Sanja Pavlovic

Impairment of cardiac autonomic control in patients with amyotrophic lateral sclerosis

Abstract The aim of this study was to investigate autonomic cardiac control in patients with amyotrophic lateral sclerosis (ALS). Fifty-five patients with sporadic ALS (28 female and 27 male; average age 56.00 ± 10.34 years) were compared to 30 healthy controls (17 female and 13 male; average age 42.87 ± 11.91 years). Patients with previous history of cardiac disease, diabetes mellitus, and impaired respiratory function were excluded from the study. Cardiovascular autonomic tests according to Ewing, power spectrum analysis of RR variability (low- and high-frequency bands – LF and HF, LF/HF index), real-time beat-to-beat ECG signal monitoring with heart rate variability analysis and baroreflex function analysis were carried out in all patients. Time-domain parameters of heart rate variability (mean RR interval, SDNN, SDANN, SDNN index, rMSSD and pNN50%) were obtained from 24-h ECG monitoring. ALS patients had a significantly higher score of sympathetic (p <0.01) and parasympathetic (p <0.001) dysfunction, as well as of the overall score of autonomic dysfunction (p <0.001). LF/HF index was significantly increased; baroreflex sensitivity and time-domain parameters of heart rate variability were highly significantly decreased in ALS patients (p <0.001). Our results demonstrated impaired cardiac autonomic control in ALS with marked parasympathetic dysfunction and sympathetic predominance.

Biotransformation of nitric oxide in the cerebrospinal fluid of amyotrophic lateral sclerosis patients

Abstract Recent findings indicate that nitric oxide (NO•) over-production might be an important factor in the pathogenesis of sporadic amyotrophic lateral sclerosis (SALS). We measured significantly higher concentrations of uric acid and thiol group-containing molecules (R–SH groups) in the cerebrospinal fluid (CSF) from SALS patients compared to controls. The above factors, together with a slightly increased free iron concentration found in the CSF, favour conditions necessary for the formation of the dinitrosyl iron complex, capable of NO• bio-transformation. Thus, we performed ex vivo saturation of CSF (from both SALS patients and controls) with NO•. A decrease in the level of R–SH was found. This was more pronounced in the CSF from SALS patients. In the CSF from SALS patients the production of nitrite and hydroxylamine was greater than that observed in the CSF from controls. Moreover, we also found increased Cu,Zn-SOD activity in the CSF from SALS patients (when compared to control subjects) but no activity corresponding to Mn-SOD in any CSF samples. As Cu,Zn-SOD can react with nitroxyl forming NO•, the conditions for a closed, but continuous, loop of NO• biotransformation are present in the CSF of ALS patients.

Peripheral neuropathy in patients with myotonic dystrophy type 1

Abstract Objectives: To assess the frequency and type of peripheral neuropathy (PNP) in patients with myotonic dystrophy type 1 (DM1), as well as to identify factors that may be associated with this abnormality. Methods: This study comprised 111 adult patients with DM1. Nerve conduction study was performed on sural, peroneal and median nerves of both limbs. Results: PNP was somewhat more frequent in DM1 patients with glucose intolerance and diabetes mellitus (66·7 vs 33·7%, P = 0·05). In DM1 patients with no glucose intolerance, diabetes mellitus and thyroid dysfunction, the most frequent type of PNP was demyelinating (70·0%) and motor (83·3%). PNP was more frequent in males (45·7 vs 20·9%, P<0·05). Patients with PNP were older (43·7±7·3 vs 39·6±9·6 years, P<0·05) and had a longer duration of DM1 compared to those without PNP (18·6±9·9 vs 12·7±8·3 years, P<0·01). DM1 patients with PNP had a higher body mass index) (24·9±5·5 vs 22·4±4·2 kg/cm2, P<0·05), higher triglycerides (3·1±3·3 vs 1·8±0·8 mmol/l, P<0·01), total cholesterol (6·2±1·4 vs 5·4±1·1 mmol/l) and LDL cholesterol (4·3±1·2 vs 3·4±1·0, P<0·05). Achilles reflexes were absent in 76·9% patients with PNP and in 51·9% patients without PNP (P<0·05). Patellar reflexes and muscle strength were similar in both groups (P>0·05). Conclusions: PNP was present in one-third of DM1 patients. The most common type was motor and demyelinating PNP. Our results suggest the association between the presence of peripheral nerve impairment in DM1 and male gender, age, duration of disease and certain metabolic parameters.

Cardiologic predictors of sudden death in patients with myotonic dystrophy type 1

The aim of this study was to analyze survival, causes of death and cardiologic predictors of sudden death in a large cohort of patients with myotonic dystrophy type 1 (DM1). The study was comprised of 171 adult DM1 patients hospitalized at the Neurology Clinic in a 20-year period. Severe electrocardiographic (ECG) abnormality included at least one of the following: rhythm other than sinus, PR interval of ≥240 ms, QRS complex duration of 120 ms or more, and second-degree or third-degree atrioventricular (AV) block. Survival data were analyzed by the Kaplan-Meier test, log-rank test and Cox regression analysis. During the mean follow-up period of 9.4±5.4 years, a pacemaker was implanted in 5.8% of DM1 patients and 14% of patients died. The mean age at death was 55.6±12.5 years. The most common causes of death in our cohort were sudden death (41.7%) and respiratory failure (29.2%). The presence of palpitations (hazard ratio [HR]=4.7, p<0.05) and increased systolic blood pressure (HR=9.8, p<0.05) were significant predictors of sudden death. Among ECG parameters, severe ECG abnormality (HR=4.7, p<0.05), right bundle branch block (RBBB; HR=3.9, p<0.05) and bifascicular block (HR=5.8, p<0.05) were significant predictors of sudden death.

