non-MS Group Research Articles

Etiology and Characteristics of Pseudotumoral Lesions and Tumefactive Demyelination in Multiple Sclerosis

IntroductionCerebral pseudotumoral lesions (CPTL) (>2cm) on magnetic resonance imaging (MRI) may pose a clinical challenge. A majority will occur in the context of multiple sclerosis (MS) – also referred to as tumefactive demyelinating lesions (TDL). The aim of this study was to define and analyze clinical, MRI, and paraclinical data for MS and non-MS patients. MethodsThis prospective study included adult patients with CPTL on brain MRI referred to the Neurology Clinic, Belgrade as a tertiary University Center (2019-2023) for clinical workup and treatment. Demographic, clinical, MRI, and paraclinical data were reviewed. ResultsThis study included 75 patients, of which 58.7% had MS. Fourteen patients had previously been diagnosed with MS, while 30 (68.2%) received the diagnosis of MS in the later course. The concordance of initial and final diagnoses was 52%. Relapsing disease (p<0.001) and brainstem presentation (p=0.039) were significantly more common in MS patients. Headache (p= 0.008) and lethal outcome (p=0.014) were significantly more common in the non-MS group. Lesions were ring-like more frequently in the MS group (p<0.001), while patients in the non-MS group frequently displayed infiltrative (p=0.001) and nonspecific lesions (p=0.002). The presence of headache and megacystic morphology was associated with the presence of pathology other than MS while the relapsing disease was in favor of MS. ConclusionMultiple sclerosis was the most common cause of CPTL. Headache, relapsing course of disease, and megacystic morphology may help discern MS from non-MS pathology. These findings should be challenged in future studies examining larger cohorts.

Dietary patterns and metabolic syndrome amongst adult residents: A cross-sectional study in a rapidly urbanized Southern Chinese city.

We aimed to investigate and summarize dietary patterns and explore the association between dietary patterns and metabolic syndrome (MS) and its components among adult residents in a rapidly urbanized city. We employed a multi-stage random sampling method to select 1000 adult residents who underwent a comprehensive survey, including questionnaires, physical examinations, and laboratory tests. The diagnosis of metabolic syndrome was made when the participant met 3 or more of the 5 criteria outlined in the "2017 Chinese Guidelines for the Prevention and Treatment of Type 2 diabetes." Factor analysis and a nonconditioned logistic regression model were used. Nine hundred seventy-five participants with a mean (SD) age of 41.08 (11.06) were included. The prevalence of metabolic syndrome was 19.4% (n = 189). Significant differences were observed between the MS and non-MS groups in terms of patient characteristics in terms of sex (P < .001), age (P < .001), education (P < .001), marital status (P = .025), smoking (P < .001), and alcohol consumption (P = .044). Three dietary patterns were summarized: traditional, coastal, and meat. The coastal pattern was associated with a significantly lower prevalence of MS (P < .001), elevated blood pressure (P < .001), and high triglyceride levels (P = .03). However, in the multivariate analysis, we found no significant associations between dietary patterns and MS or its components after adjusting the demographic characteristics and behaviors, even when the P-value was close to .05. In this study, we did not find an association between dietary patterns and MS and its components after adjusting covariates as much as possible in Pingshan, Shenzhen, a rapidly urbanized city, but underscore the potential health benefits of the coastal dietary pattern, which highlights the importance of conducting further research for a comprehensive understanding.

Long term outcome in non-multiple sclerosis paediatric acquired demyelinating syndromes

ObjectivesWe aimed to study the risks of relapse and long term disability in children with non-MS acquired demyelinating syndromes (ADS). MethodsIn this prospective, multi-centre study, from the 14 UK pediatric neurology centres, children (<16 years) experiencing a first episode of ADS were recruited from 2010 to 2014. Case report forms were collected prospectively. ResultsA total of 269 children were recruited and followed up for a median of 7.2 years. Median age at onset was 9y (IQR 9.5–14.5, 126 females). At last follow-up, 46 (18 %) had MS, 4 AQP4-Ab NMOSD and 206 (80 %) had other ADS, of which 27 (13 %) relapsed. Relapsing MOGAD was the diagnosis in 12/27, 6 were seronegative and 9 did not have antibodies tested. Frequency of relapse differed according to first presentation in non-MS ADS, being least likely in transverse myelitis (p = 0.025). In the non-MS group, MOG-Ab was predictive of relapse (HR = 8.42; p < 0.001) occurring 8 times as often decreasing over time. Long-term difficulties did not differ between children with monophasic vs relapsing diseases. ConclusionThe risk of relapse in non-MS ADS depends on initial diagnosis, and MOG-Ab positivity. Long-term difficulties are observed regardless of relapses and are determined by presenting phenotype.

