Pediatric Multiple Sclerosis in Tunisia: A Retrospective Study over 11 Years

Introduction. Pediatric multiple sclerosis (pMS) is a rare demyelinating disorder with an onset before the age of 18 years. In this study, we aimed to investigate the characteristics of pMS in Tunisian children. Patients and Methods. We conducted a retrospective study over 11 years (2005–2016) including all patients diagnosed with pMS according to the International Pediatric Multiple Sclerosis Study Group (IPMSSG) criteria of 2012 and followed up in a tertiary care research center. Epidemiological, clinical, neuroimaging, laboratory, and therapeutic data were collected and analyzed. Results. There were 21 patients. The male-female ratio was 1 : 3. Mean age at onset was 11 years (range: 3–17 years). Three patients had type 1 diabetes. Polyfocal presentation was preponderant (81%) with motor dysfunction in 57% of patients. Paroxysmal dystonia was noticed in 24%. All patients were diagnosed with relapsing-remitting form. Interferon beta was prescribed in 80% with a reduction of annual relapse rate. Conclusion. The annual incidence of pMS in Tunisian children aged below 18 years could be estimated as 0.05 per 100,000. Singular features in our cohort were the frequent association with type 1 diabetes and the increased occurrence of dystonia. Greater awareness of pMS may be helpful to improve management strategies of children and their families.

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To be or not to be optimistic when one is chronically ill: The role of optimism in relation to adaptation to type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis

PsycEXTRA Dataset ◽

10.1037/e537142011-002 ◽

2000 ◽

Author(s):

Marijda Fournier

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Multiple Sclerosis ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Chronically Ill

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Time in range for multiple technologies in type 1 diabetes: a systematic review and network meta-analysis

10.2337/figshare.12116691 ◽

2020 ◽

Author(s):

Anthony Pease ◽

Clement Lo ◽

Arul Earnest ◽

Velislava Kiriakova ◽

Danny Liew ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Closed Loop ◽

Meta Analysis ◽

Management Strategies ◽

Glucose Testing ◽

Closed Loop Systems ◽

Percent Time ◽

Time In Range

Background: Time-in-range is a key glycaemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. Purpose: We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycaemic ranges. Data sources: We searched All Evidenced Based Medicine Reviews, CINAHL, EMBASE, MEDLINE, MEDLINE In-Process and other non-indexed citations, PROSPERO, PsycINFO, PubMed, and Web of Science until 24 April, 2019. Study selection: We included randomised controlled trials >2 weeks duration comparing technologies for management of type 1 diabetes in adults (>18 years of age), excluding pregnant women. Data extraction: Data were extracted using a predefined template. Outcomes were percent time with sensor glucose levels 3.9–10.0mmol/l (70–180mg/dL), >10.0mmol/L (180mg/dL), and <3.9mmol/L (70mg/dL). Data synthesis: We identified 16,772 publications, of which 14 eligible studies compared eight technologies comprising 1,043 participants. Closed loop systems lead to greater percent time-in-range than any other management strategy and was 17.85 (95% predictive interval [PrI] 7.56–28.14) higher than usual care of multiple daily injections with capillary glucose testing. Closed loop systems ranked best for percent time-in-range or above range utilising surface under the cumulative ranking curve (SUCRA–98.5 and 93.5 respectively). Closed loop systems also ranked highly for time below range (SUCRA–62.2). Limitations: Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low. Conclusions: In the first integrated comparison of multiple management strategies considering time-in-range, we found that the efficacy of closed loop systems appeared better than all other approaches.

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Cell-based Tolerogenic Therapy, Experience from Animal Models of Multiple Sclerosis, Type 1 Diabetes and Rheumatoid Arthritis

Current Pharmaceutical Design ◽

10.2174/1381612823666170214120708 ◽

2017 ◽

Vol 23 (18) ◽

Cited By ~ 8

Author(s):

Ivana Stojanovic ◽

Mirjana Dimitrijevic ◽

Marta Vives-Pi ◽

Maria Jose Mansilla ◽

Irma Pujol-Autonell ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Multiple Sclerosis ◽

Type 1 Diabetes ◽

Animal Models

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Self-management strategies for adults with type 1 diabetes mellitus

10.1002/14651858.cd002103 ◽

2000 ◽

Author(s):

M Watson ◽

E Briganti ◽

T Skinner ◽

C Manning

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Management Strategies ◽

Self Management

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Solar Radiation and Vitamin D: Mitigating Environmental Factors in Autoimmune Disease

Journal of Environmental and Public Health ◽

10.1155/2012/619381 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Gerry K. Schwalfenberg

Keyword(s):

Rheumatoid Arthritis ◽

Multiple Sclerosis ◽

Inflammatory Bowel Disease ◽

Vitamin D ◽

Type 1 Diabetes ◽

Autoimmune Disease ◽

Solar Radiation ◽

Inflammatory Bowel

This paper looks at the environmental role of vitamin D and solar radiation as risk reduction factors in autoimmune disease. Five diseases are considered: multiple sclerosis, type 1 diabetes, rheumatoid arthritis, autoimmune disease of the thyroid, and inflammatory bowel disease. Clinical relevant studies and factors that may indicate evidence that autoimmune disease is a vitamin D-sensitive disease are presented. Studies that have resulted in prevention or amelioration of some autoimmune disease are discussed. An example of the utility of supplementing vitamin D in an unusual autoimmune disease, idiopathic thrombocytic purpura, is presented.

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Insulin doses requirements in patients with type 1 diabetes using glargine U300 or degludec in routine clinical practice

Journal of Investigative Medicine ◽

10.1136/jim-2020-001633 ◽

2021 ◽

pp. jim-2020-001633

Author(s):

Florentino Carral San Laureano ◽

Mariana Tomé Fernández-Ladreda ◽

Ana Isabel Jiménez Millán ◽

Concepción García Calzado ◽

María del Carmen Ayala Ortega

Keyword(s):

Type 1 Diabetes ◽

Clinical Practice ◽

Retrospective Study ◽

Real World ◽

Glycosylated Hemoglobin ◽

Routine Clinical Practice ◽

Insulin Analogs ◽

Total P ◽

Real Clinical Practice

There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.

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