Background: With the increasing median age of people with multiple sclerosis (MS), age-related syndromes such as frailty have emerged as new challenges to patient well-being. Prior research on frailty in MS has primarily focused on physical aspects, leaving the relationship between frailty and mental health unexplored. Objective: To investigate the associations between frailty, mental health, and quality of life (QoL) in people with MS. Design: Cross-sectional questionnaire-based study conducted at the Center for MS Care at the University of Kansas Medical Center. Methods: Participants completed validated measures of frailty (Tilburg Frailty Indicator), anxiety and depression (Hospital Anxiety and Depression Scale), QoL (Multiple Sclerosis Quality of Life-54), and disability level (Patient-Determined Disease Steps). Results: A total of 204 patients with MS (median age: 51 (interquartile range = 18) years, 74% women) took part in the study. Overall, 50.5% of respondents were classified as frail. Frail participants were older than their non-frail counterparts ( p = 0.018) and had higher levels of anxiety and depression ( p < 0.001). Frailty status was also associated with lower QoL scores across physical and mental health domains ( p < 0.001). In logistic regression analyses adjusted for age, sex, and disability, higher anxiety scores (odds ratio (OR) = 1.45, 95% confidence interval (CI) (1.28, 1.65), p < 0.001) and depression scores (OR = 1.58, 95% CI (1.365, 1.843), p < 0.001) were associated with greater odds of being frail. Conclusion: This study revealed a strong association between frailty, mental health, and QoL in people with MS. These findings underscore the need for greater attention to both physical and psychological well-being in people with MS. Future research should explore whether integrated care strategies may improve outcomes in this population.
Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease that requires long-term pharmacotherapy and self-management. Disease knowledge and medication adherence are essential for achieving optimal outcomes, but remain under-researched in low-resource settings such as Nepal. Objective:This study aimed to assess the factors associated with disease knowledge and medication adherence among RA patients attending a private rheumatology clinic in Nepal. Design:Cross-sectional study. Methods:A hospital-based cross-sectional study was conducted from March to September 2023 among 428 RA patients who had been on a disease-modifying anti-rheumatic drugs (DMARDs) regimen for at least 3 months prior to the start of the study. Disease knowledge was assessed using the Rheumatoid Arthritis Knowledge Assessment Scale, and medication adherence was measured using the General Medication Adherence Scale. Pearson's χ² test and multivariate logistic regression analyses were employed to examine the associations between levels of the disease knowledge, medication adherence, and related variables, using a 95% confidence interval and a 5% level of significance. Results:A total of 82.2% of RA patients had poor knowledge of the disease, and 62.2% demonstrated low medication adherence. Poor disease knowledge was significantly associated with older age, illiteracy, being a homemaker or unemployed, functional disability, higher disease activity, lower income, and absence of a family history of RA. Low medication adherence was significantly associated with male gender, being a homemaker or unemployed, rural residence, longer disease duration, presence of the comorbidities, obesity, higher disease activity, functional disability, and the use of multiple DMARDs. Conclusion:The findings highlight a critical gap in the disease knowledge and medication adherence among RA patients in Nepal, emphasizing the urgent need for targeted educational and adherence-enhancing interventions. Tailored strategies focusing on older adults, individuals with low literacy, and rural populations are essential to improve health outcomes and support effective RA management in resource-constrained settings.
Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition marked by insulin resistance, decreased insulin production, and persistent low-grade inflammation. The prevalence of T2DM has increased significantly in recent decades; as a result, it is now regarded as one of the fastest-growing public health concerns worldwide. Long-term micro- and macrovascular problems such as nephropathy, retinopathy, neuropathy, and cardiovascular disease can be caused by poor blood glucose control. Therefore, developing reliable diagnostic indicators for early diagnosis and investigating new treatment targets are critical for addressing the increasing prevalence of T2DM. Several novel diagnostic approaches have been created by targeting endogenous proteins, with fetuin-A being one of the most promising targets. Human fetuin-A, also referred to as alpha-2-Heremans Schmid glycoprotein, is a liver-produced glycoprotein that is abundantly secreted into the bloodstream and seems to be involved in insulin resistance, metabolic syndrome, and inflammation. Clinical studies have shown that circulating fetuin-A levels are closely associated with T2DM and its complications, underscoring its potential as both a biomarker and a therapeutic target. This narrative review provides a detailed overview of the evolving role of fetuin-A in the development of T2DM and its associated complications, as well as its future perspectives.
