Assistive Technology in Multiple Sclerosis Patients-Two Points of View.

OBJECTIVE: The goal of our study was determining the current needs and acceptance of patients with multiple sclerosis (MS) in the field of assistive technologies using materials from the "RAMCIP" project (Robotic Assistant for Mild Cognitive Impairment Patient at Home). METHODS: There were two target groups: a population with MS, and medical personnel experienced in treating MS patients. This study was based on a two-step design method (workshops and surveys). Using the Likert scale, we identified the prioritization of users' needs. Additionally, demographic and disease-specific data and their correlations with each other and with the level of priority of functionality were analyzed. Moreover, the acceptance aspect of the assistant robot and the respondents' readiness to use it were determined. RESULTS: We gathered 307 completed surveys (176 from MS patients, 131 from medical personnel). Functional capabilities from the safety category were a high priority in most cases. The medium priority functions concerned daily activities that required physical assistance and home management. The differences in prioritization between the two groups were also found. Variables such as age, level of disability, cognitive impairment, depression, and fatigue were associated with the priority level of the functionalities. CONCLUSION: In summary, our findings might contribute to a better adaptation of robotic assistants to the needs and expectations of the MS population.

[Features of the incarcerated population followed on an outpatient basis in the Department of Psychiatry of the National University Hospital of Fann in Senegal]. / Caractéristiques de la population carcérale suivie en ambulatoire au service de psychiatrie du Centre Hospitalier National Universitaire de Fann, Sénégal.

INTRODUCTION: psychiatric disorders affect the highest number of incarcerated individuals. Indeed, detention conditions in Senegal have been criticized for several years by referring, in particular, to overcrowding. These conditions probably play a determining role in the occurrence of mental disorders in this population. This work describes the socio-demographic and clinical characteristics of these inmates followed on an outpatient basis in the Department of Psychiatry of the National University Hospital Center in Fann. METHOD: we conducted a retrospective and descriptive study. Data were collected from all the inmates presenting to the External Consultation Unit of the Department of Psychiatry of the National University Hospital Center of Fann between 1st January 2005 and 31st December 2010. RESULTS: our study population consisted of 62 inmates, 92% men and 8% women. The average age of patients was 32 years, nearly three-quarters (72.6%) of individuals were single. In the majority of cases they were in a precarious employment situation and 69.3% of them had not completed secondary education. Insomnia was the leading reason for consultation (29%) followed by auditory verbal hallucinations (22.6%). Physical aggression and/or threats to fellow inmates were observed in 17.7% of cases. The main diagnostic categories found were schizophrenic disorders (32.3%) and depressive disorders (27.4%). Between 2005 and 2010, the number of consultations increased threefold/year, from 7 to 19. CONCLUSION: this study showed that the incarcerated population, followed on an outpatient basis in the Department of Psychiatry, were young, mostly male and single, with low level of education and disadvantaged professional status. Similar cases have been reported in the international literature. Considering Senegal's socio-economic situation and health systems development, we note that, although the number of consultations has increased over the years, only inmates with severe mental disorders are followed in specialized health services. Given the number of incarcerated subjects, the biography background of these subjects, the conditions of detention and the absence of some diseases, a survey should be conducted in prisons in order to assess mental healthcare needs of incarcerated subjects and the specific issues that could affect them.

Correlation between vitamin D and alterations in MRI among patients with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a disease of unknown etiology. Diagnosis of MS is primarily based on detection of myelin damage by magnetic resonance imaging (MRI) and classification of demyelination according to the McDonald Criteria. Cholecalciferol (vitamin D3) has been shown to affect the onset and progression of MS via its immunomodulating properties. The role of vitamin D in MS pathogenesis and treatment deserves further investigation, as there is sufficient evidence to suggest a correlation between vitamin D blood level and brain MRI lesion load. STATE OF KNOWLEDGE: Elevated blood vitamin D concentration is linked with demyelination, as determined by T2-weighted and gadolinium-enhanced MRI. Blood vitamin D blood levels are affected by sun exposure, among other factors; however, there is no evident connection between abnormalities in myelination and seasonality. Vitamin D supplementation among MS patients has been associated with a lower probability of new lesions and loss of existing lesion volume, as observed seen in T1-weighted MRI scans (p=0.03). An increase in TGF-beta levels was noted among patients using vitamin D supplementation, which may suggest a mechanism by which cholecalciferol may improve MS prognosis. Patients with clinically isolated syndrome (CIS) exhibited an inverse correlation between vitamin D concentration and risk of new lesions as seen in T2-weighted MRI scans. Moreover, vitamin D intake among these patients lowered the risk of progression to clinically definite multiple sclerosis (CDMS). Daily intake of vitamin D during fingolimod treatment correlated strongly with lower numbers of new lesions. High dose vitamin D supplementation during interferon beta-1a treatment was linked to lower mean percentage of lesions compared with volume pre-treatment seen by T2-weighted MRI. RESULTS: Recent findings advocate for the monitoring of vitamin D blood levels in MS patients. Vitamin D supplementation should be considered in both MS patients and patients with CIS, where other signs of disease may be delayed. Moreover, vitamin D supplementation appears to lower the likelihood of new demyelination changes apparent in MRI examinations.

