Key clinical point: The incidence of trigeminal neuralgia (TN) is 15-fold higher in patients with multiple sclerosis (MS) compared with the general neurological outpatient population.

Major finding: Concomitant diagnoses of MS and TN were verified in 55 patients, giving a prevalence of 2.1% for TN in patients with MS. Patients with MS had a significantly higher incidence of TN vs. general neurological outpatient population (149 vs. 9.9 per 100,000 person-years). A demyelinating lesion in the proximity of the trigeminal ganglia was observed in 26 (63%) of the 41 patients with a concomitant MS diagnosis and with magnetic resonance imaging scans available.

Study details: Single-center retrospective study included 2,575 patients with MS and 2,008 patients with a diagnosis of TN using data from the Finnish MS register.

Disclosures: The presenting author received fee for lecture from Merck; congress expenses from Roche, Merck. Funding for building the Finnish MS registry was received from Biogen Idec, Merck, Novartis, Sanofi-Genzyme, Roche, Teva, and Business Finland.

Citation: Laakso SM et al. Acta Neurol Scand. 2020 Mar 18. doi: 10.1111/ane.13243. 

Key clinical point: The incidence of trigeminal neuralgia (TN) is 15-fold higher in patients with multiple sclerosis (MS) compared with the general neurological outpatient population.

Major finding: Concomitant diagnoses of MS and TN were verified in 55 patients, giving a prevalence of 2.1% for TN in patients with MS. Patients with MS had a significantly higher incidence of TN vs. general neurological outpatient population (149 vs. 9.9 per 100,000 person-years). A demyelinating lesion in the proximity of the trigeminal ganglia was observed in 26 (63%) of the 41 patients with a concomitant MS diagnosis and with magnetic resonance imaging scans available.

Study details: Single-center retrospective study included 2,575 patients with MS and 2,008 patients with a diagnosis of TN using data from the Finnish MS register.

Disclosures: The presenting author received fee for lecture from Merck; congress expenses from Roche, Merck. Funding for building the Finnish MS registry was received from Biogen Idec, Merck, Novartis, Sanofi-Genzyme, Roche, Teva, and Business Finland.

Citation: Laakso SM et al. Acta Neurol Scand. 2020 Mar 18. doi: 10.1111/ane.13243. 

Key clinical point: The incidence of trigeminal neuralgia (TN) is 15-fold higher in patients with multiple sclerosis (MS) compared with the general neurological outpatient population.

Major finding: Concomitant diagnoses of MS and TN were verified in 55 patients, giving a prevalence of 2.1% for TN in patients with MS. Patients with MS had a significantly higher incidence of TN vs. general neurological outpatient population (149 vs. 9.9 per 100,000 person-years). A demyelinating lesion in the proximity of the trigeminal ganglia was observed in 26 (63%) of the 41 patients with a concomitant MS diagnosis and with magnetic resonance imaging scans available.

Study details: Single-center retrospective study included 2,575 patients with MS and 2,008 patients with a diagnosis of TN using data from the Finnish MS register.

Disclosures: The presenting author received fee for lecture from Merck; congress expenses from Roche, Merck. Funding for building the Finnish MS registry was received from Biogen Idec, Merck, Novartis, Sanofi-Genzyme, Roche, Teva, and Business Finland.

Citation: Laakso SM et al. Acta Neurol Scand. 2020 Mar 18. doi: 10.1111/ane.13243. 

Key clinical point: Exposure to passive smoking during adolescence is a strong risk factor for developing multiple sclerosis (MS) in later life.

Major finding: Among never smokers, female patients with MS more often than healthy control participants reported exposure to passive smoking between the age of 10 and 19 years (women: odds ratio [OR], 1.432; P = .037 and men: OR, 1.232; P = .390). Among active smokers aged 19 years or older, male MS patients more often than male control participants reported with passive smoking (men: OR, 1.593; P = .022 and women: OR, 1.102; P = .440).

Study details: The data come from a case-control study of 919 MS cases and 3,419 controls (never active smokers: 342/822 cases/controls; active smokers aged 19 years or older: 577/2,597 cases/controls).

