PURPOSE OF REVIEW: This article provides an overview of genetic, environmental, and lifestyle risk factors affecting the disease course of multiple sclerosis (MS) and reviews the pathophysiologic characteristics of both relapsing and progressive MS.RECENT FINDINGS: The prevalence of MS has increased in recent decades, and costs of care for patients with MS have risen dramatically. Black, Asian, and Hispanic individuals may be at risk for more severe MS-related disability. Multiple genetic MS risk factors have been identified. Factors such as low vitamin D levels and a history of Epstein-Barr virus, smoking, and obesity, especially during childhood, also influence MS risk. Traditionally thought to be a T-cell-mediated disease, recent research has highlighted the additional roles of B cells and microglia in both relapsing and progressive MS. SUMMARY: Complex interactions between genetic, environmental, and lifestyle factors affect the risk for MS as well as the disease course. People of color have historically been underrepresented in both MS clinical trials and literature, but current research is attempting to better clarify unique considerations in these groups. MS pathology consists of the focal inflammatory lesions that have been well characterized in relapsing MS, as well as a more widespread neurodegenerative component that is posited to drive progressive disease. Recent advances in characterization of both the inflammatory and neurodegenerative aspects of MS pathophysiology have yielded potential targets for future therapeutic options.

The Technicon sequential multiple analysis system was used to measure plasma uric acid, lactate dehydrogenase, chloride, and total protein of 8 week old broilers exposed for 4 weeks and 9 week old broilers exposed for 4 hours to both 18-22°C. and 33-35°C.Broilers exposed for 4 weeks to 18-22°C. had a significant higher (P < 0.05) level of total ". protein than those exposed to 33-35°C. (3.6 vs. 3.3 gm. %). Plasma zinc analyzed by atomic • absorption spectrophotometry was found to be significantly higher (P < 0.05) in the broilers >~ exposed to 18-22°C. for 4 weeks (303 vs. 208 /ig./ml.) Broilers exposed for 4 hours to 33-35°C. had significantly (P < 0.05) higher plasma levels of uric acid (6.7 vs. 5.5 mg. %), lactate dehydrogenase (399 vs. 328 mU./ml.) and chloride (114 vs. Ill meq./L.) than sham treated broilers maintained at 18-22°C. Body temperature was significantly higher (P < 0.01) in the 33-35°C. 4-week exposed broilers than in the birds maintained at 18-22°C. (42 vs. 41°C. mean rectal temperature). In the 33-35°3. 4 hour exposed broilers body temperature was significantly higher (P < 0.05) than in the sham treated broilers (42 vs. 41°C).

Background: Rural people with Multiple Sclerosis (PwMS) face distinctive challenges in the COVID-19 pandemic. The purpose of this study was to determine the COVID-19 vaccine intent and factors associated with vaccine hesitancy among Appalachian adults with MS. Method: We conducted a cross sectional phone and in-person survey of PwMS in a large academic center in West Virginia (WV) from February to May 2021. The study sample consists of 306 adult participants. Results: Among the 306 participants, 104 (33.99%) indicated vaccine hesitancy. Statistically significant factors (p<0.05) associated with vaccine hesitancy compared to those who received or intend to get vaccinated included concerns about vaccine safety, vaccine causing MS relapse, vaccine making MS medication ineffective, vaccine causing other diseases, getting the COVID-19 infection, vaccine fast approval, vaccine ingredients, how well the vaccine works, and its side-effects. Additional factors included prior bad experiences with other vaccines, history of not getting the flu vaccine, and lack of consultation about COVID-19 vaccine with healthcare providers. Conclusions: Vaccine hesitancy among Appalachian adult PwMS is higher compared to PwMS in the larger United States. Vaccine hesitancy is especially higher among those who are female, younger than 50 years old, and residing in rural areas. Concerns about vaccine safety, perception of infection risks, past vaccine behaviors and consultation with healthcare providers are important factors associated with vaccine intent. Factors influencing vaccine hesitancy in Appalachian PwMS are largely consistent with the general public, however, concerns for interaction between the vaccine and MS are specific to this population and thus could be the focus of further vaccine effort.

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