COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

Cerebral Arterial Thrombosis in Ulcerative Colitis

Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature

The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study

Background: Many studies investigated the association between air pollution and Covid-19 severity but the only study focusing on patients with Multiple Sclerosis (MS) exclusively evaluated exposure to PM2.5. We aim to study, in a sample of MS patients, the impact of long-term exposure to PM2.5, PM10 and NO2 on Covid-19 severity, described as occurrence of pneumonia. Methods: A 1:2 ratio case-control study was designed, differentiating cases and controls based on Covid-19 pneumonia. Associations between pollutants and outcome were studied using logistic regression. Weighted quantile sum (WQS) logistic regression was used to identify the individual contribution of each pollutant within the mixture; Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression was performed to confirm the variable selection from WQS. All the analyses were adjusted for confounders selected a priori. Results: Of the 615 eligible patients, 491 patients provided detailed place of exposure and were included in the principal analysis. Higher concentrations of air pollutants were associated with increased odds of developing Covid-19 pneumonia (PM2.5: 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96); PM10: 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68); NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Pollutants were highly correlated with each other; WQS index was associated to an increased risk of pneumonia (β=0.44; p-value=0.004) and the main contributors to this association were NO2 (41%) and PM2.5 (34%). Consistently, Lasso method selected PM2.5 and NO2. Conclusions: Higher long-term exposure to PM2.5, PM10 and NO2 increased the odds of Covid-19 pneumonia among MS patients and the most dangerous pollutants were NO2 and PM2.5

The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study

Background: Many studies investigated the association between air pollution and Covid-19 severity but the only study focusing on patients with Multiple Sclerosis (MS) exclusively evaluated exposure to PM2.5. We aim to study, in a sample of MS patients, the impact of long-term exposure to PM2.5, PM10 and NO2 on Covid-19 severity, described as occurrence of pneumonia.Methods: A 1:2 ratio case-control study was designed, differentiating cases and controls based on Covid-19 pneumonia. Associations between pollutants and outcome were studied using logistic regression. Weighted quantile sum (WQS) logistic regression was used to identify the individual contribution of each pollutant within the mixture; Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression was performed to confirm the variable selection from WQS. All the analyses were adjusted for confounders selected a priori.Results: Of the 615 eligible patients, 491 patients provided detailed place of exposure and were included in the principal analysis. Higher concentrations of air pollutants were associated with increased odds of developing Covid-19 pneumonia (PM2.5: 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96); PM10: 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68); NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Pollutants were highly correlated with each other; WQS index was associated to an increased risk of pneumonia (beta=0.44; p-value=0.004) and the main contributors to this association were NO2 (41%) and PM2.5 (34%). Consistently, Lasso method selected PM2.5 and NO2.Conclusions: Higher long-term exposure to PM2.5, PM10 and NO2 increased the odds of Covid-19 pneumonia among MS patients and the most dangerous pollutants were NO2 and PM2.5

Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy

OBJECTIVES: To determine the prevalence of different comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and their impact on outcome, treatment choice and response.METHODS: Using a structured questionnaire, we collected information on comorbidities from 393 patients with CIDP fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society criteria included in the Italian CIDP database.RESULTS: One or more comorbidities were reported by 294 patients (75%) and potentially influenced treatment choice in 192 (49%) leading to a less frequent use of corticosteroids. Response to treatment did not differ, however, from that in patients without comorbidities. Diabetes (14%), monoclonal gammopathy of undetermined significance (MGUS) (12%) and other immune disorders (16%) were significantly more frequent in patients with CIDP than expected in the general European population. Patients with diabetes had higher disability scores, worse quality of life and a less frequent treatment response compared with patients without diabetes. Patients with IgG-IgA or IgM MGUS had an older age at CIDP onset while patients with other immune disorders had a younger age at onset and were more frequently females. IgM MGUS was more frequent in patients with motor CIDP than in patients with typical CIDP.CONCLUSIONS: Comorbidities are frequent in patients with CIDP and in almost 50% of them have an impact on treatment choice. Diabetes, MGUS and other immune diseases are more frequent in patients with CIDP than in the general population. Only diabetes seems, however, to have an impact on disease severity and treatment response possibly reflecting in some patients a coexisting diabetic neuropathy

Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults

reserved85nomixedPoli, L.; Zedde, Marialuisa; Zini, Andrea; Del Sette, Massimo; Lodigiani, Corrado; Spalloni, Alessandra; Di Lisi, Filomena; Toriello, Antonella; Piras, Valeria; Stilo, Cesare; Tomelleri, Giampaolo; Tancredi, Lucia; Paciaroni, Maurizio; Silvestrelli, Giorgio; Adami, Alessandro; Costa, P.; Morotti, A.; De Giuli, V.; Caria, F.; Gamba, Massimo; Malferrari, Giovanni; Simone, Anna Maria; Musolino, Rossella; Giorli, Elisa; Banfi, Elena; Marcheselli, Simona; Rasura, Maurizia; Pugliese, Nicola; Melis, Maurizio; Bovi, Paolo; Padovani, A.; Burlina, A.; Pezzini, A; Del Zotto, Elisabetta; Giossi, Alessia; Sessa, Maria; Gilberti, Nicola; Magoni, Mauro; Ferrazzi, Paola; Librè, Luca; Rota, Lidia Luciana; Patella, Rosalba; Calabrò, Rocco Salvatore; Bramanti, Placido; La Spina, Paolo; Finocchi, Cinzia; Balestrino, Maurizio; Bruno, Chiara; Massucco, Davide; Gandolfo, Carlo; Traverso, Elisabetta; Delodovici, Maria Luisa; Verrengia, Elena Pinuccia; Carimati, Federico; Bono, Giorgio; Dell'Acqua, Maria Luisa; Bigliardi, Guido; Vandelli, Laura; Nichelli, Paolo Frigio; Carletti, Monica; Cerrato, Paolo; Iacoviello, Licia; Di Castelnuovo, Augusto; de Gaetano, Giovanni; Grassi, Mario; Locatelli, Giampiero; Caso, Valeria; D'Amore, Cataldo; Agnelli, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Arnaboldi, Marco; Giacalone, Giacomo; Zanoli, Elisa; Cavallini, Anna; Persico, Alessandra; Micieli, Giuseppe; Chiti, Alberto; Orlandi, Giovanni; Marchi, Piernicola; Lanari, Alessia; Ciccone, Alfonso; Cucurachi, Laura; Bonifati, Marco Domenico; Marcello, NorinaPoli, L.; Zedde, Marialuisa; Zini, Andrea; Del Sette, Massimo; Lodigiani, Corrado; Spalloni, Alessandra; Di Lisi, Filomena; Toriello, Antonella; Piras, Valeria; Stilo, Cesare; Tomelleri, Giampaolo; Tancredi, Lucia; Paciaroni, Maurizio; Silvestrelli, Giorgio; Adami, Alessandro; Costa, P.; Morotti, A.; De Giuli, V.; Caria, F.; Gamba, Massimo; Malferrari, Giovanni; Simone, Anna Maria; Musolino, Rossella; Giorli, Elisa; Banfi, Elena; Marcheselli, Simona; Rasura, Maurizia; Pugliese, Nicola; Melis, Maurizio; Bovi, Paolo; Padovani, A.; Burlina, A.; Pezzini, A; Del Zotto, Elisabetta; Giossi, Alessia; Sessa, Maria; Gilberti, Nicola; Magoni, Mauro; Ferrazzi, Paola; Librè, Luca; Rota, Lidia Luciana; Patella, Rosalba; Calabrò, Rocco Salvatore; Bramanti, Placido; La Spina, Paolo; Finocchi, Cinzia; Balestrino, Maurizio; Bruno, Chiara; Massucco, Davide; Gandolfo, Carlo; Traverso, Elisabetta; Delodovici, Maria Luisa; Verrengia, Elena Pinuccia; Carimati, Federico; Bono, Giorgio; Dell'Acqua, Maria Luisa; Bigliardi, Guido; Vandelli, Laura; Nichelli, Paolo Frigio; Carletti, Monica; Cerrato, Paolo; Iacoviello, Licia; Di Castelnuovo, Augusto; de Gaetano, Giovanni; Grassi, Mario; Locatelli, Giampiero; Caso, Valeria; D'Amore, Cataldo; Agnelli, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Arnaboldi, Marco; Giacalone, Giacomo; Zanoli, Elisa; Cavallini, Anna; Persico, Alessandra; Micieli, Giuseppe; Chiti, Alberto; Orlandi, Giovanni; Marchi, Piernicola; Lanari, Alessia; Ciccone, Alfonso; Cucurachi, Laura; Bonifati, Marco Domenico; Marcello, Norin