Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Quality of life (QoL) refers to the perception of an individual’s life in the context of the system of culture and values in which they live. Aim: The aim of the study was to determine the distribution of cognitive disorders in people with MS. Methods: The prospective study included 135 participants with MS and 50 healthy participants. Participants were divided into three groups: the first group consisted of 85 participants where the disease lasted longer than one year, the second group consisted of 50 participants with newly diagnosed MS, the third group consisted of 50 healthy participants. The instruments of clinical assessment were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Beck Depression Scale, and Quality of Life Scale (SF-36, Contemporary Health Survey). Results: The quality of life related to health is impaired in the physical, mental dimension and overall quality of life. In the first group of participants, 62% had mild depression, and in the second group 38% of participants, while more severe forms were recorded in 16% of participants in both groups. As depression increases, the quality of life decreases in all measured dimensions, which would mean that depression negatively affects the quality of life. The results of all dimensions as well as the overall quality of life score are worse with the increase in the degree of clinical disability, for both groups of study patients. Conclusion: Quality of life is impaired in MS patients, and a higher degree of clinical disability and an increase in depressive disorder are predictors of deteriorating quality of life in MS patients.

Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Cognitive disorders are found in over 50% of patients. Aim: The aim of the study was to determine the distribution of cognitive disorders in people with MS. Methods: The prospective study included 135 respondents with MS and 50 healthy respondents. The respondents were divided into three groups: the first group consisted of 85 respondents where the disease lasted longer than one year, the second group consisted of 50 respondents with newly diagnosed MS, the third group consisted of 50 healthy respondents. Clinical assessment instruments were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Battery of Tests to Assess Cognitive Functions: Wechsler Intelligence Scale, Revised Beta Test, Raven Colored Progressive Matrices, Wechsler Memory Scale, Rey Audio Verbal Learning Test -Osterriecht’s complex character test, verbal fluency test. Results: Cognitive disorders were present in 40-60% of respondents with MS. Visuospatial, visuoconstructive and visuoperceptive functions are worse in the first group. Mnestic functions (learning process, short-term and long-term memory, recollection, verbal-logical memory) were most affected in both groups of respondents, ranging from 30-60%. Poorer cognitive domains are in the first groups of respondents. Immediate working process memory (current learning), memory, attention, short-term and logical memory is worse in the examinees of the first group. At the beginning of the disease, 16% had verbal fluency difficulties, and as the disease progresses, the difficulties become more pronounced. Conclusion: Cognitive disorders are heterogeneous, they can be noticed in the early stages of the disease. They refer to impairments of working memory, executive functions and attention, while global intellectual efficiency is later reduced.

Dear Editor-in-Chief Marius M. Scarlat, We have read with great attention the article “Medications in COVID-19 patients: summarizing the current literature from an orthopaedic perspective”, written by Shi Heng Sharon Tan and colleagues (Authors) in the forthcoming August issue of International Orthopaedics [1]. We welcome the opportunity to make a short comment as well. This very interesting article evaluates current literature regarding common medications prescribed in orthopaedic surgery and their potential implications in COVID-19 patients. The Authors emphasized that vitamins are commonly prescribed in various orthopaedic conditions. We want to highlight that older people are in increased risk for mortality due to pandemic of COVID-19, but also for different vascular accidents after hip and/or other bone fractures. Also, hyperhomocysteinemia is common in elderly people and often associated increased risk for fractures and cardiovascular diseases, too. Interestingly, values of vitamin B9 (folic acid) and B12 are in negative correlation with levels of homocysteine [2]. Unfortunately, hyperhomocysteinemia appeared to be predictive of all-cause mortality, independent of frailty, an agerelated clinical state characterized by a global impairment of physiological functions and involving multiple organ systems [3]. In one of the very rare studies, high number of pulmonary embolism was noted in COVID-19 pneumonia patients (20.6%), despite the fact that 90% of them were receiving prophylactic antithrombotic treatment due to the current guidelines [4]. Furthermore, according to PubMed survey, there was no reliable data due to concomitance of COVID19, hyperhomocysteinemia and osteoporosis/fractures. So, what to do when we have older COVID-19 patient with high risks for different cardiovascular diseases, including pulmonary thromboembolism, as well as bone fracture? There is an urgent need to different opinions and recommendations, when proper data are absent due to enormous speed of COVID-19 disaster. Clinicians need to adapt to the challenges posed by this crisis and consider ways to continue serving the most vulnerable amongst us, those with chronic disease with their own substantive morbidity and mortality [5]. In light of this, we suggest that level of homocysteine and B9/B12 vitamin should be measured at clinical follow-up in all patients with COVID-19, immediately after hospitalization. If persistent, hyperhomocysteinemic proosteoporotic/ procoagulability state should be promptly decreased in acute phase of COVID-19, on the base of Latin phrase primum non nocere. Our studies from Bosnia and Herzegovina showed that the intake of B9 vitamin, sometimes with B12 vitamin as well, was efficient in creating normalized homocysteine levels in older patients with ischemic stroke and Parkinson’s disease [6, 7]. Fortunately, risk of side effects is minimal if the daily dose of B9 vitamin is 1–5 mg [8]. In addition, B2/B3/B6 vitamins are, as Authors wrote, enhancers of the immune system and might be efficient as soldiers from second echelon in battling with COVID-19. Lastly, we emphasize that further studies will elucidate hidden but also harmful potential of hyperhomocysteinemia on bone fractures/vascular accidents in COVID-19 patients as well as beneficial add-on effects of B9/B12 vitamin on their osteoporotic/vascular complications. * Suljo Kunić suljo.kunic@hotmail.com

ABSTRACT Objective To evaluate memory in patients with drug-resistant epilepsy. Methods Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. Results Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). Conclusion Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

BACKGROUND In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.