Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis

Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS).; Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset 18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and 50 years). Patients' demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan-Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS.; A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up.; Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment

Higher Disease and Pain Severity and Fatigue and Lower Balance Skills Are Associated with Higher Prevalence of Falling among Individuals with the Inflammatory Disease of Neuromyelitis Optica Spectrum Disorder (NMOSD)

Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory and autoimmune disorder that is associated with impaired vision, sensory loss, pain, fatigue, and spasms in the upper and lower limbs. Typically, persons with this disorder are also at higher risks of falls. Given this, the aims of the study were to compare the prevalence rates of falling for NMOSD cases and healthy controls (HCs), and to predict falling in the former group based on sociodemographic, psychological, and illness-related factors.; A total of 95 adults with NMOSD (Mean age = 34.89 years; 70.5% females) and 100 matched HCs took part in the study. All participants completed a series of questionnaires covering sociodemographic information and falling rates. The NMOSD individuals also reported on disease duration, pain, fatigue, and fear of falling, while their balance performance was objectively assessed.; Compared to healthy controls, the NMOSD cases had a 2.5-fold higher risk of falling. In this latter group, higher scores for pain, fatigue, fear of falling, and higher EDSS scores were distinguished between fallers and non-fallers, and objective balance skills had no predictive value.; Compared to healthy controls, NMOSD sufferers had a 2.5-fold higher risk of experiencing falls. In this group, disease impairments (EDSS, fatigue, pain) predicted falling. Specific interventions such as regular resistance training might reduce the risk of falling

Knowledge and attitude investigation of hospitalized patients in nephrology ward to Clinical Training

Background: To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it. Methods: A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire. Results: 146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physicians' behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028). Conclusion: The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant

Investigation of prevalence of Shigella sonnei in children with diarrhea admitted to two hospital Emam Khomeini and Milad in Tehran in 1391 with Antimicrobial susceptibility of isolates

Background and Aim: Shigella infection is one of the prevalent causes of diarrhea disease in most developing countries in children under 10 years old. Conventional microbiological examination to identify Shigella species are time-consuming and requires a lot of work and cost. The object of the present research was to isolate and identify of serotypes of Shigella, Shigella sonnei from patients with bacillary dysentery and to detect their one major virulence genes ipaH by using PCR. Materials and Methods: 3000 stool sample from children with diarrhea admitted in two famous hospitals in1391 in summer & autumn in Tehran were used in this study. The identification of isolated was done by serogrouping and biochemical test & the prevalence of ipaH gene determined by PCR method using specific pairs of primers. Antimicrobial susceptibility of isolates was performed according to the CLSI guidelines. Results: All Shigella spp isolates in this study harbored the ipaH gene. Out of 160 shigella isolates, 50 isolates determined as S. sonnei with serogrouping and biochemical test. 90% of isolates were resistant to Tetracycline, Cotrimoxazole, Streptomycin and Minocycline. Conclusions: We conclude that ipaH PCR procedure is more reliable, sensitive, easier, reproducible and specific which is significantly faster than current conventional detection assays such as serologic test. Althuogh in this study we report that among Shigella .spp cause diarrhea infection most of them are S .sonnei resistant antibiotic