Darija Kisic Tepavcevic

Quality of life in patients with focal dystonia.

OBJECTIVES The aims of this study were to identify the clinical and demographic factors influencing health-related quality of life (HR-QoL) and to compare HR-QoL measures between various types of focal dystonia (cervical dystonia, blepharospasm, and writers cramp). METHODS We examined 157 consecutive patients with adult-onset primary focal dystonia, and HR-QoL was assessed by using the SF-36 questionnaire. Univariate and multivariate regression analyses were performed. RESULTS Patients with writers cramp scored better in all SF-36 domains, except role functioning physical (RP), while these differences were statistically significant for physical functioning (PF) (p=0.020), bodily pain (BP) (p=0.001), and general health (GH) (p=0.004). Patients with writers cramp and blepharospasm scored significantly better for BP (p=0.001) than patients with cervical dystonia. We found that each of the eight dimensions of SF-36 proved to be significantly correlated to the Hamilton depression rating scale score in patients with torticollis and blepharospasm, while vitality (VT), social functioning (SF), and mental health (MH) scales showed statistically significant correlations in patients with hand dystonia. Similar relationships were observed between anxiety and SF-36 domains. CONCLUSION Depression and anxiety are the most important predictors of poorer HR-QoL in patients with all three types of focal dystonia.

Validation and cross-cultural adaptation of the disease-specific questionnaire MSQOL-54 in Serbian multiple sclerosis patients sample

The objective of this study was to translate the MSQOL-54 into Serbian, and investigate the validity of the translated and cross-culturally adapted inventory in Serbian MS patients. The questionnaire was validated in 200 consecutive MS patients seen between February and September 2005 at the Institute of Neurology, Clinical center of Serbia, in Belgrade. The translation followed an internationally accepted methodology. Associations between age, gender, education, marital and employment status, disease course, the expanded disability status scale (EDSS) score, and the MSQOL-54 physical and mental health composite scores were determined. Patients’ participation in the assessment was satisfactory and all scales fulfilled the usual psychometric standards. Highly significant inverse relationship was found between both composite scores and clinical characteristics of the disease, the EDSS and the disease course. Additionally, both composite scores, correlated significantly with patients’ age, education and employment status. The Serbian-translated version of this questionnaire may be useful as clinical outcome measures in patients with MS.

Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting

Falls represent continuing, disabling and costly problem in Parkinsons disease (PD). The study was carried out at the Neurology Clinic in Belgrade from August 2011 to December 2012. As many as 180 community dwelling persons with PD aged 22-83 years who sustained a fall in past 6 months were included. Characteristics of the most recent fall were obtained through detailed interviews. Inclusion criteria were: Mini Mental State Examination (MMSE)≥24, ability to walk independently for at least 10 m and ability to statically stand for at least 90 s. Exclusion criteria were: presence of other neurologic as well as psychiatric, visual, audio-vestibular and orthopedic impairments. Falls more frequently took place outside (57.2%) and in the morning (53.9%). As much as 38.9% of persons with PD sustained an injury. Soft-tissue contusion was the most common injury (71.8%) both after indoor and outdoor falls. Fractures accounted for 5% of all fall-related injuries. All the fractures were either arm, clavicle or rib fractures. Tripping was identified as risk factor for outdoor falls (OR=7.90; 95% confidence interval [95% CI] 3.21-19.39; p=0.001). In contrast, lower extremity weakness (OR=0.20; 95% CI 0.05-0.72; p=0.015) and internal sense of sudden loss of balance (OR=0.19; 95% CI 0.05-0.73; p=0.015) were risk factors for indoor falls. To accomplish long-term results, development of particular prevention programs for persons with PD who fall at home vs. outdoors is recommended.

Risk factors for hepatocellular carcinoma: a case-control study in Belgrade (Serbia).