Association of retinal microvascular curve tortuosity and multiple sclerosis: A cross-section analysis from the UK Biobank

BackgroundThere is growing evidence supporting that vascular abnormalities contribute to multiple sclerosis (MS), and retinal microvasculature functions as a visible window to observe vessels. We hypothesized that retinal vascular curve tortuosity is associated with MS, which this study aims to address. MethodsParticipants from the UK Biobank with complete clinical records and gradable fundus photos were included in the study. Arteriolar and venular curve tortuosity and vessel area density are quantified automatically using a deep learning system. Individuals with MS were matched to healthy controls using propensity score matching (PSM). Conditional logistic regression was used to investigate the association between retinal vascular characteristics and MS. We also used a receiver operating characteristic (ROC) curve to assess the diagnostic performance of MS. ResultsVenular curve tortuosity (VCT) was found to be significantly associated with MS. And patients with multiple sclerosis were probable to have lower VCT than the non-MS group (OR = 0.22 [95 % CI, 0.05 to 0.92], P < 0.05). ConclusionsOur study reveals a significant association between vessel curve tortuosity and MS. The lower curve tortuosity of the retinal venular network may indicate a higher risk of incident multiple sclerosis.

Diagnostic Utility of Free Kappa Light Chain Index in Egyptian Multiple Sclerosis Patients

Abstract Background Multiple sclerosis (MS) is a chronic autoimmune-mediated demyelinating disease of the central nervous system (CNS) that is usually associated with varying degrees of progressive disability. Free Kappa light chain (FKLC) has attracted growing attention as a significant diagnostic marker of MS. Aim of the Work The aim of this work was to study the diagnostic utility of free kappa light chain index in a sample of Egyptian MS patients versus IgG oligo clonal bands (OCBs) in CSF and serum in an attempt to throw light on a new simpler non subjective potential diagnostic marker in MS. Patients and Methods This was a case control study of MS patients carried at Ain Shams University Hospitals during the period from January 2021 till January 2022. Subjects included in this study were 30 patients with symptoms suggestive of MS yet undiagnosed and 20 controls, on the basis of their MRI findings, clinical presentation and according to the revised McDonald criteria 2017. Accordingly, patients were diagnosed as MS including 4 CIS patients, 18 RRMS patients and 3 PPMS patients and non-MS including 2 NMO patients, 1 ADEM patient, 1 APS and 1 SLE patient. They were 8 males and 22 female patients, their age ranged from 20 to 40 years old with mean 30.13 ± 6.85 SD. The control group included 5 males and 15 females; their ages ranged from 20 to 40 years with mean 30.13 ± 6.85 SD. Results We found a statistically significantly higher FKLC index and FKLC IF among MS patients in comparison to both control and non-MS group. it could be used for diagnosis of MS with a diagnostic sensitivity of 100 % and a diagnostic specificity of 100 %. Conclusion The significant association between FKLC index and MS led us to conclude FKLC index can be used as a promising diagnostic marker of MS.

In vitro phenotypic susceptibility of HIV-1 non-group M to CCR5 inhibitor (maraviroc): TROPI-CO study.

Unlike HIV-1 group M, the scarcity of studies on HIV-1 non-M groups (O, N, and P) presents challenges in understanding their susceptibility to antiretroviral treatments, particularly due to their natural resistance to non-nucleoside reverse transcriptase inhibitors. The TROPI-CO study logically complements our prior investigations into integrase inhibitors and anti-gp120 efficacy. The largest panel of 45 non-M strains existing so far yielded valuable results on maraviroc (MVC) susceptibility. The significant variations in MVC IC50 reveal a spectrum of susceptibilities, with most strains displaying R5 tropism. Notably, the absence of MVC-resistant strains suggests a potential therapeutic avenue. The study also employs a robust novel cell-based phenotropism assay and identifies distinct groups of susceptibilities based on inhibition curve slopes. Our findings emphasize the importance of determining tropism before initiating MVC and provide crucial insights for selecting effective therapeutic strategies in the delicate context of HIV-1 non-M infections.

