CIRCADIAN RHYTHM DISORDERS AND NON-MOTOR SYMPTOMS IN DIFFERENT MOTOR SUBTYPES OF PARKINSON'S DISEASE.

The phenotype of the disease depends not only on the prevalence of certain motor signs, but also on non-motor symptoms. Determination of different profiles of Parkinson's disease improves disease prognosis and management. A clinical study was conducted in patients with Parkinson's disease. For this purpose, 64 patients with various motor subtypes of the disease were examined. Diagnosis was made according to the UK Brain Bank Criteria. The patients were divided into groups according to the motor subtype verified by the results of interference electroneuromyography. In each group, demographic data were collected, staging according to the Hoehn-Yahr scale and the overall score of the unified UPDRS scale were studied. The study of gait was evaluated using the Nonmotor Symptom Rating Scale for Parkinson's Disease (NMSS). The Munich Chronotype Questionnaire (MCTQ) was used to determine sleep onset, wake-up time, sleep duration, mid-sleep, average sleep duration, average weekly light exposure, chronotype, and for working patients, relative jet lag and average weekly sleep deficit. Circadian rhythm disorders were diagnosed according to the international classification of sleep disorders-3. Patients with Parkinson's disease have a more characteristic evening chronotype and a shorter sleep duration due to late sleep onset. On the other hand, the tendency towards the morning or evening chronotype is not associated with the severity of the disease or the level of daytime sleepiness. It was found that PD patients are characterized by more pronounced disorders of the gastrointestinal, genitourinary systems, sleep and cognitive-affective disorders, and others. In patients with a mixed motor subtype, mood and cognitive impairments are more pronounced, and gait disorders are more pronounced in patients with a mixed motor subtype. Thus, different motor subtypes of Parkinson's disease have differences in the severity of motor manifestations and features of the circadian rhythm. Circadian dysregulation is associated with features of daily functioning and disorders of the motor sphere.

FACTORS ASSOCIATED WITH THE TIME-BASED PHENOMENOLOGY OF POST-STROKE FATIGUE OVER THE FIRST YEAR AFTER STROKE OCCURRENCE.

Aim - analyze factors associated with certain time-based types of post-stroke fatigue (PSF) over the first year after stroke occurrence. There were examined patients consequently in definite time points after ischemic or hemorrhagic strokes: at hospital stay (234 patients), at 1 month (203), at 3 months (176), at 6 months (156), at 9 months (139) and at 12 months (128). PSF and certain PSF domains were measured by fatigue assessment scale and multidimensional fatigue inventory-20 scale. All PSF cases were divided as early PSF (presented only within the first month after stroke), persistent PSF (presented within the first post-stroke month and later) and late PSF (appeared only at three months observation or later). In univariate logistic regression analysis there were no any significant associations between risk of every time-based PSF types and majority of studied factors. On the other hand, Fazekas scale score was significantly associated with higher risk of persistence of global and mental PSF. Post-stroke functional disability, according to modified Rankin scale, was significantly associated with increased risk of global and physical PSF persistence. Mild cognitive impairments were associated with increased risk of global and mental PSF persistence. The presence of depressive signs at 1 month and 3 months after stroke was significantly associated with increased risk of late PSF (due to increased risk of various PSF components). Management of post-stroke functional abnormalities, mild cognitive impairments and depressive signs probably may be helpful for prevention of early PSF persistence and development of late PSF.

FACTORS ASSOCIATED WITH POST-STROKE FATIGUE DURING THE SECOND HALF YEAR AFTER STROKE.

