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Coronavirus disease 2019 (COVID-19) vaccines have been reported as possible triggers of the production of antibodies pathogenic to the peripheral nerve and neuromuscular junction. We report on a patient who experienced vertical diplopia three weeks after the booster dose of the Pfizer-BioNTech vaccine (Comirnaty®). The diagnosis of myasthenia gravis (MG) was established based on highly positive antibodies to the nicotinic acetylcholine receptor (nAChR). Treatment with pyridostigmine and prednisone was started with gradually raising doses. On a follow- up exam two months after treatment initiation, clinical improvement was noted with an almost normal bulbomotor examination. The occurrence of diplopia following COVID-19 vaccination should raise suspicion of new-onset ocular MG and testing for anti-nAChR antibodies is advised.

Operacije mozga, odnosno kraniotomije u budnom stanju omogućuju kortikalno i subkortikalno mapiranje, kao i kontinuiranu kliničku procjenu te se primjenjuju u neurokirurškim resekcijama prvenstveno tumora mozga, poglavito difuznih glioma niskog gradusa, koji se nalaze ili u blizini klinički funkcionalnih područja, poput kortikalnih regija za govor (inzula, rolandičko područje, lijevi perisilvijani korteks), ili tumora koji se nalaze u blizini kapsule interne ili bazalnih ganglija, a kako bi se smanjio mogući rizik neurokirurških komplikacija i deficita kao što su disfazija, neglect ili motorni deficit. Značajni napredak u područjima neuroradiologije, neurofiziologije, neuroanestezije, neurokirurgije i mapiranja mozga doveo je do razvoja tehnika intraoperacijskog praćenja u budnih bolesnika primjenom metode izravne električne stimulacije (engl. Direct electric stimulation- DES). Kortikalno mapiranje primjenom DES omogućuje funkcionalno mapiranje mozga u stvarnom vremenu te vodi resekciju tumora tijekom operacije u budnom stanju čime se smanjuje rizik trajnih neuroloških deficita i omogućuje maksimalna resekcija tumora. DES omogućuje i mapiranje subkortikalnih struktura odnosno identifikaciju i mapiranje senzomotornih, vizuospacijalnih, jezičnih i socio-kognitivnih putova i njihove interakcije. Također se mogu ispitati i multimodalni sustavi, kao što je radna memorija, pozornost, izvršne funkcije i svijest. Pristup svakom bolesniku je individualiziran, multimodalan i koordiniran te obuhvaća timsku obradu, odabir prikladnih kandidata te opsežno predoperacijsko funkcijsko mapiranje i planiranje, intraoperacijsko praćenje i testiranje kao i poslijeoperacijsko timsko praćenje stručnjaka tima - neurokirurga, neuroanesteziologa, neurologa, logopeda, neuropsihologa i neurofiziologa. Multimodalnim pristupom bolesnicima reducira se rizik razvoja trajnih postoperacijskih neuroloških deficita i maksimalizira opseg resekcije što rezultira kraćim postoperativnim oporavkom, bržim povratkom normalnom društvenom i profesionalnom životu uz dulje preživljenje i kvalitetu života operiranih bolesnika.

The possible association between arterial hypertension and disorders of micturition and sexual function is an interesting topic. Even though different studies report the correlations, there are other studies that did not confirm these findings. Previous literature on metabolic syndrome and arterial hypertension and their association with disorders of micturition is not conclusive (1, 2), whereas the literature on the possible connection to issues with sexual function is not extensive (3, 4). The aim of this study was to explore the possible associations between arterial hypertension and disorders of micturition and sexual function in obese patients. Participants, Materials/Methods: This cross- sectional study was carried out in a tertiary healthcare center. 111 participants were included (81 women and 30 men, age 23-78 years), with BMI>30 kg/m2. Lower urinary tract symptoms (LUTS) were evaluated using International consultation on incontinence questionnaires (ICIQ) investigating symptoms of overactive bladder (OAB) and urinary incontinence (UI): ICIQ-OAB and ICIQ-UI Short Form (SF). We evaluated also some of the questions on the EQ-5D-5L questionnaire. Sexual dysfunction (SD) symptoms were assessed using the internationally acclaimed questionnaire Arizona Sexual Experience Scale (ASEX). Results: On ICIQ- OAB patients most often reported: UI (46.85% (N=52)), nocturia (42.34% (N=47)) and increased frequency of urination (34.23% (N=38)), and on ICIQ-UI SF: UI when coughing and sneezing (44.44% (N=32)), urgency UI (43.06% (N=31)) and UI during exercise/physical activity (22.22% (N=16)). Women were found to be more significantly affected by OAB symptoms (p