Disclosures: This study was supported by grants from the Danish Multiple Sclerosis Society, the Danish Council for Strategic Research, Novartis, Biogen (Denmark), the Sofus Carl Emil Friis og Hustru Olga Doris Friis foundation, the Foundation for Research in Neurology, and the Director Einar Jonasson (Johnsen) and Wife foundation. Some of the authors reported receiving research support from various pharmaceutical companies.

Citation: Oturai DB et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912500. 

Key clinical point: Exposure to passive smoking during adolescence is a strong risk factor for developing multiple sclerosis (MS) in later life.

Major finding: Among never smokers, female patients with MS more often than healthy control participants reported exposure to passive smoking between the age of 10 and 19 years (women: odds ratio [OR], 1.432; P = .037 and men: OR, 1.232; P = .390). Among active smokers aged 19 years or older, male MS patients more often than male control participants reported with passive smoking (men: OR, 1.593; P = .022 and women: OR, 1.102; P = .440).

Study details: The data come from a case-control study of 919 MS cases and 3,419 controls (never active smokers: 342/822 cases/controls; active smokers aged 19 years or older: 577/2,597 cases/controls).

Disclosures: This study was supported by grants from the Danish Multiple Sclerosis Society, the Danish Council for Strategic Research, Novartis, Biogen (Denmark), the Sofus Carl Emil Friis og Hustru Olga Doris Friis foundation, the Foundation for Research in Neurology, and the Director Einar Jonasson (Johnsen) and Wife foundation. Some of the authors reported receiving research support from various pharmaceutical companies.

Citation: Oturai DB et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912500. 

Key clinical point: Exposure to passive smoking during adolescence is a strong risk factor for developing multiple sclerosis (MS) in later life.

Major finding: Among never smokers, female patients with MS more often than healthy control participants reported exposure to passive smoking between the age of 10 and 19 years (women: odds ratio [OR], 1.432; P = .037 and men: OR, 1.232; P = .390). Among active smokers aged 19 years or older, male MS patients more often than male control participants reported with passive smoking (men: OR, 1.593; P = .022 and women: OR, 1.102; P = .440).

Study details: The data come from a case-control study of 919 MS cases and 3,419 controls (never active smokers: 342/822 cases/controls; active smokers aged 19 years or older: 577/2,597 cases/controls).

Disclosures: This study was supported by grants from the Danish Multiple Sclerosis Society, the Danish Council for Strategic Research, Novartis, Biogen (Denmark), the Sofus Carl Emil Friis og Hustru Olga Doris Friis foundation, the Foundation for Research in Neurology, and the Director Einar Jonasson (Johnsen) and Wife foundation. Some of the authors reported receiving research support from various pharmaceutical companies.

Citation: Oturai DB et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912500. 

Genetic variation plays a greater role in the phenotype of cutaneous psoriasis, compared with psoriatic arthritis or psoriasis vulgaris, according to a study published in Scientific Reports.

Psoriatic disease is known to have a strong genetic basis, but understanding variations in the heritability of different forms of psoriasis is important for research into new genes, risk factors, and potential treatments, wrote Quan Li, PhD, of the faculty of medicine at Memorial University, St. John’s, Nfld., and coauthors.

“Heritability essentially refers to how much variation in a trait is due to variation in genetic factors,” the authors wrote. “Better approximation of the heritability of PsC [cutaneous psoriasis], PsV [psoriasis vulgaris], and PsA [psoriatic arthritis] will culminate in more efficient genetic profiling of psoriatic disease and facilitate gene identification studies by providing more accurate estimates of sample sizes needed based on the heritability of different subsets of psoriatic disease.”

The analysis used data from a previous genome-wide association study that looked at single nucleotide polymorphisms – a variation in the DNA sequence of a particular gene – in 2,938 people with PsV, 1,155 with PsC, 715 with PsA, and 3,117 unaffected controls.

The authors used two different modeling approaches to estimate the contribution these genetic variations made to each condition. These both revealed that PsC had a greater heritability than both PsV and PsA.