Aims and background The objective of this case-control study was to test the existing hypotheses about factors related to the occurrence of hepatocellular carcinoma in the population of Belgrade (Serbia). Methods and study design The investigation was conducted between 2004 and 2007 and consisted of 45 newly diagnosed, histologically confirmed hepatocellular carcinoma patients and 90 individually gender- and age-matched hospital controls. Conditional univariate and multivariate logistic regression analyses were applied. Results A highly statistically significant association (P = 0.001) was demonstrated between hepatocellular carcinoma and HBsAg positivity and the presence of hepatitis C virus antibodies. Diabetes mellitus was significantly (P = 0.018) associated with an increased risk of hepatocellular carcinoma. A statistically significant inverse association was shown between low parity and the risk of hepatocellular carcinoma (P = 0.033). The risk increased significantly with a longer history of cigarette smoking (P = 0.044), as well as the daily consumption of hard liquor (P = 0.049). A weekly intake of fish (P = 0.003) and yogurt (P = 0.003) and daily intake of boiled vegetables (P = 0.001) were reported more frequently by controls than hepatocellular carcinoma cases. In the current study, a high intake of salty food also significantly increased the risk of hepatocellular carcinoma (P = 0.027). Based on multivariate analysis, the presence of hepatitis C virus antibodies (OR = 24.6, P = 0.001) and duration of smoking ≥25 years (OR = 3.8, P = 0.020) were significantly related to hepatocellular carcinoma, whereas the daily consumption of boiled vegetables (OR = 0.1, P = 0.011) was inversely associated with the risk of hepatocellular carcinoma. Conclusions The findings obtained in the current study support the hypotheses that non-viral factors, such as lifestyle factors, reproductive factors, and a history of diabetes, might be involved in the etiology of hepatocellular carcinoma. Free full text available at www.tumorionline.it

Fall frequency and risk factors in patients with Parkinson's disease in Belgrade, Serbia: A cross‐sectional study

The aim of the present study was to estimate fall frequency as well as demographic and clinical factors related to falling in a cohort of Serbian patients with Parkinsons disease (PD).

Validation and cross-cultural adaptation of the Falls Efficacy Scale in patients with Parkinson's disease in Serbia.

The aim of the present study was to assess the validity and reliability of the Falls Efficacy Scale (FES) in Parkinsons disease (PD) patients in Serbia.

Trends in mortality from different subtypes of stroke in the population of Belgrade (Serbia)

OBJECTIVE To estimate trends in mortality due to different stroke subtypes in the population of Belgrade during the period 1989-2003. PATIENTS AND METHODS Mortality data for stroke were compiled from material of the Municipal Institute of Statistics. Stroke mortality rates were standardized by world standard population. Linear regression coefficient in time trend analysis of mortality rates was assessed by Fishers test. RESULTS In Belgrade, 1989-2003, the highest values of mortality rates were for ischemic stroke in both sexes: 50.1/100,000-men, and 39.9/100,000-women. The mortality rate from subarachnoid hemorrhage (SAH) was lower in men (3.9/100,000) compared to women (5.3/100,000). For intracerebral hemorrhage (ICH), the death rate was 3.1 times higher than that for SAH. Stroke due to hemorrhage was a more common cause of death than ischemic stroke for both sexes in all age groups up to 59. In older age, ischemic stroke became the more frequent cause of death. The time trends of stroke mortality rates in the Belgrade population during the period 1989-2003 showed that the most excessive statistically significant increase in death rates was related to ICH in both sexes. The death rates from SAH had increasing tendency in both sexes, especially in women (p=0.017). Upward trends were observed for ischemic stroke mortality rates too, with statistical significance in men (p=0.048). CONCLUSION Further research is needed to explain the causes of the increasing burden of stroke in Serbia. Since different profiles of risk factors play a role in the etiology of different stroke subtypes, these facts should be taken into account in the creation of both prevention and management strategies.