Prikazujemo rijedak slučaj sekundarne kamptokormije u pacijentice s miotoničnom distrofi jom tip 2. Dijagnoza kamptokormije temelji se na kliničkom zapažanju abnormalne antefl eksije trupa (>45°) u stojećem položaju, koja se pogoršava pri hodanju, a smanjuje u ležećem položaju. Dijagnoza miotonične distrofi je tip 2 temelji se na kliničkoj slici proksimalne miopatije, tipičnom elektromiografskom nalazu i neuroradiološkoj obradi kralježnice (MSCT/MR), a potvrđuje se DNA analizom. Postoje brojni uzroci sekundarne kamptokormije, a miotonična distrofi ja tip 2 je jedan od rjeđih. Hipotrofi ja/atrofi ja paravevertebralne muskulature pri čemu je mišićno tkivo nadomješteno masnim tkivom, verifi cirana neuroslikovnim metodama, upućuje na potrebu za dodatnom obradom s ciljem isključenja različitih mišićnih bolesti i poremećaja. Ovaj slučaj zorno prikazuje da u pozadini kroničnih, bolnih, vertebrogenih sindroma ponekad egzistiraju puno kompleksnije i rjeđe bolesti., We present a rare case of secondary camptocormia in a patient with myotonic dystrophy type 2. The diagnosis of camptocormia is based on clinical observation of abnormal torso antefl exion (>45°) in standing position, which worsens with walking and decreases in supine position. The diagnosis of myotonic dystrophy type 2 is based on the clinical picture of proximal myopathy, typical electromyographic findings, and neuroradiological examination of the spine (MSCT/MR), and is confirmed by DNA analysis. There are a number of causes of secondary camptocormia, and myotonic dystrophy type 2 is one of the rarer ones. Hypotrophy/atrophy of the paravertebral musculature, where the muscle tissue is replaced with fat tissue, verifi ed by neuroimaging methods, indicates the need for additional processing to exclude various muscle diseases and disorders. This case clearly shows that in the background of chronic, painful, vertebrogenic syndromes, much more complex and rare diseases sometimes exist.

Prikazujemo prvi slučaj pacijentice sa sindromom ukočene osobe i pridruženom torakalnom hidromijelijom s pozitivnim antitijelima na glutamatdekarboksilazu. U literaturi je do sada opisan samo slučaj sindroma ukočenog psa s pozitivnim antitijelima na glutamatdekarboksilazu te cervikalnom siringomijelijom zbog Arnold- Chiarijeve malformacije. Glutamatdekarboksilaza je enzim nužan za sintezu gama-aminomaslačne kiseline, inhibicijskog neurotransmitera. Manjak gama-aminomaslačne kiseline dovodi do poremećaja ravnoteže ekscitacijskih i inhibicijskih utjecaja na alfa-motoneurone prednjih rogova kralježnične moždine te posljedične kontinuirane stimulacije mišića što se klinički prezentira rigiditetom i nekontroliranim mišićnim spazmima. Hidromijelija hipotetski izaziva oštećenje i gubitak GABAergičkih neurona kralježnične moždine što dovodi do imunološkog odgovora na antigene enzima glutamatdekarboksilaze. Možemo pretpostaviti da je značajan broj bolesnika s ovim sindromom neprepoznat, odnosno da im je utvrđena pogrešna dijagnoza te da nisu liječeni na adekvatan način.

Prikazujemo rijedak slučaj sekundarne kamptokormije u pacijentice s miotoničnom distrofi jom tip 2 (MD2). Dijagnoza kamptokormije temelji se na kliničkom zapažanju abnormalne antefl eksije trupa (>45°) u stojećem položaju, koja se pogoršava pri hodanju, a smanjuje u ležećm položaju (1). Dijagnoza MD2 temelji se na kliničkoj slici proksimalne miopatije, tipičnom elektromiografskom (EMG) nalazu i neuroradiološkoj obradi kralježnice (MSCT/ MR), a potvrđuje se DNA analizom (2). Postoje brojni uzroci sekundarne kamptokormije, a MD2 je jedan od rjeđih.

Intracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of the necessity of treatment of patients with an asymptomatic intracranial aneurysm. For long, the only treatment option was surgical clipping of aneurysm neck. In the last 25 years, endovascular techniques have been developed as an alternative solution for patients who are not eligible for neurosurgical procedures. Research has shown better results of embolization procedures with lower rates of complications, but a higher rate of recanalization is still a major drawback of endovascular coiling. There are no strict protocols and the treatment of choice for intracranial aneurysms should be agreed upon by both the physician and the patient. This review aims to provide an insight into the management of intracerebral aneurysms with emphasis on the decision making problems faced by clinicians., Intrakranijske aneurizme prisutne su u oko 2% populacije. Uobičajen su slučajni nalaz neinvazivnih neuroslikovnih metoda otvarajući pitanje nužnosti liječenja bolesnika s asimptomatskom intrakranijskom aneurizmom. Dugo je jedina mogućnost liječenja bila kirurško podvezivanje vrata aneurizme, no u posljednjih 25 godina usavršen je endovaskularni pristup pružajući alternativu bolesnicima koji ne ispunjavaju uvjete za neurokirurške zahvate. Istraživanja su pokazala bolje rezultate embolizacijskih postupaka s nižim stopama komplikacija, ipak, veća stopa rekanalizacija i dalje je glavni nedostatak endovaskularnog pristupa. Ne postoje strogi protokoli tretiranja intrakranijskih aneurizma te konačna odluka leži u dijalogu između liječnika i bolesnika. Cilj ovoga preglednog rada jest pružiti uvid u pristup intracerebralnim aneurizmama s naglaskom na probleme donošenja odluka s kojima se suočavaju kliničari.