JC Virus Seroprevalence and JCVAb Index in Polish Multiple Sclerosis Patients Treated with Immunomodulating or Immunosuppressive Therapies.

The use of a highly-effective treatment for multiple sclerosis (MS) is associated with a severe risk of developing complications, such as progressive multifocal leukoencephalopathy (PML) caused by the John Cunningham virus (JCV). The aim of this study was to evaluate the correlation between anti-JCV Ab seroprevalence, anti-JCV AI, demographic and clinical factors as well as the type of therapy used in the Polish MS population. This is a multicentre, prospective and cross-sectional study involving 1405 MS patients. The seroprevalence of anti-JCV Ab and anti-JCV AI levels as well as AI categories were analysed with the use of a second-generation two-step ELISA test (STRATIFY JCV DxSelect). The overall prevalence of anti-JCV Ab was 65.8%. It was shown that seroprevalence increases with the patient's age. The seroprevalence was significantly associated with the treatment type, and the highest values (76%) were obtained from immunosuppressant-treated patients. Overall, 63.3% of seropositive patients had an antibody index (AI) level of >1.5. In the seropositive patient group, the mean AI level amounted to 2.09. Similarly to the seroprevalence, AI levels correlated with the patient's age; AI level for patients above 40 years old and from subsequent age quintiles plateaued, amounting to at least 1.55. Patients treated with immunosuppressants and immunomodulatory drugs obtained the highest (1.67) and lowest (1.35) AI levels, respectively. Of the immunosuppressants used, the highest mean AI levels were observed in mitoxantrone and cladribine groups, amounting to 1.75 and 1.69, respectively. In patients treated with immunomodulatory drugs, the lowest AI levels were observed in the dimethyl fumarate (DMF) group (1.11). The seroprevalence rate in the Polish MS population is one of the highest in Europe. The majority of seropositive patients had an anti-JCV Ab level qualifying them for a high-risk category. The highest mean AI levels are observed in patients receiving immunosuppressants, especially mitoxantrone and cladribine. Patients receiving immunomodulatory drugs have lower AI levels compared to treatment-naïve subjects, especially when treated with DMF. Further studies, especially longitudinal studies, are required to determine the impact of MS drugs on the seroprevalence of anti-JCV Ab and AI levels.

Internal carotid and vertebral artery dissections - a comparison of clinical, radiological and prognostic characteristics.

AIM OF STUDY: To examine whether baseline characteristics, potential risk factors, clinical symptoms, radiological presentation, and long-term outcomes differ between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). CLINICAL RATIONALE FOR STUDY: Cervical artery dissection (CeAD) is a major cause of cerebral ischaemia in young adults. Its clinical course is highly variable, resulting in challenges in making a proper diagnosis. METHODS: We performed a retrospective analysis of 31 patients (mean age 42.2 years) with CeAD (18 with ICAD, 13 with VAD) treated in our neurology department from 2008 to 2018. Appropriate imaging confirmed the diagnosis of CeAD. RESULTS: Patients with ICAD presented Horner syndrome significantly more often (44.4% vs 7.6%; p = 0.04). Patients with VAD more often had ischaemic events (ischaemic stroke, TIA or transient blindness) (84.6% vs 44.6%; p = 0.0032). Ischaemic stroke was more severe in patients with ICAD [(median NIHSS 6, interquartile range 4-12) vs VAD (median NIHSS 4, interquartile range 1.5-5.5), p = 0,03]. Occlusion occurred more often in patients with VAD (69.2% vs 22.2%; p = 0.013). Most patients had a favourable outcome (mRS 0-2). CONCLUSIONS AND CLINICAL IMPLICATIONS: In a series of patients with CeAD, we observed significant differences between VAD and ICAD in terms of clinical symptoms and radiological features.

JC Virus Seroprevalence and JCVAb Index in Polish Multiple Sclerosis Treatment-Naïve Patients.

Multiple sclerosis (MS) treatment with new agents is associated with the risk of the development of progressive multifocal leukoencephalopathy (PML). The seropositivity and a high index of anti-John Cunningham virus (JCV) antibodies are some of the risk factors for PML development. The aim of this study was to assess the seroprevalence of anti-JCVAb and JCVAb index (AI), as well as its correlations with demographic and clinical characteristics in treatment-naïve Polish MS patients. This is a multicenter, prospective, and cross-sectional study involving 665 MS patients. The overall prevalence of anti-JCVAb was 65.3%, while 63.1% of seropositive patients had an index level of >1.5. The seroprevalence was shown to increase along with the patient's age. Except for age, the prevalence of anti-JCVAb was not associated with demographic or clinical data. No correlations between the index levels and the demographic or clinical data were observed. In Poland, the seroprevalence of anti-JCVAb in treatment-naïve MS patients is one of the highest in Europe. The majority of seropositive patients had an anti-JCV antibody level denoting a high-risk category. This means that we need further studies to be conducted on the individualization of MS treatment in order to provide patients with an appropriate therapeutic safety level.

