Background: Myelin oligodendrocyte glycoprotein (MOG)-IgG is increasingly detected in children with CNS demyelinating diseases. Due to the clinical overlap in children with CNS demyelination with and without MOG-IgG positivity, identifying distinct characteristics would help early diagnosis. Objective: To compare the specific features that may help differentiate MOG-IgG positive from negative children with CNS demyelinating diseases. To compare characteristics of patients with high and low MOG-IgG titers. Methods: Children with CNS demyelinating disorders with onset before 18 years of age who were tested for MOG-IgG at the University of California San Francisco were included. This retrospective study collected the following by chart review: demographic, clinical, MRI, CSF, and treatment data. Serum was tested for MOG-IgG at Mayo Clinic by live cell-based fluorescent activated cell sorting assay with titer ≥1:20 confirming positivity. Results: We assessed 65 Mog-IgG positive and 65 MOG-IgG negative patients. Median (IQR) age of onset was 7.6 (6.6) years for MOG-IgG positive and 13.8 (5.8) years for MOG-IgG negative (p<0.001). The female to male ratio was approximately 1:1 for the MOG-IgG positive group and 3:1 for the negative group (p=0.042). The most common initial diagnosis was demyelinating disease not otherwise specified (52.3%) in the positive group, compared to relapsing-remitting multiple sclerosis (41.5%) in the negative group (p<0.01). Optic nerve involvement (52.3%) was the most common clinical localization at onset for the MOG-IgG positive group, while brainstem/cerebellar (49.2%) localization predominated in the MOG-IgG negative group. The positive group also presented more often with a severe event at disease onset than the negative group (81.5% vs 60.3%; p< 0.002). MOG-IgG positive children had a lower frequency of oligoclonal bands (15.8% vs 57.4%; p<0.001). The frequency of baseline brain and spinal cord MRI abnormalities were similar in both groups; however, MOG-IgG positive patients more often had T2 hyperintense lesions in the optic nerves (26/43 vs 10/41; p<0.001). Disease-modifying medications were used in 64.6% of MOG-IgG positive patients versus 80% of negative children. Of the 32 positive patients with follow-up titers, seven reverted to negative while two who tested negative initially converted to positive. Positive titers greater than 1:160 were only observed within four months of a clinical event (disease onset or relapse). Patients with high and low MOG-IgG titers were comparable in demographic and clinical characteristics. Conclusion: Despite some clinical overlap, we report notable demographic, MRI and CSF differences between MOG-IgG positive and negative children with CNS demyelinating disorders at disease onset. High MOG-IgG titers were only observed close to a clinical event.
Introduction: Reported clinical outcomes for elderly patients with acute intestinal failure receiving parenteral nutrition (PN) in the acute hospital setting is limited. Our study aims to characterize the use of PN in the elderly and compare clinical outcomes against younger patients. Methods: A retrospective review of inpatients administered PN from 1st January 2019 to 31st December 2019 was performed. Demographics, indications for PN, biochemical results and clinical outcomes were compared. Patients were categorized into < 65 (younger) or ≥ 65 years old (elderly). Results: 235 patients were included. There were 103 patients in the elderly group with a mean age of 73.9 years (± 6.9 years) and 132 patients in the younger group with a mean age of 52.4 years (± 12.5 years). There was a significantly higher Charlson Comorbidity Index and comordities and lower Karnofsky score in the elderly group. Indications for PN were similar between both groups. There was more younger patients who required PN for ≥28 days. The elderly group received a significantly lower total calorie, dextrose and protein compared to the younger group (20.8 (7.8) vs 22.8 (6.3) kcal/kg/day ; 3.1 (1.4) vs 3.6 (1.4) g/kg/day ; 1.1 (0.4) vs 1.2 (0.3) g/kg/day ). Mean length of stay was significantly longer in the younger group than in the elderly group (59.8 (± 55.3 ) vs 35.9 (± 21.3) days). There was no significant difference in clinical outcomes: line sepsis, hypoglycemia, hyperglycemia, fluid overload, inpatient mortality and total mortality between the two groups. Conclusion: The usage of PN in elderly patients with acute intestinal failure was not associated with an increased rate of PN related complications nor worse clinical outcomes when compared with younger patients. and hence should not be denied when appropriate indications are present.
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