INFLUENCE OF METABOLIC SYNDROME AND ITS COMPONENTS ON TELOMERE LENGTH

Objective: to assess the influence of different metabolic markers, metabolic syndrome (MS) and its components on telomere length Design and method: we examined 45 patients (44.4% men) age median was 26[21;39] years. All patients underwent waist circumference (WC), hip circumference (HC), neck circumference (NC) measurement, LAP (Lipid Accumulation Product), VAI (Visceral Adiposity Index), BFP (Body Fat Percentage), BAI (Body Adiposity Index) indices evaluation, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TC), blood glucose testing. Telomere length was assessed by PCR and fluorimetry. Statistical processing of the data was done with STATISTICA 10 software. Results: the patients were divided into two groups: with MS (n=10; 22.2%) and without MS (n=35; 77.8%). Groups had no difference by gender, age and smoking status (p&gt;0.05). MS group had elevated levels of BMI, WC, HC, NC and percentage of obesity in comparison with non-MS group (p&lt;0.05). Patients with MS more frequently suffered from hypertension (50%), dyslipidemia (90%), hyperglycemia (20%) and had higher systolic blood pressure (SBP), diastolic blood pressure (DBP) than non-MS group (p&lt;0.05). In MS group LAP (138.7[90.6;156]), BFP (33.3[28.7;43.9]) and BAI (33.6[29.7;38.5]) indices were significantly higher than in control group (LAP (16.17[9.7;38.2]), BFP (25.8[17.6;29.2]) and BAI (24.8[21.5;27.4])) (p&lt;0.001). We revealed correlation relationships of telomere length with WC (r=-0.3; p&lt;0.05), HC (r=-0.35; p&lt;0.05), NC (r=-0.53; p&lt;0.05); TC (r=-0.64; p&lt;0.05), LDL (r=-0.52; p&lt;0.05), HDL (r=0.59; p&lt;0.05), TG (r=-0.46; p&lt;0.05), blood glucose (r=-0.33; p&lt;0.05), integral metabolic indices: LAP(r=-0.4; p&lt;0.05), BAI(r=-0.32; p&lt;0.05) and presence of MS (r=-0.36; p&lt;0.05), dyslipidemia (r=-0.76; p&lt;0.05) and DBP level (r=-0.31; p&lt;0.05). We performed multivariate linear regression analysis to assess influence of different MS components that demonstrated correlation with telomere length: TC (b = -0.4, Std. Err of b = -0.1, p= 0.003), blood glucose (b = -0.26, Std. Err of b = 0.12, p= 0.004) and HDL (b = 0.69, Std. Err of b = 0.26, p= 0.001). Conclusions: telomere length is significantly shorter in patients with MS than in patients of comparable age without MS. Decrease in HDL and increase in TC and blood glucose significantly influences on telomere length.

Short-Term Changes in Weight, Body Composition, and Metabolic Biomarkers After Laparoscopic Sleeve Gastrectomy in Patients with Obesity: A Comparative Prospective Study.

To investigate the changes in weight, body composition, and metabolic biomarkers in patients with obesity after laparoscopic sleeve gastrectomy (LSG) and compare those changes between patients with and without metabolic syndrome (MS). This retrospective longitudinal study included 76 patients who underwent LSG, among whom 32 had complete 1-year postoperative body composition and metabolic biomarkers. Body composition was measured by quantitative CT. Weight changes were compared between the MS and non-MS groups at 1-, 3-, 6-, and 12-month post-LSG in all patients; changes in body compositions and metabolic biomarkers from one day pre-LSG to 12-month post-LSG were also compared in those 32 patients. MS occurred in 46% (35/76) of all patients and 44% (14/32) of patients with complete follow-up data. Excess weight loss was lower in the MS group than that in the non-MS group at 1-, 3-, 6-, and 12-month post-LSG; the 12-month difference was significant (MS vs. non-MS: 0.91 ± 0.22 vs. 1.07 ± 0.42, P = 0.04). The greatest rate of visceral fat area (VFA) change occurred 12-month post-LSG in both the non-MS [0.62(0.55,0.7)] and MS [0.6(0.51,0.63)] groups. The most significant reduction in ectopic fat occurred in liver fat (LF) [non-MS, 0.45(0.22,0.58); MS, 0.39(0.23,0.58)]. LGS significantly improves weight, body composition, and metabolic biomarkers in populations with obesity, regardless of whether they have MS. Among the body composition, VFA and LF were the most significantly improved body composition measurements.

