyme-linked immunosorbent assay. Gene expression in PBL mononuclear cells (PBMCs) was detected by quantitative PCR for RAGE, HMGB1, S100A12 and several proinflammatory/immunoregulatory cytokines.

Results: We found a significantly lower expression of IL-10 (p = 0.031) in the PBMCs of MS patients. The level of sRAGE in the CSF of MS patients was lower (p = 0.021), with the ability to discriminate between MS patients and control subjects. Moreover, PBMC gene expression for HMGB1 and S100A12 positively correlated with IL-6.

Conclusions: Our study confirmed that the cytokine network is disturbed in PBL and CSF at MS clinical onset. The deregulated HMGB1/RAGE axis found in our study may present an early pathogenic event in MS, proposing sRAGE as a possible novel therapeutic strategy for MS treatment.
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http://dx.doi.org/10.1159/000357002DOI Listing
January 2015

Difficulties with diagnosis and consequential poor outcome due to stigma of acquired immunodeficiency syndrome - a case report.

Pathog Glob Health 2013 Sep 1;107(6):325-8. Epub 2013 Aug 1.

University Hospital Dubrava, Zagreb, Croatia.

Low incidence of human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) has been detected in Croatia so far. Toxoplasmic encephalitis (TE) is the most common opportunistic cerebral infection in AIDS patients and is highly responsive to antiparasitic chemotherapy, if treated at an early stage. We present the case of the brain biopsy confirmed as TE on a 36-year-old female patient who at admission presented with unconsciousness and a right hemiplegia. A MSCT was performed and two hypodense lesions were diagnosed. The patient's family initially denied the presence or history of any medical problem or infection. An MRI showed multiple ring-enhanced mass lesions. An infectologist required a brain biopsy to exclude cerebral lymphoma and multiple metastases. Pathohistological analysis suggested TE. Meanwhile, patient's blood samples were found to be HIV positive. The patient was transferred to University Hospital for Infectious Diseases in Zagreb, where she died 2 days following admission. The patient's family terminally confessed that the patient had been HIV positive for 10 years and had refused any treatment. Family's denial of infection as well as 'hiding information' concerning patient's health from physicians involved in her treatment caused a delay in proper on-time patient treatment. We would like to emphasize that TE must be considered as a differential diagnosis in patients presenting with multiple cerebral lesions, including patients without acknowledged past history of HIV infection. A stigma towards HIV infection and ignorance of the disease still exist and therefore hinders proper treatment.
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http://dx.doi.org/10.1179/2047773213Y.0000000108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001613PMC
September 2013

Prevalence of the metabolic syndrome in the old institutionalized people in Zagreb, Croatia.

Coll Antropol 2013 Mar;37(1):203-6

University of Zagreb, Dubrava University Hospital, Department of Neurology, Zagreb, Croatia.

Metabolic syndrome (MeS) is defined by a cluster of abnormalities comprising obesity, hypertension, carbohydrate intolerance and dyslipidemia. MeS increases the risk of developing various diseases, including coronary heart disease, stroke, peripheral angiopathy and type 2 diabetes. In our study, the subjects were 561 persons, residents of 11 homes for the elderly in Zagreb, Croatia. There were 160 men (28.5%) and 401 women (71.5%), aged from 56 to 96 years (the average being 79 years). Physical examination was conducted, which included blood pressure measurement, and body height and weight. Blood samples were taken for biochemical analysis. Along with other biochemical parameters, the levels of glucose, triglycerides and cholesterol (LDL, HDL-C) were also measured. The results have shown the prevalence of MeS in the elderly instutionalised people to be in the range of 20.8%, according to WHO criteria. The most common MeS component was hypertension, and it was significantly more frequent in women than in men; also, the elevated triglyceride levels were more often found in women; the difference between men and women was also statistically significant. MeS is a serious and growing health problem not only in Croatia but worldwide as well. Further studies are needed to verify the prevalence of MeS in Croatia, as it is a major risk for CVD and many other severe diseases.
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March 2013

Effect of indomethacin on cerebrovascular reactivity in patients with type 2 diabetes mellitus.

Diabetes Res Clin Pract 2013 Jul 15;101(1):81-7. Epub 2013 May 15.

Medical Director, Medical Centre "Aviva", Zagreb, Croatia.

Aim: Impaired cerebral vasoreactivity to endothelium-dependent stimuli were described in type 2 diabetes mellitus (T2DM), but the mechanisms underlying that impairment are still unclear. The aim of this study was to investigate the role of cyclooxygenases' metabolites in response to acute hypercapnic stimulus in cerebral vessels, in patients with T2DM.

