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Journal Article 2015; 36(4): 363-367 PubMed PMID: 26454492 Citation  Keywords:  Adult, Age Factors, Aged, Aged, 80 and over, Comorbidity, Electromyography, Female, Humans, Levodopa:administration & dosage, Male, Middle Aged, Parkinson Disease:drug therapy, Peripheral Nervous System Diseases:diagnosis,.   

BACKGROUND: Recent studies suggest an increased frequency of peripheral neuropathy (PN) in Parkinson's disease patients (PD) (Toth et al. 2010). The aim of our study is to verify the increased frequency of PN in our group of PD patients compared to an age-matched control group. We sorted patients according to the duration of L-DOPA treatment, L-DOPA dosage, and age below or over 50 years.

METHODS AND RESULTS: We conducted electromyography examinations (using conduction studies and needle electromyography) of 49 PD patients with asymptomatic polyneuropathy and 40 controls. Patients without risk factors for PN were included (fasting blood was analyzed to rule out possible causes of PN), as were relatively healthy controls without risk factors for PN. PN was defined using the American Academy of Neurology and Electrodiagnostic Medicine criteria (England et al. 2005).

CONCLUSION: The frequency of polyneuropathy was significantly higher in PD patients than in controls (45% versus 2%, p<0.0001). We did not establish a relationship in the PD group according to long-term L-DOPA usage, PD duration, or age. It should be assumed that a neurodegenerative process underlies the involvement of the central and peripheral nervous systems in PD patients....

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Journal Article 2015; 36(3): 294-300 PubMed PMID: 26313398 Citation  Keywords:  Adult, Aged, Bipolar Disorder:epidemiology, Cognition Disorders:epidemiology, Comorbidity, Female, Humans, Hypertension:epidemiology, Male, Middle Aged.   

OBJECTIVES: Cognitive impairment in euthymic phase of bipolar disorder has been documented in many studies. Several factors may contribute to such impairment, e.g. sedative medication, thyreopathy. Metabolic syndrome with its components represents another frequent condition found in bipolar disorder exerting probably adverse impact on cognition. Since it is treatable factor and current literature suggests possible connection with cognitive dysfunction, we aimed to explore such associations to identify promising targets of complex treatment.

METHODS: Forty euthymic bipolar patients have been enrolled. Their body and metabolic parameters were measured. Medical history data were collected. Cognition was evaluated using battery of tests. Neuropsychological performance was transformed into neurocognitive composite score. Cognition of subjects was compared dichotomously according to presence or absence of pathological body and metabolic parameters. Correlations of selected parameters and composite score were done.

RESULTS: Low neurocognitive score was found in presence of hypertension, metabolic syndrome, abdominal obesity and hyperglycemia. Only connection of hypertension and cognitive score reached sufficient statistical power. Patients presenting hypertension performed worse in all tested domains of cognition when compared with normal blood pressure group. Subjects using lithium performed substantially worse in cognitive tests. However, in comparison with anticonvulsant group, lithium users had markedly longer disorder history as well as longer duration of thymoprofylaxis. No significant correlation of HDRS score, insulinemia or HOMA-IR was found.

CONCLUSION: Despite relatively small sample size, noticeable association of hypertension and cognitive impairment was revealed. This might indicate possible way of enhancing cognition in bipolar disorder by treating elevated blood pressure....

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Case Reports 2015; 36(3): 226-230 PubMed PMID: 26313387 Citation  Keywords:  Aged, 80 and over, Cataplexy:diagnosis, Comorbidity, Female, Humans, Narcolepsy:diagnosis, Parkinson Disease:diagnosis,.   

: We present the case of an 86 year old female, in whom narcolepsy with cataplexy (NC) manifested at 52 years of age. She was treated by an amphetamine-like drug phenmetrazine and tricyclic antidepressants for more than 10 years. Hypokinetic-rigid syndrome manifested at 83 years of age and Parkinson´s disease (PD) was diagnosed. Detailed examination at the age of 86 confirmed the previous diagnosis of NC and the diagnosis of PD. Severe periodic limb movements in sleep, severe sleep apnea, REM sleep behavior disorder and restless legs syndrome, which are frequently comorbid in NC and PD, were revealed. The patient's somnolence worsened, apparently accentuated by pramipexole treatment, as changing therapy to levodopa led to a reduction of sleepiness....

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Journal Article 2015; 36(1): 53-58 PubMed PMID: 25789595 Citation  Keywords:  Adult, Circadian Rhythm, Comorbidity, Female, Humans, Hyperprolactinemia:blood, Polycystic Ovary Syndrome:blood, Prolactin:blood, Retrospective Studies, Young Adult,.   

