Background: Male and female patients differ in their risk factors (RFs) and ischemic stroke (IS) subtype. A better understanding of the gender–related differences an important approach to successful prevention strategies for reducing the impact and burden of IS in young adults. Objective: To compare the gender–related differences in the prevalence of modifiable RFs and IS subtypes in young and middle-aged patients. Material and Methods: In the study were included 80 patients with acute IS, aged 18 – 59 years, admitted to the Neurology Clinic of UMHAT "Dr Georgi Stranski" Pleven. The following RFs were analyzed: arterial hypertension (AH), diabetes mellitus (DM), dyslipidemia, atrial fibrillation (AF), current smoking, number of cigarettes smoked per day, alcohol abuse, low physical activity, body overweight and chronic psychosocial stress. IS subtype was identified according to the Org 10172 Trial of Acute Stroke (TOAST). The statistical analysis was performed with the Statistical Package for Social Sciences, version 26.0 (SPSS). Results: Of all the 80 patients, 46 (57,5%) were males with a mean age 48,15±7,42 years, and 34 (42,5%) were females with a mean age 47,38±8,56. Male patients had higher rates of AH (80,4%), DM (47.8%), AF (4,3%), current smoking (73,9%), number of cigarettes smoked per day (60,9%), alcohol abuse (41,3%) and chronic psychosocial stress (52,2%), while the female ones showed higher rates of low physical activity (61,8%) and body overweight (38,2%). A statistical significance was found only for AH (p=0,004), DM (p=0,026), current smoking (p=0,007), number of cigarettes smoked per day (p=0,025) and alcohol abuse (p=0,031). The most common subtype of IS in males was large artery atherosclerosis (47,8%) and small vessel occlusion (28,3%). The female patients demonstrated a higher frequency of IS with other determined etiology (38,2%) and undetermined etiology (26,5%). Conclusion: Our data contribute to a better understanding of the gender–related differences of modifiable RFs and IS subtype in young and middle-aged patients with acute IS. The above findings definitely imply the necessity of developing additional specific therapeutic strategies for the effective control of modifiable RFs and lifestyle improvement in order to reduce the incidence of the most common subtypes of IS.

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Purpose: This pilot study was designed to investigate the impact of a moderate-calorie Mediterranean diet compared to a regular diet with omega-3 PUFAs (eicosapentaenoic and docosahexaenoic acids) supplementation on fatigue symptoms in patients with relapsing-remitting multiple sclerosis (RRMS) and to assess the optional benefit of the diet on their quality of life. Material/Methods: This 12-month pilot study was conducted in 2021 at the Department of Neurology, Medical University – Pleven, Bulgaria. A total of 60 patients with RRMS aged 18-64 were selected from the database of the Neurology Clinic at the University Hospital "Dr Georgi Stranski" – Pleven. From the selected patients, only 30 were included in the pilot phase and respectively assigned to the nutritional arms. Blood samples were collected twice – at the first and second visit in 3 months, for metabolic and dietary parameters analysis. Symptoms of fatigue were assessed with Fatigue Scale for Motor and Cognitive Functions (FSMC) and Modified Fatigue Impact Scale (MFIS). Results: From the 30 participants included in the study, 17 patients attended the clinic centre for complete follow-up; the remaining 13 were only partially observed. The dynamics of the followed-up parameters showed a statistically significant change in the body mass index (BMI), the fatigue symptoms in the FSMC and MFIS scales, total cholesterol and triglycerides levels, and the serum concentrations of IL17A, EPA and DHA. The metabolic caloric values were also found to be significantly changed. Conclusions: Despite the small study size limitation, this pilot study might be of benefit for further extensive research on the potential favorable impact of diet and lifestyle modifications on the symptoms of fatigue in multiple sclerosis patients.

Summary Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system (CNS) with unclear and multifactorial etiology, variable clinical symptoms with different severity, and treatment with limited efficacy. Authors conclude that the immune system has a role in pathogenesis, and many modern therapies target the immune system. Among clinicians, it is accepted that not every patient will progress in the same way, and there is high variability between clinical courses of MS in different patients. Modern therapies have shown to reduce new lesions and clinical relapses but lack effectiveness at halting underlying neurodegeneration at lesions, the localized inflammation on a small scale, chronic demyelination, and axonal and neuronal damage. Dietary metabolites have far-reaching and systemic effects. It has been suggested that diet can play an essential role in helping to modify immune system function to promote regulation as opposed to inflammation. Polyunsaturated fatty acids decrease inflammation through conversion into anti-inflammatory prostaglandins E1 and E2, which affect cytokine production, leukocyte migration, and other immune system components. The Mediterranean style diet is a diet low in saturated fats, high in polyunsaturated and monounsaturated fats, rich in fruits and vegetables, and low in processed foods (low salt content). Eating a Mediterranean-style diet can help reduce fatigue (as reported by patients) and change the clinical course favorably.