Methods: Vascular responses in the breath-holding test (BHT) were assessed in the absence/presence of a non-selective, reversible-inhibitor of cyclooxygenases, indomethacin (INDO), by functional transcranial Doppler sonography of the middle cerebral artery (N of patients=50; 33 men and 17 women). The functional hemodynamic parameter mean flow velocity (MFV) was assessed at rest, before and 90min after 100mg of INDO, and during the BHT. Breath holding index (BHI) [(MFV at the end of BHT minus MFV at rest)/MFV at rest)×100/s of breath-holding] was calculated after BHT performed before and 90min after INDO.

Results: MFV at rest significantly decreased after INDO administration compared with a control condition before INDO (at rest before INDO from 49.36±15.09 to 36.72±8.45 after INDO, p<0.001) However, overall cerebral vessel vasoreactivity to hypercapnia, evaluated with BHI, was significantly improved after INDO administration compared with the BHI before INDO administration (from 0.68±0.4 to 1.27±0.42, p<0.001).

Conclusions: The improvement in cerebral vasoreactivity in response to BHT after INDO administration suggests that the production of a vasoconstrictor metabolite of cyclooxygenase in diabetic patients was reduced by indomethacin consumption.
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http://dx.doi.org/10.1016/j.diabres.2013.04.004DOI Listing
July 2013

Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center, prospective longitudinal study.

Croat Med J 2013 Feb;54(1):25-32

Department of Medicine, Dubrava University Hospital, Zagreb, Croatia.

Aim: To determine if red cell distribution width (RDW) is associated with all-cause mortality in patients on chronic dialysis and to evaluate its prognostic value among validated prognostic biomarkers.

Methods: This is a single center, prospective longitudinal study. At the time of inclusion in January 2011, all patients were physically examined and a routine blood analysis was performed. A sera sample was preserved for determination of NT-pro-brain natriuretic peptide (NT-pro-BNP) and eosinophil cationic protein. Carotid intima media thickness (IMT) was also measured. Following one year, all-cause mortality was evaluated.

Results: Of 100 patients, 25 patients died during the follow-up period of one-year. Patients who died had significantly higher median [range] RDW levels (16.7% [14.3-19.5] vs 15.5% [13.2-19.7], P<0.001. They had significantly higher Eastern Cooperative Oncology Group (ECOG) performance status (4 [2-4] vs 2 [1-4], Plt;0.001), increased intima-media thickness (IMT) (0.71 [0.47-1.25] vs 0.63 [0.31-1.55], P=0.011), increased NT-pro-BNP levels (8300 [1108-35000] vs 4837 [413-35000], P=0.043), and increased C-reactive protein (CRP) levels (11.6 [1.3-154.2] vs 4.9 [0.4-92.9], Plt;0.001). For each 1% point increase in RDW level as a continuous variable, one-year all cause mortality risk was increased by 54% in univariate Cox proportional hazard analysis. In the final model, when RDW was entered as a categorical variable, mortality risk was significantly increased (hazard ratio, 5.15, 95% confidence interval, 2.33 to 11.36) and patients with RDW levels above 15.75% had significantly shorter survival time (Log rank Plt;0.001) than others.

Conclusions: RDW could be an additive predictor for all-cause mortality in patients on chronic dialysis. Furthermore, RDW combined with sound clinical judgment improves identification of patients who are at increased risk compared to RDW alone.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583391PMC
http://dx.doi.org/10.3325/cmj.2013.54.25DOI Listing
February 2013

Anxiety and depressive symptoms in acute ischemic stroke.

Acta Clin Croat 2012 Jun;51(2):243-6

Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.

Inadequate attention is being paid to the anxiety and depressive symptoms in acute stroke, although these problems are known to influence the patients' neurological outcome. The aim of our study was to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke and to identify the factors associated with such problems. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale in 40 patients with acute ischemic stroke admitted during a period of one month. Statistical analyses were performed by the SigmaStat (Version 2.0) software. Study results showed 55% of study patients to suffer from depressive symptoms and 40% from both anxiety symptoms and depressive symptoms. There was a correlation of depressive symptoms (HADS-D score) with MMSE (p < 0.001), age (p = 0.003) and BI (p < 0.001), and of anxiety symptoms (HADS-A score) with MMSE (p < 0.001) and BI (p = 0.01). There was no significant association of HADS-A and HADS-D score with other patient characteristics. In conclusion, depressive symptoms were more frequent in the acute stage ofischemic stroke. Study patients had a high prevalence of both groups of symptoms. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients' emotional stress and personal suffering, which could improve their neurological outcome.
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June 2012

Motor and cognitive impairment after stroke.