“This is the first study to quantify the additive heritability of three subsets of psoriatic disease that is attributable to common susceptibility [single nucleotide polymorphisms] from large-scale genotyping arrays,” the authors wrote.

The authors wrote that this finding differed from other population-based genetic epidemiologic studies, which had pointed to much greater heritability for PsA than for PsV. However, these earlier results could be attributed to common environmental factors.

Given these heritability estimates previously made for PsA, the authors commented on the surprising absence of PsA-specific genes that reach significance in genome-wide association studies.

“This is partly explained by the much larger number of patients in the PsC or PsV [genome-wide association] studies to date, compared with PsA,” they wrote, also suggesting that this may be because of the greater disease heterogeneity seen with PsA, compared with psoriasis.

“Considerably increasing the number of PsA patients in [genome-wide association] studies will help clarify the heritability estimate question for PsA,” they wrote, but acknowledged that lower heritability or greater environmental influence could also be an explanation for this finding.

The study was supported by the Atlantic Innovation Fund. The authors reported having no conflicts of interest.

SOURCE: Li Q et al. Sci Rep. 2020 Mar 18. doi: 10.1038/s41598-020-61981-5

Genetic variation plays a greater role in the phenotype of cutaneous psoriasis, compared with psoriatic arthritis or psoriasis vulgaris, according to a study published in Scientific Reports.

Psoriatic disease is known to have a strong genetic basis, but understanding variations in the heritability of different forms of psoriasis is important for research into new genes, risk factors, and potential treatments, wrote Quan Li, PhD, of the faculty of medicine at Memorial University, St. John’s, Nfld., and coauthors.

“Heritability essentially refers to how much variation in a trait is due to variation in genetic factors,” the authors wrote. “Better approximation of the heritability of PsC [cutaneous psoriasis], PsV [psoriasis vulgaris], and PsA [psoriatic arthritis] will culminate in more efficient genetic profiling of psoriatic disease and facilitate gene identification studies by providing more accurate estimates of sample sizes needed based on the heritability of different subsets of psoriatic disease.”

The analysis used data from a previous genome-wide association study that looked at single nucleotide polymorphisms – a variation in the DNA sequence of a particular gene – in 2,938 people with PsV, 1,155 with PsC, 715 with PsA, and 3,117 unaffected controls.

The authors used two different modeling approaches to estimate the contribution these genetic variations made to each condition. These both revealed that PsC had a greater heritability than both PsV and PsA.

“This is the first study to quantify the additive heritability of three subsets of psoriatic disease that is attributable to common susceptibility [single nucleotide polymorphisms] from large-scale genotyping arrays,” the authors wrote.

The authors wrote that this finding differed from other population-based genetic epidemiologic studies, which had pointed to much greater heritability for PsA than for PsV. However, these earlier results could be attributed to common environmental factors.

Given these heritability estimates previously made for PsA, the authors commented on the surprising absence of PsA-specific genes that reach significance in genome-wide association studies.

“This is partly explained by the much larger number of patients in the PsC or PsV [genome-wide association] studies to date, compared with PsA,” they wrote, also suggesting that this may be because of the greater disease heterogeneity seen with PsA, compared with psoriasis.

“Considerably increasing the number of PsA patients in [genome-wide association] studies will help clarify the heritability estimate question for PsA,” they wrote, but acknowledged that lower heritability or greater environmental influence could also be an explanation for this finding.

The study was supported by the Atlantic Innovation Fund. The authors reported having no conflicts of interest.

SOURCE: Li Q et al. Sci Rep. 2020 Mar 18. doi: 10.1038/s41598-020-61981-5

Genetic variation plays a greater role in the phenotype of cutaneous psoriasis, compared with psoriatic arthritis or psoriasis vulgaris, according to a study published in Scientific Reports.

Psoriatic disease is known to have a strong genetic basis, but understanding variations in the heritability of different forms of psoriasis is important for research into new genes, risk factors, and potential treatments, wrote Quan Li, PhD, of the faculty of medicine at Memorial University, St. John’s, Nfld., and coauthors.