Electroneuromyography comparison between pre-elderly adult females with and without MS; the potential role of a mind-body therapy in improving neurophysiological profile of MS during pandemic

IntroductionImaginary exercises seem to be useful therapeutic approaches to modulate neuromuscular functions due to two main reasons: first, this training would not greatly increase body temperature, and secondly, it can positively affect brain-muscle pathways—which are both primary factors should be considered in rehabilitation programs for patients with multiple sclerosis (MS). Method32 pre-elderly adult females with relapsing-remitting MS (n = 16 - age M (SD): 56.75 (5.07)) and without MS (n = 16 - age M (SD): 56.56 (4.35)) voluntarily recruited. First, they were assigned into two groups: MS patients and healthy controls, to investigate baseline between-group comparison. Then, MS patients were randomly divided into two groups of eight each, designated as experimental and control groups. Recording the nerve conduction velocity (NCV) of tibial nerve and integrated electromyographic muscle activation (IEMG) of gastrocnemius muscle was conducted twice, before and after a six-week mind-body exercise therapy to evaluate its effectiveness on improving neuromuscular function. ResultsThe results showed significant difference in both tibial NCV (P < 0.001) and IEMG (P = 0.001) variables between non-MS group and MS group. Furthermore, there was a significant main effect of intervention (P = 0.05) and time (P < 0.001) on IEMG in the MS group, while there was no significant effect of intervention (P = 0.18) and time (P = 0.23) on NCV (p = 0.89). ConclusionNeuromuscular dysfunction were apparent in MS patients, and a mind-body therapy of imagery isometric training was found to be useful on improving the neurological deficit in women with MS. Trial registration numberUMIN000046935.

Prognostic value of metabolic syndrome in patients with heart failure and malnutrition

BackgroundMalnutrition is severely associated with worst prognosis of patients with heart failure (HF). Malnourished patients with the metabolic syndrome (MS) can result in a double burden of malnutrition. We aimed to investigate the impact of the MS on clinical outcomes in malnourished HF patients.MethodsWe examined 529 HF patients at risk of malnutrition with a mean age of (66 ± 10) years and 78% (415) were male. Nutritional status defined primarily by the prognostic nutritional index (PNI), with PNI < 40 being defined as malnutrition. The follow-up endpoint was cardiovascular death or all-cause death.ResultsDuring the 36-month follow-up, survival rates for cardiovascular and all-cause death were significantly lower in the MS group than in the non-MS group (log-rank P < 0.01). Multivariate Cox proportional hazards regression models showed that MS was independently associated with cardiovascular death (HR:1.759, 95%CI:1.351–2.291, p < 0.001) and all-cause death (HR:1.326, 95%CI:1.041–1.689, p = 0.022) in malnourished patients with HF. MS significantly increased the predictive value of cardiovascular death (AUC:0.669, 95%CI:0.623–0.715, p < 0.001) and all-cause death (AUC:0.636, 95%CI:0.585–0.687, p < 0.001) on the basis of established risk factors. The predictive effect of MS on cardiovascular death was independent of sex, age, functional class and left ventricular ejection fraction.ConclusionsIn malnourished patients with HF, MS is an independent risk factor for cardiovascular and all-cause mortality. MS significantly enhance the predictive value for clinical events in patients.

RELATIONSHIP OF PUPIL SIZE WITH REFRACTIVE ERROR IN METABOLIC SYNDROME AND NON METABOLIC SYNDROME: AMONG RURAL POPULATION IN MALANG

Introduction &amp; ObjectivesNearly one in four Indonesians has metabolic syndrome (MS). One of the microvascular side effectsin Metabolic Syndrome affects the eyes. The aim of this study to evaluate the relationship of pupilsize with refractive error in MS and non-MS groups among rural populations in Malang.&#x0D; MethodsA descriptive study was carried out in 2019 in three villages in Malang districts. A detailed ocularexamination was conducted on all participants who attended a research facility. We definedpupillary abnormalities and clinically important refractive errors. Blood samples were obtained todetermine the parameter of the metabolic syndrome by IDF 2006 criteria. Subjects were classifiedinto 2 groups: Metabolic Syndrome status and non metabolic syndrome.&#x0D; Results953 participants completed the examination which consists of 944 right eyes and 942 left eyes. Theresults of visual acuity on the right eye: emmetropia in 434 eyes, myopia with 252 eyes, hyperopiawith 141 eyes, and astigmatism with 17 eyes where if it is not significant if associated with pupillaryabnormalities (P-value 0.893). On the left eye, the emmetropia results were 444 eyes, while formyopia were 244 eyes, hyperopia as many as 138, and astigmatism in 116 eyes and if associatedwith pupillary abnormalities, the result also not significant (P-value 0.864). The result of pupil sizewith metabolic syndrome 499 eye and non syndrome metabolic 454 eye are not significant (p-value0.649).&#x0D; ConclusionRefractive error didn’t relate pupil size in metabolic syndrome and non metabolic syndrome.

