Biljana Stern, Gregor Socan, Ksenija Rener-Sitar, Andreja Kukec and Lijana Zaletel-Kragelj
To validate the Slovenian version (SOC-13-SVN) of Sense of Coherence 13-item instrument (SOC-13) in Slovenian multiple sclerosis (MS) patients.
A consecutive 134 Slovenian MS patients were enrolled in a cross-sectional study in 2013. The reliability of the SOC-13-SVN was assessed for internal consistency by Cronbach’s alpha coefficient (α), dimensionality by the confirmatory factor analysis (CFA), and criterion validity by Pearson correlation coefficient (r) between SOC-13-SVN global score and MSQOL-54 composite scores – Mental Health Composite score (MHC) and Physical Health Composite score (PHC).
For the SOC-13-SVN instrument as a whole, internal consistency was high (αtotal=0.88) while it was low for three subscales (αcomprehensibility=0.79; αmanageability=0.66; αmeaningfulness=0.69). The results of the CFA confirmed a three-factor structure with good fit (RMSEA=0.059, CFI=0.953, SRMR=0.065), however, the correlations between the factors were very high (rcomprehensibility/manageability=0.938; rcomprehensibility/meaningfulness=0.811; rmanageability/meaningfulness=0.930). The criterion validity analysis showed a moderate positive strength of relationship between SOC-13-SVN global score and both MSQOL-54 composite scores (MHC: r=0.597, p<0.001; PHC: r=0.437, p<0.001).
Analysis of some psychometric properties confirmed that this instrument is a reliable and valid tool for use in Slovenian MS patients. Despite the three-dimensional structure of the instrument, the use of the global summary score is encouraged due to the low reliability of the subscale scores and high correlations between them.
Biljana Stern, Tanja Hojs Fabjan, Ksenija Rener-Sitar and Lijana Zaletel-Kragelj
To cross-culturally adapt and validate Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument.
The study which enrolled 134 Slovenian multiple sclerosis (MS) patients was conducted from March to December 2013. The internal consistency of the MSQOL-54 instrument was evaluated by Cronbach’s alpha coefficient (α), and its dimensionality assessed by the principal component analysis (PCA).
The whole instrument had high internal consistency (α=0.88), as well as the majority of its twelve subscales (α=0.83-0.94). The results of the PCA showed two components with eigenvalue greater than 1, explaining 59.4% of the cumulative variance. Further results indicated good construct validity of the instrument with the physical health-related-quality-of-life subscales loading highly on the physical component, and mental health-related-quality-of-life subscales loading highly on the mental component.
The Slovenian version of the MSQOL-54 instrument proved to be an internally consistent and accurate tool, well accepted by the Slovenian MS patients. The adequate psychometric properties warrant the scientifically sound version of the MSQOL-54 instrument, which is from now on at disposal to all health professionals dealing with MS patients in Slovenia.
Sanela Slavkovic, Spela Golubovic, Matilda Vojnovic and Congor Nadj
Multiple sclerosis (MS) results in a wide range of disabilities. The effects of cognitive and motor dysfunctions are significant and affect level of functioning in people with MS.
The aim of the research was to determine the common contribution of neurological, motor and cognitive status to the overall functioning of MS patients.
The sample consisted of 108 subjects with RRMS. The instruments used in the research included: The General Questionnaire, the World Health Organization Disability Assessment Schedule, the Audio Recorded Cognitive Screen, Paced Auditory Serial Addition Test, the Nine Hole Peg Test, the 25 Foot Walk Test, and the Expanded Disability Status Scale.
Subjects with a mild neurological deficit had a higher level of current functioning in all domains (a lower WHODAS 2.0 score) than subjects with a moderate neurological deficit (r=0.43, p<0.001). We found a positive correlation between the level of cognitive impairment and motor deficits of both upper and lower extremities and the level of neurological deficit (p<0.001). Subjects with lower neurological deficits had significantly lower WHODAS 2.0. scores, i.e. better motor abilities of both upper and lower extremities than subjects with moderate neurological deficits (p<0.001). The greatest contribution to explaining the overall level of current functioning of people with MS had subjects’ age, cognitive abilities and motor abilities of the upper extremities.
Inverse relationship of neurological, motor and cognitive status affects the overall daily functioning of people with MS, requiring planning of comprehensive programs in the rehabilitation of people with MS.
Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia
Background: The University Rehabilitation Institute in Ljubljana provides comprehensive rehabilitation for the whole territory of Slovenia. The aim of the study was to verify a clinical observation that the demandingness of rehabilitation has been increasing because of a decrease in patients' functional abilitites on admission, with rehabilitation outcomes having remained unchanged or even improved.
Methods: Functional Independence Measure (FIM) scores of 651 cerebrovascular insult (CVI) and 151 multiple sclerosis (MS) patients gathered between September 2004 and September 2006 (all eligible cases) were compared with those for patients with the same diagnosis (N=144 and 74, respectively) collected during the period from September 1999 to September 2000 (a random sample), considering only first-admission cases. The average FIM (motor, cognitive and total) scores and FIM gain after rehabilitation during the two periods were determined for each diagnostic group adjusted for patient age. Rehabilitation efficiency and effectiveness levels were compared in the same way. Effect Size and Standardised Response Mean were also analysed.
