Background: Multiple sclerosis (MS) is a complex autoimmune disease with a heterogeneous presentation and diverse disease course. Recent studies indicate a rising prevalence of MS in the Middle East. Objective: To characterize the demographics and disease features of Egyptian patients attending four tertiary referral MS centers in Cairo. Materials and methods: This was a retrospective, observational study on 1,581 patients between 2001 and 2015. Medical records were reviewed and data were identified and extracted in a standardized electronic registry. Results: The mean age of disease onset was 26.6±7.8 years, with the majority being female (2.11:1). Relapsing–remitting MS was the most common type (75.1%). The main presenting symptom was motor weakness (43.9%), which was also the most frequent symptom during the disease course. Family history of MS was found in 2.28%. Higher initial Expanded Disability Status Scale score, black holes, and infratentorial lesions on initial magnetic resonance imaging were independent factors for disease progression by univariate analysis (OR 3.87 [95% CI 1.84–6.51], 4.14 [95% CI 3.08–5.58], 4.07 [95% CI 3.21–4.99], respectively); however, in multivariate analysis, only infratentorial lesions were an independent risk for disease progression (OR 6, 95% CI 2.99–12.02; P=0.0005). Conclusion: The results from this registry – the largest for MS in the Arab region to date – are comparable to other registries with slight differences.

Background: Inflammatory mechanisms and immune activation have been hypothesized to play a role in the pathogenesis of age-associated diseases, including Alzheimer’s disease. Purpose: The evaluation of inflammatory markers in patients with dementia, and to determine whether these markers can be used to differentiate between vascular dementia (VD) and Alzheimer’s dementia (AD). Patients and Methods: Twenty demented patients (10 AD and 10 VD) and 20 non-demented controls were subjected to clinical evaluation, MRI brain scans and laboratory tests, including interleukin (IL) 6, C-reactive protein and serum protein electrophoresis. Results: The results of this study revealed that serum levels of IL-6 and C-reactive protein were significantly elevated among patients with both types of dementia compared to normal elderly subjects. Although the mean IL-6 level was higher in patients with AD compared to patients with VD, this difference was not significant. The cutoff value at which the serum level of IL-6 gave maximum sensitivity and specificity was 14.25 pg/ml. Moreover, α1- and α2-globulins were able to discriminate between AD and VD (being significantly higher in AD). Conclusion: IL-6 levels could be used to differentiate dementia from normal aging. Moreover, α1- and α2-globulins could differentiate between AD and VD. It can be concluded that inflammation plays an important role in both types of dementia.

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient’s immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.