Specialized predictive model, that was built on the data of patients with multiplesclerosis (MS), has proved to be more successfull at predictingreadmission of patients with MS in less than 30 days than the global model, which was built on the basis of all patients irrespective of diagnosis. The average AUC value of a specialized model was 0.708, which is 0.042 higher than the average AUC of a global model (AUC = 0.666). We have also detected higher average values of accuracy, sensitivity, specificity and NPV of a specialized model. An additional contribution of a specialized model in comparison with the global model was also reflected in a lower Brier score and a smaller number of the input variables and, consequently, less complex model. All of this argues in favor of specialized predictive model for patients with MS, that is why we went further and added information about previous hospitalizations and found that the inclusion of historical data on hospitalizations also has a positive impact on the prediction of unplanned readmissions.
Abstract: Multiplesclerosis (MS) is a disease that heavily affects postural control, predispos- ing patients to accidental falls and fall-related injuries, with a relevant burden on their families, health care systems and themselves. Clinical scales aimed to assess balance are easy to administer in daily clinical setting, but suffer from several limitations including their variable execution, subjective judgment in the scoring system, poor performance in identifying patients at higher risk of falls, and statistical concerns mainly related to distribution of their scores. Today we are able to objectively and reliably assess postural control not only with laboratory-grade standard force platform, but also with low-cost systems based on commercial devices that provide accept- able comparability to gold-standard equipment. The sensitivity of measurements derived from force platforms is such that we can detect balance abnormalities even in minimally impaired patients and predict the risk of future accidental falls accurately. By manipulating sensory inputs (dynamic posturography) or by adding a concurrent cognitive task (dual-task paradigm) to the standard postural assessment, we can unmask postural control deficit even in patients at first demyelinating event or in those with a radiologic isolated syndrome. Studies on neuroanatomical correlates support the multifactorial etiology of postural control deficit in MS, with the associa- tion with balance impairment being correlated with cerebellum, spinal cord, and highly ordered processing network according to different studies. Postural control deficit can be managed by means of rehabilitation, which is the most important way to improve balance in patients with MS, but there are also suggestions of a beneficial effect of some pharmacologic interventions. On the other hand, it would be useful to pay attention to some drugs that are currently used to manage other symptoms in daily clinical setting because they can further impair postural controls of patients with MS.
Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiplesclerosispatients. Patients and Methods: It is a case control cross matching age related study done on totally 40 subjects (20 patients are newly diagnosed as MS; patients don’t start any medication for MS (naive patients) and 20 subjects are controls with the same age and sex). Base line vitamin D level was measured (i.e. vitamin D, 25-OH (total)) and MRI brain with contrast was done for all patients. Results: Low total vitamin D level was seen among 65% of patients with MS (13/20); however, this was only 20% of normal controls (4/20). Conclusion: Hypovitaminosis D is common in MS patients.
The value of high frequency of depressive disorder in patients with multiplesclerosis assessed in this study is in line with other studies. The Subcommittee on Development of Guidelines of the American Academy of Neurology presented a publication on the evaluation and management of psychiatric disorders in individuals with multiplesclerosis. According to this subcommittee, the prevalence of depressive disorder in the population of patients with multiplesclerosis varies between 36% and 54%, being considered high in relation to the population without the clinical condition, and the difference reaches three times more (MINDEN et al., 2014). A systematic review conducted in 2017 by Boeschoten et al highlighted the increased risk of depressive disorders in the population with multiplesclerosis and found that prevalence rates vary widely from 14% to 54%. (BOESCHOTEN et al., 2017). As in the population with multiplesclerosis evaluated, a higher prevalence of women with multiplesclerosis associated with depression was also identified. A significant correlation was found between higher PHQ-9 values and female sex. A cross- sectional study of 2018 also identified a higher prevalence of depression among women with multiplesclerosis than in men (ALHAZZANI, 2018) Of the various hypotheses to explain the increase in frequency, the increase in the prevalence of multiplesclerosis in women observed in the last years stands out in principle (TROJANO et al., 2012; ALONSO e HERNÁN, 2008). Another highlight is the fact that women are
SUMMARY – In the study, we evaluated 61 multiplesclerosispatients hospitalized at our hospital in the period from October 1, 2013 to february 15, 2014. The aim of the study was to investigate pain syndromes associated with the underlying disease. Pain in the month preceding assessment was reported by 90% of patients. Most patients suffered from low back pain (52%) and musculoskeletal pain (39%), followed by neck pain (31%), painful tonic spasm (26%), neuropathic extremity pain (23%) and pain due to spasticity (21%). Other types of pain were present in less than 20% of patients. A total of 67% of patients were taking analgesics; the most frequently used were nonsteroidal antiinflammatory drugs, while drugs against neuropathic pain were taken by a smaller number of patients. The high incidence of pain syndromes pointed to the importance of regular physical therapy procedures.