Acta Clin Croat 2011 Dec;50(4):463-7

Department of Neurology, Vinkovci General Hospital, Vinkovci, Croatia.

Cognitive abilities have great impact on rehabilitation program in stroke patients. Therefore, fast and practical psychometric assessment as an indicator of individual rehabilitation program is of great importance. The aim of this study was to analyze and compare motor and cognitive impairment in stroke patients in acute, subacute and chronic phase of the disease, taking age, sex, education, stroke risk factors, lateralization and type of stroke in consideration. The study included 50 stroke patients, 33 male and 17 female. Ischemic stroke was diagnosed in 78% and hemorrhagic stroke in 22% of patients. Hypertension was the leading stroke risk factor in 82% of patients. Cognitive impairment in acute, subacute and chronic phase of the disease was noticed in 12% of stroke patients with ischemia in the left brain hemisphere, mMMSE average score 31 and SKT score 19, IQ under 90. Better motor recovery in acute and subacute phase of stroke was followed by better cognitive status. All cognitively impaired stroke patients had low level of education, some had accomplished elementary education and others had not, all much below the dementia risk age of 75 years. Exclusion of patients with severe stroke from the study led to overestimation of the results. Finally, a coherent algorithm for somatic and cognitive stroke assessment in stroke patients poses itself as an imperative as a guideline for plastic, individualized and appropriate rehabilitation.
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December 2011

Post-stroke fatigue.

Acta Clin Croat 2011 Sep;50(3):341-4

University Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.

Post-stroke fatigue is still a relatively unexplored, often neglected condition. The fatigue often manifests as physical and mental lack of energy, and many patients mention fatigue as one of the most difficult sequels to which they have to adjust. Our aim was to assess the fatigue in 35 three-month post-stroke patients and its relation to personal and stroke-related factors, and to compare them with 35 age- and sex-matched healthy control subjects. The main outcome measures for the fatigue were Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory (MFI-20). Barthel index was used for functional status assessment, while anxiety and depressive symptoms were evaluated using Hospital Anxiety and Depression Scale (HADS). Study results showed fatigue to be frequent (45%) and often severe. Post-stroke patients showed higher values of general fatigue dimensions, physical fatigue and reduced activity. The number of subjects reporting fatigue problems on the FSS and MFI-20 scales was significantly greater in the stroke group (16/35; 45%) than in the control group (4/35; 11%; chi2 = 12.5; P < 0.001). Considering associations between fatigue and Barthel index score, age, sex, HADS-A (anxiety) and HADS-D (depression) scores, statistically significant associations were recorded between fatigue and anxiety (P = 0.01) and depression symptoms (P = 0.02). Global fatigue showed positive correlation with Barthel index score too (P = 0.01). Multivariate analysis showed that anxiety and depression symptoms could predict post-stroke fatigue (adjusted R2 = 0.556; P < 0.05). Clinical trials and follow-up studies to find an effective treatment for patients with post-stroke fatigue are warranted.
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September 2011

Are we ready for intravenous thrombolysis in acute stroke treatment in our region?

Acta Clin Croat 2011 Jun;50(2):145-8

University Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.
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June 2011

Impaired cerebral vasoreactivity in type 2 diabetes mellitus.

Coll Antropol 2011 Mar;35(1):27-31

University of Zagreb, Dubrava University Hospital, Department of Neurology, Zagreb, Croatia.

The aim of our study was to assess cerebral vasoreactivity (CVR) in type 2 diabetes mellitus (DM2) and factors which may influence on it. According to previous studies, evaluating CVR in DM2 on the similar way, the results were dubious. For the evaluation CVR we used breath holding index (BHI) and transcranial Doppler ultrasound (TCD) in 50 patients with DM2 and 50 sex- and age-matched healthy controls. We observed epidemiologic and clinic data, other vascular risk factors and laboratory parameters. We found statistically significant difference in BHI between patients with DM2 (BHI = 0.69 +/- 0.31) and age- and sex-matched healthy controls (BHI = 1.33+/-0.28) (p < 0.05 ). Because of a significant correlation between BHI and age (p < 0.001) in healthy controls we made an adjustment of BHI for age before further analyses (BHIadj). In DM2 group we found a significant correlation between BHIadj and age (p = 0.0004), fasting glycemia (p = 0.04), and albuminuria (p = 0.04) (creatinine clearance in multivariate analysis (p = 0.007)). Our study has shown that CVR is impaired in DM2 patients and that it's severity was associated with age, fasting glycemia and renal function. Functional TCD is a very good screening method for detection and monitoring of cerebral microangiopathic changes in DM2 patients.
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March 2011