“Heritability essentially refers to how much variation in a trait is due to variation in genetic factors,” the authors wrote. “Better approximation of the heritability of PsC [cutaneous psoriasis], PsV [psoriasis vulgaris], and PsA [psoriatic arthritis] will culminate in more efficient genetic profiling of psoriatic disease and facilitate gene identification studies by providing more accurate estimates of sample sizes needed based on the heritability of different subsets of psoriatic disease.”

The analysis used data from a previous genome-wide association study that looked at single nucleotide polymorphisms – a variation in the DNA sequence of a particular gene – in 2,938 people with PsV, 1,155 with PsC, 715 with PsA, and 3,117 unaffected controls.

The authors used two different modeling approaches to estimate the contribution these genetic variations made to each condition. These both revealed that PsC had a greater heritability than both PsV and PsA.

“This is the first study to quantify the additive heritability of three subsets of psoriatic disease that is attributable to common susceptibility [single nucleotide polymorphisms] from large-scale genotyping arrays,” the authors wrote.

The authors wrote that this finding differed from other population-based genetic epidemiologic studies, which had pointed to much greater heritability for PsA than for PsV. However, these earlier results could be attributed to common environmental factors.

Given these heritability estimates previously made for PsA, the authors commented on the surprising absence of PsA-specific genes that reach significance in genome-wide association studies.

“This is partly explained by the much larger number of patients in the PsC or PsV [genome-wide association] studies to date, compared with PsA,” they wrote, also suggesting that this may be because of the greater disease heterogeneity seen with PsA, compared with psoriasis.

“Considerably increasing the number of PsA patients in [genome-wide association] studies will help clarify the heritability estimate question for PsA,” they wrote, but acknowledged that lower heritability or greater environmental influence could also be an explanation for this finding.

The study was supported by the Atlantic Innovation Fund. The authors reported having no conflicts of interest.

SOURCE: Li Q et al. Sci Rep. 2020 Mar 18. doi: 10.1038/s41598-020-61981-5

Key clinical point: Physical exercise significantly reduces fatigue in patients with multiple sclerosis (MS).

Major finding: The standardized mean difference between the intervention groups before and after the intervention was estimated to be 23.8±6.2 and 16.9±3.2, respectively.

Study details: Meta-analysis of 31 studies including 1,434 participants (714 in the intervention group; 720 in the control group).

Disclosures: This study was funded by the Student Research Committee of Kermanshah University of Medical Sciences, Deputy for Research and Technology, Kermanshah University of Medical Sciences. The authors declared no conflict of interest.

Citation: Razazian N et al. BMC Neurol. 2020 Mar 13. doi: 10.1186/s12883-020-01654-y. 

Key clinical point: Physical exercise significantly reduces fatigue in patients with multiple sclerosis (MS).

Major finding: The standardized mean difference between the intervention groups before and after the intervention was estimated to be 23.8±6.2 and 16.9±3.2, respectively.

Study details: Meta-analysis of 31 studies including 1,434 participants (714 in the intervention group; 720 in the control group).

Disclosures: This study was funded by the Student Research Committee of Kermanshah University of Medical Sciences, Deputy for Research and Technology, Kermanshah University of Medical Sciences. The authors declared no conflict of interest.

Citation: Razazian N et al. BMC Neurol. 2020 Mar 13. doi: 10.1186/s12883-020-01654-y. 

Key clinical point: Physical exercise significantly reduces fatigue in patients with multiple sclerosis (MS).

Major finding: The standardized mean difference between the intervention groups before and after the intervention was estimated to be 23.8±6.2 and 16.9±3.2, respectively.

Study details: Meta-analysis of 31 studies including 1,434 participants (714 in the intervention group; 720 in the control group).

Disclosures: This study was funded by the Student Research Committee of Kermanshah University of Medical Sciences, Deputy for Research and Technology, Kermanshah University of Medical Sciences. The authors declared no conflict of interest.

