Search

•Cognitive impairment (CI) is common in MS (PwMS) people.•Studies demonstrate CI leads to decreased work responsibility and unemployment.•This study explored if employment mediates self-assessment of CI.•Employment and mood affected self-reported CI.•Employed PwMS scored better on objective cognitive tests.

ABSTRACT:Background:The effect of hormonal therapy has been extensively studied in women. However, similar data on male-to-female (MTF) transgenders, another important population that receives hormonal therapy is lacking. Existing studies in MTF transgenders are skewed toward mental health and health-harming behaviors while few have focused on chronic health conditions. Our study aims to review the existing data on stroke in MTF transgenders and perform a quantitative analysis on the frequency of this condition in this special population.Methods:PubMed, Cochrane, Scopus, Embase, ClinicalTrials.gov, and Web of Science were systematically searched for studies that reported data on the occurrence of cerebrovascular diseases in MTF transgenders. We reported the hormonal regimens, clinical characteristics, and outcomes of stroke in MTF transgenders. A meta-analysis of proportions was performed by the random-effects model to compute for the frequency of cerebrovascular events in MTF transgenders.Results:Fourteen studies were included in the qualitative analysis while five studies were included in the quantitative analysis. A total of 109 MTF transgenders (Mean 14; range 1–53) suffered a cerebrovascular event. Random-effect modeling analysis showed an overall estimated frequency of 2% for cerebrovascular events in transgenders with a moderate degree of heterogeneity (I2= 62%).Conclusion:Hormonal therapy in MTF transgenders may confer cardiovascular risks in this population. However, more population-based studies that include clinical characteristics and outcomes of chronic health diseases in MTF transgenders are warranted. Such studies may be crucial in directing future guidelines on the health care and management of MTF transgenders.

Background: Wernicke-Korsakoff syndrome (WKS) is a triad of ophthalmoplegia, ataxia and memory deficits due to thiamine insufficiency resulting from under- or untreated Wernicke’s encephalopathy (WE), which may be associated with hyperemesis gravidarum (HEG).Case presentation: We present a case of a 36-year-old Filipino woman in her first trimester with HEG, along with the WKS triad and abnormal hyperintense signals in the bilateral thalami and midbrain, left occipital lobe, periaqueductal gray matter and pontine periventricular areas. Neurologic deficits partially improved but persisted despite intravenous thiamine administration.Evidence review: A review of current treatments for WE, and the prevention and neurocognitive recovery of WKS was done. The beneficial effects of thiamine for acute WKS are supported by several case reports and clinical experience. Evidence from one randomized controlled trial wherein thiamine was given in various doses for treating WE or preventing WKS in an alcohol-dependent population is limited by methodological issues. Rehabilitation and pharmacotherapy for neurocognitive recovery seems promising, but they have inadequate evidentiary support. More robust studies on multi-modal strategies are warranted to facilitate the neurocognitive recovery of patients with WKS.

ABSTRACT:Background:Growing evidence showed that coronavirus disease 2019 (COVID-19) infection may present with neurological manifestations. This review aimed to determine the neurological manifestations and complications in COVID-19.Methods:We conducted a systematic review and meta-analysis that included cohort and case series/reports involving a population of patients confirmed with COVID-19 infection and their neurologic manifestations. We searched the following electronic databases until April 18, 2020: PubMed, Embase, Scopus, and World Health Organization database (PROSPERO registration number: CRD42020180658).Results:From 403 articles identified, 49 studies involving a total of 6,335 confirmed COVID-19 cases were included. The random-effects modeling analysis for each neurological symptom showed the following proportional point estimates with 95% confidence intervals: “headache” (0.12; 0.10–0.14; I2= 77%), “dizziness” (0.08; 0.05–0.12; I2= 82%), “headache and dizziness” (0.09; 0.06–0.13; I2= 0%), “nausea” (0.07; 0.04–0.11; I2= 79%), “vomiting” (0.05; 0.03–0.08; I2= 74%), “nausea and vomiting” (0.06; 0.03–0.11; I2= 83%), “confusion” (0.05; 0.02–0.14; I2= 86%), and “myalgia” (0.21; 0.18–0.25; I2= 85%). The most common neurological complication associated with COVID-19 infection was vascular disorders (n= 23); other associated conditions were encephalopathy (n= 3), encephalitis (n= 1), oculomotor nerve palsy (n= 1), isolated sudden-onset anosmia (n= 1), Guillain–Barré syndrome (n= 1), and Miller–Fisher syndrome (n= 2). Most patients with neurological complications survived (n= 14); a considerable number of patients died (n= 7); and the rest had unclear outcomes (n= 12).Conclusion:This review revealed that neurologic involvement may manifest in COVID-19 infection. What has initially been thought of as a primarily respiratory illness has evolved into a wide-ranging multi-organ disease.