MSQoL-54 predicts change in fatigue after inpatient rehabilitation for people with multiple sclerosis

Purpose: The aim of our study was to investigate the impact of a short-term inpatient rehabilitation program on fatigue in patients with multiple sclerosis (MS) and to assess whether the scales of Multiple Sclerosis Quality of Life 54 (MSQoL-54) could predict change in fatigue after rehabilitation. Method: Included in the study were 151 moderately disabled MS patients admitted for 3 weeks of inpatient rehabilitation. Fatigue (Fatigue Severity Scale; FSS) was assessed at baseline and after treatment, and quality of life (MSQoL-54), disability (Expanded Disability Status Scale; EDSS) and depression (Beck Depression Inventory; BDI) were estimated at baseline. Results: Sixty-four percentage of the subjects showed fatigue. Both EDSS (r = 0.720, p = 0.001) and BDI (r = 0.655, p = 0.001) scores showed statistically significant positive correlation with FSS scores. Significant negative correlation was demonstrated between FSS and both, Physical Health Composite (PHC) and Mental Health Composite (MHC) scores of MSQoL-54 (r = −0.770, p = 0.001, and r = −0.646, p = 0.001, respectively). The mean FSS score significantly decreased by 0.19 ± 0.29 points in the fatigue group, immediately after rehabilitation. The multiple regression analyses with change of FSS as dependent variable and baseline scores of MSQoL-54 as independent variables showed statistically significant relation between change in fatigue and baseline PHC score (p = 0.034). Conclusions: Inpatient rehabilitation decreased MS patients’ fatigue. Change in fatigue was predicted with certain domains of QoL at baseline. Implications for Rehabilitation The rehabilitation programmes which comprise physiotherapy (physical input) and verbal interactions with people with multiple sclerosis (MS) (non-physical input) improve fatigue in this study. Predictive value of certain quality of life domains on change in fatigue status could suggest that the way in which people interpret their symptoms, may have a significant impact on the effect of rehabilitation interventions for fatigue in MS. The assessment of the baseline quality of life may be useful in decision-making before undergoing rehabilitation therapy and could help in the process of guiding individualized rehabilitation programmes in this cohort.

INCIDENCE OF PRIMARY CENTRAL NERVOUS SYSTEM TUMORS AMONG CHILDREN IN BELGRADE (SERBIA), 1991–2004

The aim of this survey was to estimate the incidence of primary CNS tumors among children aged 0–14 in Belgrade during the period 1991–2004. Incidence rates were age-adjusted according to the world standard population. The average age-adjusted incidence rates were 3.4/100,000 for boys, 2.4/100,000 for girls, and 2.9/100,000 for both genders. There was a nonsignificant tendency toward increased CNS tumor incidence (y = 2.547 + 0.052x, p =. 549). The age-specific incidence rates were 3.0/100,000 (0–4 years), 2.2/100,000 (5–9 years), and 3.8/100,000 (10–14 years). Among the population aged between 0 and 14, the cumulative probability of acquiring primary CNS tumors was 1 per 1961 for boys and 1 per 2778 for girls. Astrocytoma was the most common pathohistological type of primary CNS tumors accounting for 41.5% of cases.

Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia)

Background : The aetiology of multiple sclerosis (MS) is unclear, but numerous studies suggest that different exogenous factors can lead to the development of the disease in genetically susceptible individuals. The objective of this case-control study was to determine the role of food and dietary patterns in patients with MS in the population of Belgrade (Serbia). Methods : In this matched case-control study, we included 110 cases with definite MS according to McDonald’s criteria, in whom the onset symptoms occurred up to 2 years prior to the interview, who were followed-up at the Institute of Neurology, Clinical Centre of Serbia, Belgrade. The identical number of controls from the same institution, individually matched by sex, age and area of residence, was recruited from patients with various non-autoimmune neurological disorders. Dietary information was obtained by using a frequency history approach. Results : According to univariate conditional logistic regression analysis the following factors were significantly related to MS: body mass index (BMI) less than 25 (OR=2.2, p=0.009), frequent consumption of beef (OR=1.7, p=0.043), chicken (OR=2.0, p=0.045), meat of the lamb (OR=2.1, p=0.013), butter (OR=1.7, p=0.056) and ice-cream (OR=1.8, p=0.031), with dose-response relationship. Consumption of majority of various fruit was more frequently reported by controls. According to multivariate conditional logistic regression analysis, BMI less than 25 (OR=2.3, p=0.008), consumption (weekly) of beef (OR=2.0, p=0.017) and butter (OR=1.9, p=0.027) was significantly related to MS, while regular consumption of cherry (OR=0.4, p=0.024) had protective role. Conclusions : This study might assist in potential defining of the dietary factors that could contribute to the risk of developing MS.