Citation: Razazian N et al. BMC Neurol. 2020 Mar 13. doi: 10.1186/s12883-020-01654-y. 

Key clinical point: In patients with relapsing-remitting multiple sclerosis (RRMS), both fingolimod (FIN) and natalizumab (NTZ) reduce the annualized relapse rate (ARR), but ARR percent reduction is significantly higher with NTZ after 12 months of treatment.

Major finding: ARR reduction during the first year of treatment was statistically significant in both the groups, from 1.67±0.98 to 0.28±0.62 in the FIN group and from 1.71±1.37 to 0.12±0.33 in the NTZ group (P less than .0001 for both). Nevertheless, the ARR percent reduction was significantly higher in the NTZ group vs. FIN group during the first year of treatment (92.3% vs. 81.8%; P = .0064).

Study details: Retrospective, observational study compared the ARR over the first year in 314 patients with RRMS after the treatment with FIN (n = 184) or NTZ (n = 130) as a second-line therapy in routine clinical practice in Spain.

Disclosures: This study was funding by Novartis Farmaceutica, S.A. The authors declared no conflicts of interest.

Citation: Meca-Lallana J et al. Eur Neurol. 2020 Mar 18. doi: 10.1159/000505778. 

Key clinical point: In patients with relapsing-remitting multiple sclerosis (RRMS), both fingolimod (FIN) and natalizumab (NTZ) reduce the annualized relapse rate (ARR), but ARR percent reduction is significantly higher with NTZ after 12 months of treatment.

Major finding: ARR reduction during the first year of treatment was statistically significant in both the groups, from 1.67±0.98 to 0.28±0.62 in the FIN group and from 1.71±1.37 to 0.12±0.33 in the NTZ group (P less than .0001 for both). Nevertheless, the ARR percent reduction was significantly higher in the NTZ group vs. FIN group during the first year of treatment (92.3% vs. 81.8%; P = .0064).

Study details: Retrospective, observational study compared the ARR over the first year in 314 patients with RRMS after the treatment with FIN (n = 184) or NTZ (n = 130) as a second-line therapy in routine clinical practice in Spain.

Disclosures: This study was funding by Novartis Farmaceutica, S.A. The authors declared no conflicts of interest.

Citation: Meca-Lallana J et al. Eur Neurol. 2020 Mar 18. doi: 10.1159/000505778. 

Key clinical point: In patients with relapsing-remitting multiple sclerosis (RRMS), both fingolimod (FIN) and natalizumab (NTZ) reduce the annualized relapse rate (ARR), but ARR percent reduction is significantly higher with NTZ after 12 months of treatment.

Major finding: ARR reduction during the first year of treatment was statistically significant in both the groups, from 1.67±0.98 to 0.28±0.62 in the FIN group and from 1.71±1.37 to 0.12±0.33 in the NTZ group (P less than .0001 for both). Nevertheless, the ARR percent reduction was significantly higher in the NTZ group vs. FIN group during the first year of treatment (92.3% vs. 81.8%; P = .0064).

Study details: Retrospective, observational study compared the ARR over the first year in 314 patients with RRMS after the treatment with FIN (n = 184) or NTZ (n = 130) as a second-line therapy in routine clinical practice in Spain.

Disclosures: This study was funding by Novartis Farmaceutica, S.A. The authors declared no conflicts of interest.

Citation: Meca-Lallana J et al. Eur Neurol. 2020 Mar 18. doi: 10.1159/000505778. 

In the wake of the 2012 shooting at Sandy Hook Elementary, in Newtown, Conn., after 20 children and seven adults were murdered, American gun sales surged on fears of new restrictions.

Bytmonas/ThinkStock

In the ensuing months, 20 more children and 40 more adults died from unintentional shootings believed to be tied to that surge in gun purchases.¹ More recently, American gun sales surged in response to the COVID-19 pandemic with heated legal battles brewing over whether gun sales are essential.^2,3 The results of this surge in sales are yet to fully manifest, but I would like to discuss several risks.