The aim of this review is to emphasize the importance of mental activity and aerobic physical exercise as one of the most important health- related activities which may delay the onset or slow down the progression of Alzheimer's dementia. Studies have shown that the elderly who regularly engage in mental and physical activities have a lower risk of dementia development. Performing mental and physical activities regularly has a synergistic effect on the improvement of cognitive functions. Complex mental activity during life is associated with a reduction in the hippocampal atrophy rate, which is a sensitive early-stage biomarker of dementia while regular physical exercise can slow down the progressive reduction of the cortical brain volume which occurs during aging. Mental activity increases a person's "cognitive reserve" and promotes the formation of new communications between brain cells. Since it is not possible to influence genetic components of Alzheimer's dementia, preventative interventions such as encouraging regular engagement in mental and physical activities are extremely important. Activities need to be safe, moderate, comfortable, and adapted as to type, duration, and especially the health and functional status of the patient. In the near future, it is expected that genome analysis in personalized medicine will guide us in the right direction on certain types of physical and mental exercise.

Eponyms are numerous in neurology. It is estimated that there are about 450 „human” eponyms commonly used by neurologists, neuroradiologists and neuroscientists. In this short review we describe 36 „animal“ eponyms and 42 „animal“ clinical signs often used in neurology. If we take into account the continuous creativity of neurologists and neuroradiologists in !nding animal eponyms, it is to be expected that this list will continue in the future.

Background: Patients with epilepsy commonly report sexual dysfunction (SD) and reproductive difficulties. This study aimed to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and SD, and its association with the quality of life and depressive symptoms. Subjects and methods: This was a prospective study carried out in a tertiary healthcare centre. SD was evaluated using the internationally acclaimed questionnaire Arizona Sexual Experiences Scale (ASEX) that was successfully translated into Croatian and validated for this purpose. Depressive symptoms and quality of life were evaluated using the Hamilton Rating Scale for Depression (HAM-D17) and Quality of life in epilepsy-31 inventory (QOLIE-31). Results: Of 108 patients (68 (63 %) women, 40 (37 %) men, mean age 39.54±15.91 (range18-80) years) with epilepsy, 16 (14.8%) had focal, 38 (35.2%) generalized and 44 (40.7%) both types of epilepsy. Mean overall total score on the ASEX questionnaire was 11.94±5.61 (mean total score women 12.85±6.00, mean total score men 10.4±4.55), with 48 reporting that they had sexual activity in the past week. Nine (8.33%) patients (7 (6.48%) women, 2 (1.85%) men, mean age 47.66±19.33 (range 25-80) years) had a score 19 and above, 38 (35.18%) patients (27 (25%) women, 9 (8.33%) men, mean age 46.82±17.78 (range 19-80) years) individual score 5 and above on any one item, and 33 (30.55%) patients (26 (24.07%) women, 7 (6.48%) men, mean age 48.87±17.8 (range 19-80) years) had an individual score 4 and above on any three items. Significant correlations were found between SD and older age (p=0.001) and between more pronounced symptoms regarding SD on ASEX and female gender (p=0.000). There were no significant correlations between the type of epilepsy and SD, nor between the AEDs (old generation vs. modern) and SD. Significant correlations were found between the SD and more pronounced depressive symptoms (p=0.003) and between the SD and a lower quality of life (p=0.001). Conclusions: Results of our study suggest SD is experienced by around one-third of patients in our group, which is similar to the previous percentage of SD reported in the community sample. Women were found to experience more pronounced symptoms of SD on ASEX. Symptoms of SD were found to be significantly correlated with older age, female gender, lower quality of life and depressive symptoms, while no significant correlations were found with the type of epilepsy and the AEDs.