The Mini Nutritional Assessment combined with body fat for detecting the risk of sarcopenia and sarcopenic obesity in metabolic syndrome.

Malnutrition is a key factor in metabolic syndrome (MS) and sarcopenia, assessing the nutritional status of these patients is a pressing issue. The purpose of this study was to clarify sarcopenia and sarcopenic obesity in patients with MS based on nutritional status. This was a case-control study between MS/non-MS. Body composition was measured by dual-energy X-ray absorptiometry. Muscle function was assessed by handgrip strength, five times sit-to-stand test, gait speed test and short physical performance battery (SPPB). The Mini Nutritional Assessment (MNA) was performed to assess the nutritional status in the participants in this study. Overall, a total of 56 % and 13 % of participants suffered from possible sarcopenia and sarcopenia, respectively. There was a higher rate of possible sarcopenic obesity in the MS group than in the non-MS group (48·9 % v. 24·7 %, P < 0·01), and all the sarcopenia participants in the MS group had sarcopenic obesity. MNA score was significantly associated with sarcopenia status (P < 0·01). The MNA combined with body fat score showed better acceptable discrimination for detecting sarcopenic obesity and sarcopenia in MS (AUC = 0·70, 95 % CI 0·53, 0·86). In summary, there was a higher prevalence of possible sarcopenic obesity in MS, and all the MS patients with sarcopenia had sarcopenic obesity in the present study. We suggest that the MNA should be combined with body fat percentage to assess the nutritional status of MS participants, and it also serves as a good indicator for sarcopenia and sarcopenic obesity in MS.

Metabolic syndrome facilitates histopathological changes and the risk of postoperative recurrence in chronic rhinosinusitis with nasal polyps

BackgroundThe relationship between metabolic syndrome (MS) and chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear. This study aimed to examine the effects of MS on histopathological features and postoperative recurrence in patients with CRSwNP. MethodsWe recruited 529 patients with CRSwNP who underwent functional endoscopic sinus surgery. They were divided into MS and non-MS groups and followed up for 2 years to evaluate postoperative recurrence. Clinical characteristics, histopathological features, the immunoactivity of signature cytokines, and the risk of postoperative recurrence were compared between the two groups. ResultsIn total, 490 patients with CRSwNP were included in the study, 145 of whom experienced postoperative recurrence. The recurrence rate, tissue eosinophil count and percentage, and expression levels of IL-5 and IL-17A were significantly higher in the MS group compared to the non-MS group. Furthermore, within the MS group, patients who experienced recurrence exhibited higher tissue eosinophil counts and IL-5 and IL-17A levels than those in the non-MS group. Notably, the eosinophil count and IL-5 and IL-17A levels were higher in tissues collected during revision surgery than in those collected during primary surgery, particularly in patients with MS. Binary logistic regression analysis and Kaplan-Meier survival curves consistently indicated that MS independently increased the risk of postoperative recurrence in patients with CRSwNP. Furthermore, the risk increased with the number of MS components presented. ConclusionMS promoted tissue eosinophil infiltration, and IL-5 and IL-17A expression, and increased the risk of postoperative recurrence in patients with CRSwNP. MS was identified as an independent risk factor for postoperative recurrence, and the risk increased with an increase in the number of MS components.

