Neurofilament light chain as an indicator of exacerbation prior to clinical symptoms in multiple sclerosis.

BACKGROUND: Biomarkers may be a sensitive measure of disease activity in patients with multiple sclerosis (pwMS). OBJECTIVE: A pwMS had a marked increase of neurofilament light chain (NfL) in CSF 9-weeks prior to a clinical exacerbation. METHODS AND RESULTS: Brain MRI, CSF, EDSS were measured at baseline, 6 weeks and 28 weeks. The patient had an exacerbation at week 15 of study but the NfL measured at week 6 were found to show a nearly 3-fold increase of CSF NfL levels prior to symptoms when the NfL levels were later measured. CONCLUSION: This is an example supporting the usefulness of NfL in monitoring disease activity in pwMS which may predict disease activity prior to a clinical exacerbation.

Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy.

BACKGROUND: Natalizumab is an effective treatment for relapsing multiple sclerosis. Return of disease activity upon natalizumab discontinuance creates the need for follow-up therapeutic strategies. OBJECTIVE: To assess the efficacy of teriflunomide following natalizumab discontinuance in relapsing multiple sclerosis patients. METHODS: Clinically stable relapsing multiple sclerosis patients completing 12 or more consecutive months of natalizumab, testing positive for anti-John Cunningham virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their final natalizumab infusion. Physical examination, Expanded Disability Status Scale, laboratory assessments, and brain magnetic resonance imaging were performed at screening and multiple follow-up visits. RESULTS: Fifty-five patients were enrolled in the study. The proportion of patients relapse-free was 0.94, restricted mean time to first gadolinium-enhancing lesion was 10.9 months and time to 3-month sustained disability worsening was 11.8 months. The mean number of new or enlarging T2 lesions per patient at 12 months was 0.42. Exploratory analyses revealed an annualized relapse rate of 0.08, and a proportion of patients with no evidence of disease activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95% of which were mild to moderate. CONCLUSIONS: Teriflunomide therapy initiated without natalizumab washout resulted in a low rate of return of disease activity. Clinicians may consider this a worthwhile strategy when transitioning clinically stable patients off natalizumab to another therapy.ClinicalTrials.gov Identifier: NCT01970410.

Patterns of injury in geriatric falls.

Falls are the most common cause of trauma in the elderly. Data regarding patterns of injury following geriatric falls are scant. We conducted a retrospective review of falls in patients aged 65 years and older seen at a trauma center over a nine year period. Two thousand eighty three patients met the inclusion criteria. Hip fracture proved to be the dominant injury (55%), 98% of which were isolated. Five hundred seven (21%) were non-hip fractures. Two hundred thirty eight patients (10%) sustained traumatic intracranial hemorrhage. Chest injury was the next most common injury type (6.7%) with rib fractures comprising 86% of this subgroup. A pattern of association between intracranial hemorrhage and cervical spine fractures was identified. Intra-abdominal injuries are rare.

Vital capacity as a predictor of outcome in elderly patients with rib fractures.

BACKGROUND: This study tests the relationships between early bedside vital capacity (VC) measurement and morbidity, mortality, and resource consumption in geriatric blunt chest trauma patients with rib fractures. METHODS: This was a retrospective study examining all patients > or = 65 years old with rib fractures who had a VC measured within 48 hours of their emergency department evaluation. Outcome variables included pulmonary complications, death from pulmonary complications, hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and discharge disposition. RESULTS: Thirty-eight patients met the study criteria. The mean age was 80.2 (+/-7.4) years, the mean number of rib fractures was 3.6 (+/-1.6), and the mean ISS was 6.9 (+/-4.7). VC and the percentage of the predicted vital capacity (pVC) were both inversely correlated with LOS (p = 0.0076 and p = 0.0172, respectively). Linear regression analysis suggested that patients with a VC < 1.4 L or < 55% of their pVC had a LOS > 3 days. Mean VC was 36% higher in patients who were discharged home versus those discharged to an extended care facility (ECF; p = 0.025). There was a trend toward significance when comparing VC to ICU LOS (p = 0.079), but none in predicting pulmonary complications (p = 0.3299). No correlations between VC and mortality can be drawn given the single death in the cohort. CONCLUSIONS: Bedside VC is a simple measurement which could predict LOS in elderly patients with rib fractures and may identify those patients requiring ECF upon discharge. Further prospective study may highlight the utility of emergency room VC in determining the disposition of these patients.