Background: Patients with obesity may have symptoms of sexual dysfunction (SD). Little is known about these symptoms in obese patients in Croatia and the aim of this study was to explore them. Subjects and methods: This was a cross- sectional study carried out in tertiary healthcare centre at the Croatian Obesity Treatment Referral Center in University Hospital Center of Zagreb. 103 patients (72 female, 31 male, mean age 48.7±11.87 years, mean BMI 40.42) were included. SD symptoms were assessed using the internationally acclaimed questionnaire Arizona Sexual Experience Scale (ASEX), that was recently validated for Croatian language. Patients were also administered a questionnaire, prepared for this purpose, that enquired about their previous known chronic disorders. Statistical analyses included t-test, chi-squared test and bivariate Pearson’s correlations. Results: Average total response on the questionnaire was 12.4 (women 13.2, range 3-30 ; men 10.6, range from 5- 19). A total score of 19 or more was present in 5 (4.8%, range from 19-30, average 22.4 ; 1 man, 4 women), at least one question with a score 5 or greater on any item was found in 36 (34.9%, 5 men, 31 women), while a score of 4 or more on three items was found in 20 patients (19.4%, 2 men, 18 women). Overall median response was 3 (range 1-6). Women were found to have more pronounced symptoms of SD (p

Introduction/Objectives: Patients with obesity may have lower urinary tract symptoms (LUTS) (1). Little is known about these symptoms in patients with obesity in Croatia. The aim of the study was to asses LUTS in patients with obesity in Croatia. Participants, Materials/Methods: This was a prospective study carried out in tertiary healthcare centre. 111 participants (81 women (72.97%), 30 men (27.03%), mean age 49.03 ± 12.21 years were included. Following questionnaires, were used to assess LUTS: ICIQ-OAB (currently under validation for Croatian language) and recently validated for Croatian language ICIQ-UI (1). Results: On ICIQ OAB patients reported following symptoms: 34.23% (N=38) increased frequency of urination (38.27% (N=31) women, 23.33% (N=7) men), 42.34%(N=47) nocturia (48.15% (N=39) women, 26.67% (N=8) men), 25.23% (N=28) urgency (28.4% (N=23) women, 16.67% (N=5) men) and 46.85%(N=52) urgency urinary incontinence (51.85% (N=42) women, 33.33% (N=10) men). On ICIQ-UI patients reported following symptoms: 43.06% (N=31, 51.92% (N=27) women, 20% (N=4) men) urgency urinary incontinence, 44.44% (N=32, 61.54% (N=32) women, 0 men) urinary incontinence when coughing and sneezing, 2.78% (N=2, 3.85% (N=2) women, 0 men) urinary incontinence when sleeping, 22.22% (N=16, 28.85% (N=15) women, 5% (N=1) men) urinary incontinence during exercise/physical activity, 18.06% (N=13, 17.31% (N=9) women, 20% (N=4) men) urinary leakage after having urinated and getting dressed, 6.94% (N=5, 7.69% (N=4) women, 5% (N=1) men) urinary leakage for no obvious reasons. Women were found to be more significantly affected by increased incidence of urinary frequency and mixed urinary incontinence than men (p

Epilepsy is a common neurological disease that affects 1% of the population and at least 30% of patients have drug-resistant epilepsy. In these patients, non pharmacological treatment options should be considered early rather than late because of change in the epileptogenic network, cognitive decline, injuries caused by seizures, and worse postoperative outcome as a consequence of late operation. Only resective surgery can be curative and when this is not an option, neurostimulation modalities can be considered. Vagus nerve stimulation (VNS) launched modern era of neurostimulation 30 years ago. Responsive neurostimulation (RNS) and deep brain stimulation (DBS) are relatively new and change the landscape and approaches to drug-resistant epilepsy. For both generalized and multifocal epilepsies, VNS is an option, RNS is not, and DBS has only limited evidence. Neurostimulation therapies, at least VNS and RNS, may reduce the risk of sudden unexplained death in epilepsy. VNS decreases seizure frequency by approximately 50% in 30-40% of implanted patients. Adverse events can be stimulation or implantation associated. VNS has FDA approval for depression and has positive effects on mood and cognition. However, it can also be used in children with drug- resistant epilepsy, and the rationale behind this is a reduction of strong epileptic activity interfering with their cognitive processes and sensorimotor functions, with support of a remarkable amount of plasticity at a very young age. The authors presented experience of the Referral Centre for Epilepsy of the Ministry of Health of the Republic of Croatia in treating patients with drug- resistant epilepsy with VNS.

Razvili smo novi uređaj koji pomaže u ranoj dijagnozi blagog kognitivnog oštećenja (mild cognitive impairment – MCI, odnosno blagog neurokognitivnog poremećaja prema DSM-5) i demencije (velikog neurokognitivnog poremećaja prema DSM-5, najčešće uzrokovanog Alzheimerovom bolešću - AB). Sustav se temelji na određivanju pozicije cilja koji nakon kratkotrajnog prikazivanja više nije vidljiv, pa ispitanik mora svoju navigaciju do cilja temeljiti na prethodno upamćenom položaju cilja u odnosu na svoj početni položaj (četiri egocentričke podvarijante) ili zadane orijentire (četiri alocentričke podvarijante testa). U tom smislu ovaj test podsjeća na Morrisov vodeni labirint za glodavce. Testiranje prosječno traje oko 20 minuta te omogućuje brz, jeftin i neinvazivan dijagnostički postupak. Sustav je namijenjen klinikama i znanstvenoj zajednici, farmaceutskoj industriji te zdravstvenim i drugim ustanovama koje se brinu za starije osobe za koje je važno rano otkrivanje spoznajnog urušavanja, kao i kontinuirano praćenje njihovog statusa i uspješnosti terapijskih postupaka. Tijekom predavanja bit će prikazani naši preliminarni rezultati, koji su pokazali izvrstan potencijal testa za probir osoba s početnim spoznajnim urušavanjem.

