Disability Status Research Articles

Non-Modifiable Factors Associated with Progression to Irreversible Disability in Multiple Sclerosis Patients

Introduction: Multiple sclerosis (MS) is the leading cause of acquired motor disability in young adults. The increase in disability follows the progression of the disease and imposes on those affected a permanent multidimensional handicap. The identification of the factors associated with the evolution towards an irreversible handicap is important for an adequate therapeutic management. Objective: Identify the non-modifiable factors associated with progression to irreversible disability in patients with MS. Material and Methods: This is a prospective collection study that was carried out in the physical medicine and rehabilitation departments of the University Hospital of Oran and the HMRU of Oran, between January 2017 and December 2019. For the main analysis, we retained an EDSS score (Expanded Disability Status Scale) for the patient if he had the same functional status during the last six months. Results/Discussion: This study included 103 MS cases, including 72 women and 31 men, with a mean age at onset of symptoms of 31.83 years and a mean EDSS of 5.12 ± 1.97. The progression of the disability assessed by the EDSS scale is related to: male gender, age at advanced onset and progressive form of MS. we did not find a correlation between the severity of the handicap and the place of birth and/or residence. Our results are unanimous in the literature for certain parameters, and the same is not true for others. Conclusion: Non-modifiable factors in MS, such as age, gender and place of birth and/or residence, are important predictors of disability and should alert the clinician to appropriate and specific management even at an early stage of the disease.

Impact of sex on clinical outcome in early Multiple Sclerosis

BackgroundPrevious evidence suggests sex differences in the clinical course of relapsing remitting multiple sclerosis (RRMS), but comprehensive early-stage prospective studies are lacking. We aim to quantify the impact of sex on clinical outcomes in early-stage RRMS. MethodsUtilizing prospective cohort data, we assessed the impact of biological sex on time-to-relapse, disability progression (Expanded Disability Status Scale [EDSS]), extremity function (Nine-Hole Peg Test, Timed-25-food walk test), cognition (Paced Auditory Serial Addition Test, Symbol Digit Modalities Test), quality-of-life (Hamburg Quality of Life Questionnaire in Multiple Sclerosis, Short-Form-36), fatigue (Fatigue Severity Scale, Fatigue Scale for Motor and Cognitive functions), and depression (Beck Depression Inventory-II) in clinically isolated syndrome (CIS) or RRMS patients. Inclusion was within 12 months of symptom onset. Linear, negative binomial, mixed, and Cox models estimated male vs. female effects at the four-year follow-up including baseline-to-follow-up course. ResultsWe included 149 patients (65.1 % female). Eighty-five completed four-year follow-up. No sex differences in time-to-relapse emerged (HR = 0.91;95 %CI = 0.53–1.58). Males had no increased risk of EDSS worsening (OR = 0.75;95 %CI = 0.21–2.35) compared to females. Similarly, minor/no sex differences emerged in other outcomes. ConclusionsFour years after first manifestation, neither disease activity (disability progression and relapse rate) nor patient-reported outcomes showed sex-related disparities in this early-MS-cohort. ClinicalTrials.gov Identifier: NCT01371071

Early reduction of retinal thickness predicts physical and cognitive disability in newly diagnosed multiple sclerosis patients: results from a cross-sectional study

IntroductionRetinal nerve fiber layer (RNFL) thickness is a promising biomarker of axonal loss and a potential outcome predictor in Multiple Sclerosis (MS). Cognitive impairment (CoI) exhibits a high prevalence in patients with MS (pwMS), even in the early phases of the disease. Our aim was to explore the role of RNFL thickness as a predictor of physical and cognitive disability in pwMS.MethodsAll newly diagnosed pwMS referred to the MS centre of the University-Hospital “Policlinico-San Marco” between 2015–2019 were evaluated at baseline and at 3 years. RNFL and ganglion cell layer (GCL) thickness for right (r.e.) and left eyes (l.e.) were measured with Optical Coherence Tomography (OCT). Disability level and cognitive profile were assessed, using the Expanded Disability Status Scale (EDSS) and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, respectively.ResultsWe consecutively enrolled 487 pwMS, including 68 (14.0%) with primary progressive MS (PPMS). At baseline, RNFL and GCL were bilaterally thinner in PPMS (r.e. 90.4 ± 12.7; l.e. 90.2 ± 13.5, and r.e. 80.1 ± 11.2; l.e. 80.3 ± 12.6, respectively) compared to relapsing–remitting MS (RRMS) (r.e. 94.6 ± 13.1; l.e. 94.3 ± 14.8, and r.e. 85.1 ± 9.5; l.e. 84.9 ± 9.3, respectively) (p < 0.01). Both groups exhibited reduced RNFL and GCL thickness, worse cognitive performance and higher EDSS scores at 3-years follow-up compared with baseline. RNFL thickness ≤ 88.0 μm was an independent predictor of CoI (OR = 5.32; 95% CI = 1.84–9.12; p = 0.02) and disability worsening (OR = 3.18; 95% CI = 1.21–10.33; p = 0.05).DiscussionRNFL thickness, as a biomarker of neurodegeneration, could be considered a predictive biomarker of cognitive degeneration and physical disability in MS.