Application of Citicoline in Neurological Disorders: A Systematic Review.

Citicoline is a chemical compound involved in the synthesis of cell membranes. It also has other, not yet explained functions. Research on the use of citicoline is conducted in neurology, ophthalmology, and psychiatry. Citicoline is widely available as a dietary supplement. It is often used to enhance cognitive functions. In our article, accessible databases were searched for articles regarding citicoline use in neurological diseases. This article has a systemic review form. After rejecting non-eligible reports, 47 remaining articles were reviewed. The review found that citicoline has been proven to be a useful compound in preventing dementia progression. It also enhances cognitive functions among healthy individuals and improves prognosis after stroke. In an animal model of nerve damage and neuropathy, citicoline stimulated regeneration and lessened pain. Among patients who underwent brain trauma, citicoline has an unclear clinical effect. Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases. Its positive impact on learning and cognitive functions among the healthy population is also worth noting.

Smoking as a risk factor of onset and relapse of Multiple Sclerosis - a review.

INTRODUCTION AND OBJECTIVE: Multiple Sclerosis (MS) is a chronic demyelinating disease caused by damage to myelin in the brain and spinal cord. The cause of the disease is unclear, but it is probably correlated with dysregulation of the immunological system, as well as non-modifiable and modifiable risk factors. Unfortunately, there is no cure for MS. However, the course of the condition has been shown to be modifiable by treatment and various environmental factors. Cigarette smoking is one of the most common addictions around the world, and may be a key modifiable risk factor in MS. Here, we review data available on Pubmed and Scopus from the last 10 years. The following consecutive key words were used in our search: "multiple sclerosis", "smoking", "cigarette", "impact", "progression", and "tobacco". This search yielded 248 initial articles, 43 of which were included in our review. CURRENT STATE OF KNOWLEDGE: In our review, we have examined the impact of smoking on the immunology, course, treatment, relapse, recurrence, quality of life, and changes visualised on MRI among patients with MS in general. We have also explored these patterns in MS subtypes. In general, smoking is reported to have negative effects on MS, including a decrease in quality of life, as well as cognitive and mental state, and an increase in disability, as well as in the frequency of relapses and recurrences. CLINICAL IMPLICATIONS: Smoking has a widespread negative impact on patients with MS. Thus, it is important to educate patients and to help them to give up smoking to improve their health and quality of life. FUTURE DIRECTIONS: Further research about the impact of smoking and nicotine on MS and other neurodegenerative diseases is needed; in particular, research on e-cigarettes.

Factors associated with caesarean sections in Phnom Penh, Cambodia.

C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the over-usage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge.

[Stigmatization in psoriasis patients]. / Stygmatyzacja osób chorych na luszczyce.

Psoriasis is a chronic disease that affects the skin, nail plates and/or joints in which correlation between the onset of skin changes or more severe symptoms and the psychical condition of a patient is observed. At present it is assumed that stigmatization are events and situations in a person's life that are recognized by the society as those that stigmatize a given person and lead to their rejection and finally downgrade and ruin their social status. Opinions and behaviour patterns of the members of the society create the sigma feeling in a patient and affect his/her psyche. The aim of the present paper is the analysis of the latest data presented in the literature on the sigma feeling in psoriasis patients. In the study, the analysis of the types of stigmatization experienced by patients has been carried out. Life events influence the severity of psoriatic changes, but also psoriasis as a somatic disease affects the everyday life of a patient. Some reactions and behaviours of other people may create the feeling of rejection in social situations and the subjective feeling of being stigmatized. Then, as a result of the sigma feeling, the general health condition, functioning in the society and quality of life are affected.

Toward a comprehensive demography: rethinking the research agenda on change and response.

This essay drafts a new interdisciplinary agenda for research on population and development. Starting from Kingsley Davis's 1963 formulation of change and response, Davis's analytical categories are broadened to include inertia as well as change and to encompass both demographic and non-demographic responses at the micro, meso, and macro levels. On that basis the essay proposes what can be called a comprehensive demography, an approach drawing principally on micro-level methodologies like those employed in anthropological demography. Like anthropological demography, comprehensive demography questions the rationality of actors, emphasizes cultural infuences, and stops short of the postmodernist extremes of anthropology. But it also takes explicit account of higher-level social, economic, and political factors bearing on demographic behavior and outcomes. The conclusion raises some epistemological issues. Illustrative examples are offered throughout to demonstrate the feasibility of the approach, mainly referring to sub-Saharan africa and the Caribbean and often drawn from the authors' own fieldwork.