Background: Chronic Graft-versus-Host Disease (cGvHD) is a serious late complication after allogeneic hematopoietic stem cell transplantation (alloHSCT) with heterogeneous presentation and still poorly understood pathophysiology including inflammation and endothelial dysfunction. Factor VIII (FVIII) and von Willebrand Factor (VWF) are coagulation factors but also known indicators of endothelial dysfunction and inflammation in different settings, and therefore could serve as interesting candidate biomarkers of cGvHD. Methods: Since 2013 patients after alloHSCT were assessed by the Multidisciplinary cGvHD team at the University Hospital Center Zagreb, Croatia, using established NIH cGvHD-related measurements. An extensive history, physical and laboratory evaluations were performed, including FVIII, VWF:Ag and VWF:Ac analysis. Descriptive statistic and non-parametric analyses were performed. Variables that showed significant univariate correlations were used in multivariate logistic regression (MLR) to identify the most predictive for FVIII, VWF:Ag and VWF:Ac in cGvHD patients. Results: 70 cGvHD patients and 41 controls (subjects after alloHSCT without cGvHD) were analysed. Median age of cGvHD patients was 42 (9-65) years, 50% females, 91.5% underwent alloHSCT for hematologic malignancies, 55.7% had myeloablative conditioning and 52.9% matched related donor. Median time from HSCT to study was 450.5 days and from cGvHD diagnosis to study 82 days. There were no demographic neither transplant related significant differences between cGvHD patients and controls beside stem cell source (peripheral blood 71.4% vs 51.2%, p=0.041) and history of acute GvHD (70.0% vs 22.0%, p< 0.001). Majority of patients had moderate (52.9%) or severe (42.6%) NIH global cGvHD score, 57.2% active cGvHD by clinician´s impression. Median number of organs involved by cGvHD was 3 (1-6), and the most frequently involved organs were mouth, skin and eyes (52.0% each). cGvHD patients compared to controls had higher FVIII levels (median 206 (52-453)% vs 182 (51-406)%, p=0.044, reference range 50-149%) and higher VWF:Ag (median 261.6 (76.6-601)% vs 203.2 (51.9-600)%, p=0.030, reference range 50-160%), while VWF:Ac showed a trend toward higher levels among patients (median 253.4 (54-601)% vs 178 (48.6-601)%, p=0.084, reference range 50-150%). Patients had higher GGT (p=0.002), lower anticardiolipin IgG (p=0.001) and IgM (p=0.003), and lower albumin (p=0.018) than controls, without differences between other laboratory parameters. Univariate analysis showed that among cGvHD patients higher FVIII was associated with worse Karnofsky score (KS) (p=0.031) and performance score (PS) (p=0.030), higher leukocytes (p=0.031), cholesterol (p=0.003), triglycerides, AST, ALT, GGT, LDH, and lower albumin. Higher VWF:Ag and VWF:Ac in cGvHD patients were associated with worse KS and PS (p< 0.001), with more active cGvHD (p< 0.001), worse NIH cGvHD liver (p=0.042 ; p=0.039) and NIH cGvHD mouth (p=0.012 ; p=0.009), higher total NIH score (p=0.044 ; p=0.005), higher number organs involved (p=0.013 ; p=0.003), higher ESR, monocytes, D-dimers, AST, ALT, GGT, LDH, triglycerides, β-2-microglobulin, ferritin, total proteins, IgA and lower albumin. MLR analysis showed leukocytes (p=0.018) and cholesterol (p=0.010) as the strongest predictor of FVIII (r2=49.8% ; p< 0.001), while strongest predictor of VWF:Ac was number of organs involved by cGvHD (r2=71.7% ; p=0.031). Conclusions: Results of this study detected high FVIII and VWF levels in cGvHD patients with possible reflections to cGvHD manifestations, what needs to be further confirmed in larger longitudinal studies. Disclosure: This work was supported, in part, by the Unity Through Knowledge Fund project entitled “Clinical and biological factors determining severity and activity of chronic Graft-versus-Host disease after allogeneic hematopoietic stem cell transplantation”, and also, in part, by the Croatian Science Foundation project entitled “New biomarkers for chronic Graft-versus-Host disease”. Antonela Samardzic - Work financed by the Croatian Science Fondations` “Young researchers` career development project - training of doctoral students”