Raftlin - a potential biomarker for axial spondyloarthritis and psoriatic arthritis: An observational study.

Our aim is to evaluate serum Raftlin levels as a biomarker for diagnosing and monitoring disease activity in patients with axial spondyloarthritis (axSpA) and Psoriatic arthritis (PsA). This trial included 40 axSpA patients, 40 PsA patients, and 40 healthy participants as the control group. Disease activity was assessed with Ankylosing Spondylitis Disease Activity Score for axSpA patients and The Disease Activity Index for Psoriatic Arthritis for PsA patients. The Spondyloarthritis Research Consortium of Canada index, health assessment questionnaire-disability index, and numeric rating scale were used to evaluate the enthesitis severity, disability, and pain status of all patients. Serum Raftlin levels were determined using the ELISA method. The 3 groups had no statistical differences regarding gender, age, weight, height, BMI, educational status, and exercise habits. The axSpA group had higher Raftlin levels than the PsA and control groups, and Raftlin levels were statistically significant in predicting the likelihood of axSpA. We found no statistically significant differences between the PsA and control groups. We found no statistically significant difference in Raftlin levels in HLA-B27 positive versus HLA-B27 negative patients in both axSpA and PsA groups. Our results also did not detect any correlation of Raftlin levels with Ankylosing Spondylitis Disease Activity Score, C-reactive protein, erythrocyte sedimentation rate, health assessment questionnaire-disability index, numeric rating scale, and Spondyloarthritis Research Consortium of Canada index in axSpA patients. Receiver operating characteristic analysis determined that Raftlin level ≥ 6.31 ng/mL discriminates axSpA from normal individuals with 92.5% sensitivity, 59% specificity, and an area under the curve of 0.738. Our results demonstrate that although serum Raftlin levels are elevated in axSpA patients, Raftlin cannot be used as an alone diagnostic marker for axSpA. Furthermore, it was not found to be related to the monitoring of disease activity, the level of pain, disability, or severity of enthesitis. This study is prospectively registered at www.clinicaltrials.gov (ID: NCT05771389).

Enhanced choroid plexus segmentation with 3D UX-Net and its association with disease progression in multiple sclerosis

BackgroundThe choroid plexus (CP) is suggested to be closely associated with the neuroinflammation of multiple sclerosis (MS). Segmentation based on deep learning (DL) could facilitate rapid and reproducible volume assessment of the CP, which is crucial for elucidating its role in MS. PurposeTo develop a reliable DL model for the automatic segmentation of CP, and further validate its clinical significance in MS. MethodsThe 3D UX-Net model (3D U-Net used for comparison) was trained and validated on T1-weighted MRI from a cohort of 216 relapsing-remitting MS (RRMS) patients and 75 healthy subjects. Among these, 53 RRMS with baseline and 2-year follow-up scans formed an internal test set (dataset1b). Another 58 RRMS from multi-center data served as an external test set (dataset2). Dice coefficient was computed to assess segmentation performance. Compare the correlation of CP volume obtained through automatic and manual segmentation with clinical outcomes in MS. Disability and cognitive function of patients were assessed using the Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT). ResultsThe 3D UX-Net model achieved Dice coefficients of 0.875 ± 0.030 and 0.870 ± 0.044 for CP segmentation on dataset1b and dataset2, respectively, outperforming 3D U-Net's scores of 0.809 ± 0.098 and 0.601 ± 0.226. Furthermore, CP volumes segmented by the 3D UX-Net model aligned consistently with clinical outcomes compared to manual segmentation. In dataset1b, both manual and automatic segmentation revealed a significant positive correlation between normalized CP volume (nCPV) and EDSS scores at baseline (manual: r = 0.285, p = 0.045; automatic: r = 0.287, p = 0.044) and a negative correlation with SDMT scores (manual: r = -0.331, p = 0.020; automatic: r = -0.329, p = 0.021). In dataset2, similar correlations were found with EDSS scores (manual: r = 0.337, p = 0.021; automatic: r = 0.346, p = 0.017). Meanwhile, in dataset1b, both manual and automatic segmentation revealed a significant increase in nCPV from baseline to follow-up (p < 0.05). The increase of nCPV was more pronounced in patients with disability worsened than stable patients (manual: p = 0.023; automatic: p = 0.018). Patients receiving disease-modifying therapy (DMT) exhibited a significantly lower nCPV increase than untreated patients (manual: p = 0.004; automatic: p = 0.004). ConclusionThe 3D UX-Net model demonstrated strong segmentation performance for the CP, and the automatic segmented CP can be directly used in MS clinical practice. CP volume can serve as a surrogate imaging biomarker for monitoring disease progression and DMT response in MS patients.

