BackgroundComprehensive epidemiologic data for multiple sclerosis (MS) in Poland are limited. The aim of this cross-sectional population-based study was to determine the incidence and prevalence of MS in the Swietokrzyskie Region (central Poland).MethodsThis study identified MS cases every year between 1 January 2010 and 31 December 2014. The study area population on the prevalence day (December 31, 2014) was 1,263,176 (646,506 women and 616,670 men). A total of 1462 patients with a clinically definite diagnosis of MS according to McDonald’s criteria (2005), recorded in the Polish Multiple Sclerosis Registry, were considered for estimation of crude, age- and sex-specific prevalence, and incidence.ResultsThe overall crude prevalence rate of confirmed MS patients was 115.7/100,000 (95 % confidence interval (CI), 111.2–121.4). A significantly higher prevalence was recorded in females (159.6/100,000; 95 % CI, 151.1–165.3) than in males (69.7/100,000; 95 % CI, 62.4–77.3) (P < 0.001). Age-adjusted rates for the Polish and European Standard Population were 109.8/100,000 (95 % CI, 105.4–114.8) and 106.6/100,000 (95 % CI, 101.1–111.2), respectively. The female/male ratio was 2.4. The mean annual incidence was 4.2/100,000 (95 % CI. 3.7–4.4).ConclusionThe incidence and prevalence of MS in the Swietokrzyskie region confirm that central Poland is a high risk area for MS. Compared with previous epidemiologic studies from Poland, the prevalence of MS has increased during recent years.
Background Susac syndrome (SS) is characterized by the triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. However, the diagnosis of SS remains difficult because the clinical triad rarely occurs at disease onset, and symptom severity varies. SS symptoms often suggest other diseases, in particular multiple sclerosis (MS), which is more common. Misdiagnosing SS as MS may cause serious complications because MS drugs, such as interferon beta-1a, can worsen the course of SS. This case report confirms previous reports that the use of interferon beta-1a in the course of misdiagnosed MS may lead to exacerbation of SS. Moreover, our case report shows that glatiramer acetate may also exacerbate the course of SS. To the best of our knowledge, this is the first reported case of exacerbation of SS by glatiramer acetate. Case presentation We present a case report of a patient with a primary diagnosis of MS who developed symptoms of SS during interferon beta-1a treatment for MS; these symptoms were resolved after the discontinuation of the treatment. Upon initiation of glatiramer acetate treatment, the patient developed the full clinical triad of SS. The diagnosis of MS was excluded, and glatiramer acetate therapy was discontinued. The patient’s neurological state improved only after the use of a combination of corticosteroids, intravenous immunoglobulins, and azathioprine. Conclusions The coincidence of SS signs and symptoms with treatment for MS, first with interferon beta-1a and then with glatiramer acetate, suggests that these drugs may influence the course of SS. This case report indicates that treatment with glatiramer acetate may modulate or even exacerbate the course of SS.
Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan–Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered.
Introduction: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. However, this risk depends on the coexistence of other factors that predispose to stroke and AF. Aim of the research: We evaluated which of the common clinical factors were most strongly associated with stroke in patients with AF compared to patients with sinus rhythm. Material and methods: In this retrospective, observational, single-centre study we analysed patients with acute ischaemic stroke admitted to the neurology centre between 1 January 2013 and 30 April 2015, inclusive. Patients were divided into groups with and without AF. Multivariate logistic regression analysis was used to identify predictors of stroke in the AF group. Results: A total of 2339 ischaemic stroke patients were included in the study (mean age: 73.26 ±12.38 years, 51% male). Of these, 29.1% had AF. Patients with stroke and AF were significantly older (p < 0.001), were more often female (p < 0.001), and had higher rates of hypertension (p < 0.001), coronary heart disease (p < 0.001), and heart failure (p < 0.001). Multivariate logistic regression analyses identified older age (OR = 1.043, p < 0.001), female gender (OR = 1.389, p = 0.001), heart failure (OR = 2.467, p < 0.001), and coronary heart disease (OR = 1.618, p < 0.001) as independent factors that increased the risk of AF-associated stroke. Conclusions: Patients with stroke and AF had additional risk factors coexisting with arrhythmia. The detection of other potential causes of stroke in patients with AF is important to allow modification of some of them and to establish effective treatment to improve outcomes in this group of patients StreszczenieWprowadzenie: Migotanie przedsionków (MP) jest częstą arytmią i istotnym czynnikiem ryzyka wystąpienia udaru mózgu. Ryzyko to zależy jednak od współistnienia innych czynników predysponujących do wystąpienia udaru mózgu i MP. Cel pracy: Ocena, które z powszechnie występujących czynników klinicznych najsilniej wiąże się z rozwojem udaru mózgu u pacjentów z MP w porównaniu z pacjentami z rytmem zatokowym. Materiał i metody: W retrospektywnym, obserwacyjnym, jednoośrodkowym badaniu analizowano pacjentów z ostrym udarem niedokrwiennym hospitalizowanych w ośrodku neurologicznym od 1 stycznia 2013 do 30 kwietnia 2015 roku. Pacjentów podzielono na grupę z MP i bez MP. Do identyfikacji predyktorów udaru mózgu u pacjentów z MP zastosowano wieloczynnikową analizę regresji logistycznej. Wyniki: Do badania włączono 2339 pacjentów z udarem niedokrwiennym (średni wiek: 73,26 ±12,38 roku, 51% mężczyzn). Spośród nich 29,1% miało MP. Pacjenci z udarem i MP w porównaniu z pacjentami z udarem bez MP byli istotnie starsi (p < 0,001), częściej płci żeńskiej (p < 0, 001), mieli większą częstość występowania nadciśnienia tętniczego (p < 0,001), choroby niedokrwiennej serca (p < 0,001) i niewydolności serca (p < 0,001). Wieloczynnikowa analiza regresji logistycznej wykazała, że starszy wiek (OR = 1,043, p < 0,001), płeć żeńska (OR = 1,389, p = 0,001), niewydolność se...
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