The correlation between the level of 25-hydroxyvitamin D [25(OH)D] and residency of multiple sclerosis patients in Montenegro – higher levels only in men in the north of the country

Background/Aim. Multiple Sclerosis (MS) is a chronic neurological disease associated with low serum levels of 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to determine the association between serum levels of 25(OH)D and the latitude as well as clinical MS severity and progression expressed by expanded disability status scale (EDSS) and multiple sclerosis severity score (MSSS). Methods. A total of 196 patients, from North and South of Montenegro, aged 18 to 65 years, with confirmed diagnosis of MS were recruited for the study. Serum samples were collected for 25(OH)D measurement. Control group consisted of 196 health controls, randomly selected from medical staff employed in health centers from three cities in North and Clinical Centre of Montenegro from the South. Results. The serum levels of 25(OH)D were significantly lower in MS patients compared to controls (p < 0.001). The serum levels of 25(OH)D were significantly different in regard to gender, with women showing lower levels. Although in the entire group of patients there was no statistical correlation between the levels of 25(OH)D and their residence, the significantly higher levels of 25(OH)D were detected in men from the North compared to women. The course of the disease had an impact on the 25(OH)D serum levels. 25(OH)D levels also significantly correlated with clinical parameters of both, disability (Spearman''s r = -0.23, p = 0.001) and progression (Spearman''s r = -0.25, p = 0.0004) of MS. Conclusion. Serum levels of 25(OH)D were associated with disability and progression in MS patients. Lower levels of 25(OH)D were detected in female patients from the North. The low level of 25(OH)D cannot be solely explained with unfavorable latitude and insufficient sun exposure, therefore further genetic analysis is needed.

Acute Abdomen in the 17th Week of Twin Pregnancy due to Ovarian Torsion - A Late Complication of IVF

Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Conclusion: Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation.

Prevalence of epilepsy in Podgorica, Montenegro

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0–10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration.