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1.
Int. j. morphol ; 41(2): 417-422, abr. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1440301

ABSTRACT

SUMMARY: The corpus callosum (CC) includes the majority of fibers linking the two brain hemispheres. Several cross sectional studies showed an association between callosal atrophy and malfunction and neurodegenerative diseases, which may play a role in their pathological manifestations. As a result, the accurate quantification of the corpus callosum is important to have normative values according to sex, age and ethnicity. The purpose of this study is to determine the size of CC in patients suffering from multiple sclerosis, and compare it to CC size in healthyindividuals. Midsagittal size of CC were recorded prospectively from 404 routine MR brain examinations in normal individuals. The internal skull surface was measured to calculate CC/ internal skull surface ratio. Two groups of patients were studied: 200 (100 male /100 female) healthy individuals and 204 (101 males/103 females) with multiple sclerosis (MS). Mean surface area of CC in controls was 6.58±1.04 cm2 and there was no significant difference between males and females (P< 0.627). CC/ internal skull surface ratio was 4.44±0.77 %. MS patients showed a significant decrease in CC size compared to normal controls. Using MR imaging, we measured the mean sizes of the various portions of the CC in normal individuals, in addition to MS patients; these values may provide a useful basis to determine changes occurring in CC structures.


El cuerpo calloso (CC) incluye la mayoría de las fibras que unen los dos hemisferios cerebrales. Varios estudios transversales mostraron una asociación entre la atrofia y el mal funcionamiento calloso y las enfermedades neurodegenerativas, lo que puede desempeñar un papel en sus manifestaciones patológicas. En consecuencia, la cuantificación precisa del cuerpo calloso es importante para tener valores normativos según sexo, edad y etnia. El propósito de este estudio fue determinar el tamaño de CC en pacientes que padecen esclerosis múltiple y compararlo con el tamaño de CC en individuos sanos. El tamaño sagital medio del CC se registró prospectivamente a partir de 404 exámenes cerebrales de RM de rutina en individuos normales. Se midió la superficie interna del cráneo para calcular la relación CC/superficie interna del cráneo. Se estudiaron dos grupos de pacientes: 200 (100 hombres/100 mujeres) sanos y 204 (101 hombres/103 mujeres) con esclerosis múltiple (EM). El área superficial media de CC en los controles fue de 6,58±1,04 cm2 y no hubo diferencia significativa entre hombres y mujeres (P< 0,627). La relación CC/superficie interna del cráneo fue de 4,44±0,77 %. Los pacientes con EM mostraron una disminución significativa en el tamaño de CC en comparación con los controles normales. Usando imágenes de RM, medimos los tamaños medios de las diversas porciones del CC en individuos normales, además de pacientes con EM; estos valores pueden proporcionar una base útil para determinar los cambios que ocurren en las estructuras CC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Corpus Callosum/pathology , Corpus Callosum/diagnostic imaging , Multiple Sclerosis/pathology , Multiple Sclerosis/diagnostic imaging , Magnetic Resonance Imaging , Retrospective Studies
2.
J. bras. econ. saúde (Impr.) ; 15(1): 12-23, Abril/2023.
Article in English, Portuguese | LILACS, ECOS | ID: biblio-1437861

ABSTRACT

Objetivo: Compreender o cenário da esclerose múltipla (EM) em relação aos aspectos epidemiológicos, diagnósticos, progressão, tratamento e comorbidades no sistema público brasileiro. Métodos: Trata-se de um estudo retrospectivo e observacional utilizando os sistemas de dados do Departamento de Informática do Sistema Único de Saúde (DataSUS). Os dados utilizados foram obtidos por meio da base de dados do Sistema Ambulatorial/Sistema de Procedimentos de Alta Complexidade (SIA/SUS). Nessa base, o vínculo de registros foi por meio do Cadastro Nacional de Saúde (CNS). Para a quantificação de dados epidemiológicos, foram coletados os dados do Código de Endereçamento Postal (CEP), sexo e data de nascimento, além das bases de geolocalização dos pacientes. Considerou-se como desfecho primário a descrição epidemiológica da população de pacientes em uso ou que usaram MMCD para o tratamento da EM. Como desfecho secundário, consideraram-se as características dos pacientes (gênero, idade, idade ao diagnóstico e comorbidades). Resultados: Foram incluídos na análise 45.011 pacientes. Identificou-se predominância de pacientes do gênero feminino (72,9%) e com idade entre 31 e 60 anos (61,23%) diagnosticados com CID G35 no primeiro registro. A taxa de incidência de pacientes com EM foi maior (2,7 pacientes/100 mil habitantes) na região Sudeste, seguida pela região Sul (2,2 pacientes/100 mil). A prevalência na região Sul teve a maior taxa (18 pacientes/100 mil), seguida pelo Sudeste (16,7 pacientes/100 mil). As betainterferonas e o acetato de glatirâmer foram os medicamentos mais utilizados no primeiro tratamento. O acetato de glatirâmer foi o mais utilizado para o segundo tratamento no período de 2011 até 2017. Em 2018, os MMCD mais utilizados como segundo tratamento foram fingolimode e natalizumabe. A partir de 2019, fingolimode, fumarato de dimetila e natalizumabe foram os medicamentos mais utilizados como segundo tratamento, permanecendo nessa ordem até 2021. Para o terceiro tratamento, o natalizumabe foi o medicamento mais utilizado até 2017. Após esse período, o fingolimode passou a ser mais usado. Desde 2019, com o acesso ao fumarato de dimetila, os medicamentos mais prescritos foram, em ordem decrescente, fingolimode, natalizumabe e fumarato de dimetila. Conclusão: Estabelecer uma análise epidemiológica dos pacientes que usam MMCD para o tratamento da EM no Brasil, além do padrão de tratamento, são dados essenciais para a promoção do tratamento da EM de forma adequada, bem como para a implementação de políticas públicas locais, regionais e nacionais.


Objective: To understand the multiple sclerosis (MS) setting in relation to epidemiological aspects, diagnoses, progression, treatment and comorbidities in the Brazilian public system. Methods: This is a retrospective, observational study using the Unified Health System's Informatics Department [Departamento de Informática do Sistema Único de Saúde] data systems (DataSUS). The data used were obtained by means of the outpatient system/high-complexity procedure system (SIA/SUS) database. In this database, the association of entries was via the National Health Registration [Cadastro Nacional de Saúde] (CNS). For epidemiological data quantification, Zip Code, sex and date of birth information was collected, as well as data from patient geolocation databases. The epidemiological description of the patient population using or having used DMTs for MS treatment was considered as the primary endpoint. Patient characteristics (gender, age, age at diagnosis and comorbidities) were considered as the secondary endpoint. Results: 45,011 patients were included in the analysis. A predominance of female patients (72.9%) aged between 31 and 60 years (61.23%) and diagnosed with ICD code G35 in the first entry was identified. The incidence rate of patients with MS was higher (2.7 patients/100 thousand inhabitants) in the Southeast region, followed by the South region (2.2 patients/100 thousand). Prevalence in the South region had the highest rate (18 patients/100 thousand), followed by the Southeast region (16.7 patients/100 thousand). Interferons beta and glatiramer acetate were the most used drugs in the first treatment. Glatiramer acetate was the most used drug for the second treatment within the period from 2011 to 2017. In 2018, the most common DMTs used as second treatment were fingolimod and natalizumab. From 2019, fingolimod, dimethyl fumarate and natalizumab were the most used drugs as second treatment, remaining in this order until 2021. For the third treatment, natalizumab was the most used drug until 2017. After this period, fingolimod became more widely used. Since 2019, with access to dimethyl fumarate, the most prescribed drugs were, in decreasing order, fingolimod, natalizumab and dimethyl fumarate. Conclusion: Establishing an epidemiological analysis of patients using DMTs for MS treatment in Brazil, in addition to standard of care, results in critical data for adequately promoting MS treatment, as well as for implementing local, regional and national public policies.


Subject(s)
Unified Health System , Epidemiology , Prevalence , Multiple Sclerosis
3.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1425416

ABSTRACT

Tecnologia: Fampridina Indicação: Tratamento de disfunções motoras em pacientes portado-res de esclerose múltipla. Pergunta: A Fampridina é eficaz e segurança para o tratamento de disfunções motoras em adultos portadores de esclerose múltipla comparada ao placebo? Méto-dos: Levantamento bibliográfico foi realizado na base de dados PUBMED, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionados três estudos que atenderam aos critérios de inclu-são. Conclusão: A fampridina foi eficaz e segura para tratar disfunções motoras em dosagens específicas. Conforme os resultados dos estudos analisados, a fampridina pode melhora de modo significativo e contínuo a capacidade de deambular dos portadores EM. Além disso, pode ser eficaz para tratar habilidades manuais e cognitiva


Technology: Fampridine. Indication: Treatment of motor disorders in patients with multiple sclerosis. Question: Is Fampridine effective and safe for the treatment of multiple sclerosis in adults with functional limitations compared to placebo? Methods: A bibliographic survey was carried out in the PUBMED database, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the Assessing the Methodological Quality of Systematic Reviews Version 2 tool. Results: Three studies that met the inclusion criteria were selected. Conclusion: Fampridine was effective and safe to treat motor disorders at specific dosages. According to the results of the analyzed studies, fampridine can significantly and continuously improve the ability to walk in MS patients. Also, it can be effective for treating manual and cognitive skills


Subject(s)
Humans , Adult , 4-Aminopyridine/therapeutic use , Multiple Sclerosis/drug therapy , Treatment Outcome
4.
Article in Chinese | WPRIM | ID: wpr-970495

ABSTRACT

Multiple sclerosis(MS) shows the pathological characteristics of "inflammatory injury of white matter" and "myelin repair disability" in the central nervous system(CNS). It is very essential for MS treatment and reduction of disease burden to strengthen repair, improve function, and reduce disability. Accordingly, different from the simple immunosuppression, we believe that key to strengthening remyelination and maintaining the "damage-repair" homeostasis of tissue is to change the current one-way immunosuppression strategy and achieve the "moderate pro-inflammation-effective inflammation removal" homeostasis. Traditional Chinese medicine shows huge potential in this strategy. Through literature research, this study summarized the research on remyelination, discussed the "mode-rate pro-inflammation-effective inflammation removal" homeostasis and the "damage-repair" homeostasis based on microglia, and summed up the key links in remyelination in MS. This review is expected to lay a theoretical basis for improving the function of MS patients and guide the application of traditional Chinese medicine.


Subject(s)
Humans , Multiple Sclerosis/pathology , Remyelination/physiology , Myelin Sheath/pathology , Inflammation/drug therapy , Homeostasis
5.
Neuroscience Bulletin ; (6): 466-478, 2023.
Article in English | WPRIM | ID: wpr-971586

ABSTRACT

Multiple sclerosis (MS) is regarded as a chronic inflammatory disease that leads to demyelination and eventually to neurodegeneration. Activation of innate immune cells and other inflammatory cells in the brain and spinal cord of people with MS has been well described. However, with the innovation of technology in glial cell research, we have a deep understanding of the mechanisms of glial cells connecting inflammation and neurodegeneration in MS. In this review, we focus on the role of glial cells, including microglia, astrocytes, and oligodendrocytes, in the pathogenesis of MS. We mainly focus on the connection between glial cells and immune cells in the process of axonal damage and demyelinating neuron loss.


Subject(s)
Humans , Multiple Sclerosis , Neuroglia , Inflammation/pathology , Brain/pathology , Spinal Cord/pathology
6.
Article in English | WPRIM | ID: wpr-971322

ABSTRACT

The primary chemical components of Astragalus membranaceus include polysaccharides, saponins, flavonoids, and amino acids. Recent studies have shown that Astragalus membranaceus has multiple functions, including improving immune function and exerting antioxidative, anti-radiation, anti-tumor, antibacterial, antiviral, and hormone-like effects. Astragalus membranaceus and its extracts are widely used in clinical practice because they have obvious therapeutic effects against various autoimmune diseases and relatively less adverse reaction. Multiple sclerosis (MS) is an autoimmune disease of central nervous system (CNS), which mainly caused by immune disorder that leads to inflammatory demyelination, inflammatory cell infiltration, and axonal degeneration in the CNS. In this review, the authors analyzed the clinical manifestations of MS and experimental autoimmune encephalomyelitis (EAE) and focused on the efficacy of Astragalus membranaceus and its chemical components in the treatment of MS/EAE.


Subject(s)
Animals , Humans , Astragalus propinquus/chemistry , Multiple Sclerosis/drug therapy , Encephalomyelitis, Autoimmune, Experimental/metabolism , Drugs, Chinese Herbal/chemistry , Polysaccharides
7.
Fisioter. Mov. (Online) ; 36: e36101, 2023. tab, graf
Article in English | LILACS | ID: biblio-1421467

ABSTRACT

Abstract Introduction People with multiple sclerosis (MS) present wide and varied symptoms. Objective To investigate the impact of MS on subjects' motor and respiratory functions. Methods One hundred one participants were enrolled in this study. The subjects had previous diagnosis of relapsing-remittent MS (n = 48) or presented no neurologic diseases (n = 53, control group). Assess-ments involved mobility (Timed Get Up and Go) and balance (Berg Balance Scale) tests. A force platform was used to evaluate postural stabilometry. Respiratory functions were assessed with a portable spirometer and a digital manovacuometer. Data analyses were carried out with Student´s t-tests, chi-square, and Pearson correlation index. Significance was set at 5%. Results Compared to control peers, participants with MS showed higher motor dysfunctions affecting mobility, balance, and postural stability. Spirometry indicated normal parameters for pulmonary flows and lung capacities in both groups. The manovacuometer, differently, pointed to a respiratory muscle weakness in 48% of participants with MS. Correlation analyses highlighted that respiratory functions are more associated to dynamic than to static motor tests. Conclusion Pathological changes in MS lead to motor dysfunction on mobility, balance and postural stability. Respiratory tests showed normal pulmonary flows and lung capacities in patients with MS, but with commitment of respiratory muscle strength. Respiratory functions were more impacted by dynamic tasks rather than static motor tasks.


