Acute disseminated encephalomyelitis that meets modified McDonald criteria for dissemination in space is associated with a high probability of conversion to multiple sclerosis in Taiwanese patients

BACKGROUND

Patients with acute disseminated encephalomyelitis (ADEM) may relapse and some may ultimately convert to multiple sclerosis (MS); however, no criteria that can predict MS conversion are available to date. Our aim was to describe the clinical and magnetic resonance imaging (MRI) features of patients with an initial ADEM attack and evaluate which MRI criteria can predict conversion to MS.

METHODS

We retrospectively reviewed the records of 36 patients diagnosed with ADEM. We determined clinical signs/symptoms, examined the cerebrospinal fluid (CSF), and performed brain MRI scans and compared the findings between patients who did and did not convert to MS.

RESULTS

Clinical signs/symptoms, and CSF analysis show no significant difference between the two groups. The rate of conversion to MS from ADEM in Taiwanese patients is low (11%) after a mean follow-up period of 28.36 months. Modified McDonald criteria were fulfilled in 19/36 patients: 21% (4/19) of those patients developed MS according to Poser criteria subsequently. Of the other patients (17/36) who did not fulfill these criteria, none converted to MS. (log rank test; P=0.027).

CONCLUSIONS

It is difficult to predict from initial clinical presentations to address which patients with ADEM will convert to MS. Patients with ADEM whose brain MRI findings met the modified McDonald criteria may have clinically isolated syndrome because they have a significantly higher probability of conversion to MS. In contrast, patients whose brain MRI findings did not meeting these criteria may be considered as having classic ADEM because they have a lower probability of conversion to MS.

Prevalence of allergic diseases of schoolchildren in central taiwan. From ISAAC surveys 5 years apart

The prevalence of allergic disorders is increasing around the world. This study used the standardized written questionnaire from International Study of Asthma and Allergies in Childhood (ISAAC, phase III) to collect two cross-sectional appraisals of schoolchildren 5 years apart-one performed 2002 and another on 2007, to focus on the secular trends in prevalence of allergies in central Taiwan. This questionnaire was administered to schoolchildren from over 46 schools across Changhwa County in 2002, and again in 2007. The present study is a follow-up study and uses data collected from a previously reported study conducted in the year 2002 of the same location using the same methodology. Although the repeated cross-sectional survey after a 5-year lapse suggests a mere increase of diagnosed asthma cases from 7.1% to 7.4%, the prevalence of its related symptoms--nocturnal cough, rhinitis, and eczema--was found to increase significantly by 2.6% (p < 0.0001), 6.8% (p < 0.001), and 5.9% (p < 0.001), respectively. Additionally, comparing the secular trends in asthma prevalence, rhinitis, and eczema between several polluted areas in Changhwa County with its less polluted neighbors in 2002 and 2007 indicates that schoolchildren in TaiHao area, which is noted to be polluted by a petrochemical company, has a significantly increased prevalence of wheezing (3.7%, p < 0.05) and nocturnal cough (3.6%, p < 0.05). For schoolchildren living in the coastal areas, a 6% (p < 0.05) increase in the prevalence of rhinitis is noted. The prevalence of eczema uniformly increased for all areas of Changhwa County (p < 0.01). In the downtown areas, besides eczema, the prevalence of asthma and rhinitis also increased significantly (p < 0.05). Of note is the consistent finding in these two periods of the higher prevalence of childhood asthma, rhinitis, and eczema in the downtown areas compared with that from both the polluted and coastal areas. The secular trends in prevalence of asthma, rhinitis, and eczema in these two periods seem to correlate to environmental factors. While the symptoms of asthma, rhinitis, and eczema in schoolchildren affected boys more than girls, it is observed that affected girls have more marked manifestations, although it did not reach statistical significance.

A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women

BACKGROUND

French maritime pine bark extract (Pycnogenol) was found to alleviate menstrual pain and reduce hyperactivity in clinical studies. These results suggest the possibility to observe positive effects in treating climacteric syndrome.

OBJECTIVE

Clinical investigation of the effect of Pycnogenol, French maritime pine bark extract, on the climacteric syndrome.

METHODS

Some 200 peri-menopausal women were enrolled in a double-blind, placebo-controlled study, and treated with Pycnogenol (200mg) daily. Climacteric symptoms were evaluated by the Women's Health Questionnaire (WHQ), patients were checked for antioxidative status and routine chemistry. A total of 155 women completed the study.

