Lazar Ljubotin

Background and Clinical Significance: NMDAR autoimmune encephalitis is a rare but potentially life-threatening autoimmune disorder that can be hard to recognize initially because it has nonspecific symptoms. In the early phase of the disease, clinical presentation is often dominated by psychiatric symptoms, which can be misleading. A diagnosis is established by demonstrating specific anti-NMDA receptor antibodies, with cerebrospinal fluid analysis considered the most reliable diagnostic method. Timely initiation of immunomodulatory therapy, including corticosteroids, intravenous immunoglobulins, and therapeutic plasmapheresis, significantly improves disease outcomes, while second-line therapies are used in refractory cases. Case Presentation: A 21-year-old female patient (M.B.) was admitted to the Psychiatry Clinic at the University Clinical Center of Vojvodina due to the sudden onset of behavioral changes, including social withdrawal, absence of verbal communication, and unusual orofacial grimacing. During hospitalization, the patient was intermittently in a state of severe psychomotor agitation and poorly communicative, with pronounced orofacial dyskinesias and involuntary tongue movements. Anti-NMDA receptor autoantibodies were detected in both serum and cerebrospinal fluid, and the patient was subsequently transferred to the Intensive Care Unit of the Neurology Clinic. Due to the lack of an adequate clinical response to pulse corticosteroid therapy, six cycles of therapeutic plasmapheresis were performed. Following this treatment, significant clinical improvement was observed. Conclusions: Timely recognition of this condition and a multidisciplinary approach allow for early initiation of immunomodulatory therapy and significantly improve treatment outcomes.

Introduction. Urinary incontinence is a very common pelvic floor disorder defined as the “complaint of involuntary loss of urine”. Sexual dysfunction prevents a person from experiencing pleasure during sexual activities. The research aimed to analyse the frequency of urinary incontinence and sexual dysfunction in female subjects 6 to 18 months after the first delivery and the association with factors at delivery. Material and Methods. The research included 69 respondents. The inclusion criteria was one previous term birth within 6-18 months. A survey created with Google Forms was used to collect data. Results. Sexual dysfunction was reported by 21/69 (30%) respondents, and urinary incontinence by 8/69 (12%). Urinary incontinence was significantly more common among subjects with obstetric soft tissue lacerations (p<0.01). Negative emotional reactions during sexual intercourse were more frequent in respondents with a longer period since childbirth (p<0.001). Only 3/21 (14%) subjects with sexual dysfunction and 3/8 (38%) with urinary incontinence reported the problem to their doctor. The doctor asked 16/69 (23%) about the problem of urinary incontinence during a regular visit, and about sexual dysfunction in 15/69 (22%) of the respondents. Conclusion. Sexual dysfunction and urinary incontinence are common conditions after the first childbirth. Trauma of the birth canal during childbirth may contribute to urinary incontinence after delivery. Negative emotional reactions increase during the time that passes after childbirth. Patients and doctors rarely discuss sexual dysfunction and urinary incontinence.