Browsing by Author "Dujmović, Irena (6701590899)"

Tumor necrosis factor (TNF) α has been considered the prototypic cytopathogenic cytokine in multiple sclerosis (MS), but recently this cytokine has been shown to possess significant anti-inflammatory and neuroprotective effects in demyelinating diseases. It has been reported that the TNFα-308 polymorphism influences levels of TNFα production, and that the rare allele, TNF2, is associated with high TNFα production. We investigated the TNFα-308 polymorphism in 143 unrelated Serbian patients with MS and 123 ethnically matched, healthy individuals using the allele-specific restriction fragment length polymorphism polymerase chain reaction technique. The frequency of the TNF2 allele was significantly decreased in MS patients (14%) in comparison with controls (24%; p = 0.044). The TNF2 allele had no influence on disease behavior, since it was not associated with the course and severity of MS in this group of patients. The result suggests that in the Serbian population polymorphism at position -308 of TNFα or at an adjacent locus might have a role in MS susceptibility. Copyright © 2003 S. Karger AG, Basel.

Tumor necrosis factor (TNF) α has been considered the prototypic cytopathogenic cytokine in multiple sclerosis (MS), but recently this cytokine has been shown to possess significant anti-inflammatory and neuroprotective effects in demyelinating diseases. It has been reported that the TNFα-308 polymorphism influences levels of TNFα production, and that the rare allele, TNF2, is associated with high TNFα production. We investigated the TNFα-308 polymorphism in 143 unrelated Serbian patients with MS and 123 ethnically matched, healthy individuals using the allele-specific restriction fragment length polymorphism polymerase chain reaction technique. The frequency of the TNF2 allele was significantly decreased in MS patients (14%) in comparison with controls (24%; p = 0.044). The TNF2 allele had no influence on disease behavior, since it was not associated with the course and severity of MS in this group of patients. The result suggests that in the Serbian population polymorphism at position -308 of TNFα or at an adjacent locus might have a role in MS susceptibility. Copyright © 2003 S. Karger AG, Basel.

Introduction Iatrogenic Kaposi’s sarcoma (KS) represents a multifocal, angioproliferative tumor that develops in patients undergoing immunosuppressive treatment and is considered to be induced by activation of latent human herpes virus type 8 (HHV8) infection. The aim of this report is to present a patient with iatrogenic KS due to immunosuppressive treatment. Case outline We present a 69-year-old male non-HIV patient, previously treated for anti-aquaporin-4 antibody negative recurrent longitudinal extensive transverse myelitis with prednisolone and azathioprine for one year. The patient developed bluish and violet plaques and nodules on his face, trunk, and extremities. Skin biopsy findings (histopathology and immunohistochemical detection of CD31 expression and anti-HHV8 antibodies in the spindle cells) confirmed the diagnosis of KS. The reduction of immunosuppression and topical treatment with imiquimod resulted in a partial but significant regression of skin lesions, but the patient had another relapse of myelitis following the cessation of azathioprine and a reduction in the dose of prednisolone. Conclusion To the best of our knowledge, this is the first case of an inflammatory and demyelinating central nervous system disease treated with corticosteroids and azathioprine that was associated with iatrogenic KS. The efficient treatment of both conditions is highly challenging and can be troublesome in specific cases. © 2018, Serbia Medical Society. All rights reserved.

Multiple sclerosis (MS) is an inflammatory demyelinating disease with an extremely variable clinical course and prognosis. The problem of prognosis exists ever since the first diagnosis of MS had been established. A broad spectrum of different clinical and non-clinical features has been analysed up to now, with respect to their validity in assessing long-term prognosis in MS. Most investigators agree that male sex, higher age at onset, pyramidal, cerebellar, or sphincteric disturbances at onset and chronic progressive disease course (primary-progressive or secondary progressive) are related to the poor prognosis, whereas female sex, onset at a younger age, sensory symptoms at onset, as well as relapsing-remitting disease course, indicate the better disease outcome. The prognostic significance of other demographic, clinical, paraclinical features, personal or familial history data, genetic and environmental factors, is still a matter of controversy and is to be elucidated in future studies. Studies on natural course and prognosis should meet the criterion of completeness in all its senses, be prospective with a long-term follow-up, and be briefly designed in order to avoid the possible bias influences.

Multiple sclerosis (MS) is an inflammatory demyelinating disease with an extremely variable clinical course and prognosis. The problem of prognosis exists ever since the first diagnosis of MS had been established. A broad spectrum of different clinical and non-clinical features has been analysed up to now, with respect to their validity in assessing long-term prognosis in MS. Most investigators agree that male sex, higher age at onset, pyramidal, cerebellar, or sphincteric disturbances at onset and chronic progressive disease course (primary-progressive or secondary progressive) are related to the poor prognosis, whereas female sex, onset at a younger age, sensory symptoms at onset, as well as relapsing-remitting disease course, indicate the better disease outcome. The prognostic significance of other demographic, clinical, paraclinical features, personal or familial history data, genetic and environmental factors, is still a matter of controversy and is to be elucidated in future studies. Studies on natural course and prognosis should meet the criterion of completeness in all its senses, be prospective with a long-term follow-up, and be briefly designed in order to avoid the possible bias influences.