Post-stroke fatigue (PSF) is a common and often debilitating sequel of both ischemic and hemorrhagic strokes Aim - identify socio-demographic, personal and psychological factors associated with different PSF domains over the second half year after stroke occurrence. There were examined patients consequently in definite time points: at 6 months (156 patients), at 9 months (139 patients) and at 12 months (128 patients) after ischemic or hemorrhagic strokes. Global PSF and certain PSF domains (physical, mental, motivational, activity-related) were measured by multidimensional fatigue inventory-20 scale. In univariate logistic regression analysis most of the studied variables (gender, marital status, education level, apathetic impairments, excessive daytime sleepiness, waist circumference, arterial hypertension, ischemic heart disease, atrial fibrillation, diabetes mellitus) were not significantly associated with global PSF as well as with any PSF aspect at 6, 9 and 12 months after stroke occurrence. On the other hand, univariate logistic regression analysis showed reliable associations between risk of global PSF, risk of all PSF domains and anxious as well as depressive signs, reliable associations between risk of mental PSF and cognitive impairments over the second half year after stroke. Multivariate logistic regression analysis revealed that depressive signs and cognitive impairments were independent predictors of mental PSF over studied post-stroke period. Screening and early management of depressive signs, anxious signs and cognitive impairments probably may be helpful for PSF prevention over the second half year after stroke occurrence.

FACTORS ASSOCIATED WITH POST-STROKE FATIGUE WITHIN THE FIRST 3 MONTH AFTER STROKE.

Aim - identify socio-demographic, personal and psychological factors associated with certain post-stroke fatigue (PSF) domains within first 3 months after stroke. There were examined patients consequently in definite time points after ischemic or hemorrhagic strokes: at hospital stay (234 patients), in 1 month (203 patients) and in 3 months (176 patients). Global PSF and certain PSF domains were measured by multidimensional fatigue inventory-20 (MFI-20) scale. In multivariate logistic regression analysis the majority of variables (gender, marital status, education level, smoking status, level of alcohol consumption, apathetic impairments, arterial hypertension, atrial fibrillation, ischemic heart disease, diabetes mellitus, body mass index, waist circumference) were not significantly associated with any PSF domain risk at any time point after stroke. On the other hand, it had been found reliable associations between risk of global PSF and employing status before stroke, pre-stroke fatigue, anxiety symptoms, excessive daytime sleepiness, pain. Majority of risk factors for specific PSF domains (physical, mental, activity-related, motivational) are the same as for global PSF. The exception is mild cognitive impairments for mental PSF and depression signs for motivational PSF. Management of modifiable risk factors (anxiety and depression signs, excessive daytime sleepiness, chronic pain) probably may be helpful for PSF prevention within first 3 months after stroke.

Management of multi- and extensively drug-resistant tuberculosis in Ukraine: how well are we doing?

SETTING: A tertiary care facility in Ukraine, a high multi- and extensively drug-resistant tuberculosis (MDR/XDR-TB) burden country. OBJECTIVES: To assess the management and treatment outcomes of MDR, pre-XDR-TB and XDR-TB. DESIGN: Cohort study using programme data, 2006-2011. RESULTS: Of 484 individuals with drug-resistant TB, 217 (45%) had MDR-, 153 (32%) pre-XDR- and 114 (24%) XDR-TB. Of all resistant types completing the intensive phase of treatment, 322 (67%) were alive and had culture converted. This included 157 (72%) with MDR- and 61 (54%) with XDR-TB. At the end of the continuation phase of treatment, 106 (22%) had treatment success and 378 (78%) had unfavourable outcomes, including 110 (23%) failures, 21 (4%) deaths, 71 (15%) losses to follow-up and 176 (36%) with an unknown outcome. This was associated with more than one lung cavity being affected, a history of treatment with second-line anti-tuberculosis drugs, poor adherence and XDR-TB. A total of 226 (47%) patients reported at least one adverse drug reaction, the most common being gastrointestinal and vestibular toxicity. CONCLUSION: Outcomes of MDR- and XDR-TB were satisfactory in the intensive phase; however, this was not sustained during the ambulatory period. If we are to do better, urgent measures are needed to improve ambulatory management, including making safer, shorter and more effective drug regimens available.