Association between wearable device usage and engagement of strength activity among people with and without disabilities

There is a lack of literature examining the engagement in strength activities of people with disabilities (PWD) using and not using wearable devices. The objectives of the current study were to determine the prevalence of strength activity engagement among wearable device users with disabilities, and to compare strength activity engagement between wearable device users and non-users with and without disabilities. Wearable device users and non-users with and without disabilities from eight states of the CDC’s 2017 Behavioral Risk Factor Surveillance were included in the analysis. Linear regression was used to examine the association between wearable device use and disability status and the interaction term for frequency of strength activity per week, while logistic regression was used to determine the association between the two variables and the interaction term for strength activity engagement and meeting strength activity guidelines. 7055 wearable device users and non-users with and without disabilities were included in the analysis. No interaction effects were found between wearable device use and disability status. In unadjusted logistic regressions, wearable device users were more likely to engage in strength activity (OR = 1.16, 95% CI [1.16, 2.20]) and meet strength activity guidelines (OR = 1.50, 95% CI [1.07, 2.09]), whereas PWDs were less likely to engage in strength activity (OR = 0.57, 95% CI [0.44, 0.75]) and meet strength activity guidelines (OR = 0.72, 95% CI [0.53, 0.98]). The use of wearable devices could lead to engagement in strength activity. However, further research is needed to determine its effectiveness in PWD.

Real-World Study of Serum Neurofilament Light Chain Levels in Ocrelizumab-Treated People with Relapsing Multiple Sclerosis.

Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective in improving clinical and radiological outcomes and reducing sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for their short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced ARR in 83% of PwMS and radiological activity in 80%. EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNfL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs.

Clinical utility of the Lumipulse™ immunoassay for plasma neurofilament light chain in multiple sclerosis

ObjectiveBlood neurofilament light chain (NfL) is robustly associated with disease worsening in multiple sclerosis (MS), though potentially affected by concomitant factors also determining neuro-axonal loss. We investigated the association between plasma NfL (pNfL) measured with Lumipulse™ immunoassay and demographic and clinical variables in MS. MethodsThis cross-sectional study included 685 people with MS (age 49.7 ± 12.4 years; sex 65.55% females). On the same day, we collected plasma samples, along with demographics, comorbidities, and clinical variables (MS disease duration, expanded disability status scale (EDSS), Symbol Digit Modalities Test (SDMT), descriptor of disease progression, current disease modifying treatment (DMT), number of previous DMTs, evidence of disease activity in the past year (i.e. relapse or MRI new lesions), EDSS progression). pNfL was evaluated using Lumipulse™ fully automated chemiluminescent enzyme immunoassay. ResultsOn multivariable linear regression model, higher pNfL was associated with higher EDSS (Coeff = 1.73; 95%CI 0.78, 2.68; p < 0.01), recent disease activity (Coeff = 15.70; 95%CI = 5.35, 26.06; p < 0.01), and presence of cardiovascular comorbidity (Coeff = 3.84; 95%CI 0.48, 7.20; p = 0.025). Lower pNfL was found in patients on DMT treatment (Coeff = −10.23; 95%CI -18.42, −2.04; p = 0.015), when compared with no DMT (reference). For 77.81% of our population there was correspondence between pNfL levels and two previously-validated cutoffs. ConclusionspNfL measured using Lumipulse™ confirms known associations with MS activity, disability and treatments, and related confounding (e.g., cardiovascular comorbidity), thus granting further utilization in research and clinical practice.

