Dietary factors and pediatric multiple sclerosis: A case-control study

BACKGROUND

The role of diet in multiple sclerosis (MS) is largely uncharacterized, particularly as it pertains to pediatric-onset disease.

OBJECTIVE

To determine the association between dietary factors and MS in children.

METHODS

Pediatric MS patients and controls were recruited from 16 US centers (MS or clinically isolated syndrome onset before age 18, <4 years from symptom onset and at least 2 silent lesions on magnetic resonance imaging). The validated Block Kids Food Screener questionnaire was administered 2011-2016. Chi-squared test compared categorical variables, Kruskal-Wallis test compared continuous variables, and multivariable logistic regression analysis was performed.

RESULTS

In total, 312 cases and 456 controls were included (mean ages 15.1 and 14.4 years). In unadjusted analyses, there was no difference in intake of fats, proteins, carbohydrates, sugars, fruits, or vegetables. Dietary iron was lower in cases ( p = 0.04), and cases were more likely to consume below recommended guidelines of iron (77.2% of cases vs 62.9% of controls, p < 0.001). In multivariable analysis, iron consumption below recommended guidelines was associated with MS (odds ratio = 1.80, p < 0.01).

CONCLUSION

Pediatric MS cases may be less likely to consume sufficient iron compared to controls, and this warrants broader study to characterize a temporal relationship. No other significant difference in intake of most dietary factors was found.

Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population

BACKGROUND

Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results.

OBJECTIVE

To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort.

METHODS

The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT).

RESULTS

We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01).

CONCLUSIONS

While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies.

Comparison of a dedicated children's seizure clinic to mixed general paediatric clinics

BACKGROUND

In the light of recent recommendations regarding the current management of children with possible epilepsy in the UK, different models of care are compared using an existing validated audit tool.

METHODS

The initial clinical assessment process, investigation, management and communication regarding children referred with suspected epilepsy to general paediatric clinics or a paediatric seizure clinic was compared using the British Paediatric Neurology Association (BPNA) audit tool. Results Ninety-three children were included in the comparison. The history and description of the episodes was better documented in the Seizure Clinic (SC). Children's early development (79% vs. 50%) and school performance (86% vs. 42%) were better documented in the SC. Documentation of possible side effects relating to newly prescribed anti-epileptic drugs was poor in both groups (33% vs. 15%).

CONCLUSIONS

Differences between models of epilepsy care can be detected using audit tools although there are some methodological limitations of this particular study. Future similar studies as well as informing local practice can add to the debate on the appropriate way forward in improving the care for children with epilepsy.

Experimental measurement of corneal haze after excimer laser keratectomy

We developed a model of corneal haze following photorefractive keratectomy (PRK) in Iber Braun hens and studied optical properties. The animals underwent PRK for -9.0 diopters of myopia and were divided into groups based on treatment with different wound-healing modulators. At different time points postoperatively, we evaluated haze by slit-lamp microscopy. An experimental device was developed to measure transmittance spatial maps and forward scattering of He-Ne laser light in the excised corneas. Subjective and objective haze measures were compared for each group at the different times. Keratocyte densities were determined by optical microscopy and keratocyte sizes by electron microscopy. The agreement between experimental results and a simple numerical model of scattering suggests that increases in stromal keratocyte density after PRK might explain the degree of corneal haze.

Type 2 tracheal agenesis without tracheoesophageal fistula

Tracheal agenesis is a potentially lethal congenital anomaly first described by Payne in 1900. It can occur in isolation or in association with tracheoesophageal (TO) or bronchoesophageal (BO) fistula, cardiovascular anomalies, limb deformities, vertebral anomalies and gastrointestinal tract abnormalities. There are 47 reported cases of tracheal agenesis up to 1989; 45 of these were associated with TO fistula. Another 15 cases of tracheal agenesis have been reported since then, and all have been associated with TO fistula. We report only the third case of type 2 tracheal agenesis without TO fistula.

Factors associated with wrist pain in the young gymnast

We conducted a cross-sectional survey of 52 nonelite gymnasts (32 girls, 20 boys; average age, 11.8 years) to assess their history of training and wrist pain within the last 6 months. An intensity index was created using the number of training hours per week and the athletes' skill levels. Wrist pain was prevalent in 38 (73%) of the gymnasts. Gymnasts with wrist pain were older (12.6 years versus 9.7 years; P = 0.0002), trained more hours per week (13.5 versus 7.7; P = 0.0002), trained at a higher skill level (P = 0.01), and began training at an older age (7.0 years versus 5.1 years; P = 0.006). Analysis of intensity versus age suggested that a threshold of training intensity may be important in the development of wrist pain. Logistical regression found these factors to be independently associated with wrist pain: intensity (P = 0.036), age > 10 years (P = 0.018), age < 14 years (P = 0.016), and the age of initiation of training (P = 0.020). This study demonstrates that wrist pain is a common problem among nonelite young gymnasts. Training intensity, relative to the age of the participant and the age when training was initiated, appears to be an important determinant of the development of wrist pain in this population.

Monochromators: versatile design procedure for specific purposes

A design procedure is described to obtain monochromators for specific applications, which are made from optical devices that can be easily acquired or built. This procedure makes use of a constant angular deviation system consisting of a transmission grating, operating in a symmetrical arrangement, and a flat mirror which makes a fixed angle with it. An analysis of the characteristic parameters of the design and of the constraints which have an effect on them, is presented as well as two examples of applications of the procedure.

Design of aberration-balanced high-efficiency focusing holographic gratings

A volume and phase focusing holographic grating to be used as the principal element of a high-resolution spectrometer has been designed with the aid of a computer. A two-step method was used; first designs were obtained with an aberration-balancing technique, and, in the second step, these early designs are optimized by a ray tracing procedure to obtain aberration-balanced high-efficiency holograms that can be used in highresolution spectroscopy.