Dragana Cirovic

Distribution of affected muscles and degree of neurogenic lesion in patients with spina bifida

Introduction Patients with spina bifida in the lumbosacral region usually have various degrees of motor and sensory dysfunctions of the lower extremities and anal sphincter. The aim of our study was to evaluate the distribution and differences in frequencies of affected muscles, number of affected muscles and degree of neurogenic lesion between patients with spina bifida occulta (SBO) and spina bifida aperta (SBA). Material and methods In 100 patients with SB, 6 muscles in the lower limbs were separately analysed. Due to the number of affected muscles, we evaluated 5 groups of patients: with 1 affected muscle, 2 affected muscles, 3 affected muscles, 4 affected muscles and 5 affected muscles. Three degrees of neurogenic lesions were assessed: mild, moderate and severe. Results The tibialis anterior muscle was most frequently affected in SB patients. The outer anal sphincter was frequently affected in the group of SBA patients. Single muscle affection is frequent in the group of patients with SBO, while in the group of patients with SBA, 4 muscles were significantly frequently affected. The great majority of patients (45.46%) with affected outer anal sphincter (OAS) in the group of SBO were without affection of other muscles, while for the SBA group it was for every third patient. Mild neurogenic lesion was significantly frequent in SBO patients, while severe form was significantly frequent in SBA patients. Conclusions Patients with SBO usually present with mild to moderate clinical presentation, while multiple root involvement and severe degree of neurogenic lesion is associated more frequently with SBA.

Influence of the metabolic control on latency values of visual evoked potentials (VEP) in patients with diabetes mellitus type 1

The aim of our study was to investigate the relationship between the metabolic control parameters of diabetes mellitus (glycemia and HbA1c) and visual evoked potentials (VEP) latency values. The study included 61 patients with diabetes mellitus type 1 that were hospitalized at the Clinic for Endocrinology, Diabetes and Metabolic Diseases due to the poor metabolic control. All patients were divided into 3 groups. Group 1 consisted of patients on conventional insulin therapy (CT); Group 2 included patients on CT at the moment of hospitalization, with a change towards intensified insulin therapy (IIT); and Group 3 consisted of patients on IIT. Patients with diabetic retinopathy (DR) were excluded from the study. Metabolic control (glycemia and HbA1c) and VEP parameters were compared at the beginning of the study and six months later. After six months of strict glycoregulation, significant improvement in VEP parameters was followed by significant improvement of evaluated parameters of metabolic control. We found statistically significant reduction in frequency of pathological VEP findings, prolonged P100 latency and low amplitude potentials in Group 2, while in Groups 1 and 3 we found that these parameters did not significantly changed but the frequencies were lower. The VEP testing is a noninvasive diagnostic procedure which may help in early diagnosis of DR, prognosis during the metabolic control and treatment. If changes in the retina could be detected before DR is noticed using this noninvasive diagnostic procedure and include patients in a strict glycoregulation, we could be in the position to prevent serious complications that may cause blindness.

Validation of Serbian Version of Dysfunctional Voiding Symptom Score (DVSS) Questionnaire

Objective: The aims of our study were to translate the dysfunctional voiding symptom score (DVSS) from English to Serbian; culturally adopt the items; assess the internal consistency and the test–retest reliability of DVSSSR in patients with dysfunctional voiding (DV); evaluate and test the construct and divergent validity of DVSSSR against demographic parameters (gender and education); and examine the level of explained variability for each item of DVSSSR against demographic parameters (gender and education). Methods: The cross-sectional observational study included 50 patients with dysfunctional voiding aged 5 years and above. The DVSS questionnaire was translated from English into Serbian by the forward–backward method. Internal consistency was assessed with Cronbach α and test–retest reliability with intraclass correlation coefficient (ICC). For validity testing we performed construct and divergent validity analyses. Results: There was excellent internal consistency for every item except for Item 6 (0.787) and Item 3 (0.864), where internal consistency was good. The observed test/retest ICC for average measures was more than 0.75 (excellent) for all DVSSSR items. Gender and educational level does not correlate significantly with each item of DVSSSR (p > 0.05). For divergent validity, there were no significant differences in mean values of each item of DVSSSR between genders and different levels of education (p > 0.05). Variability that can be explained for gender and educational level was below 10%. Conclusion: Translated DVSSSR is of adequate validity and reliability for assessing DV in children.

Evaluation of Visual Evoked Potentials in Patient with Angelmans Syndrome - Case Report

BACKGROUND Angelman syndrome (AS) is a genetic disorder with varying degrees of neurological impairment. It is often associated with ocular involvement. CASE REPORT We present a child diagnosed with AS who had a deletion on the short arm of chromosome 15. The child seemed to be happy, with developmental delay, speech problem, and altering strabismus. To assess the potential presence and degree of damage in the visual pathway, we recorded monocular flash visual evoked potentials (VEPs). Our results revealed the presence of severe central afferent dysfunction in both optical pathways. CONCLUSION VEPs can be used in patients with AS and visual disturbances to assess the integrity of the visual system.