Sustainable Rural Tourism of Lower Danube Region in Serbia: Challenges and Realities

Sustainable tourism implies preserved space, prevents ecological and socio-cultural devastation, but at the same time encourages tourism development. Their application and adequate implementation increases the chance of a tourist destination that will be able to develop sustainable tourism, so the aim of this paper is to separate characteristics and principles of sustainability on certain areas and to show their advantages and limitations. In this paper are introspected factors of tourism development, both in a positive and in a negative context. It was hypothesized that sustainable rural tourism in the Lower Danube region has a comparative advantage, but it is also a major challenge for the community. Methodological setting is qualitative, based on the contextual dimension of the data, empirical observations, exploratory research and observations. Obtained results show that the tourist offer of sustainable rural tourism in the Lower Danube region has its own unique values, which should continue to explore.

Knowledge of Students of Tourism – Case Study: Sacral Monuments in Serbia

Abstract This paper presents the results of the knowledge of students about sacral monuments research basedon surveys conducted on students at the College of Tourism and the Faculty of Geography (study program Tourism)in Belgrade. The subjects of the research were: students’ interests in sacral monuments in Serbia, levels of informationabout them, curricula in which they studied about sacral monuments in Serbia, the influence of practice and travelon the knowledge of sacral monuments. Statistical analysis of the data using SPSS showed that students areinterested in learning more about sacral monuments in Serbia, that curricula are predominantly focused on artisticvalues, while tourism and economic aspects of sacral monuments are relatively neglected. The results also revealedthat sacral monuments of minority confessions are often neglected in the curricula. Students believe they can learnmore about sacral monuments through travel and practice rather than through lectures.

The Role of Cultural Heritage in the Development of Mountain Tourism: Case Study Mountain Rudnik, Serbia

Rudnik Mountain, as the most dominant mountain in the Sumadija region, is located about 100 km south of Belgrade, which is connected to Ibar highway. Because of its exceptional climatic conditions, in 1922 it was declared an air spa, and the geologic-geomorphological features (mountain peaks more than 1000 m above sea level, lookouts, caves, etc.), as well as the wealth of water and preserved flora and fauna, contributed to its excursion potential. Archaeological findings testify to early habitation of the area. In ancient times the mountain was the scene of mining, and remnants of the period before and after the arrival of the Romans, the Serbian medieval state, and Turkish times are preserved. The preserved cultural heritage (monasteries: Blagovestenje, Voljavca, Vracevsnica, Nikolje and Petkovica; the residence of Prince Milos; the remains of medieval towns; Ostrvica and Gradovi; archaeological site Misa; remains of mining pits and localities; rich monumental complex, etc.) had a significant role in the development of mountain tourism in Rudnik Mountain in Serbia. Regionally recognizable as a year-round holiday destination with great potential for excursion, recreation, sports, health, and other forms of tourism development, Mountain Rudnik has, thanks to the rich cultural heritage, a chance for popularization through various forms of trips, excursions, schools in nature, recreational classes, and other programs of travel agencies intended for children and adults.

Spatial Resources and Sustainable Development of Business Tourism in Serbia

Serbia has numerous tourist resources which can be used for tourism development and it is base for strategic documents about tourism. Business tourism, for its economic contribution to tourist destinations is globally recognized. Preserved and unchanged natural environment, geodiversity and biodiversity are representing important resources for the development of business tourism in Serbia. Trips and excursions are constitutive part of modern business events and because of that diversity of natural and anthropogenic resources is one of the main drives of business tourism development. This paper focuses on identification of such resources and points on possibilities of their use in development of Serbia as destination of business tourism. Tourism is one of the best opportunities for a sustainable economic and social development for Serbia and this paper is trying to explain how business tourism resources, accommodation, tourist agencies specialized in business tourism should be developed and used by tourism policy makers.

Myasthenic symptoms in a patient with Kennedy's disease.

Spinal and bulbar muscular atrophy (SBMA) is X-linked inherited slowly progressive lower motor neuron disease. It is characterized by adult onset weakness and atrophy of bulbar and proximal limb muscles and mild androgen insensitivity. Three reports describe patients with SBMA and myasthenic syndromes responding to anticholinesterase inhibitor treatment [1] and few describes decremental response to repetitive nerve stimulation (RNS) in SBMA [2]. Although fiber density (FD) in SBMA can be markedly increased, neuromuscular jitter is usually low [3]. We report a patient with SBMA who has additional myasthenic signs.

20.Prognostic value of cardiovascular autonomic control impairment for onset of respiratory insufficiency in patients with amyotrophic lateral sclerosis

reduces gait to a sequence of synergies with strongly expressed temporal and spatial components. We present the example where normal gait (averaged stride cycles from recorded sequence) is represented by a characteristic closed-pattern figure resembling to a letter D. Another parameter obtained from analysis, mutual position of Pearson’s correlation coefficients defines synergistic motion of leg segments. If gait pattern is modified, gait will be represented with distorted shapes whose distortion level is correlated with severity of gait disturbance. Also, different mutual positions of correlation coefficients may indicate joints that provoke a disturbed control and directly affect gait quality.