Screening value and correlation of body measurement indices for metabolic syndrome in the population undergoing physical examinations in Chengdu during 2018-2020

To investigate the screening value and correlation of body measurement indicators for metabolic syndrome(MS) and to provide evidence for MS screening. Through a cross-sectional research approach, data from individuals aged 18 and above who participated in health examinations at the North Health Management Center of Sichuan Provincial People&apos;s Hospital from 2018 to 2020 were reviewed. Data including height, weight, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking history, and alcohol consumption history were collected. Subsequently, a body shape index(ABSI), body roundness index(BRI), body adiposity index(BAI), abdominal volume index(AVI), relative fat mass index(RFM), and body mass index(BMI) were computed. The individuals were then divided into MS and non-MS groups. The value of body measurement indices in screening for MS in the population aged 18 and above was assessed using ROC curves. Regression analysis was employed to explore the correlation between body measurement indices and MS. A total of 73 411 valid health examination data were obtained, including 44 426 males and 28 985 females. The MS group comprised 9181 males(21%) and 1668 females(6%). In the comparison between the MS and non-MS groups, there were statistically significant differences in ABSI((0.08±0.00) vs. (0.08±0.00)), BRI((4.95±0.67) vs. (4.17±0.68)), BAI((28.08±3.52) vs. (26.39±3.39)), AVI((17.51±2.77) vs. (12.85±2.91)), BMI((27.15±2.99) vs. (23.00±3.04)) and RFM((29.77±5.35) vs. (27.13±6.39))(P&lt;0.05). Univariate Logistic regression analysis showed that ABSI(OR=2.303, 95%CI 1.190-4.457), BRI(OR=4.596, 95%CI 4.446-4.752), BAI(OR=1.144, 95%CI 1.137-1.151), AVI(OR=1.668, 95%CI 1.652-1.684), RFM(OR=1.067, 95%CI 1.064-1.071) and BMI(OR=1.516, 95%CI 1.503-1.528) were associated with MS(P&lt;0.05). Multifactorial Logistic regression analysis corrected for sex, age, smoking and alcohol consumption showed that ABSI(OR=1.767, 95% CI 4.237-7.371), BRI(OR=5.441, 95% CI 5.228-5.663), BAI(OR=1.269, 95% CI 1.260-1.279), AVI(OR=1.648, 95% CI 1.631-1.665), RFM(OR=1.504, 95% CI 1.491-1.517) and BMI(OR=1.508, 95% CI 1.495-1.522) were associated with MS(P&lt;0.05). The ROC curve analysis showed that in adults, the AVI had the highest screening value for MS in males(AUC=0.855, optimal cutoff value=16.18), followed by RFM(AUC=0.844, optimal cutoff value=25.71), BMI(AUC=0.811, optimal cutoff value=25.21), BRI(AUC=0.793, optimal cutoff value=4.39), BAI(AUC=0.709, optimal cutoff value=25.88), and ABSI(AUC=0.671, optimal cutoff value=0.08). In adult females, the RFM had the highest screening value for MS(AUC=0.918, optimal cutoff value=37.01), followed by AVI(AUC=0.911, optimal cutoff value=13.43), BRI(AUC=0.901, optimal cutoff value=4.71), BMI(AUC=0.860, optimal cutoff value=23.94), ABSI(AUC=0.804, optimal cutoff value=0.08), and BAI(AUC=0.797, optimal cutoff value=29.92). ABSI, BRI, BAI, AVI, BMI and RFM are all capable of screening for MS. Among males, AVI has the highest screening value for MS, followed by RFM, BMI, BRI, BAI and ABSI. Among females, RFM has the highest screening value for MS, followed by AVI, BRI, BMI, ABSI and BAI. ABSI, BRI, BAI, AVI, RFM and BMI are positively correlated with MS.

Sleep, physical activity, and psychological outcomes in children and adolescents with pediatric onset multiple sclerosis

