Unmasking disparities: the challenge of diversity, equity, and inclusion in Press Ganey surveys.

Data on minority group physicians from diverse racial/ethnic backgrounds is sparse and not reported by PG metrics at the national level. While PG metrics typically concentrate on the individual, patterns and trends are clearly discernible at the group level and comparison of groups to capture patterns may yield results hitherto unknown. One could even envisage using AI to capture any trends, differences, and comparative figures to build databases for the future. It is time to retool PG surveys to fit the modern U.S. healthcare workforce and be inclusive, and not selective at the individual level.

VAERS-reported new-onset seizures following use of COVID-19 vaccinations as compared to influenza vaccinations.

The incidence of new-onset seizures, which we defined as de novo seizures occurring within 4 weeks of receiving any of the US Food and Drug Administration-approved COVID-19 vaccinations as reported in patient-reported data compiled in the US Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System Data (CDC VAERS), has not been explored. The VAERS database contains de-identified patient-reported adverse events following vaccination and represents post-marketing surveillance and analysis of vaccine safety. After adjusting for time at risk, this resulted in estimated incidence rates of 3.19 seizures per 100 000 persons per year for the COVID-19 vaccine and 0.090 seizures per 100 000 persons per year for the influenza vaccines. A data-driven, individualized dataset that is comprehensive and coupled with a longitudinal follow-up in larger numbers of vaccinated individuals is needed to expand on our preliminary findings of vaccine-related seizures.

Pivotal clinical trial enrollment of Blacks in multiple sclerosis or neuromyelitis spectrum disorder: when will we achieve parity?

Patient enrollment in people of color among pivotal trials for multiple sclerosis (MS) and neuromyelitis spectrum disorder (NMOSD) continues to be dismal. It is disappointing that no clinical trial sponsored by a pharmaceutical industry or otherwise, investigating any of the disease-modifying drugs, has tackled this glaring inequity head on. The disease characteristics and phenotype of MS or NMOSD among Blacks and Hispanics are typically aggressive and for this reason alone, if not for any other metric, there needs to a radical shift in allotment of funds devoted to promoting drug research in minority populations.

Use of anti-TNF-α therapy in Crohn's disease is associated with increased incidence of multiple sclerosis.

OBJECTIVE: We investigated if anti-tumor necrosis factor-α (anti-TNF-α) drugs used in the treatment of inflammatory bowel disease (IBD) alter the incidence of MS and if so, to understand the magnitude of such an effect. METHODS: This is a retrospective cohort study of data from Truven Health Market Scan administrative claims database. The patients included in the study had to be ≥ 18 years of age. The presence of IBD was based on at least 2 claims of International Classification of Diseases (ICD-9 or 10) diagnosis codes. The IBD diagnosis index date had to precede the MS diagnosis index date for inclusion in the study. The diagnosis of multiple sclerosis (MS) was defined as having at least 2 claims for the disease (ICD 9, 340 and ICD 10 codes, G35) and at least one prescription claim for any of the drugs that were defined as MS therapy. RESULTS: Patients with IBD had 1.32 times the risk of MS incidence compared to healthy controls (adjusted incidence rate ratio (IRR): 1.32; 95% CI: 1.03 - 1.71; p = .0312). Patients with IBD exposed to anti-TNF-α therapies had a 43% increase in the incidence of MS compared to those with IBD without exposure (adjusted incidence rate: 1.43; 95% CI: .062 - 3.32; p = .3989). Among CD patients treated anti-TNF-α medications an increase in the incidence of MS, compared to CD patients not exposed to such medications was observed (IRR = 2.62; 95% CI: 1.00 to 6.83; p = 0.049), statistically significant. After adjusting for age/gender, patients with CD using anti-TNF-α agents had an increase of incidence in MS (adjusted IRR: 2.24; 95% CI: 0.85 - 5.94; p = .1035) but it was not statistically significant. CONCLUSIONS: Use of anti-TNF-α drugs in CD was associated with a statistically significant increase in the incidence of MS but this effect was lost when controlled for age/gender.

Radiologically isolated syndrome is antiquated amidst evolving McDonald criteria for multiple sclerosis.

