Updated Perspectives on Lifestyle Interventions as Secondary Stroke Prevention Measures: A Narrative Review.

Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.

Prevalence of postpartum depression at the clinic for obstetrics and gynecology in Kosovo teaching hospital: Demographic, obstetric and psychosocial risk factors.

INTRODUCTION: Postpartum depression affects 10 up to 15 % of women of childbearing age in industrialized countries and presents significant public health problem which leads to short and long-term consequences for mother, child and her family. However, social determinants, including poverty, gender stereotypes, domestic violence, gender discrimination and cultural differences make this medical issue more problematic in less developed countries. The aim of this study was to examine the prevalence and risk factors of postpartum depression at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo (a tertiary referral center). MATERIAL AND METHODS: A prospective observational cohort study was conducted from June 2019 to October 2019 at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo. A total of 247 delivery women were screened for postpartum depression at 6 weeks following delivery using the Edinburg Postnatal Depression Scale (EPDS). Socio-demographic, obstetric and psychologic factors were tested as predictors of PPD using bivariate or multivariate logistic regression analysis (Logit model). Odds ratio (OR) with 95 % confidence intervals were calculated for each risk factor. The p values < 0.05 were considered statistically significant. RESULTS: The prevalence of PPD at the Clinic for Obstetrics and Gynecology in Kosovo teaching hospital was 21 % at 6 weeks following childbirth. The bivariate and multivariate logistic regression analysis identified four predictor variables for postpartum depression: pregnancy complications (OR 1.057; 95 % CI; 1.002-1.114 and P = 0.040); fear of childbirth (OR 1.121; 95 % CI; 1.057-1.190 and P = 0.00016); prenatal depression or anxiety (OR 1.088; 95 % CI; 1.032-1.147 and P = 0.0018); poor marital relation (OR 1.085, 95 % CI; 1.002-1.174 and P = 0.044). No statistically significant association was found between the postpartum depression (PPD) and maternal age, education, employment, family type, smoking, previous abortion, parity, household income, social support, child gender, birthweight, and breast feeding. CONCLUSIONS: The high prevalence of postpartum depression in our setting and its known adverse effects on woman, infant and her family implies an urgent need for evidence-based interventions. Such interventions are needed to promote knowledge of perinatal mental illness and improve maternal mental health in particular in less developed countries. Future efforts should address early identification of high-risk women, assessment of risk factor during the antenatal period, early postpartum depression screening and timely therapeutic approaches, to improve social and psychological functioning of the woman.

Possibilities of Dementia Prevention - It is Never Too Early to Start.

Dementia represents one of the greatest global challenges for health and social care in this century. More than 50 million people worldwide suffer from dementia, and this number is predicted to triple by 2050. Ageing is often associated with cognitive impairment. Therefore, prevention of cognitive impairment is an imperative. Dementia includes a heterogeneous group of disorders, the most common being Alzheimer's disease and vascular dementia. Most cardiovascular risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, atrial fibrillation and smoking are not exclusive risk factors for vascular dementia but also for Alzheimer's disease. The ApoE4 allele is the single non-modifiable risk factor for Alzheimer's disease. Today we know that an important, modifiable risk factor is education. Better education means better protection against dementia. A large number of dementia cases are potentially preventable by early intervention. Early changes in the blood vessel wall can be detected by early ultrasound methods or early biomarkers. These methods allow us to detect changes before the disease becomes clinically evident. Early disease detection enables timely management, and studies have shown that careful control of vascular risk factors can postpone the onset or even reverse disease progression.

Polymorphic Variants of SCN1A and EPHX1 Influence Plasma Carbamazepine Concentration, Metabolism and Pharmacoresistance in a Population of Kosovar Albanian Epileptic Patients.