Background: Patients with multiplesclerosis experience various disabilities, depending on the number and placement of lesions in the brain. Red blood cells with impaired membrane fluidity, as has been reported in patients with multiplesclerosis are known to be further targeted by phospholipase A2 during inflammatory activation. Objectives: The objec- tive of the present study was therefore to investigate the haematological profile of patients with multiplesclerosis and to correlate this with their functional disability and inflammatory status. Methods: Differential full blood counts of 31 patients with multiplesclerosis and 30 age- and gender-matched control subjects were determined on a Beckman Coul- ter. The functional disability status of each patient was measured using the Kurtzke Expanded Disability Status Scale. C-reactive protein was determined on a Beckman auto-analyser. Results: The haemoglobin was significantly decreased in patients: 13.9 ± 1.40 g/dl, controls: 14.7 ± 1.60 g/dl, P = 0.01, while platelets were increased in patients: 292 ± 133 × 10 9 /l, controls: 258 ± 88.0 × 10 9 /l, P = 0.04. The number of red blood cells correlated inversely with the Kurtzke Ex- panded Disability Status Scale (R = –0.41; P = 0.02). Platelets correlated inversely with the haemoglobin (P = 0.04) and positively with Visual and Brainstem Scores (P < 0.01, P = 0.07 respectively), but inversely with the Sensory Score (P = 0.02). Conclusions: It is not clear from the results whether the compromised red blood cell profile in patients was due to unknown agents involved in the disease aetiology or from the resulting inflammatory responses, but the inverse cor- relation between the red blood cell count and the Kurtzke Expanded Disability Status Scale, a measure of neuronal function, suggested a relationship between red blood cell count and disease outcome. Furthermore, the inverse correla- tion of platelets with the haemoglobin suggested immunological involvement. Platelets, similar to white blood cells, supply fatty acids for pro-inflammatory eicosanoid synthesis.
Multiplesclerosis (MS) is a neurological inability of the central nervous system (CNS) characterized with chronic inflammation, myelin and axonal loss, brain atrophy, and progressive neurological dysfunction. It is estimated that 2.5 million people in the world are suffering from MS. Recently the concerned increase in MS patients, has been reported by Iranian neurologist, especially in Isfahan. Despite unclear etiology, genetic susceptibility, environmental factors such as smoking, viral infections especially Epstein-Barr virus (EBV), low exposure to sunlight (vitamin D deficiency) and immunologic factors proposed for susceptibility to this disease. 1-3
This case-control study was conducted on 50 patients with multiplesclerosis either relapsing-remitting mul- tiple sclerosis (RRMS) or secondary progressive multiplesclerosis (SPMS) (mean age = 30.06 ± 7.7 years, M:F = 16:34) diagnosed according to McDonald’s criteria 2017 , recruited from outpatient clinic of Faculty of Medicine, Cairo University. Expanded Disability Status Scale (EDSS) of these patients is < 5. Patients with RRMS were being in remission period (at least 2 months after last relapse). Twenty healthy volunteers were selected as a control group matching in age, gender, weight, and height to patients. Informed written consent was obtained from participants and the study was approved by the ethical committee of Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University. Registration number (NO:P.T.REC/010/001075).
performed with Jim software (Xinapse Systems Ltd., Northants (UK); http://www.xinapse.com). Global cortical thickness evaluation was performed with the semi- automated Freesurfer image analysis suite based on MPRAGE images, which is documented and freely avail- able online (https://surfer.nmr.mgh.harvard.edu/). Further information and technical details of these procedures are described in prior publications [22, 23]. To detect possible misclassifications of white and gray matter due to multiplesclerosis lesions, all images were visually inspected after the white/gray matter segmentation. In two patients, a semi-automated correction of topological defects was re- quired. We used the manual procedure of control points, which is implemented in the Freesurfer software package. No further lesion masking was needed in order to obtain accurate reconstructions of the pial and the white matter surfaces.
The first MS Therapy Centre opened in Dundee in August 1982 and now there are over 100 chambers in operation in 64 MS Therapy Centres distributed throughout the UK and the Republic of Ireland. Many wonder why after such a long time the ‘establishment’ still has difficulty accepting that oxygen can benefit patients with multiplesclerosis and other brain injuries and disease. This is particularly surprising in view of the brain's large demand for oxygen and that oxygen is not just needed for the brain to function it is also needed to allow healing. Moreover, oxygen is unique, there is no substitute and there never will be, just as water and glucose are equally unique. Underlying the failure to use oxygen as a treatment in medicine is the failure to teach the importance of pressure and oxygen in our medical schools. The treatment should be simply called ‘oxygen treatment’ to distinguish it from the standard oxygen supplementation used to ensure blood is as red as possible. Being a gas, oxygen has always to be delivered at pressure. Asked about hyperbaric oxygen treatment for patients suffering from multiplesclerosis some doctors allege that controlled trials have shown that it is of no value in multiplesclerosispatients. This is not correct; the trials did show benefit, but not enough to persuade doctors that it is worthwhile. But the key question is whether or not it is sensible to base such trials of oxygen on patients with MultipleSclerosis, that is ‘Many Scars’ of ten or more year’s duration where the expectations of any treatment must be limited.