The public health risks of firearm access are well established: Nearly every measure of harm, from suicide to negligent injury and death to homicide to shootings of police, increase along with access to firearms.⁴ That firearms in the home are associated with greater likelihoods of suicide, negligent injury and death, and intrafamilial homicide has been recognized for decades as has the substantially heightened risk in the immediate period after a firearm is brought into the home.^5,6 Defensive gun use is rare despite this being the nominal reason for firearm ownership among many.⁷ Even prior to recent events, there had been concerns of increased unsafe carrying and handling of firearms.⁸ It seems reasonable to expect such trends not to be diminished by recent events.

Added to this are several stressors, which one can reasonably expect to be associated with increased risks for unsafe use. There are new, broad social stressors from fear and uncertainty about COVID-19. Unemployment rates have skyrocketed, clinical care has been disrupted, and basic necessities have become scant. Children are home from school, unable to play with friends and unable to access mental health services as easily as before; risks of negligent and suicidal injuries and death may ensue. Couples and families are isolated in homes together for longer periods and with fewer avenues for relief; previously peaceful homes may see conflicts increase and homes with abuse have now trapped victims with their assailants. Social isolation is difficult for any person and may be even more traumatic for people with underlying vulnerabilities, including mental illness. The risks of being isolated in a home – struggling with worsening symptoms – with ready access to a firearm are self-evident.

For mental health professionals in our current situation, I would like to offer several practical ways we can intervene with patients and clients who might own firearms.

• Consider reassessing for firearm access. Patients may be in new homes, or there may be new firearms in their homes. Use gentle assumptions and focus on home access over personal access to elicit the most true, positive answers, for example: “I understand there have been a lot of changes recently; how many guns are in the home now?”
• Reinforce safer storage practices. Simple measures, such as storing ammunition separately and using trigger locks or safes, can make a substantial difference in injury risks.
• Do not forget aging clients; suicide risk increases with age, and there may be substantial risks among the geriatric population for suicide and murder-suicide. If using telepsychiatry, realize that the abuser might be in the home or within earshot of any clinical encounter, and this might put the client at heightened risk, during and after telesessions.
• Highlight access to local and national resources, including the Disaster Distress Hotline (800-985-5990) and the National Suicide Prevention Lifeline (800-273-TALK). Promote both numbers, and note that some people may be more comfortable reaching out for help for “distress” than for “suicide.”

References

1. Levine PB and McKnight R. Science. 2017 Dec 8;358(6368):1324-8.

2. Levin D. “Coronavirus and firearms: Are gun shops essential businesses?” The New York Times. 2020 Mar 25.

3. Robertson L. “Neither hurricanes nor 9/11 caused as big a surge in gun sales as coronavirus.” Miami Herald. 2020 Mar 25.

4. Moyer MW. Scientific American. 2017 Oct;317(4):54-63.

5. Kellermann AL et al. J Trauma. 1998 Aug;45(2):263-7.

6. Wintemute GJ et al. New Engl J Med. 1999 Nov 18;341(21):1583-9.

7. Firearm Justifiable Homicides and Non-Fatal Self-Defense Gun Use: An Analysis of Federal Bureau of Investigation and National Crime Victimization Survey Data. Washington: Violence Policy Center; 2019 Jul.

8. Towers S et al. bioRxiv. 2019 Apr 18;613687.
 

Dr. Rozel is the medical director of resolve Crisis Services at UPMC Western Psychiatric Hospital and president of the American Association for Emergency Psychiatry. He also is associate professor of psychiatry and an adjunct professor of law at the University of Pittsburgh. He has no conflicts of interest but has worked for a gun dealer to teach sales staff how to recognize people in crisis (rather than sell a gun).

In the wake of the 2012 shooting at Sandy Hook Elementary, in Newtown, Conn., after 20 children and seven adults were murdered, American gun sales surged on fears of new restrictions.

Bytmonas/ThinkStock

In the ensuing months, 20 more children and 40 more adults died from unintentional shootings believed to be tied to that surge in gun purchases.¹ More recently, American gun sales surged in response to the COVID-19 pandemic with heated legal battles brewing over whether gun sales are essential.^2,3 The results of this surge in sales are yet to fully manifest, but I would like to discuss several risks.

