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Background: There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta‐analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non‐culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non‐culprit lesions in acute coronary syndromes patients. Methods: A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random‐effects models. Results: Twenty‐eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin‐Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non‐culprit lesions. Non‐culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin‐Cap Fibroatheromas than in stable angina. Conclusion: Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non‐culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients. [ABSTRACT FROM AUTHOR]

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Background. The early onset forms of Multiple Sclerosis (Paediatric MS, P-MS) have a low frequency, occurring in 2% to 10% of all MS cases. Age at diagnosis is a key feature for disease progression and prognosis in MS patients. Objective. To evaluate the clinical features and course of MS in patients having the disease onset before the age of 18, according to age at diagnosis. Methods. Patients with MS onset before age of 18 identifi ed from Basse-Normandie MS regional registry, were included in the study. Patients were divided in two groups according to the age at MS diagnosis: the fi rst group (group A) of patients in whom MS diagnosis was set before age of 18 and the second group (group B) including patients older than 18 years at MS diagnosis. Data related to clinical features and disease course were evaluated and compared between the two groups and also with some clinical data of adult MS patients included in the same regional database. Results. A total of 41 patients with P-MS were included in the study, represented by 20 patients in group A and 21 patients in group B. Patients from group A had a more rapid progression to mild handicap (EDSS 3.0) than patients from group B (time to reach EDSS 3.0 of 6.34 vs 14.36 years; p=0.02) and they reached this level of disability at a younger age (21.17 vs 29.79 years; p=0.002). The duration of the fi rst remission was signifi cantly shorter in group A (1.44 vs 5.14 years; p<0.001) and the evolution to secondary-progressive (SP) form was faster when compared to group B (14.97 vs 27.57 years; p=0.01). Patients from group A had a greater risk to reach EDSS 3.0 or EDSS 6.0 as well as a greater probability to reach SP form (p<0.001) than patients from group B. Progression index (PI) of the entire paediatric group was signifi cantly lower than mean PI in the adult group (0.29 vs 0.45; p=0.003) but not signifi cantly different between the two groups (0.37 in group A vs 0.21 in group B). Conclusion. P-MS forms show some clinical peculiarities, especially those with the age of diagnosis less than 18 years. They seem to have a more severe clinical MS course and a faster progression of disability. [ABSTRACT FROM AUTHOR]

Alzheimer disease represents an important public health issue. The economic, social and financial impact is influenced by the major frequency of disease. The factors intervening in the determination of Alzheimer disease costs are numerous and mainly concern the degree of dependency, the cognitive decline, the services use and assistance; a part from these, other associated factors step in, like: behavioral, functional, social and economic factors. The treatment is a complex and extremely difficult issue. Alzheimer disease does not only affect the patient, but also the people in his entourage, the impact on the caregivers being enormous. The therapeutic approach has be a global one, adapted to each patient, without focusing only on the cognitive features, but having as a main purpose the maintenance of the patient's independence for as long as possible. Prior researches have mainly aimed at the cognitive decline and the therapeutic options have developed toward this field. Nevertheless, the psycho-behavioral disturbances are often the ones that alter the patient's life quality, hasten the hospitalization and favor the affective and physical exhaustion of the caregivers. The insurance of social protection measures is an important issue in the developing countries, being burdened by the lack of caregivers and adequate hospitalization centers. For most of the patients, there is not the possibility of long term assistance support and therefore the family has to assume this essential role. [ABSTRACT FROM AUTHOR]

Paediatric forms of multiple sclerosis are considered rare, representing 5% of all cases. The diagnosis is difficult and raises specific problems regarding the differentiation from other inflammatory demyelinating diseases of the central nervous system, more common in children and teenagers, especially the acute disseminated encephalomyelitis. Paediatric forms have some peculiarities concerning clinical features, progression and prognosis of the disease, when compared to adult-onset forms of multiple sclerosis. There is a higher female preponderance. Paediatric forms cause a significant level of disability at a younger age, although disability progression is slower than in adult forms. Also, the progression to a secondary progressive form is delayed and there is a more frequent polysymptomatic onset and a higher frequency of complete remission after the first relapse, when compared to adult forms. Nevertheless, affected ages are younger. In addition, associated cognitive deficits may affect psychosocial and academic performance of patients undergoing training. A prompt diagnosis is necessary in order to initiate a therapy as early as possible, taking into account the particular clinical profile of these forms [ABSTRACT FROM AUTHOR]

Introduction, Fatigue is a nonspecific but a common symptom in Multiple Sclerosis (MS). Its relationship w ith disease progression is contradictory. Objective. To evaluate fatigue in MS patients and to appreciate its role in the disease course, highlighting some specific clinical features in these patients. M aterial and method, 101 patients w ith MS, identified from the records of the Neurology I Department, were Included in this study. “ Modified Fatigue Impact Scale" - MFIS was used for fatigue assessment. According to the presence of fatigue (MFIS score i 38), the patients were divided in two groups: group A (43 patients w ith fatigue) and group 6 (58 patients without fatigue). Data related to clinical and imaging findings were compared between the two groups. Results. Fatigue was reported by 43.57% of patients. The progression to a secondary-progressive form was not different between the tw o groups (1S8.8 vs 141,4 months, p = 0.709), An important finding was the association between fatigue and disease severity, the patients w ith fatigue having a higher median EDSS score (4.00 vs 2.0, p<0.001). Corpus callosum lesions, highlighted by MR!, were more frequently observed in patients w ith fatigue (83.72% vs 62.07%, p = 0.017). The relative risk was 1 35 (95% Cl 1.06 1.72). Also, both patients w ith corpus callosum atrophy and those w ith cortical atrophy experienced more frequently fatigue (62.79% vs 27.59%, p <0.001, respectively 66.67% vs 35.53%, p = 0.007). Conclusion. Fatigue was a common symptom In MS patients, associated to some clinical factors of the disease. There was an association with MS severity but we didn't observe a clear association between fatigue and disease progression. Corpus callosum and cortical atrophy have been related to fatigue, suggesting ţhe role of axonal loss and neuronal degeneration In its pathogenesis. [ABSTRACT FROM AUTHOR]