Cognitive impairment (CI) affects about 40–60 % of multiplesclerosis (MS) subjects . It involves all the disease subtypes and it can be documented from the very beginning of the disease [1, 2]. Once established, it tends to progress over time, sometimes independently from the accumulation of physical disability . Deficits of complex attention, information processing speed, epi- sodic memory and executive functioning are prominent, whereas language and general intelligence are usually spared . Also independently of physical disability, CI can have an important negative impact on patient performance in everyday activities, employment, social and recreational activities . For this purpose, assess- ment of MS-related CI is strongly recommended. The most commonly used instrument to estimate cognitive dysfunction in MS patients, both for clinical practice and research purposes, is the Brief Repeatable Battery (BRB), that includes cognitive domains most frequently affected . Normative values in the Italian population are available . Despite its good psychometric proper- ties, the implementation in clinical practice is limited by its time-consuming nature (about 45 min) and the need of administration and interpretation by experienced neuropsychologists. Therefore, there has been consider- able effort over the past decade to streamline the neuro- psychological assessment in MS, by developing brief assessment tools that can be incorporated in everyday patient assessment. In particular, recently, a Brief Inter- national Cognitive Assessment for MS (BICAMS) has been recommended as an international, validated and standardized brief cognitive test . It is easily per- formed in everyday clinical practice as it can be com- pleted in 15 min and can be administered by health care professionals who are not cognitive specialists. No special equipment (beyond pen, paper and stopwatch) is required [6, 7]. Translation and validation of the BICAMS is on going in several countries. It has been recently validated in the American , Czech , Iranian  and Italian popu- lations . We can consider BICAMS as a brief, practical and universal assessment tool for CI in MS subjects. However, little is known on its performance in compari- son to other neuropsychological batteries. For this pur- pose, the aim of our study is to compare the performance of BICAMS and BRB as screening tools for cognitive impairment in MS patients [5, 10].
We calculated rates of fracture based on person-years. For each fracture site separately, we took “date of entry” into each cohort as the date of first admission for MS, or reference condition, and “date of exit” as the date of first record of each type of fracture, death, or the end of data collection (31st December 2010), whichever was the earliest. We first calculated rates for each fracture, strati- fied and then standardised by age (in five-year age groups), sex, calendar year of first recorded admission, region of residence, and quintile of patients’ Index of Deprivation score (as a measure of socio-economic sta- tus). We used the indirect method of standardisation, using the combined MS and reference cohorts as the standard population. The stratum-specific rates in the combined MS and reference cohorts were then applied to the number of people in each stratum in the MS co- hort, separately, and then to those in the reference co- hort, to give an observed (O) and expected (E) number of people with each fracture in each of the two cohorts. The ratio of the standardised rate of occurrence of frac- ture in the MS cohort was calculated relative to that in the reference cohort using the formula (O MS /E MS )/(O ref / E ref ). The confidence interval for the rate ratio and χ 2 statistics for its significance were calculated as described elsewhere . The analyses were run using a suite of
The prevalence of epilepsy at index date was calculated by dividing the number of people diagnosed with epi- lepsy before the index date (numerator) by the number of patients with incident MS or non-MS controls (de- nominators). Odds ratios (ORs) and 95% conﬁdence interval (CI) were used to estimate the association between MS and epilepsy at index date using condi- tional logistic regression adjusting for age, sex, index year, BMI category, smoking status, alcohol consump- tion and Charlson comorbidity index. Missing data for BMI, smoking and alcohol status were coded as ‘un- known’. Kaplan–Meier plots were used to estimate the probability of epilepsy in people with incident MS and those without MS at and following diagnosis. The log- rank test was used to compare the probability of epi- lepsy between patients with MS and controls. Only people at risk for epilepsy (not having epilepsy at index date) were considered to estimate the hazard ratios (HRs) for developing epilepsy. HRs and 95% CI were calculated for incident epilepsy using a Cox propor- tional hazards model. The HRs were adjusted for age, sex, index year, BMI categories, smoking status, alco- hol consumption and Charlson comorbidity index.
