Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines.

With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and time and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of MS therapies is critical to maximize patient benefit. The current guidelines review the current diagnostic criteria for MS and the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, progressive MS, pediatric cases and pregnant women. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.

The appropriateness of enoxaparin use in Lebanese hospitals: a quality evaluation study.

BACKGROUND: Although, guidelines for the appropriate use of enoxaparin are published, yet the extent of their implementation in clinical practice is still questionable. Furthermore, the optimal dosing of enoxaparin in special populations such as renal insufficiency and obesity remains controversial. In the Middle East, there are insufficient data on the appropriateness of enoxaparin use in different indications. OBJECTIVE: (1) To assess the appropriateness of enoxaparin dosing and duration per indication in compliance with the recommended guidelines and their impact on safety and efficacy outcomes in Lebanese health care centers. (2) To evaluate the influence of the hospital type (teaching vs. non-teaching) on the extent of compliance with established guidelines. SETTING: Seventeen health care centers in Lebanon, including teaching and non-teaching hospitals. METHODS: An observational, cross-sectional, multicenter study was conducted in 17 Lebanese hospitals. Data on demographics, indication, dosing regimen and clinical outcomes were collected. The appropriateness of dosing practices was determined as per the ACCP guidelines and the FDA dosing recommendations. MAIN OUTCOME MEASURE: The appropriateness of enoxaparin dosing was compared across different hospital type and among special populations including severe renal insufficiency and very obese patients. RESULTS: Of the 463 patients who participated in the study, 40% received improper enoxaparin dosing, which was mostly observed in the VTE prophylaxis group (41.6%, P < 0.001). When comparing the overall dosing practices in Lebanese hospitals, there was no statistically significant difference in the correctness of enoxaparin dosing between teaching and non-teaching hospitals (61.6% vs. 58.2%, P = 0.449), respectively. Only 11.5% of renally impaired patients and 59.4% of obese patients received correct doses. CONCLUSION: This study highlighted the improper practice and thus the need of implementation of clinical practice guidelines for the dosing of enoxaparin, in Lebanese hospitals.

Condition- and parasite-dependent expression of a male-like trait in a female bird.

In many species, females display brightly coloured and elaborate traits similar to those that males use in intra- and inter-sexual selection processes. These female characters are sometimes related to fitness, and might function as secondary sexual characteristics that have evolved through sexual selection. Here, we used descriptive data from 674 females in 10 populations and an experimental removal of Trichostrongylus tenuis parasites in four populations, to examine the effects of season, age, condition, and parasites on the size of supra-orbital combs displayed by female red grouse Lagopus lagopus scoticus. We found that comb size (i) was greater during the breeding than the non-breeding season, (ii) was greater in adult than in young females, (iii) was positively correlated with body condition, and (iv) negatively correlated with parasite abundance. Experimentally, we showed that comb size increased proportionally to the number of worms removed after parasite dosing. Our findings provide a better understanding of proximate mechanisms behind the expression of a male-like trait in females, and we discuss its possible function as a female ornament.