What is this summary about? • This is a summary of a research article published in a medical journal that describes the main results from two studies called TRuE-V1 and TRuE-V2 • These studies looked at the use of ruxolitinib cream to treat vitiligo, a long-term condition where white patches develop on the skin • Ruxolitinib belongs to a group of medicines called Janus kinase (JAK) inhibitors, which have been shown to restore the skin color (also known as skin pigment) of some people with the most common form of vitiligo (non-segmental vitiligo, also known as generalized vitiligo or bilateral vitiligo) What happened in the studies? • Researchers who designed the TRuE-V1 and TRuE-V2 studies wanted to understand if ruxolitinib cream helped to restore the skin color of people with non-segmental vitiligo, compared with an identical cream that did not contain ruxolitinib. This is called a vehicle cream • In the studies, people aged 12 years and older with non-segmental vitiligo were randomly chosen to apply either ruxolitinib cream or vehicle cream to the parts of their body affected by vitiligo twice a day for 6 months. For every one person that used the vehicle cream, two people used the ruxolitinib cream • The main goal of the studies was to find out how many people had a 75% improvement in their facial vitiligo after 6 months ○ This meant that three-quarters of the white patches on the face returned to normal skin color • Other goals included measuring: ○ How many people had a 50% improvement in the vitiligo on their whole body after 6 months ■ This meant that half of the white patches on the whole body returned to normal skin color ○ How many people felt their vitiligo was less noticeable after 6 months • The study also looked at the side effects of ruxolitinib cream and the vehicle cream What do the results mean? • In both the TRuE-V1 and TRuE-V2 studies, people who used ruxolitinib cream for 6 months had greater improvements in their vitiligo compared with those who used the vehicle cream • The most common side effects were acne (red pimples located mainly on the face) and itchy skin where ruxolitinib cream was applied • Results from the studies suggest that ruxolitinib cream helps to restore the color of the skin over time in people with non-segmental vitiligo.
Currently, the diagnosis of Parkinson’s disease (PD), Parkinson’s disease dementia (PDD), and Lewy body dementia (DLB) relies on clinical symptoms, with Lewy body (LB) pathology serving as the gold standard. The co-pathology associated with Alzheimer’s disease (AD) contributes to the clinical heterogeneity and rapid progression seen in Lewy body disorders (LBD). The AT(N) classification system may help identify the distinct biochemical, neuro-radiological, and clinical characteristics of both pure LB and PD. Recent advancements in biomarkers have improved the precise identification of pathological α-synuclein (i.e., misfolded and aggregated) in cerebrospinal fluid (CSF) through the seed amplification assay. Consequently, the Neuronal α-synuclein Integrated Staging System (NSD-ISS) has reclassified PD as a neuronal α-synuclein disease, rather than just a clinical syndrome. Although some debate the necessity of a biological definition for clinical diagnosis, biomarker-based systems continue to serve as diagnostic tools for these disorders. This narrative review will explain the definitions of the AT(N) and NSD-ISS systems and provide an updated list of research that supports the proposed biological definitions and staging systems. Additionally, it will discuss how the combination of LB-AD pathology, along with the neuronal concept of the disease, significantly influences the clinical phenotype, progression, and overall prognosis of PD. Finally, this review will overview current advancements in blood-based AD biomarkers that could facilitate faster screening of LBD patients for AD co-pathologies, thereby enhancing the diagnostic sensitivity of LBD-AD and its potential for prognostic, research, and diagnostic applications.