Comparison of ozone therapy and routine medical treatment effect on disease severity and serum level changes of IL-33 in patients with remitting-relapsing multiple sclerosis: A parallelled randomised clinical trial

IntroductionIL-33 is an inflammatory cytokine involved in the pathogenesis of Multiple sclerosis (MS) as an autoimmune inflammatory disease. Ozone therapy has been shown to improve the symptoms of the disease in previous studies. Given the limitations of previous studies, we investigated the effect of adding ozone therapy to conventional medical treatment in remitting-relapsing multiple sclerosis (RR-MS) patients from the points of disease severity and blood levels of IL-33. MethodsThis clinical trial was performed on 66 RR-MS patients, among whom 55 finished the study. The patients were divided randomly into two groups; one group (intervention) received ozone therapy in addition to the routine medical treatment, and the other group (control) received only routine medical treatment. The level of IL-33 was measured by ELISA, and the severity of the disease was measured by an expanded disability status scale (EDSS) in all patients before and after the treatment. Finally, the relationship between the serum levels of IL-33 and EDSS score with the type of treatment was evaluated. The research project was registered at the International Center for the Registration of Clinical Trials in Iran (IRCT20171105037262N3). ResultsOur findings showed that the serum levels of IL-33 in the ozone plus medical-treated group significantly decreased compared to the medical-treated group (P<0.001). The EDSS score also decreased significantly in the ozone plus medical-treated group compared to the medical-treated group (P=0.019). ConclusionOzone therapy reduces the severity of RR-MS. Such an effect may be influenced by modifying IL-33 levels.

Konectom™ cognitive processing speed test enables reliable remote, unsupervised cognitive assessment in people with multiple sclerosis: Exploring the use of substitution time as a novel digital outcome measure

Background: The Konectom™ smartphone-based cognitive processing speed (CPS) test is designed to assess processing speed and account for impact of visuomotor function on performance. Objective: Evaluate reliability and validity of Konectom CPS Test, performed in clinic and remotely. Methods: Data were collected from people with multiple sclerosis (PwMS) aged 18–64 years and healthy control participants (HC) matched for age, sex, and education. Remote test–retest reliability (intraclass correlation coefficients, ICC); correlation with established clinical measures (Spearman correlation coefficients); group analyses between cognitively impaired/unimpaired PwMS; and influence of age, sex, education, and upper limb motor function on CPS Test measures were assessed. Results: Eighty PwMS and 66 HC participated. CPS Test measures from remote tests had good test–retest reliability (ICC of 0.67–0.87) and correlated with symbol digit modalities test (highest |ρ| = 0.80, p < 0.0001). Remote measures were stable (change from baseline < 5%) and correlated with MS disability (highest |ρ| = 0.39, p = 0.0004) measured by Expanded Disability Status Scale. CPS Test measures displayed sensitivity to cognitive impairment (highest d = 1.47). Demographics and motor function had the lowest impact on CPS Test substitution time, a measure accounting for visuomotor function. Conclusion: Konectom CPS Test measures provide valid, reliable remote measurements of cognitive processing speed in PwMS.

Serum NfL and GFAP are weak predictors of long-term multiple sclerosis prognosis: A 6-year follow-up

BackgroundSerum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are promising biomarkers that might be associated with clinical and radiological markers of multiple sclerosis (MS) severity. However, it is not known whether they can accurately identify patients at risk of disability progression in the medium and long term. ObjectivesWe wanted to determine the association between sNfL and sGFAP, Expanded Disability Status Scale score changes, and conversion to secondary progressive MS (SPMS) in a cohort of 133 patients with relapsing remitting MS. MethodsBlood samples were collected at inclusion to measure SNfL and sGFAP by single molecule array and their prognostic value was assessed using a linear mixed model. ResultsIn this cohort, 37 patients (27.8 % of 133) experienced disability progression and 12 patients (9.0 %) converted to SPMS during the follow-up (mean follow-up duration: 6.4 years). Only sNfL (p = 0.03) was associated with conversion to SPMS, and neither SNfL nor sGFAP was associated with disability progression. ConclusionSerum NfL and GFAP do not seem to accurately predict MS outcome in the long term. More studies are needed to determine how serum biomarkers, associated with other clinical and MRI biomarkers, might be used to improve MS prognostication.