Lower serum levels of zinc and magnesium are associated with worse oral cGVHD and dysgeusia in cGVHD patients

Introduction/Objectives: Depression is highly prevalent among individuals suffering from obesity, and so are various other somatic complaints and disorders. The aim of this research is to assess the association between symptoms of depression, lower urinary tract symptoms (LUTS) and sexual dysfunction in Croatian obese patients. Participants, Materials/Methods: This cross- sectional study was carried out in a tertiary healthcare centre in an outpatient clinic for treatment of obesity. Overall, 111 participants (73% women), mean age 49.03 ± 12.21 years, BMI>30, were included. ICIQ-OABqol questionnaire was used to assess the quality of life in patients with LUTS. Sexual dysfunction was evaluated through Arizona Sexual Experience Scale (ASEX). Depression was documented with the general information questionnaire where patients marked all the illnesses they were being treated for. Statistical analysis included bivariate Pearson’s correlations. Results: Significant correlation was found between the presence of depression and the impact of urinary symptoms (r=0.21, p=0.03). Furthermore, significant correlations were observed between the impact of urinary symptoms and following complaints: pain/uneasiness (r=0.29, p=0.001), anxiety/melancholy (r=0.3, p=0.001) and sleep disorders (r=0.25, p=0.01). According to our study, sexual dysfunction was (significantly related to depression (r=0.22, p=0.03). Moreover, sexual dysfunction also significantly correlates with pain/uneasiness (r=0.22, p=0.03) and anxiety/melancholy (r=0.2, p=0.04). In addition, a significant association was observed between obtaining an overall score above 3.8 (standard cut-off score) on the sexual dysfunction questionnaire (ASEX) and the presence of depression (r=0.27, p=0.01). Finally, an overall score above 3.8 on ASEX was significantly associated with pain/uneasiness (r=0.23, p=0.02) and anxiety/melancholy (r=0.21, p=0.04). Conclusion: While the presence of depression was associated with sexual dysfunction and the impact of urinary symptoms in obese individuals, cross- sectional data precludes causality assessment. It remains to be determined whether treating symptoms of depression might alleviate those somatic difficulties.

Introduction/Objectives: Sleep disorders (according to ICSD-3, International Classification of Sleep Disorders, 3rd ed. ; in DSM-5, Diagnostic and Statistical Manual of Mental Disorders – 5th ed. Sleep-Wake Disorders) are common nowadays problem. They are caused by many reasons (psychiatric, neurologic, environmental, endocrine etc.). Also, there is various spectrum of symptoms and signs what we understand under the term sleep disorders and classifications vary. Most common entities are: insomnia, hypersomnolence, sleep apnea, narcolepsy etc. Lower urinary tract symptoms (LUTS) are disturbing and can be connected to sleep disorders. We wanted to assess connection between sleep disorders and lower urinary tract symptoms in obese patients in Croatia. Participants, Materials/Methods: This was a prospective study carried out in tertiary healthcare centre. 111 participants (81 women (72.97%), 30 men (27.03%)), mean age 49.03 ± 12.21 years, BMI>30 were included. Following questionnaires, were used to assess LUTS: ICIQ- OAB and ICIQ-OABqol (both currently under validation for Croatian language). Sleep disorders were evaluated through general information questionnaire where patients needed to mark all illnesses (out of 14) they have problem with. Pearson’s correlation coefficient was used. Results: Our study found significant correlation in the overall result on the overreactive bladder questionnaire (ICIQ-OAB) and sleep disorders: r=0.34 (p=0.001). Also, increased urinary frequency and sleep disorders are significantly connected: r=0.21 (p=0.03). Nocturia and sleep disorders significantly correlate as r=0.34 (p=0.001). Sleep disorders are significantly related to urinary urgency r=0.3 (p=0.001). Moreover, significant correlation is found between urinary incontinence and sleep disorders: r=0.23 (p=0.02). Significant correlation is found between the overall results of the impact of urinary symptoms on the quality of life questionnaire (ICIQ-OABqol) with sleep disorders: r=0.25 (p=0.01). On the last question on the impact of urinary symptoms on the quality of life questionnaire – ICIQ-OABqol (where patients need to assess overall impact of urinary symptoms on everyday life choosing a number between 0 (not at all) and 10 (a great deal)) is significantly correlated to sleep disorders: r=0.24 (p=0.01). Conclusion: This study has shown significant preliminary results in addition to indicating a correlation between sleep disorders and LUTS in Croatian obese patients. In the future, our study will consider a possible causal connection using the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale.