Resumo Introdução Pessoas com esclerose múltipla (EM) apresentam sintomas amplos e variados. Objetivo Investigar o impacto cau-sado pela EM nas funções motoras e respiratórias. Métodos Cento e um participantes foram incluídos neste estudo. Os sujeitos tinham diagnóstico prévio de EM remitente-recorrente (n = 48) ou não apresentavam doenças neurológicas (n = 53, grupo controle). As avaliações envolveram testes de mobilidade (Timed Get Up and Go) e equilíbrio (Berg Balance Scale). Uma plataforma de força foi utilizada para avaliar a estabilometria postural dos sujeitos. As funções respiratórias foram avaliadas com um espirômetro portátil e um manovacuômetro digital. A análise dos dados foi realizada pelos testes t de Student, qui-quadrado e pelo índice de correlação de Pearson. Nível de significância foi estipulado em 5%. Resultados Comparados com controles saudáveis, participantes com EM apresentaram maiores disfunções motoras que afetam mobilidade, equilíbrio e estabilidade postural. A espirometria indicou parâmetros nor-mais para fluxos pulmonares e capacidades pulmonares em ambos os grupos. A manovacuômetria, diferentemente, apontou fraqueza dos músculos respiratórios em 48% dos participantes com EM. Análises de correlação destacaram que as funções respiratórias estão mais associadas a testes motores dinâmicos do que a testes estáticos. Conclusão As alterações patológicas na EM levam à disfunção motora na mobilidade, no equilíbrio e na estabilidade postural. Os testes respiratórios mostraram padrões normais para fluxos pulmonares e capacidades pul-monares em pacientes com EM, mas com comprometimento da força muscular respiratória. As funções respiratórias foram mais afetadas por tarefas motoras dinâmicas do que por tarefas estáticas.


Subject(s)
Humans , Spirometry , Motor Activity , Multiple Sclerosis , Respiratory Function Tests , Lung Volume Measurements
8.
Med. lab ; 27(1): 51-64, 2023. ilus, Tabs
Article in Spanish | LILACS | ID: biblio-1414243

ABSTRACT

El virus de Epstein-Barr (VEB) fue el primer virus asociado a neoplasias en humanos. Infecta el 95 % de la población mundial, y aunque usualmente es asintomático, puede causar mononucleosis infecciosa y se relaciona con más de 200.000 casos de neoplasias al año. De igual forma, se asocia con esclerosis múltiple y otras enfermedades autoinmunes. A pesar de ser catalogado como un virus oncogénico, solo un pequeño porcentaje de los individuos infectados desarrollan neoplasias asociadas a VEB. Su persistencia involucra la capacidad de alternar entre una serie de programas de latencia, y de reactivarse cuando tiene la necesidad de colonizar nuevas células B de memoria, con el fin de sostener una infección de por vida y poder transmitirse a nuevos hospederos. En esta revisión se presentan las generalidades del VEB, además de su asociación con varios tipos de neoplasias, como son el carcinoma nasofaríngeo, el carcinoma gástrico, el linfoma de Hodgkin y el linfoma de Burkitt, y la esclerosis múltiple. Adicionalmente, se describen los mecanismos fisiopatológicos de las diferentes entidades, algunos de ellos no completamente dilucidados


Epstein-Barr virus (EBV) was the first virus associated with human cancer. It infects 95% of the world's population, and although it is usually asymptomatic, it causes infectious mononucleosis. It is related to more than 200,000 cases of cancer per year, and is also associated with multiple sclerosis and other autoimmune diseases. Despite being classified as an oncogenic virus, only a small percentage of infected individuals develop EBV-associated cancer. Its persistence involves the ability to alternate between a series of latency programs, and the ability to reactivate itself when it needs to colonize new memory B cells, in order to sustain a lifelong infection and be able to transmit to new hosts. In this review, the general characteristics of EBV are presented, in addition to its association with various types of cancers, such as nasopharyngeal carcinoma, gastric carcinoma, Hodgkin's lymphoma and Burkitt's lymphoma, and multiple sclerosis. Additionally, the pathophysiological mechanisms of the different entities are described, some of them not completely elucidated yet


