The Significance of Interleukin-6 and Tumor Necrosis Factor-Alpha Levels in Cognitive Impairment among First-Ever Acute Ischaemic Stroke Patients.

BACKGROUND: Acute ischemic stroke (AIS) frequently results in the development of cognitive impairment, which quite often persists. The pathophysiological mechanisms involved in the development of cognitive impairment are only partially elucidated. The aim of this study was to evaluate the correlation between interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) serum levels with cognitive impairment in AIS patients. SUBJECTS AND METHODS: This hospital-based case-control study was performed during December 2014 - May 2018. A total number of 130 randomly selected patients were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. The study examined 100 first-ever AIS patients, while 30 comprised the non-stroke control group of patients with discogenic lumbosacral radiculopathy. All participants were evaluated using the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. Cognitive testing and laboratory analyses were performed within the first three days of admission in all patients while AIS patients were reassessed on the 15thday of hospitalization. RESULTS: Female stroke patients with cognitive impairment had significantly higher baseline levels of IL-6 (p<0.017), and TNF-α (p<0.017) than those without cognitive impairment. In the control measurement, a significant difference in IL-6 levels (p=0.037) in male and TNF-α levels (p=0.042) in female stroke patients with cognitive impairment was observed. CONCLUSIONS: These findings indicate that pro-inflammatory cytokines are probably implicated in the pathogenesis of cognitive decline in AIS patients.

Analysis of Serum Inflammatory Markers in Cognitive Impairment among Acute Ischaemic Stroke Patients.

BACKGROUND: Previous studies have indicated that changes in the expression of certain inflammatory biomarkers are associated with cognitive impairment (CI), but only a limited number of studies were conducted in patients with acute ischemic stroke (AIS). The present study aimed to evaluate the potential association between serum levels of several inflammatory markers and cognitive impairment in AIS patients. These markers included interleukin 6 (IL-6), C-reactive protein (CRP), plasma fibrinogen, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. SUBJECTS AND METHODS: All participants were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. A total of 100 patients with first-ever AIS were included in stroke group and 30 in the non-stroke control group. Each patient underwent a comprehensive cognitive assessment and laboratory tests (IL-6, CRP, fibrinogen, ESR and WBC) within the first three days of admission. Cognitive status was assessed using cognitive instruments: the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised. RESULTS: Female stroke patients with CI had higher levels of IL-6 compared to those without CI and controls (p<0.017). AIS patients with CI had significantly higher plasma fibrinogen (p<0.001) and CRP levels (p<0.001) than controls, whereas there was no significant difference in comparison with cognitively intact patients. There were no statistical differences in ESR or WBC count between groups. CONCLUSIONS: Of the inflammatory markers, only IL-6 levels were associated with CI in AIS patients. Measuring circulating IL-6 could be used as a screening test to identify all such patients.

Accidental Drowning: The Importance of Early Measures of Resuscitation for a Successful Outcome.

CASE REPORT: The case of a drowning teenager is described involving application of cardiopulmonary resuscitation (CPR) by an untrained rescuer in the field and fast transport to a hospital enabling a positive resuscitation outcome despite an underorganized emergency medical service in a rural area. In our case hypoxia led to extended functional disorders of the cardiovascular system, which fully recovered after adequate therapy. CONCLUSION: Knowledge about BLS measures by ordinary citizens, together with continuous education of health professionals concerning modern techniques of CPR, is crucial for increasing the number of patients surviving after cardiac arrest.

Xanthine Oxidase Activity in Type 2 Diabetes Mellitus Patients with and without Diabetic Peripheral Neuropathy.

This study investigated the relationship between serum xanthine oxidase (XOD) activity and the occurrence of diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients. Serum XOD activity, ischemia-modified albumin (IMA), uric acid (UA), albumin, glycated hemoglobin (HbA1c), advanced glycation end products (AGE), total free thiols, atherogenic index of plasma (AIP), and body mass index (BMI) were measured in 80 T2DM patients (29 with and 51 without DPN), and 30 nondiabetic control subjects. Duration of diabetes, hypertension, medication, and microalbuminuria was recorded. Serum XOD activities in controls, non-DPN, and DPN were 5.7 ± 2.4 U/L, 20.3 ± 8.6 U/L, and 27.5 ± 10.6 U/L (p < 0.01), respectively. XOD activity was directly correlated to IMA, UA, BMI, HbA1c, and AGE, while inversely correlated to serum total free thiols. A multivariable logistic regression model, which included duration of diabetes, hypertension, AIP, HbA1c, UA, and XOD activity, revealed HbA1c [OR = 1.03 (1.00-1.05); p = 0.034] and XOD activity [OR = 1.07 (1.00-1.14); p = 0.036] as independent predictors of DPN. Serum XOD activity was well correlated to several other risk factors. These results indicate the role of XOD in the development of DPN among T2DM patients.

CONTEMPORARY PRINCIPLES OF SUICIDE PREVENTION.

INTRODUCTION: Suicide remains a significant public health problem worldwide. This study is aimed at analyzing and presenting contemporary methods in suicide prevention in the world as well as at identifying specific risk groups and risk factors in order to explain their importance. in suicide prevention. MATERIAL AND METHODS: The literature search covered electronic databases PubMed, Web of Science and Scopus. In order to select the relevant articles, the authors searched for the combination of key-words which included the following medical subject heading terms (suicide or suicide ideation or attempted) and (prevention or risk factors) and (man or elders or mental disorders). Data analysis covered meta-analyses, systematic reviews and original scientific papers with different characteristics of suicide preventions, risk factors and risk groups. RESULTS: Worldwide evidence-based interventions for suicide prevention are divided in universal, selective and indicated interventions. Restricted approach to various methods of committing suicide as well as pharmacotherapy contributes to a lower suicide rate. Suicide risk factors can be categorized as proximal and distal. The following groups are at highest risk of committing suicide: males. older persons and persons with registered psychiatric disorders. CONCLUSION: There is a lot of evidence that suicide is preventable. It is known that only 28 coun tries in the world have national suicide prevention strategies and Serbia is not one of them.