OBJECTIVES: Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility. Both pathologies are characterized in common by several clinical features. At the same time, there are essential discrepancies in medical literature on mutual relations between PCOS and hyperprolactinemia. The objective of our study was to answer several questions, e.g. about frequency of hyperprolactinemia in PCOS patients, typical concentrations of prolactin (Prl) in PCOS patients vs women without polycystic ovaries and/or an assessment of circadian Prl level profiles vs single Prl sampling, as regards diagnostic usefulness.

METHODS: The study was retrospective analysis of medical records of female patients in whom nine (9) points daily profile of prolactinemia had been performed.

RESULTS: Prl levels appeared to be slightly higher in women without PCOS but the difference did not reach a border of statistical significance. The incidence of elevated Prl concentrations in 8:00 AM and 11:00 AM samples was higher in women without PCOS than in PCOS patients (32.0% vs 16.3% - 8:00 AM, and 8.5% vs 4.6% - 11:00 AM, respectively). Also, elevated mean daily prolactinemia, assessed as area under the curve (AUC) of Prl concentrations, was more frequent in the group of women without PCOS than in those with PCOS (22.0% vs 13.9%).

CONCLUSIONS: Polycystic overy syndrome is not associated with higher levels of Prl, measured in daily profiles. Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as characteristic feature of PCOS - both are distinct clinical entities. Prolactin concentrations should be assessed in each woman with PCOS suspicion because of certain common clinical signs in both disorders. Every woman diagnosed with PCOS and hyperprolactinemia should further be examined in terms of the actual causes of hyperprolactinemia because the coexistence of these two disease entities - as distinct - is also possible....

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Journal Article 2015; 36(1): 48-52 PubMed PMID: 25789588 Citation  Keywords:  Adolescent, Adult, Aged, Child, Comorbidity, Female, Goiter:classification, Humans, Iodine:deficiency, Male, Middle Aged, Pakistan:epidemiology, Retrospective Studies, Thyroid Neoplasms:epidemiology, Thyroidectomy:statistics & numerical data, Thyroiditis:.   

OBJECTIVES: To identify the histopathological patterns of goiter in thyroidectomy specimens and their frequency in relation to age and gender of the patients.

METHODOLOGY: We present a retrospective data of 624 thyroidectomy specimens diagnosed over a period of six year (2007-2012) at the Department of Pathology, Holy Family Hospital, Rawalpindi, Pakistan.

RESULTS: A total of 624 consecutive thyroidectomy specimens were selected. Patient's age ranges from 11-89 years, 541 females and 83 males. There were 512 (82%) non-neoplastic lesions, which includes; 475 (76.1%) multi-nodular goiter (MNG), 16 (2.6%) Hashimoto thyroiditis, 11 (1.8%) colloid goiter, 4 (0.6%) toxic goiter, 2 (0.3%) chronic lymphocytic thyroiditis, 2 (0.3%) tuberculous thyroiditis and 2 (0.3%) miscellaneous. From 112 (18%) neoplastic lesions, 43 (6.9%) were adenomas (41 females and 2 males) and 69 (11.0%) were carcinomas (58 females and 11 males). Peak age for thyroid malignancy was 3rd to 4th decades. The histological subtypes of thyroid carcinomas includes, 35 (5.6%) follicular variant of papillary carcinoma (FVPC), 15 (2.5%) well-differentiated tumor of uncertain malignant potential (WDT-UMP), 6 (1%) medullary carcinomas, 6 (1%) papillary carcinomas, 3 (0.5%) anaplastic carcinomas, 2 (0.3%) follicular carcinomas and 2 (0.3%) other carcinomas. Twenty-nine (4.6%) neoplastic lesions were associated with MNG, includes; 2 (3.5%) follicular adenomas, 3 (0.5%) WDT-UMP and 4 (0.6%) FVPC.

CONCLUSIONS: MNG is common and FVPC is the common thyroid cancer seen in females. The overall frequency of thyroid cancer is 11%. Follicular adenoma and FVPC appears to be associated with long standing MNG of iodine deficiency....

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Journal Article 2014; 35(8): 691-696 PubMed PMID: 25702297 Citation  Keywords:  Age of Onset, Aged, Aged, 80 and over, Alzheimer Disease:epidemiology, Apolipoprotein E4:genetics, Comorbidity, Diabetes Mellitus:epidemiology, Female, Humans, Hypertension:epidemiology, Male, Protective Factors, Risk Factors, Stroke:epidemiology,.   