Time to Proficiency in Young English Learners and Factors That Affect Progress

AbstractWe investigated the time it takes 54,146 English learners (ELs) to attain English proficiency as they progressed from age 5 to 11 on average (Kindergarten through fifth grade in the United States). We also examine to what extent the time‐to‐proficiency estimate is affected by child‐internal and child‐external factors, including primary disability status, primary home language, home English use, instructional programming, and retention status. We used discrete‐time survival analysis to analyze the children's English growth. Survival analysis often concerns time from treatment until death: Here, “survival” is the time from EL‐program entry until “proficiency,” indicated via standardized testing. Half of the students attained proficiency in 5 years. Literacy skills (reading and writing) in general developed at slower rates than oral language skills (speaking and listening), with writing being ELs' biggest barrier to proficiency. While time to proficiency was significantly related to primary disability status, primary home language, and retention status, exposing ELs to their home language at home or at school does not have a substantial effect on their rates of English acquisition. The results are discussed for their research and practical implications.

Long-Term Outcomes After Lung Transplantation in Children With Intellectual Disabilities.

The United Network for Organ Sharing (UNOS) started recording data on intellectual disability status in 2008. This study aimed to characterize the long-term outcomes for children with intellectual disabilities (IDs) undergoing lung transplantation. All pediatric patients (under 18 years old) undergoing bilateral lung transplantation were identified using the UNOS database. The patients were grouped into the following categories: no cognitive delay, possible cognitive delay, and definite cognitive delay. The primary endpoint was graft survival at 3-year posttransplantation. Multivariate Cox proportional hazards modeling was used to estimate the independent effect of cognitive disability on graft survival. Five hundred four pediatric patients who underwent lung transplantation between March 2008 and December 2022 were retrospectively analyzed. 59 had a definite cognitive delay (12%), 23 had a possible delay (5%), and 421 had no delay (83%). When comparing these three groups, there was no significant difference in 60-day graft survival (p = 0.4), 3-year graft survival (p = 0.6), 3-year graft survival for patients who survived at least 60-day posttransplantation (p = 0.9), distribution of causes of death (p = 0.24), nor distribution treatment of rejection within 1-year posttransplantation (p = 0.06). Intellectual disability does not impact long-term outcomes after bilateral lung transplantation. Intellectual disability should not be a contraindication to bilateral lung transplantation on the basis of inferior graft survival.

Brain and cervical spinal cord MRI correlates of sensorimotor impairment in patients with multiple sclerosis.

Cervical spinal cord (cSC) lesions and atrophy contribute to disability in multiple sclerosis (MS), but associations with specific sensorimotor dysfunction require further exploration. To investigate the associations of brain and cSC magnetic resonance imaging (MRI) measures with sensorimotor impairment in MS. One hundred fifty-one MS patients and 69 healthy controls underwent 3T MRI and clinical assessments including Expanded Disability Status Scale (EDSS), 9-hole peg test (9-HPT), finger tapping test (FTT), timed 25-foot walk test (T25FWT), and vibration detection threshold (VDT). Random forest ranked brain (T2-hyperintense lesion volume (T2-LV) and normalized deep gray matter (GM), cortical and white matter (WM) volumes) and cSC (T2-LV and total, GM, and WM cross-sectional areas (CSAs) at C2/C3 level) MRI measures relevance in explaining EDSS milestones (EDSS ⩾3.0, ⩾4.0, and ⩾6.0), VDT, pyramidal and sensory functional systems (P-FS and S-FS ⩾2), and motor tests impairment. Various combinations of brain and cSC MRI measures explained EDSS milestones (area under the curve (AUC) =0.879-0.900), VDT (R2 = 0.194), and impaired P-FS (AUC = 0.820), S-FS (AUC = 0.795), 9-HPT (AUC = 0.793), FTT (AUC = 0.740), and T25FWT (AUC = 0.825). cSC GM CSA was the most informative feature for all outcomes, except 9-HPT. cSC MRI measures, especially GM CSA, explain EDSS and sensorimotor dysfunction better than brain measures in MS.