BackgroundSleep, physical activity (PA) and sedentary behavior (SED) have bidirectional associations with mental health in children. The relationships among sleep, PA, SED, with depressive and fatigue symptoms have not been investigated in Pediatric Onset Multiple Sclerosis (POMS) but are needed to inform sleep and PA behavior change interventions. Objectives(1) To describe sleep quality including: sleep efficiency, latency, total sleep time, number of awakenings, time in bed, and wake after sleep onset using actigraphy in children and adolescents ages 11 to 18 diagnosed with POMS, and to compare these sleep metrics to those of an age- and sex-matched non-MS group (2) To examine the relationship between time spent in sedentary, light (LIPA), moderate and vigorous PA (MVPA), sleep quality, with depression, fatigue, and quality of life in children and adolescents with POMS and an age and sex matched non-MS group. MethodsA cross-sectional study recruited children and adolescents with POMS ages 11 to 18 years followed at a tertiary pediatric hospital (Toronto, Canada) and an age and sex matched non-MS group from the general population. Participants were consented prior to initiation of study procedures. Participants wore an Actiwatch monitor and GT3X accelerometer and completed standardized questionnaires validated to capture data on sleep disturbances, depression, fatigue, and quality of life. Objective sleep data were collected using an Actiwatch including sleep efficiency, total sleep time, number of awakenings, wake after sleep onset (WASO), and sleep latency. A GT3X accelerometer was used to collect PA data including time spent in SED, light (LPA), and moderate to vigorous (MVPA) PA. Correlational analyses and tests of difference were used to compare the groups. Results25 POMS (21F; 16.6 years ±1.1 yrs., median Expanded Disability Status Scale (EDSS) =1.5, IQR=1) and 25 Non-MS (22 F; 16±1.3 yrs.) took part. POMS had higher BMI (T= -5.1, P<0.001) compared to Non-MS. No differences in sleep efficiency (MS mean = 87%, vs. 88%) sleep time (MS Mean = 7.3 hrs. vs. 7.4 hrs.,), WASO (MS mean=37 mins. vs. 36 mins), latency (MS mean=15 mins vs. 11 mins), SED (MS mean =763 mins. vs. 730 mins) or PA (MS, mean LPA = 68 mins. vs 60 mins; MS mean MVPA = 12.7 mins. vs. 12.4 mins). Within POMS, higher sleep efficiency was associated with more SED (SR= 0.4, p = 0.05), while higher sleep efficiency was associated with less SED in Non-MS (SR = -0.7, p< 0.0). In children with POMS, less sleep time, shorter sleep onset latency and more WASO was associated with more SED (SR range = -0.45 to -0.58, P< 0.01). Higher sleep efficiency was associated with less fatigue. Less WASO was associated with lower depression, lower fatigue (SR = 0.67, p<0.01) and better quality of life (SR= -0.6, p<0.01). Greater LPA was associated with lower sleep onset latency (-0.45, p<0.05). ConclusionsChildren with POMS did not differ in Actiwatch monitored sleep quality metrics. However, within the POMS group sleep quality was associated with better fatigue, depression and QOL. Further, total sleep time, WASO and latency associated with time spent SED and LPA, which independently associate with mental health outcome. Longitudinal work should determine the temporal associations between WASO, sleep latency, sleep time, PA, and mental health outcomes and whether reallocation of specific sleep or PA behaviors (time to sleep, total sleep time, sedentary to MVPA) result in improved depression fatigue, or quality of life in children and adolescents with POMS.

Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting.

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.

The clinical value of carotid plaque score in patients with metabolic syndrome and cardiovascular diseases

ObjectiveTo investigate the relationship between carotid plaque load score (CPS) and metabolic syndrome (MS) and cardiovascular diseases (CVD), in order to provide theoretical basis for the precaution and control of MS and CVD. MethodsA total of 1962 patients were incorporated into the study and divided into MS group and non-MS group, CVD group and non-CVD group. CPS and CIMT were obtained by carotid artery ultrasound, and the data of each group were statistically analyzed. ResultsAge, BMI, basal metabolic rate, body fat rate, gender, and the incidence of central obesity, hypertension, diabetes and dyslipidemia are statistical different between MS group and non-MS group (P < 0.05). CIMT between CVD group and non-CVD group are statistical different (1.040 ± 0.239 VS 0.972 ± 0.297, P < 0.001).CPS was statistically significant between MS group and non-MS group(2.254 ± 2.728 VS 1.548 ± 2.219, P = 0.003) and between CVD group and non-CVD group (2.322 ± 2.760 VS 1.688 ± 2.347, P = 0.004). ConclusionPatients in MS group and CVD group have higher carotid plaque burden than those in non-MS group and non-CVD group. The higher the CPS was, the higher the incidence of MS and CVD was, and the distribution of CPS in MS and CVD population was consistent.

Absence of Oligoclonal Bands in Multiple Sclerosis: A Call for Differential Diagnosis.