AIM: The present study aimed to evaluate the effects of gene variants in key genes influencing pharmacokinetic and pharmacodynamic of carbamazepine (CBZ) on the response in patients with epilepsy. MATERIALS & METHODS: Five SNPs in two candidate genes influencing CBZ transport and metabolism, namely ABCB1 or EPHX1, and CBZ response SCN1A (sodium channel) were genotyped in 145 epileptic patients treated with CBZ as monotherapy and 100 age and sex matched healthy controls. Plasma concentrations of CBZ, carbamazepine-10,11-epoxide (CBZE) and carbamazepine-10,11-trans dihydrodiol (CBZD) were determined by HPLC-UV-DAD and adjusted for CBZ dosage/kg of body weight. RESULTS: The presence of the SCN1A IVS5-91G>A variant allele is associated with increased epilepsy susceptibility. Furthermore, carriers of the SCN1A IVS5-91G>A variant or of EPHX1 c.337T>C variant presented significantly lower levels of plasma CBZ compared to carriers of the common alleles (0.71 ± 0.28 vs 1.11±0.69 µg/mL per mg/Kg for SCN1A IVS5-91 AA vs GG and 0.76 ± 0.16 vs 0.94 ± 0.49 µg/mL per mg/Kg for EPHX1 c.337 CC vs TT; P<0.05 for both). Carriers of the EPHX1 c.416A>G showed a reduced microsomal epoxide hydrolase activity as reflected by a significantly decreased ratio of CBZD to CBZ (0.13 ± 0.08 to 0.26 ± 0.17, p<0.05) also of CBZD to CBZE (1.74 ± 1.06 to 3.08 ± 2.90; P<0.05) and CDRCBZD (0.13 ± 0.08 vs 0.24 ± 0.19 µg/mL per mg/Kg; P<0.05). ABCB1 3455C>T SNP and SCN1A 3148A>G variants were not associated with significant changes in CBZ pharmacokinetic. Patients resistant to CBZ treatment showed increased dosage of CBZ (657 ± 285 vs 489 ± 231 mg/day; P<0.001) but also increased plasma levels of CBZ (9.84 ± 4.37 vs 7.41 ± 3.43 µg/mL; P<0.001) compared to patients responsive to CBZ treatment. CBZ resistance was not related to any of the SNPs investigated. CONCLUSIONS: The SCN1A IVS5-91G>A SNP is associated with susceptibility to epilepsy. SNPs in EPHX1 gene are influencing CBZ metabolism and disposition. CBZ plasma levels are not an indicator of resistance to the therapy.

A comparison of mckenzie therapy with electrophysical agents for the treatment of work related low back pain: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Chronic low back pain (LBP) is a major public health problem in industrialized countries and is one of the most common reasons for seeking healthcare. Although the McKenzie therapy is widely used for the treatment of low back pain, there is evidence for no improvement with exercise in short-, intermediate-, or long-term outcomes of pain relief or function. The aim of this study was to compare the effect of the McKenzie therapy with electrophysical agents (EPAs) in patients with chronic LBP. MATERIAL AND METHOD: A randomized controlled comparative trial with a 3-month follow-up period was conducted between January 2009 and June 2012. 271 patients with chronic LBP, (more than three months duration of symptoms) were randomized into two groups: the McKenzie therapy group (n=134), and electrophysical agents group, (n=137). The treatment period of both groups was 4 weeks at an outpatient clinic. Clinical outcomes (pain intensity, trunk flexion range of motion, and disability) were obtained at follow-up appointments at the end of the treatment period, 2 and 3 months. RESULTS: Significant improvement of spinal motion, reduction of pain and disability were demonstrated in both groups but the results show the greater improvement in the McKenzie group (p< 0.05). CONCLUSION: McKenzie therapy reduces pain, and disability, among subjects with chronic LBP. This study revealed that the McKenzie therapy is more effective than EPAs group.

Brain tumors and epilepsy.