ABSTRACT:Background:Intravenous tissue-type plasminogen activator (IVtPA) is a proven treatment for acute ischemic stroke; however, diabetes mellitus (DM) and previous cerebral infarction (PCI) were considered relative contraindications for thrombolysis within the 3–4.5 h period.Objective:The study aimed to determine the safety and efficacy of IVtPA among diabetic patients with PCI presenting with acute ischemic stroke.Methods:Studies which evaluated the outcome of IVtPA in terms of symptomatic intracerebral hemorrhage (sICH), functional outcome in modified Rankin scale, and death among diabetic patients with PCI presenting with acute ischemic stroke within the 3–4.5 h period were systematically searched until July 2019. Screening and eligibility criteria were applied. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Odds ratios (ORs) with 95% confidence interval (CI) were used to compare measures of treatment effect. Mantel–Haenszel method and random-effects model were also employed.Results:Four registry-based studies with a total of 44,572 patients were included for quantitative synthesis. Giving IVtPA among DM+/PCI+ patients did not result in significantly increased rate of sICH (OR, 1.09; 95% CI, 0.88, 1.36) compared to No DM+/PCI+ patients. However, there was significantly higher mortality (OR, 1.81; 95% CI, 1.60, 2.06) in the DM+/PCI+ group. Conversely, among those who survived, the DM+/PCI+ patients were more functionally independent at 3 months (OR, 0.76; 95% CI, 0.61, 0.94).Conclusion:Limited evidence suggests that thrombolysis in DM+/PCI+ patients does not result in significantly higher incidence of sICH and may improve functional independence. However, the significantly higher mortality in this group warrants an assessment of the individualized risk–benefit ratio in the use of IVtPA.

Objective: To describe the association between hypertension and clinical outcomes in a cohort of patients with coronavirus disease 2019 (COVID-19). Design: Retrospective cohort study. Setting: Thirty-seven (37) hospitals in the Philippines. Patients: 10,881 patients admitted for COVID-19 from February to December 2020. Measurements and main results: Among the 10,881 patients included in the Philippine CORONA Study, 3647 (33.5%) had hypertension. On regression analysis adjusted for confounders (age group, sex, smoking history, diabetes, chronic cardiac disease, chronic kidney disease, chronic respiratory disease, chronic neurologic disease, chronic liver disease, HIV/AIDS, and malignancy), patients with hypertension had significantly greater odds of in-hospital mortality (OR 1.33, 95% CI 1.17–1.52), respiratory failure (OR 1.99, 95% CI 1.75–2.28), ICU admission (OR 2.16, 95% CI 1.90–2.45) and severe/critical disease (OR 1.57, 95% CI 1.41–1.75), compared to patients without hypertension. The time-to-event analysis with confounder adjustment also showed that hypertension was significantly associated with shorter time-to-event outcomes of in-hospital mortality (HR 1.13, 95% CI 1.01–1.26), respiratory failure (HR 1.86, 95% CI 1.65–2.10), and ICU admission (HR 1.99, 95% CI 1.76–2.23). Conclusions: Our analysis of nationwide data confirmed previous findings that hypertension is an independent risk factor for worse clinical outcomes among patients hospitalized for COVID-19, with increased odds of in-hospital mortality, respiratory failure, ICU admission, and severe/critical COVID-19. More specific studies should be done to elucidate the impact of hypertension characteristics, such as chronicity, severity, drug therapy, and level of control on these clinical outcomes.

•Azathioprine was inferior to rituximab for neuromyelitis optica spectrum disorder (NMOSD).•Current efficacy data for azathioprine compared to other studied drugs were very limited.•Azathioprine was linked to frequent adverse events which may lead to intolerance.•At present, azathioprine may be offered as second-line treatment option for patients with NMOSD.

•Eighteen Filipinos with neuromyelitis optica spectrum disorder were documented.•Eight patients were positive for the antibody specific for this condition.•Most common presentation was inflammation of the spinal cord.•Profile of Filipinos with this condition are comparable to other populations.•Certain ancillary tests may be useful for this condition.

•A systematic review and meta-analyses were conducted on HDB for MS.•Three RCTs involving 889 patients with MS were analyzed.•HDB was beneficial in terms of ITW25 among PMS (moderate certainty of evidence).•Incidence of any AE were similar between HDB and placebo (high certainty of evidence).•“Laboratory test interference” is increased in HDB (high certainty of evidence).

•MS management in the Philippines faces several challenges•There is paucity of epidemiologic data on MS in the Philippines•Very limited disease modifying therapies for MS are available in the Philippine market•Much of diagnostics and therapeutics for MS are not covered by the insurance system•Healthcare provision for MS patients in the Philippines is inadequate

•MS and NMOSD scientific productivity in the SEA was low in quantity and quality.•Most studies from the SEA were cross-sectional and case reports/series.•Several countries in SEA yielded low scores in the PlumX metrics components.•Thailand, Malaysia, and Singapore produced the greatest number of publications.•% GDP for R&D was correlated with many productivity indices in the MS/NMOSD field.