Introduction/Objectives: Patients with obesity may have symptoms of sexual dysfunction (SD) . Little is known about these symptoms in patients with obesity in Croatia. The aim of the study was to asses SD in patients with obesity in Croatia. Participants, Materials/Methods: This was a prospective study carried out in tertiary healthcare centre. 103 patients (72 female, 31 male, mean age 48, 7 ± 11.87 years) were included. SD symptoms were assessed using questionnaire - Arizona Sexual Experience Scale (ASEX) that is currently under validation for Croatian language, where higher score represents more pronounced symptoms of SD (2). Results: 20.42% (N=20, 6.45% (N=2) male and 25% (N=18) female) patients had higher score than average (3.8) on ASEX. 27.18% (N=28, 12.9% (N=4) male and 33.33% (N=24) female) patients answered at least one question with a score 5 or greater than 5. Significant correlation was found between having answered at least one question with a score 5 or greater than 5 and the depression r = 0.31 (p

Istraživali smo pretile bolesnike koji su prošli program liječenja pretilosti kroz dnevnu bolnicu u Referentnom Centru za debljinu Zavoda za endokrinologiju u Kliničkom bolničkom centru Zagreb. S obzirom da je pretilost multifaktorijalna bolesti i pristup našeg centra je multidisciplinaran. Tijekom 5-dnevnog programa u Dnevnoj bolnici uključeni su brojni subspecijalisti kako bi se provela edukacija i utvrdilo postojeće stanje pretilih bolesnika, tako su uključeni i neurolozi s interesom za poremećaje mokrenja. : Istraživali smo 111 bolesnika s debljinom (30 muškaraca, 81 žena, srednja dob 48.4 ± 12.03 godina). Uvjet ulaska u studiju bio je BMI>30kg/m2, a korišteni su međunarodni upitnici za procjenu smetnji mokrenja: ICIQ-OAB i ICIQ-UI te su tražene statistički značajne korelacije pomoću Pearsonovog koeficijenta korelacije ( upitnik ICIQ-OAB je trenutno u tijeku validacije za hrvatski jezik, dok je ICIQ-UI validiran ). Pokazano je da dislipidemija značajno korelira s povećanom frekvencijom mokrenja r=0.33 (p=0.001), urgencijom r=0.23 (p=0.02), posebno pitanja vezana uz curenje urina prije nego se stigne na zahod r=0.25 (p=0.04), prilikom kihanja i kašljanja r=0.26 (p=0.03), prilikom tjelovježbe r=0.28 (p=0.02). S obzirom da pretili bolesnici imaju metabolički sindrom, a da je dislipidemija jedna od odrednica, biti će zanimljivo proučavati iste parametre u ispitanika koji će postići gubitak na tjelesnoj masi barem 2-5% što se pokazalo kardiovaskularno protektivno.

Razvili smo novi uređaj koji pomaže u ranoj dijagnozi blagog kognitivnog oštećenja (mild cognitive impairment - MCI, odnosno blagog neurokognitivnog poremećaja prema DSM-5) i demencije (velikog neurokognitivnog poremećaja prema DSM-5, najčešće uzrokovanog Alzheimerovom bolešću). Sustav se temelji na određivanju pozicije cilja koji nakon kratkotrajnog prikazivanja više nije vidljiv, pa ispitanik mora svoju navigaciju do cilja temeljiti na prethodno upamćenom položaju cilja u odnosu na svoj početni položaj (četiri egocentričke podvarijante) ili zadane orijentire (četiri alocentričke podvarijante testa). U tom smislu ovaj test podsjeća na Morrisov vodeni labirint za glodavce. Testiranje prosječno traje oko 20 minuta te omogućuje brz, jeftin i neinvazivan dijagnostički postupak. Sustav je namijenjen klinikama i znanstvenoj zajednici, farmaceutskoj industriji te zdravstvenim i drugim ustanovama koje se brinu za starije osobe za koje je važno rano otkrivanje spoznajnog urušavanja, kao i kontinuirano praćenje njihovog statusa i uspješnosti terapijskih postupaka. Tijekom predavanja bit će prikazani naši preliminarni rezultati, koji su pokazali izvrstan potencijal testa za probir osoba s početnim spoznajnim urušavanjem.