Conclusion: Cognitive impairment was present in 35% of the study population. The most affected domains were working memory and verbal memory. Working memory and verbal flu ency deficit are independent factors of disease evolution. Cognitive decline is related to clinical variables and psychological measures such as fatigue or depression but not to anxiety. Keywords: cognitive status, cognitive impairment, Lanzarote, multiplesclerosis
Jean Charcot first identified multiplesclerosis (MS) in 1860 . MS is an inflammatory auto- immune disease which affects the central ner- vous system . MS is a demyelinating disease. Myeline accelerate electrical flow along the neurons so that demyelination can change ess- ential central functions . This disease leads to the improper transmission of the electrical impulses in the central nervous system (CNS) or stop them entirely and consequently various manifestations, including tiresome, speech dis- orders, and visual defects can be developed . In this disease, T cells that typically play a pro- tective role in the body, attack the CNS, and destroy myelin sheath . MS has an unknown
In this study, the prevalence of significant depression in MS was 81.3 %, while this result in Mattioli et al.’s study was 25% in Italian MS patients (17), which was lower than what we reported. Our prevalence of depression in MS patients were much higher than the general population and also those reported in earlier studies (19, 22, 23). Moreover, consistent with previous studies, the moderate intensity was the most common form of depression (15, 16, 24). The prevalence of depression in the Iranian general population is reported from 4.1 % (33) to 43.55% (25). Modabernia et al. (2008) found that 23 % of people living in Rasht, the capital city of Guilan province, had a BDI-II score over 15 and 9.5 % suffered from depressive disorders based on semi- structured psychiatric interview (DSMIV-TR) (25). It seems that high prevalence of depression in our study population than another study might be due to the use of various diagnostic or screening tools for the diagnosis of depression or the use of different cutoff points for screen tools. Other possible explanations for this could be related to study design or population sampling, as well as the lack of adequate studies, appropriate interventions, and on time standardized treatment.
If a patient has positive results, the treatment for MS should not be delayed for the finishing TB treatment. The treatment of latent tuberculosis can be: a) 3 months of once-weekly Isoniazid (INH) 15mg/kg - 900mg max. plus Rifapentine (RPT) ≥ 50.0 kg, 900 mg maximum; b) 4 months of daily Rifampin (RIF) 10mg/kg - 600mg max.; c) 3 months of daily Isoniazid (INH) 5mg/kg - 300mg max. plus Rifampin (RIF) 10mg/kg - 600mg max. These options have made the treatment eﬀective, safe and, as it is for a short period of time, there is greater patient compliance. Alternative therapies regimens are daily Isoniazid for 6 or 9 months, which is eﬃcacious but has higher hepatotoxic toxicity and lower adherence. There is a potential risk of treatment-related hepatotoxicity with anti- TB and MS treatments. Thus, monitoring of liver enzyme values with consideration of age as well as comorbid conditions like alcoholism, obesity, hepatotoxic drugs and liver disease should be done. (Sterling T, et al. 2020; Navas C, et al. 2018).
MS nurses intervene with patients at diagnosis, providing ongoing support and education. At the initiation of treat- ment, nurses provide injection training along with education about realistic expectations of the effects of DMTs and tips for managing side effects. In the early phase of treatment, when side effects may be at their worst, the early support and intervention of nurses can be effective in assisting patients to remain adherent to therapy. It is important for nurses to maintain contact with patients over the long-term, as, later in treatment, the patients may show signs of treatment fatigue and feelings that they may not need to continue taking their medication as prescribed. In these cases, nurses can reinforce and educate as to the importance of remaining on therapy long-term. Patient-assistance programs that include nurse support are vital for imparting knowledge about self-injection and management of adverse events. 6 Regularly reinforcing
All eligible patients had to sign informed consent for enrollment. In this study, a neurologist performed neurologic exams including EDSS evaluation. Three general practitioners (GPs) evaluated patients’ baseline characteristic information (such as age, marital status, parity, number of sex partners, smoking status, using OCP, STDs, pregnancy, past medical history, and previous MS medications) and performed Pap smear on patients. Simple Pap smear examinations were performed under standard conditions.
The reasons, to be sure, will be many. Beyond the sequestration-of-published-conversation issue, we will need to admit that, however much the subject may prick our inter- est, clinical neurologists don’t pursue it because they are busy, stressed, and barely can get through the primary professional journals, let alone go searching Entrez PubMed to satisfy ethical, psychological, and spiritual yearnings. Perhaps we believe that, as mature, well-trained professionals, our days of learning how to talk and listen to patients are over, and no further work need be done to help us hold up our end of the physician–patient relationship. The days when one passionately read through books on the art of medicine and the nature of suffering may seem to be far-off history (with apologies to Eric Cassell). And even if the foray is made, very few authors one discovers – let alone we readers – can articulate how to move the conversation from a study-find- ing’s hyper-specificity, or over-generalized abstractions, to the life-wrenching, painful, complex, messy circumstances that surface in the exam room.