RESULTS

All climacteric symptoms improved, antioxidative status increased and LDL/HDL ratio was favourably altered by Pycnogenol. No side effects were reported.

CONCLUSION

Pycnogenol may offer an alternative method to reducing climacteric symptoms without unwanted effects.

Prevalence of asthma, rhinitis, and eczema from ISAAC survey of schoolchildren in Central Taiwan

Asthma is a common disease among schoolchildren in Taiwan. It is clearly a trend that the prevalence of asthma, rhinitis, and eczema has been increasing in developed countries such as Taiwan, but the data remain limited. This study is part of an effort to evaluate the epidemiology of asthma, rhinitis and eczema in Taiwan and to assess the prevalence and severity of those disorders among school age in central Taiwan. The International Study of Asthma and Allergies in Childhood (ISAAC, phase III) standard written questionnaire was administered to 7,873 first grade schoolchildren, 6 to 8 years of age from 47 different elementary schools in Changhwa county, which is located in central Taiwan. The overall cumulative and 12-month prevalence of wheezing is 10.4% and 5.0%, respectively. The prevalence of diagnosed asthma by doctor is 7.0%. Rhinitis is 24.6% and eczema 18.0%. Multiple logic regression analysis shows that a higher prevalence of wheezing and rhinitis is associated with males. Among these school-age children, the peak incidence of asthma and rhinitis is in the winter months, especially in December and January.We also compared the prevalence of asthma, rhinitis, and eczema in two severely polluted areas in Changhwa County with the prevalence in less polluted parts of the county. One is the area near a huge petrochemical company, TaiHao Petroleum Company, located in the central area of the county. The other is XiZhao, a rural area located near an incinerator. These were compared with the less-polluted Coast-Area and with the rest Changhwa County area. The school-age children living near the TaiHao Company have a higher prevalence of wheezing, diagnosed asthma, and diagnosed eczema, but there are no differences for rhinitis. As for XiZhao and Coast areas, those children have significantly higher rates of nasal problems, diagnosed rhinitis, and eczema than the rest of the area, but we did not find a significant difference in the prevalence of asthma. Among school-age children who lived in the Coast area, we found a higher prevalence of rhinitis and nasal problems with associated itchy eyes than among children in other areas of the county.

Evaluation of the serum antioxidant status in asthmatic children

Many studies have shown the balance between the oxygen reactive species (ROS) and the antioxidant capacities, and that the massive ROS generation could lead to cell damage and diseases such as atherosclerosis, aging and cancer. Changes in antioxidant capacity like free radicals scavenging antioxidant agents such as vitamin E, C content, serum concentrations of bilirubin, uric acid, albumin and antioxidant enzyme systems like SOD, and GPx activities have been described to be related to many diseases. However, the research on chronic airway inflammatory disease and the antioxidant defence system is still not enough. Understanding of the antioxidant status and antioxidant enzymes in asthmatic patients is still unclear. In the present controlled study, we investigated the total antioxidant status (TAS) in serum and the antioxidant enzyme (total SOD and GPx) activities in 46 asthmatic children and 52 normal controls. The serum level of TAS in asthmatic children was significantly lower than the controls. The SOD concentration in asthmatic children was higher than the control, however the GPx was much lower than the control children, even though it was not statistical significance. In conclusion, these results suggested the existence of higher oxidative stress and reactive oxygen species (ROS) in asthmatic children, and that the antioxidant capacities in asthmatic children were altered. If the production of ROS was persistent, it would result in chronic inflammation and the imbalance of oxidative-reductive status in those patients.

Ultrasound measurement of the ventricular size in newborn infants

High resolution real-time ultrasound scans were obtained through the anterior fontanelle to measure the lateral ventricles of 540 neonates of various gestational ages. Coronal scans showed that the distance between the falx and the lateral wall of the body of the lateral ventricle (ventricular index) and the greatest axis of the lateral ventricle (ventricular axis) were correlated with increasing gestational age. Growth charts were constructed for neonates of various gestational ages, from 24 to 40 weeks. The greatest distance perpendicular to the ventricular axis was defined as the ventricular depth. The depth of normal lateral ventricles was 0.18 cm (range, 0.13-0.23 cm). Hopefully, the data concerning ventricular sizes obtained in this survey can be utilized for the early diagnosis and control of posthemorrhagic ventriculomegaly.