Background: Electromyography (EMG) and nerve conduction studies (NCS) are an unpleasant and sometimes painful examinations. Pain can reduce patient’s compliance and have a negative effect on the examination results. Different studies rep ort that music affects pain perception by acting as a distractor, by inducing positive emotional valence or through the concept of convergence of different sensory modalities. The aim of this study was to explore the effect of music and different environment al and sociodemographic factors on pain perception during EMG and NCS. Subjects and methods: Sixty patients with suspected neuromuscular disease were randomized into music and control group. Specific questionnaire assessed sociodemographic characteristics, medical history, examination waiting time, examination extent and biometeorological forecast. The numerical rating scale was used for the evaluation of pain. The examiner evaluated patient’ s compliance after the examination. Results: NCS was less painful for patients in the music group (p=0.03), as well as for more cooperative patients (p=0.011). For patients who previously underwent EMG/NCS, present NCS was more painful (p=0.001), regardless of the music intervention (p=0.019). EMG was more painful for older patients (p=0.041). Patients with lower level of education reported lower pain during NCS (p=0.026). Gender, financial satisfaction, biometeorological forecast, diabetes, depression or malignant disease, use and dosing of analgesics or antidepressants, symptoms, examination waiting time and the examination extent had no effect on pain perception. Conclusions: Music significantly decreased the perception of pain associated with NCS, but not the EMG portion of the examination. During EMG pain level was not significantly reduced, but the median of pain was still lower. Generally, the pain l evel during NCS, unlike the one during EMG, was affected by patients' compliance, level of education and painful predetermination. W e propose using music during EMG/NCS because it can make the examination more comfortable for the patient and thus contribute to better quality of this examination.

Vagus nerve stimulation (VNS) is a viable minimally invasive neurosurgical treatment option in drug resistant epilepsy and depression. In patients with drug resistant epilepsy, polytherapy is necessary, emphasizing the greater incidence of side effects which further impair the quality of life (QoL) at the physical, psychosocial and neurocognitive level. Patients with epilepsy oft en have depression, which can be the result of seizures, antiepileptic drugs (AEDs) or sociodemographic factors. In addition, epilepsy and depression share a similar neurobiologic basis that has been linked to biochemical changes, altered neurotransmission, hypothalamic-pituitary- adrenal axis abnormalities involved in chronic stress, inflammation, reduced neuroplasticity, and network dysfunction. However, the diagnosis of depression in patients with epilepsy, confirmed by psychiatric assessment, should be better understood when making a decision on early treatment with VNS. Selective serotonin reuptake inhibitors or psychotherapy should be considered as first line treatments for depression in patients with epilepsy, but these drugs can also compound cognitive and sedative side effects of antiepileptic agents. On the other hand, we should also consider side effects of VNS that can be implantation or stimulation associated. Considering the fact that QoL is known to be strongly linked to mood and improvement in the Beck Depression Inventory scores, and following published VNS studies in epilepsy that assessed QoL, we performed a study of QoL in a group of patients with drug resistant epilepsy treated at the Zagreb University Hospital Centre who had undergone VNS implantation. The study included 27 patients with drug resistant epilepsy with implanted VNS – case group (14 M and 13 F ; mean age 34.7±28.3 years) and 18 control patients with drug resistant epilepsy without implanted VNS (10 M and 8 F ; mean age 45.2±30.8 years). QoL was examined using the questionnaires Quality of life in Epilepsy (QoLIE-31 validated Croatian 1.0 version) and Beck Depression Inventory I (BDI I validated Croatian version). On statistical analysis, nonparametric Mann- Whitney test for independent samples was used. The study was approved by the Ethics Committee of the Zagreb University Hospital Centre. The Mann-Whitney test showed significant difference in the QoLIE-31 score between the case and control groups (p=0.041). In the case group, we noticed that younger patients had lower QoLIE-31 score and higher BDI-I score than the older ones. Our results showed positive influence on the QoL and mood improvement following VNS implantation in patients with drug resistant epilepsy.

Gliomas are the most common primary brain tumors, which include a variety of different histologic tumor types and malignancy grades. Neurosurgical resection is the standard therapeutic procedure in multimodal treatment plan, based on the goal of achieving maximal tumor resection without inducing new neurologic deficits. However, brain tumors located within or in the proximity to critical functional areas, such as eloquent cortical regions (insula, rolandic and left perisylvian cortex) or tumors located near internal capsule and basal ganglia still bear a high risk of surgery related deficits such as dysphasia, neglect or motor deficit. In the last decades, we have witnessed improvement in neuroradiology, neurophysiology, neuroanesthesiology, neurosurgery and brain mapping techniques, which have allowed intraoperative monitoring in awake patients with direct electrical stimulation (DES). DES allows direct and real-time investigation of individual functional connectivity of the brain, not only for cortical regions, but also for subcortical mapping of sensorimotor, visuospatial, language and socio- cognitive pathways and their interactions. Multimodal systems such as working memory, attention, executive functions and consciousness can also be investigated by axonal stimulation. Coordinated teamwork and multimodal approach tailored for each patient is required, which includes preoperative functional mapping and planning, intraoperative monitoring and postoperative follow-up by a team consisting of surgeon, anesthesiologist, neurologist, speech therapist, neuropsychologist and neurophysiologist. Following this postulate, we can minimize permanent postoperative deficits while maximizing the extent of resection, especially in cases of infiltrative tumors such as low-grade gliomas, which implies shorter recovery to normal social and professional life with better patient survival and quality of life. Our experiences and dilemmas in awake brain surgery in patients with diffuse infiltrative brain tumors will be presented.