Evaluation of machine learning-based classification of clinical impairment and prediction of clinical worsening in multiple sclerosis

BackgroundRobust predictive models of clinical impairment and worsening in multiple sclerosis (MS) are needed to identify patients at risk and optimize treatment strategies.ObjectiveTo evaluate whether machine learning (ML) methods can classify clinical impairment and predict worsening in people with MS (pwMS) and, if so, which combination of clinical and magnetic resonance imaging (MRI) features and ML algorithm is optimal.MethodsWe used baseline clinical and structural MRI data from two MS cohorts (Berlin: n = 125, Amsterdam: n = 330) to evaluate the capability of five ML models in classifying clinical impairment at baseline and predicting future clinical worsening over a follow-up of 2 and 5 years. Clinical worsening was defined by increases in the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FW), 9-Hole Peg Test (9HPT), or Symbol Digit Modalities Test (SDMT). Different combinations of clinical and volumetric MRI measures were systematically assessed in predicting clinical outcomes. ML models were evaluated using Monte Carlo cross-validation, area under the curve (AUC), and permutation testing to assess significance.ResultsThe ML models significantly determined clinical impairment at baseline for the Amsterdam cohort, but did not reach significance for predicting clinical worsening over a follow-up of 2 and 5 years. High disability (EDSS ≥ 4) was best determined by a support vector machine (SVM) classifier using clinical and global MRI volumes (AUC = 0.83 ± 0.07, p = 0.015). Impaired cognition (SDMT Z-score ≤ −1.5) was best determined by a SVM using regional MRI volumes (thalamus, ventricles, lesions, and hippocampus), reaching an AUC of 0.73 ± 0.04 (p = 0.008).ConclusionML models could aid in classifying pwMS with clinical impairment and identify relevant biomarkers, but prediction of clinical worsening is an unmet need.

Disability and functional status among patients post Covid 19 - A tertiary care hospital based prospective study

BackgroundThe long-term sequelae of COVID-19 infection, the persistence of disability, its temporal profile, and associated factors remain under-documented in South India. ObjectivesTo estimate the proportion of disability in survivors of COVID-19 at different time points (first, second, and sixth months) and determine the demographic and clinical variables associated with poor functional status which will aid in developing effective treatment and rehabilitation strategies. MethodsA total of 139 COVID-19 patients were interviewed at discharge from a tertiary care hospital and followed up in the first, second, and sixth months. Persistent symptoms and post-COVID functional status (PCFS) scores were recorded at all these time points. Univariate and Multivariate Poisson regression analysis was used to determine the association of socio-demographic variables and other clinical factors with functional status post-COVID-19. Results48.92 % of patients had complete recovery. However, a majority (51.08 %) experienced persistent functional limitation - 33.81 % had negligible, 15.83 % mild, 0.72 % moderate, and 0.72 % severe limitation. Common symptoms at six months were breathlessness (23.02 %), fatigue (20.14 %), memory loss (10.07 %), myalgia (8.63 %), and post-traumatic stress disorder (7.91 %). Vaccination emerged as a significant predictor of disability status (p < 0.05). Taking two vaccine doses lowered the risk of disability by 0.48 times. ConclusionAt the six-month follow-up of discharged COVID-19 patients, they continue to exhibit persistent functional limitations and symptoms. Administration of two vaccine doses is recommended to improve functional status at six months. Multidisciplinary clinics, telemedicine, and community-based rehabilitation programs are essential to minimize post-COVID-19 functional disability and facilitate complete recovery.

Weak grip strength among persons with multiple sclerosis having minimal disability is not related to agility or integrity of the corticospinal tract