The diagnosis of radiologically isolated syndrome (RIS) is untenable in the modern era as new diagnostic criteria for multiple sclerosis (MS) continue to evolve. Even without optic nerve involvement, the shift in the diagnostic criteria for MS forces clinicians to make a diagnosis at the earliest possible time and appropriate treatment initiated. In this analysis, we revisit the original RIS criteria as published and conclude that RIS as a diagnostic entity is obsolete.

Anti-MOG and Anti-AQP4 positive neuromyelitis optica spectrum disorder in a patient with myasthenia gravis.

Aquaporin 4 antibody (anti-AQP4) positive neuromyelitis optica spectrum disorder (NMOSD) is known to occur in the setting of myasthenia gravis (MG). However, comorbid MG with myelin oligodendrocyte glycoprotein antibody (anti-MOG) positive NMOSD has not been reported. We present a case of anti-MOG and anti-AQP4 positive NMOSD in a patient with long-standing MG. The patient presented with acute right-sided weakness with MRI demonstrating extensive spinal cord edema extending from T2 to the medulla with associated contrast enhancement. To our knowledge, this is the first reported case of anti-MOG and anti-AQP4 positive NMOSD in a patient with known MG.

Can a diagnosis of multiple sclerosis be made without ruling out neuromyelitis optica spectrum disorder ?

BACKGROUND: The symptoms of multiple sclerosis (MS) can overlap with neuromyelitis optica spectrum disorder (NMOSD). Although testing is available for aquaporin 4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, screening for NMOSD is recommended but not mandatory to establish a diagnosis of MS. METHODS AND RESULTS: We queried 319,994 individuals who filed claims for MS and NMOSD in a Truven Health Analytics (THA) database and had at least one year of uninterrupted health insurance coverage. Of this cohort, 2001 (0.62%) were diagnosed as having NMOSD after an initial diagnosis of MS, based on ICD 9/10 codes. Since THA only offers claims-based data, we initiated an individual patient-based data search at our medical center to screen for potential misdiagnoses. We identified 4/54 (7.4%) NMOSD cases that were initially diagnosed as having MS. CONCLUSIONS: The results from our small study have significant implications--symptoms, clinical presentation or classic radiological findings perhaps cannot reliably separate MS from NMOSD. If our study findings can be replicated, guidelines to diagnose MS ought to recommend that NMOSD be excluded first despite typical clinical and radiological findings pointing to MS.

FDA-approved drugs for multiple sclerosis have no efficacy or disability data in non-Caucasian patients.

Pharmacotherapy of multiple sclerosis (MS) is evolving rapidly. Despite impressive gains over the past 2 decades in the approval of multiple drugs for MS, lack of recruitment of minorities with MS in phase 3 clinical studies is a persistent concern and skews efficacy and disability data.

Can Aspirin Minimize Stroke Risk and New Lesion Formation in Multiple Sclerosis?

Even with increasing data implicating the venous side of the vascular tree of the brain in MS, no diagnostic or treatment protocol has addressed the risk of acute stroke in MS and no systematic study has documented the incidence or prevalence of acute strokein MS patients. Approximately 795,000 strokes occur in the U.S. each year-every 40 s, someone has a stroke and every 4 min, a person dies from a stroke. However, no large, prospective, multi-center study has investigated acute stroke incidence in MS patients either in the U.S. or internationally, leaving a gap in our understanding of the association between stroke and MS. Additionally, data on acute stroke in MS as determined by age, gender or ethnicity are unknown. To compound this further, the diagnosis and definition of acute stroke in MS remains poorly understood. A survey of published literature shows a few anecdotal reports of acute stroke occurring among MS patients, but most studies do not address the fundamental association between acute stroke and MS. Symptoms of acute stroke and MS can overlap and the lack of clear clinical/radiological criteria that alert the patient or clinician to the development of acute stroke in an MS patient compound the dilemma, even leading to the administration of IV alteplase in cases that are later diagnosed as either MS or having an "MS flare." Clinical trials that use aspirin in multiple sclerosis are urgently needed.