Immunoglobulin gamma (IgG) oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) are absent in a small group of multiple sclerosis (MS) patients. According to previous research, OCB-negative MS patients differ genetically but not clinically from OCB-positive MS patients. However, whether OCB-negative MS is a unique immunological and clinical entity remains unclear. The absence of OCB poses a significant challenge in diagnosing MS. (1) Objective: The objective of this study was twofold: (1) to determine the prevalence of OCB-negative MS patients in the Uppsala region, and (2) to assess the frequency of misdiagnosis in this patient group. (2) Methods: We conducted a retrospective study using data from the Swedish MS registry (SMSreg) covering 83% of prevalent MS cases up to 20 June 2020 to identify all MS patients in the Uppsala region. Subsequently, we collected relevant information from the medical records of all OCB-negative MS cases, including age of onset, gender, presenting symptoms, MRI features, phenotype, Expanded Disability Status Scale (EDSS) scores, and disease-modifying therapies (DMTs). (3) Results: Out of 759 MS patients identified, 69 had an OCB-negative MS diagnosis. Upon re-evaluation, 46 patients had a typical history and MRI findings of MS, while 23 had unusual clinical and/or radiologic features. An alternative diagnosis was established for the latter group, confirming the incorrectness of the initial MS diagnosis. The average EDSS score was 2.0 points higher in the MS group than in the non-MS group (p = 0.001). The overall misdiagnosis rate in the cohort was 33%, with 22% of misdiagnosed patients having received DMTs. (4) Conclusions: Our results confirm that the absence of OCB in the CSF should raise suspicion of possible misdiagnosis in MS patients and prompt a diagnostic reassessment.

Analysis of the association between glomerular filtration rate, proteinuria and metabolic syndrome in chronic kidney patients based on longitudinal data.

Chronic kidney disease (CKD) is a group of chronic diseases caused by kidney damage from multiple causes. Metabolic syndrome (MS) manifests as dysfunction of endothelial cells and chronic functional inflammatory states, and may be involved in pathological changes related to renal impairment. Based on longitudinal data analysis of the association between estimated glomerular filtration rate (eGFR), proteinuria and MS in patients with CKD, this study aims to provide new ideas for the pathophysiological mechanism of CKD and a theoretical basis for the early prevention and effective intervention of MS-related kidney damage. A total of 126 patients with CKD were divided into non-MS group and MS group. According to the eGFR level, 126 patients with CKD were divided into G1 group, G2 group, G3a group, G3b group, G4 group and G5 group. Serum markers such as eGFR, urine protein, and triglycerides (TG) were collected. The correlation between eGFR, urine protein and MS-related indexes was analysed, and therisk factors affecting CKD complicated by MS were analysed. In patients with CKD, the levels of urine protein, abdominal circumference, TG, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FPG) were increased with the course of the disease, but the levels of eGFR and high density lipoprotein (HDL-C) were decreased (p<0.05). Abdominal circumference, TG, SBP, DBP, FP were significantly negatively correlated with eGFR, but HDL-C was positively correlated with eGFR (p<0.05). Diabetes, hyperlipidemia, UA, and SBP were independent risk factors affecting CKD complicated MS, and eGFR were independent protective factors (p<0.05). The combination of diabetes, hyperlipidemia, UA, SBP, and eGFR exhibited higher prediction value for the CKD patients complicated by MS. There was a certain correlation between between MS components with eGFR and urinary protein in patients with CKD. The early intervention treatment of MS was helpful in delaying the development of CKD and reducing proteinuria.

Analysis of metabolic syndrome and cognitive functional analysis in schizophrenic patients based on psychological intervention

In this paper, we explore the characteristics of cognitive dysfunction in patients with schizophrenia complicated with metabolic syndrome (MS), and to explore the effects of psychological intervention on MS and cognitive function changes in patients with schizophrenia, and to provide theoretical basis for early intervention of MS. 159 patients with schizophrenia were retrospectively analyzed and divided into 2 groups according to whether they were accompanied by MS. (41 cases), the second group was not MS. (118 cases). Results shows PANSS total score as (53.72 ± 5.03), positive symptom score (12.39 ± 2.68), negative symptom score (14.94 ± 3.27), general pathological score (26.27 ± 3.63). In MS group,Verbal fluency (16.69 ± 1.27), symbol coding (30.46 ± 2.55), number sequence (15.21 ± 1.84), spatial span (10.14 ± 0.68), continuous operation (16.72 ± 1.34), verbal memory (16.72 ± 1.34), and visual memory (14.24 ± 1.26), all indicators were significantly lower than those of non-MS group. The cognitive impairment of schizophrenia patients with multiple sclerosis is more severe than that of schizophrenia patients without multiple sclerosis. Increasing psychological intervention can effectively improve the therapeutic effect and cognitive function of schizophrenia patients. Early identification and intervention of MS in the clinical treatment of schizophrenia is particularly important.