The public health risks of firearm access are well established: Nearly every measure of harm, from suicide to negligent injury and death to homicide to shootings of police, increase along with access to firearms.⁴ That firearms in the home are associated with greater likelihoods of suicide, negligent injury and death, and intrafamilial homicide has been recognized for decades as has the substantially heightened risk in the immediate period after a firearm is brought into the home.^5,6 Defensive gun use is rare despite this being the nominal reason for firearm ownership among many.⁷ Even prior to recent events, there had been concerns of increased unsafe carrying and handling of firearms.⁸ It seems reasonable to expect such trends not to be diminished by recent events.

Added to this are several stressors, which one can reasonably expect to be associated with increased risks for unsafe use. There are new, broad social stressors from fear and uncertainty about COVID-19. Unemployment rates have skyrocketed, clinical care has been disrupted, and basic necessities have become scant. Children are home from school, unable to play with friends and unable to access mental health services as easily as before; risks of negligent and suicidal injuries and death may ensue. Couples and families are isolated in homes together for longer periods and with fewer avenues for relief; previously peaceful homes may see conflicts increase and homes with abuse have now trapped victims with their assailants. Social isolation is difficult for any person and may be even more traumatic for people with underlying vulnerabilities, including mental illness. The risks of being isolated in a home – struggling with worsening symptoms – with ready access to a firearm are self-evident.

For mental health professionals in our current situation, I would like to offer several practical ways we can intervene with patients and clients who might own firearms.

• Consider reassessing for firearm access. Patients may be in new homes, or there may be new firearms in their homes. Use gentle assumptions and focus on home access over personal access to elicit the most true, positive answers, for example: “I understand there have been a lot of changes recently; how many guns are in the home now?”
• Reinforce safer storage practices. Simple measures, such as storing ammunition separately and using trigger locks or safes, can make a substantial difference in injury risks.
• Do not forget aging clients; suicide risk increases with age, and there may be substantial risks among the geriatric population for suicide and murder-suicide. If using telepsychiatry, realize that the abuser might be in the home or within earshot of any clinical encounter, and this might put the client at heightened risk, during and after telesessions.
• Highlight access to local and national resources, including the Disaster Distress Hotline (800-985-5990) and the National Suicide Prevention Lifeline (800-273-TALK). Promote both numbers, and note that some people may be more comfortable reaching out for help for “distress” than for “suicide.”

References

1. Levine PB and McKnight R. Science. 2017 Dec 8;358(6368):1324-8.

2. Levin D. “Coronavirus and firearms: Are gun shops essential businesses?” The New York Times. 2020 Mar 25.

3. Robertson L. “Neither hurricanes nor 9/11 caused as big a surge in gun sales as coronavirus.” Miami Herald. 2020 Mar 25.

4. Moyer MW. Scientific American. 2017 Oct;317(4):54-63.

5. Kellermann AL et al. J Trauma. 1998 Aug;45(2):263-7.

6. Wintemute GJ et al. New Engl J Med. 1999 Nov 18;341(21):1583-9.

7. Firearm Justifiable Homicides and Non-Fatal Self-Defense Gun Use: An Analysis of Federal Bureau of Investigation and National Crime Victimization Survey Data. Washington: Violence Policy Center; 2019 Jul.

8. Towers S et al. bioRxiv. 2019 Apr 18;613687.
 

Dr. Rozel is the medical director of resolve Crisis Services at UPMC Western Psychiatric Hospital and president of the American Association for Emergency Psychiatry. He also is associate professor of psychiatry and an adjunct professor of law at the University of Pittsburgh. He has no conflicts of interest but has worked for a gun dealer to teach sales staff how to recognize people in crisis (rather than sell a gun).

In the wake of the 2012 shooting at Sandy Hook Elementary, in Newtown, Conn., after 20 children and seven adults were murdered, American gun sales surged on fears of new restrictions.