Brain tumors are a common cause of epilepsy. Tumor type and location are determining factors that significantly influence seizure frequency. The aim of this study was to analyze clinical data of patients diagnosed with brain tumors and epilepsy. Data for this study were obtained from patient medical records over a 6-year period (2000-2005). Patient history and findings obtained by diagnostic methods such as electroencephalography, computerized tomography and magnetic resonance were analyzed. Data were analyzed by appropriate statistical methods and the structure, prevalence, mean and standard deviation were calculated. The significance of results was tested by use of t-test and chi2-test. A total of 15 933 patient charts were analyzed. Out of 15 933 patients, 10.8% were diagnosed with epilepsy and 175 (1.09%) patients had brain tumor, 75 (42.86%) of which were significantly associated with epilepsy (P > 0.05). Almost forty-three percent (42.86%) of tumors were epileptogenic, with no significant sex difference (confidence level of 95%). Fifty-seven (32.5%) brain tumor patients were aged 51-60. The mean age of all patients with brain tumors was 41.6 years. Focal sensorimotor seizures were dominant in 40 (53.3%) cases. Among epilepsy cases with known etiology, 75 (6.8%) patients had epileptogenic tumors. Types of seizures in patients with epilepsy were different from seizures provoked by brain tumors. The most common tumor site was temporal region (43.4%). There was no significant difference according to epileptogenesis. Focal sensorimotor seizures were common in patients with frontal and parietal region tumors.

Management of patient with Sturge-Weber syndrome: a case report.

INTRODUCTION: Sturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. CASE PRESENTATION: This is case report of a 18-year-old mentally disabled boy, with long-standing seizures, with a port-wine nevi on the left side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the left hemisphere, with epileptogenic activity in the left temporo-parietal region. Skull radiograph, computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the left brain hemisphere. CONCLUSION: Professional counseling and support in addition to drug treatment can provide help to patients and their family to overcome their problems and improve the treatment outcome.

Results of laser treatment-PRP to the diabetic retinopathy.

INTRODUCTION: Diabetic retinopathy-(DR) presents the most aggressive form of the retinopathy that has progressive movement and often it ends with optic-atrophic blindness end includes heavy complications unless carried out by laser pan-retinal-photocoagulation. PURPOSE OF THE STUDY: The aim of this study was analyzing the diabetic retinopathy and impact of the PRP laser treatment, proposition of the precautious as well to managing the complications and PDR prevention. MATERIAL: In this study were presented the treatment results of diabetic retinopathy treated in the Eye's Clinic in Prishtina, during the period of time (2004-2009). There were examined and diagnosed 42 patients with DR of whom 24 males or (57.14%) and 18 females or (42.85%). In 18 patients or (27%) we have had improvement, in 35 cases or (53%) stabilization and 13 cases or (20%) worsening of state after laser treatment with PRP to DR. The most frequently complications were vitreous hemorrhage in 5 cases or (38.46%) and blindness in 3 cases or (23.07%). METHODS: There have been used statistical methods of processing and analysis according to the WHO standards. CONCLUSIONS: We consider that through an advanced education and research programs for inovative projects that meet criterias of our strategic targets to protecting the retina and optic-nerv by understanding DR and PDR and developing a better laser treatment and accurately monitoring of DM, we can manage to prevent complications and heavy consequences of DR. In order to achieve this aim we have to work hard to standardized protocols.

Neuropathic pain.

Neuropathic pain refers to pain that originates from pathology of the nervous system. Common causes of neuropathic pain are diabetes mellitus, reactivation of herpes zoster, nerve compression or radiculopathy, alcohol, chemotherapy or abuse of some drugs, and trigeminal neuralgia. Specific symptoms of neuropathic pain are mechanical allodynia and cold hyperalgesia. Drugs to treat neuropathic pain can be divided into adjuvant analgesics (antidepressants and anticonvulsants), opioids and topical agents. The use of multiple drug therapies is common in practice. Despite considerable increase in the number of randomized placebo-controlled trials in neuropathic pain in the last few years, the medical treatment of neuropathic pain is still far from being satisfactory, with less than half of patients achieving significant benefit with any pharmacological drug.