Results: There were no differences in gender structure of the groups between the periods studied. During the recent period, the average age was higher by around two years in both groups. The length of stay was marginally shortened for CVI patients and remained unchanged for MS patients. There were no differences between the two periods concerning the time elapsed since stroke. In both groups, admission motor and cognitive FIM scores were on average approximately five points lower in the recent period, while the average rehabilitation gain from admission to discharge increased over time (in total by 1 in CVI patients and by 3 in MS patients). Regarding motor and total FIM scores, the standardised gain, rehabilitation efficiency and rehabilitation effectiveness increased as well.
Conclusions: The Institute is admitting more severely affected patients than it did five to ten years ago, and parallelly the patient age has increased. Despite that and notwithstanding the tendency towards shorter rehabilitation, expected age-adjusted functional independence gain, rehabilitation efficiency, rehabilitation effectiveness, and the standardised functional independence gain have increased.
Olgica Trenčevska, Vasko Aleksovski and Kiro Stojanoski
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Sanja Kovačić, Stjepan Pepeljnjak, Zdravko Petrinec and Maja Klarić
Fumonisin B1 Neurotoxicity in Young Carp (Cyprinus Carpio L.)
For years scientists have suspected that the environment plays a role in neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis. Mycotoxin fumonisin B1 (FB1) is produced by several Fusarium species, mainly by Fusarium verticilioides, which is one of the most common fungi associated with corn worldwide. Fumonisins are known to cause equine leukoencephalomalacia, a disease associated with the consumption of corn-based feeds contaminated with FB1. Here we have reported chronic experimental toxicosis in one-year-old carp (Cyprinus carpio L.) receiving feed containing 100 mg kg-1 or 10 mg kg-1 of added FB1 for 42 days. We focused on fumonisin toxicity in the fish brain. After staining with hemalaun-eosin, histology of the fish brain revealed vacuolated, degenerate, or necrotic neural cells, scattered around damaged blood capillaries and in the periventricular area. These findings suggest that fumonisin, although it is a hydrophilic molecule, permeated the blood-brain barrier of young carp and had a toxic effect on neuronal cells.
Svetlana Popadić, Zorica Ramić, Ljiljana Medenica, Marija Mostarica-Stojkovic and Dušan Popadić
Numerous clinical studies demonstrate benefits of dietary supplementation with fish oils in autoimmune diseases and other inflammatory diseases such as psoriasis, multiple sclerosis, systemic lupus erythematodes and so on. Docosahexaenoic acid (DHA) is an omega-3 fatty acid which is abundantly found in fish oil. In the present study we investigated effects of DHA on proliferation of human keratinocytes established from skin of seven adult donors, cultivated in growth medium that allows optimal cell proliferation. We found a dose-dependent inhibition of cell proliferation when keratinocytes were incubated with 6.25, 12.5 and 25 -μM of DHA. Inhibition of proliferative capacity considerably varied in keratinocyte cultures derived from different donors, particularly when incubated with the lowest concentration of the assessed substance. Lactate dehydrogenase-release assay excluded necrosis of cultivated keratinocytes as a cause of decreased proliferation. Our results suggest that DHA may potentially be used as a routine adjuvant therapy, with classical therapy of inflammatory hyperproliferative skin diseases.
Katerina Damevska, Lence Neloska, Gjeorgji Gocev and Marija Mihova
Previous studies have shown a higher prevalence of cardiometabolic diseases among patients with psoriasis compared to non-psoriatics. However, little attention has been paid to the effects of systemic antipsoriatic drugs. The aim of this study was to investigate the association between psoriasis and these comorbidities, comparing untreated patients with psoriasis and population-based control non-psoriatic patients. A hospital-based case-control study included 122 patients with plaque-type psoriasis and 122 age- and gender-matched controls. Patients who ever received systemic antipsoriatic drugs were excluded. There were no significant differences between psoriatic patients and controls regarding the prevalence of hypertension (p=0.311), coronary heart disease (p=0.480), diabetes (p=0.641), myocardial infarction (p=0.71), stroke (2.4% vs. 2.4%, p=1.00) and metabolic syndrome (p=0.764). The prevalence of hypertriglyceridemia in patients with psoriasis and controls was 41.8% and 28.7%, respectively (OR 1.78, 95% CI 1.04-3.04, p=0.032). Furthermore, significant differences were observed in mean triglyceride levels (p=0.013). Smoking was significantly more often reported in psoriatic patients compared to controls. Patients with psoriasis also had a higher mean BMI (26.24, SD 4.42) compared with controls (24.73, SD 3.86), p=0.005. Psoriasis showed a statistically significant association with BMI obesity classification [χ2(4)=11.560, p=0.02]. The prevalence of cardiovascular and metabolic comorbidities was not significantly higher in patients with plaquetype psoriasis who were never treated with systemic antipsoriatic drugs, compared to population-based non-psoriatic controls. Our data suggest that systemic antipsoriatic drugs may play an important role in the development of these comorbidities. However, this study confirms that untreated psoriasis patients have three major modifiable increased cardiovascular risk factors, such as smoking, obesity and hypertriglyceridemia.