Introduction/Objective Patient-reported outcomes have been recognized as an important way of assessing health and well-being of patients with multiple sclerosis (MS). The aim of the study is to determine the correlation between different subscales of Patient-Reported Impact of Spasticity Measure (PRISM) and Multiple Sclerosis Spasticity Scale (MSSS-88) scales in the estimation of spasticity influence on different domains Methods The study is a cross-sectional observational study. MSSS-88 and PRISM scales were analyzed in five domains (body-function domain, activity domain, participation domain, personal factors/wellbeing domain, and hypothesis). For statistical interpretation of the correlation we performed the Spearman’s ρ-test, concurrent validity, divergent validity, and the linear regression model. Results We found a significant correlation between subscales of evaluated MSSS-88 and PRISM scales for body domains; the highest correlation was between the need for assistance/positioning (NA/P) and walking (W). Spasticity has the weakest correlation with the need for intervention (NI). The presence of pain has a negative impact and significant positive correlation between pain discomfort and NI. In the domain of body function for males, there was a non-significant correlation between muscle spasms and NI. The same applies for social functioning and social embarrassment domains, as well as for emotional health and psychological agitation for personal factors/wellbeing domain. The differences between genders of MS patients persist in different domains; muscle spasms are strong predictors for NI, and body movement is a strong predictor versus W for NA/P. Conclusion MSSS-88 and PRISM scales can be considered reliable in measuring different domains of disability for MS patients with spasticity. Because it is shorter, quicker, and simple to use, it is concluded that the PRISM scale can successfully compete with and replace the MSSS-88 scale in certain domains. © 2017, Serbia Medical Society. All rights reserved.

Introduction The Expanded Disability Status Scale (EDSS) is the most widely used disability measure in multiple sclerosis (MS). The effect of fatigability on EDSS components has been underreported to date. Objective We investigated daytime variability in EDSS score and EDSS components–functional scores (FS) and walking distance (WD) up to 500 m, in MS patients who underwent a standardized fatiguing exercise. Methods Twenty-four patients with relapsing-remitting MS (n = 7), secondary-progressive MS (n = 8) and primary-progressive MS (n = 9) were included. Exclusion criteria were as follows: current MS relapse, infection/fever/flu-like symptoms, conditions prohibiting safe exercise testing, current medication affecting fatigue. One trained examiner performed baseline (BL) and follow-up (FU) assessments (FU1 after a standardized fatiguing exercise, FU2 after rest) over a single day. EDSS score change of ≥1 point if BL EDSS score was <5.5 or of ≥0.5 point if BL EDSS score was ≥5.5 were considered clinically meaningful. Results In progressive MS subtypes, WD decreased at FU1, but recovered at FU2, more so in secondaryprogressive MS subgroup with the highest BL EDSS score. Although BL EDSS scores (median, 5.0; range 4.0–6.5) and FS remained relatively stable over repeated assessments in the total group, a clinically meaningful transitory post-exercise EDSS score increase was observed in three patients with progressive MS. Conclusion WD seems to be more influenced by fatigability than the total EDSS score, more so in patients with progressive MS and higher disability. WD should be assessed after rest and this strategy should be implemented into protocols of clinical trials recruiting patients with progressive MS phenotypes. © 2016. Srpski Arhiv za Celokupno Lekarstvo. All right reserved.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P=0.068). However, the mean serum UA level from patients with active MS (202.6+67.1 μmol/l) was significantly lower than that in inactive MS patients (226.5+78.6 μmol/l; P=0.046) and OND controls (P=0.007). We found a significant inverse correlation of serum UA concentration with female gender (P=0.0001), disease activity (P=0.012) and duration (P=0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P=0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P=0.0001), disease activity (P=0.014) and duration of the disease (P=0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P=0.068). However, the mean serum UA level from patients with active MS (202.6+67.1 μmol/l) was significantly lower than that in inactive MS patients (226.5+78.6 μmol/l; P=0.046) and OND controls (P=0.007). We found a significant inverse correlation of serum UA concentration with female gender (P=0.0001), disease activity (P=0.012) and duration (P=0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P=0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P=0.0001), disease activity (P=0.014) and duration of the disease (P=0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.

Aim To validate and cross-culturally adapt Croatian and Serbian versions of composite autonomic symptom score- 31 (COMPASS-31) for the detection of dysautonomia in patients with multiple sclerosis (MS). Methods A total of 179 patients, 67 with clinically isolated syndrome (CIS) and 112 with MS, completed the COMPASS- 31 at two MS centers in Zagreb and Belgrade between April 1 and October 31, 2016. Demographic and clinical data including age, gender, MS phenotypes, and the Expanded Disability Status Scale (EDSS) score were collected. Results The Cronbach's alpha coefficient of COMPASS-31 total score was 0.844 for the Croatian MS sample and 0.779 for the Serbian MS sample. A joint analysis yielded Cronbach's alpha coefficients ranging from 0.394 to 0.796, with values in four domains higher than 0.700. In Croatian and Serbian samples and the total study sample, the Cronbach's alpha coefficient of COMPASS-31 was 0.785. Reproducibility measured by intra-class correlation coefficient (ICC) was acceptable (ICC = 0.795). With regard to the clinical validity, significant correlation was found between EDSS and the COMPASS-31 total score (P < 0.001). Furthermore, significant differences between MS phenotypes were detected for bladder and gastrointestinal domains and for the COMPASS-31 total score (P < 0.001, P = 0.005, and P = 0.027, respectively). Finally, significant differences between MS phenotypes in patients with score > 0, which implies the existence of at least one of the symptoms investigated in each domain, were detected for secretomotor and bladder domains (P = 0.015 and P < 0.001, respectively). Conclusion COMPASS-31 represents a valid and acceptable self-assessment instrument for the detection of dysautonomia in MS patients.