Bytmonas/ThinkStock

In the ensuing months, 20 more children and 40 more adults died from unintentional shootings believed to be tied to that surge in gun purchases.¹ More recently, American gun sales surged in response to the COVID-19 pandemic with heated legal battles brewing over whether gun sales are essential.^2,3 The results of this surge in sales are yet to fully manifest, but I would like to discuss several risks.

The public health risks of firearm access are well established: Nearly every measure of harm, from suicide to negligent injury and death to homicide to shootings of police, increase along with access to firearms.⁴ That firearms in the home are associated with greater likelihoods of suicide, negligent injury and death, and intrafamilial homicide has been recognized for decades as has the substantially heightened risk in the immediate period after a firearm is brought into the home.^5,6 Defensive gun use is rare despite this being the nominal reason for firearm ownership among many.⁷ Even prior to recent events, there had been concerns of increased unsafe carrying and handling of firearms.⁸ It seems reasonable to expect such trends not to be diminished by recent events.

Added to this are several stressors, which one can reasonably expect to be associated with increased risks for unsafe use. There are new, broad social stressors from fear and uncertainty about COVID-19. Unemployment rates have skyrocketed, clinical care has been disrupted, and basic necessities have become scant. Children are home from school, unable to play with friends and unable to access mental health services as easily as before; risks of negligent and suicidal injuries and death may ensue. Couples and families are isolated in homes together for longer periods and with fewer avenues for relief; previously peaceful homes may see conflicts increase and homes with abuse have now trapped victims with their assailants. Social isolation is difficult for any person and may be even more traumatic for people with underlying vulnerabilities, including mental illness. The risks of being isolated in a home – struggling with worsening symptoms – with ready access to a firearm are self-evident.

For mental health professionals in our current situation, I would like to offer several practical ways we can intervene with patients and clients who might own firearms.

• Consider reassessing for firearm access. Patients may be in new homes, or there may be new firearms in their homes. Use gentle assumptions and focus on home access over personal access to elicit the most true, positive answers, for example: “I understand there have been a lot of changes recently; how many guns are in the home now?”
• Reinforce safer storage practices. Simple measures, such as storing ammunition separately and using trigger locks or safes, can make a substantial difference in injury risks.
• Do not forget aging clients; suicide risk increases with age, and there may be substantial risks among the geriatric population for suicide and murder-suicide. If using telepsychiatry, realize that the abuser might be in the home or within earshot of any clinical encounter, and this might put the client at heightened risk, during and after telesessions.
• Highlight access to local and national resources, including the Disaster Distress Hotline (800-985-5990) and the National Suicide Prevention Lifeline (800-273-TALK). Promote both numbers, and note that some people may be more comfortable reaching out for help for “distress” than for “suicide.”

References

1. Levine PB and McKnight R. Science. 2017 Dec 8;358(6368):1324-8.

2. Levin D. “Coronavirus and firearms: Are gun shops essential businesses?” The New York Times. 2020 Mar 25.

3. Robertson L. “Neither hurricanes nor 9/11 caused as big a surge in gun sales as coronavirus.” Miami Herald. 2020 Mar 25.

4. Moyer MW. Scientific American. 2017 Oct;317(4):54-63.

5. Kellermann AL et al. J Trauma. 1998 Aug;45(2):263-7.

6. Wintemute GJ et al. New Engl J Med. 1999 Nov 18;341(21):1583-9.

7. Firearm Justifiable Homicides and Non-Fatal Self-Defense Gun Use: An Analysis of Federal Bureau of Investigation and National Crime Victimization Survey Data. Washington: Violence Policy Center; 2019 Jul.

8. Towers S et al. bioRxiv. 2019 Apr 18;613687.
 

Dr. Rozel is the medical director of resolve Crisis Services at UPMC Western Psychiatric Hospital and president of the American Association for Emergency Psychiatry. He also is associate professor of psychiatry and an adjunct professor of law at the University of Pittsburgh. He has no conflicts of interest but has worked for a gun dealer to teach sales staff how to recognize people in crisis (rather than sell a gun).

Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.