IntroductionMobility impairment is common in multiple sclerosis (MS); however, agility has received less attention. Agility requires strength and neuromuscular coordination to elicit controlled propulsive rapid whole-body movement. Grip strength is a common method to assess whole body force production, but also reflects neuromuscular integrity and global brain health. Impaired agility may be linked to loss of neuromuscular integrity (reflected by grip strength or corticospinal excitability). ObjectivesWe aimed to determine whether grip strength would be associated with agility and transcranial magnetic stimulation (TMS)-based indices of corticospinal excitability and inhibition in persons with MS having low disability. We hypothesized that low grip strength would predict impaired agility and reflect low corticospinal excitability. MethodsWe recruited 34 persons with relapsing MS (27 females; median [range] age 45.5 [21.0-65.0] years) and mild disability (median [range] Expanded Disability Status Scale 2.0 [0-3.0]), as well as a convenience sample of age- and sex-matched apparently healthy controls. Agility was tested by measuring hop length during bipedal hopping on an instrumented walkway. Grip strength was measured using a calibrated dynamometer. Corticospinal excitability and inhibition were examined using TMS-based motor evoked potential (MEP) and corticospinal silent period (CSP) recruitment curves, respectively. ResultsMS participants had significantly lower grip strength than controls independent of sex. Females with and without MS had weaker grip strength than males. There were no statistically significant sex or group differences in agility. After controlling for sex, weaker grip strength was associated with shorter hop length in controls only (r = 0.645, p < .05). Grip strength did not significantly predict agility in persons with MS, nor was grip strength predicted by corticospinal excitability or inhibition. ConclusionsIn persons with MS having low disability, grip strength (normalized to body mass) was reduced despite having intact agility and walking performance. Grip strength was not associated with corticospinal excitability or inhibition, suggesting peripheral neuromuscular function, low physical activity or fitness, or other psychosocial factors may be related to weakness. Low grip strength is a putative indicator of early neuromuscular aging in persons with MS having mild disability and normal mobility

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases.

Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment. This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses. This prospective observational study was designed in a tertiary center during one year. All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded. Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively). The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

Micro-analysis of earnings and its determinants in eastern cape province of South Africa

Earnings disparities in South Africa, and specifically the Eastern Cape region are influenced by a complex interplay of historical, socio-economic, and demographic factors. Despite significant progress since the end of apartheid, persistent disparities in earnings continue to raise questions about the effectiveness of policies aimed at reducing inequality and promoting equitable social system. Individual-level dataset from the 2021 South African general household survey were subjected to exploratory analysis, while Heckman selection model was used to investigate the determinants of earnings disparities in the study area. The results showed that majority of the population are not working for a wage, commission or salary, which also pointed to the gravity of unemployment situation in the area of study. Most of the working population (both male and female) are lowest earners (R ≤ 10,000), and this also cuts across all age-group categories. Majority of working population have no formal education, are drop out, or have less than grade-12 certificate, and very few working populations with higher education status were found in the moderate and relatively high earnings categories. While many of the working population are engaged in the informal sector, those in the formal sector are in the lowest earners group. Compared to any other race, the Black African group constituted the majority of non-wage earners, and most in this group were found in the lowest earners group. Some of the working population who were beneficiaries of social grants and medical aids scheme were found in the lowest, low, and moderate earnings categories. The findings significantly isolated the earnings-effect of age, marital status, gender, race, education, geographic indicators, employment sector, and index of health conditions and disabilities. The study recommends interventions addressing racial, gender, and geographic wage gaps, while also emphasizing the importance of equitable access to education, health infrastructure, and skills development.

Facilitators and barriers to employment for people with physical disabilities: A cross-sectional study

BACKGROUND: There is increasing evidence that employment, or the lack thereof, affects an individual’s health. Consequently, employment provides people with physical disabilities (PWPD) with financial independence, enhances their well-being and self-worth, and facilitates a sense of purpose. People with physical disabilities often retain job skills and motivation to return to work after acquiring a disability. Their vocational rehabilitation and job accommodation needs likely differ from people with disabilities resulting from developmental, sensory, cognitive, and mental health conditions. To better target the needs of PWPD and improve vocational rehabilitation services, it is crucial to identify the modifiable factors that influence their employment outcomes. OBJECTIVE: This research aimed to examine systematically the client-, employer-, and context-related facilitators and barriers to employment experienced by PWPD. METHODS: We recruited to this cross-sectional study, PWPD from the Midwestern United States who returned to work after injury or illness. An online survey collected data on demographic characteristics and educational history; disability and functional status; supports, facilitators and barriers to employment; and job information and accommodations. RESULTS: 347 working-age PWPD completed the survey; at the time of survey completion, 270 were working and 77 were not. People with physical disabilities who reported social support and encouragement at work were more likely to be working than respondents who did not. Negative attitudes of supervisors and colleagues, inaccessible work environments, and inflexible work schedules were barriers to employment. Important reasons for working included financial needs, a sense of purpose, and self-worth. CONCLUSIONS: Results provide insights into the importance of social supports in the work environment. Novel approaches are needed to develop supportive relationships with supervisors and coworkers.