OBJECTIVE: The aim of our current research project is to further evaluate the role of risk factors in the pathogenesis of Alzheimer's disease; these include genetic variations, environmental factors and lifestyle issues.

METHODS: We have been conducting an association study on 373 patients with Alzheimer's disease and 286 unrelated control individuals. The occurrence and the age of onset of diabetes and cardiovascular diseases were evaluated in both groups. Apolipoprotein E genotype was analyzed in all subjects by PCR method.

RESULTS: We report that, in Czech population carrying ApoE4 allele increases risk of Alzheimer's disease 2.1-fold and genotype E4E4 increases the risk 8.4-fold. We have also identified a significant association between ApoE4 allele, Alzheimer's disease and hypertension. Hypertensive subjects with the ApoE4 allele have 1.5-fold greater risk of Alzheimer's disease. Thus, hypertension together with ApoE4 allele translates into 1.5-fold higher risk of AD. The most intriguing original finding in the present study is that Alzheimer's disease patients have significantly later onset of diabetes, hypertension and stroke in comparison with control subjects. This effect was not influenced by ApoE genotype. The diabetes appeared in AD patients on average more than 10 years later than in the control subjects (p<0.0001), hypertension was diagnosed 14 years later in AD patients (p<0.00001) and stroke occurred on average 6 years later (p<0.005), compared to the control group.

CONCLUSIONS: Overall, in addition to the above novel findings, our study expands the data base on risk factors that could be used in near future when testing for the genetic risk of Alzheimer's disease.

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Journal Article 2014; 35(7): 613-618 PubMed PMID: 25617885 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Biopsy:adverse effects, Brain Neoplasms:mortality, Female, Humans, Lymphoma:mortality, Magnetic Resonance Imaging:methods, Male, Middle Aged, Morbidity, Retrospective Studies, Risk Factors, Stereotaxic Techniques:adverse ef.   

OBJECTIVES: Stereotactic biopsy is a suitable method for sampling intrinsic brain lesions. Although this method is considered to be a safe procedure, some risk of complications still exists. The aim of the study was to retrospectively assess the morbidity and mortality of MRI-guided stereotactic biopsy of lesions which were histologically proven to be brain lymphoma.

METHODS: We retrospectively studied all accessible medical records for patients who had undergone MRI-guided stereotactic biopsy of brain lesions with histologically proven brain lymphoma from January 2007 to December 2012. Our cohort included 45 patients, 27 males and 18 females, aged 23-84 (63±14) years.

RESULTS: Forty-nine biopsies were carried out on 45 patients; the average number of tissue specimens was 3±1. The diagnostic yield of the stereotactic biopsy was 92%. Overall major morbidity directly related to stereotactic biopsy of brain lymphoma was 6.1% (3 cases) including 4.1% mortality (2 cases). Both deaths after the stereotactic procedure were due to intracranial hemorrhage and subsequent complications and both these patients had a history of treatment of systemic lymphomas. In one patient the stereotactic biopsy was complicated by a brain abscess which was successfully treated.

CONCLUSION: Stereotactic biopsy is still a mandatory diagnostic procedure for primary brain lymphomas, with an acceptable risk of complications. However, according to our results, the risk of complications can be higher in patients who have previously been treated for secondary lymphomas....

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Comparative Study 2014; 35(1): 42-49 PubMed PMID: 24625917 Citation  Keywords:  Age Factors, Aged, Aged, 80 and over, Alzheimer Disease:blood, Biomarkers:blood, Comorbidity, Depressive Disorder:blood, Female, Homocysteine:blood, Humans, Male, Middle Aged, Severity of Illness Index,.   

OBJECTIVE: Elevated homocysteine is associated with a variety of diseases, including Alzheimer's disease (AD) and depressive disorder. This study was designed to detect an association between plasma homocysteine and AD with or without co-morbid depressive symptoms.

METHODS: Plasma homocysteine concentrations were measured in 85 AD patients (36 of them with depressive symptoms), 33 non-AD patients with a depression diagnosis and 44 healthy controls, all aged above 50 years.

RESULTS: Positive correlation between age and homocysteine was confirmed. Significantly higher mean plasma homocysteine was found in AD patients, but not in depressive patients, when compared with controls. We confirmed significant correlation between homocysteine concentration and the degree of cognitive impairment in AD patients. There was no incremental effect of concurrent depressive symptoms on homocysteine concentration in AD patients.

CONCLUSION: The association of high homocysteine with degree of cognitive impairment or stage of dementia in AD indicate potential role of high plasma homocysteine as a biomarker of the disease and/or indicator of brain damage during the progression of AD dementia....

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