Clinically isolated syndrome

The most common presentation of multiple sclerosis (MS) is with a clinically isolated syndrome (CIS) affecting the optic nerves, brainstem or spinal cord. Two thirds of patients with CIS will have further episodes of neurological dysfunction and convert to relapsing remitting MS, while the remaining patients have a monophasic illness, at least clinically. Abnormalities on a baseline MRI scan predict the subsequent development of MS in patients with CIS. In the long term, about 80% of patients with an abnormal MRI convert to MS compared with 20% with a normal MRI. For patients who develop MS the long term prognosis is varied. After 20 years, almost half will have developed secondary progressive MS, while around one third have a benign disease course with little physical disability. Disease-modifying treatments delay conversion to MS in selected CIS patients with abnormal MRI but an effect on long term disability has not been demonstrated. In this review we discuss recent advances in the diagnosis, management and prognostication of patients with CIS.

IntroductionPrevious reports have shown that brain atrophy appears early in the course of multiple sclerosis (MS). The aim of the present study was to evaluate whether brain atrophy already exists in clinically isolated syndrome (CIS) by comparing with a control sample.

Introduction The objective of this work is to study the relationship between the presence of lipid-specific oligoclonal IgM bands (LS-OCMB) in CSF, with both T2 lesion volume (T2LV) accumulation and brain atrophy (percentage change of brain volume–PCBV–and brain parenchyma fraction–BPF) in patients with clinically isolated syndromes (CIS) suggestive of demyelination. Methods Twenty-four CIS patients were included in this prospective study. IgG oligoclonal bands (OCGB) and LS-OCMB were determined in paired serum and CSF samples within 3 months since clinical onset. Brain MRI studies were scheduled at baseline, 3 months, first and second years after CIS onset. Differences in T2LV, PCBV and BPF between CIS patients according to the type of OCB were studied. Results Nine patients had no OCB; 15 had only OCGB, and seven had OCGB + LS-OCMB present in the CSF. LS-OCMB were associated with greater T2LV in all scheduled MRI studies. At the end of follow-up (year 2), it was threefold higher in patients with these antibodies than in those without LS-OCMB (3.95 cm3 vs. 1.36 cm3, p = 0.001). At that point, brain atrophy was also higher in patients with LS-OCMB (BPF, 0.73 in LS-OCMB+ patients vs. 0.76 in negative ones, p = 0.03). The rate in brain atrophy was higher in the first group of patients as well. Considering only patients with OCGB, the presence of LS-OCMB was also related to greater T2LV, T2LV increase and a trend towards higher atrophy rate. Conclusion The presence of LS-OCMB in the first event suggestive of demyelination is related to an early increase in lesion load and brain atrophy. These data are in line with prospective studies showing the clinical prognostic value of LS-OCMB.

Serum autoantibodies against the water channel aquaporin-4 (AQP4) are important diagnostic biomarkers and pathogenic factors for neuromyelitis optica (NMO). However, AQP4-IgG are absent in 5-40% of all NMO patients and the target of the autoimmune response in these patients is unknown. Since recent studies indicate that autoimmune responses to myelin oligodendrocyte glycoprotein (MOG) can induce an NMO-like disease in experimental animal models, we speculate that MOG might be an autoantigen in AQP4-IgG seronegative NMO. Although high-titer autoantibodies to human native MOG were mainly detected in a subgroup of pediatric acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) patients, their role in NMO and High-risk NMO (HR-NMO; recurrent optic neuritis-rON or longitudinally extensive transverse myelitis-LETM) remains unresolved.

Reptile plays an essential role in human life and act as a reservoir of pathogenic bacteria. It became necessary because of some bacteria resistant against several antibiotics. This study aimed to evaluate the potency of Sansevieria masoniana (SM) leaf extract against isolated bacteria from the faeces of pet-reptile. A total of 129 fresh faecal samples were collected from the reptile communities in Surabaya on February 2018 until January 2019. The faeces obtained from 72 snakes, 43 lizards and 14 tortoises. The isolation was conducted using the Micro ID system. All the isolated bacteria were tested against several antibiotics using disc diffusion method, and SM extract using minimum inhibitory concentration test. The isolated bacteria were Aeromonas hydrophila (44.96%), Bacillus sp (32.55%), Enterobacter cloacae (40.31%), Enterococcus sp (82.17%), Escherichia coli (96.89%), Proteus sp (76.74%), Pseudomonas sp (48.83%), Salmonella enteritidis (55.03%), and Salmonella enterica arizonae (53.48%). Those isolated bacteria indicated various resistance patterns against several commercial antibiotics. The minimum concentration of SM extracts that potential to inhibit the colonisation of both resistant and susceptible isolated bacteria was 62.5 mg/mL. This study proved that SM extract potential to inhibit the colonisation of the isolated bacteria from faeces of pet-reptile, even though, several of those isolates resistant against several commercial antibiotics.

Purpose: Our study aims to evaluate and analyze the effect of a mineralizing varnish on the progression of the initial caries of the enamel in the primary dentition. Materials and methods: Subject of observation-there are 200 children from the city of Varna, aged 3 to 6 years, distributed equally in standardized age groups, with the same number of boys and girls. Dental caries diagnosed with d1 and d2. Units of observation: Children with high caries risk of development: A group of 100 children treated with mineralizing varnish CV; Control group of 100 children. Carious teeth with threshold d1, d2 lesions. Carious surfaces with d1, d2 lesions. After processing the results and determining the highlights, the actual study was performed by processing the data with a mathematical-statistical processing package SPSS v 20.0. Results: The results of the comparative analysis of the therapeutic efficacy of the mineralizing varnish used-Clinpro White Varnish showed a significant difference in the percentage of effectiveness (t=-3.68, p<0.001). Clinpro White Varnish showed better results after the application (64.58%). Conclusion: The use of these medications may be beneficial for patients with dental caries of primary teeth from 3 to 6 years of age.