Subject(s)
Humans , Herpesvirus 4, Human/physiology , Epstein-Barr Virus Infections/complications , Stomach Neoplasms/physiopathology , Stomach Neoplasms/virology , Hodgkin Disease/physiopathology , Hodgkin Disease/virology , Nasopharyngeal Neoplasms/physiopathology , Nasopharyngeal Neoplasms/virology , Burkitt Lymphoma/physiopathology , Burkitt Lymphoma/virology , Carcinogenesis , Nasopharyngeal Carcinoma/physiopathology , Nasopharyngeal Carcinoma/virology , Multiple Sclerosis/physiopathology , Multiple Sclerosis/virology
9.
Biomédica (Bogotá) ; 42(4): 650-664, oct.-dic. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1420313

ABSTRACT

Introducción. La disfagia se define como la dificultad para movilizar la comida desde la boca hasta el estómago. La prueba diagnóstica para esta condición es la videofluoroscopia, la cual no es totalmente inocua pues utiliza radiación ionizante. La electromiografía de superficie registra la actividad eléctrica de los músculos de manera no invasiva, por lo que puede considerarse como una alternativa para evaluar la deglución y estudiar la disfagia. Objetivo. Evaluar la relación entre los tiempos relativos de activación de los músculos implicados en la fase oral y faríngea de la deglución, con los movimientos registrados durante la videofluoroscopia. Materiales y métodos. Se analizaron las señales de la electromiografía de superficie de 10 pacientes neurológicos con síntomas de disfagia, captadas en forma simultánea con la videofluoroscopia. Se suministraron 5 ml de yogur y 10 ml de agua, y 3 g de galleta. Se estudiaron bilateralmente los grupos musculares maseteros, suprahioideos e infrahioideos. Se analizó el paso del bolo por la línea mandibular, las valleculas y el músculo cricofaríngeo, correlacionándolo con el tiempo inicial y el final de la activación de cada uno de los grupos musculares. Resultados. El tiempo promedio de la fase faríngea fue de 0,89 ± 0,12 s. En la mayoría de los casos, hubo activación muscular antes del paso por la línea mandibular y las valleculas. La terminación de la actividad muscular parece corresponder al momento en que se completa el paso del bolo alimenticio por el músculo cricofaríngeo. Conclusión. Se determinaron los tiempos de actividad muscular, la duración de la fase faríngea y la secuencia de la activación de los grupos musculares involucrados en la deglución, mediante electromiografía de superficie, validada con la videofluoroscopia.


Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing. Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy. Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously with videofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation. Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete. Conclusion: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study.


Subject(s)
Deglutition Disorders , Neurologic Manifestations , Parkinson Disease , Signal Processing, Computer-Assisted , Electromyography , Multiple Sclerosis
11.
Rev. argent. reumatolg. (En línea) ; 33(4): 223-227, oct. 2022. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1449427

ABSTRACT

Introducción: la capilaroscopia es un método no invasivo que permite observar la microvasculatura en el área periungueal. Los resultados informados pueden ser altamente variables entre distintos observadores. A lo largo del tiempo surgieron métodos cuantitativos y semicuantitativos para mejorar la reproducibilidad. Objetivos: conocer el nivel de acuerdo intra e interobservador al informar los diferentes patrones capilaroscópicos en individuos con diferente nivel de entrenamiento. Materiales y métodos: estudio de corte transversal. Participaron médicos reumatólogos especialistas y en formación que habían realizado previamente un curso virtual de capacitación en capilaroscopia. Recibieron 40 imágenes capilaroscópicas proyectadas en una presentación de PowerPoint y debían responder a través de un cuestionario digital. Se evaluó la concordancia de respuestas intra e interobservador. Resultados: se encontró un alto nivel de concordancia global con un kappa 0,66 IC 95% (0,63-0,70) p<0,0000. También en otros grupos como reumatólogos en formación: kappa 0,65 IC 95% (0,60-0,71) p=0,0000, y médicos reumatólogos: kappa 0,67 IC 95% (0,62-0,72) p=0,0000. Conclusiones: el nivel de concordancia encontrado fue globalmente alto, independientemente del nivel de entrenamiento de los profesionales, y de ser o no reumatólogo. La concordancia fue superior cuando se comparó a quienes tenían más de 4 años de experiencia en la realización de videocapilaroscopia.


Introduction: videoapillaroscopy is a non-invasive method that allows the observation of the microvasculature in the periungual area. Reported results can be highly variable between different observers. Over time, quantitative and semi-quantitative methods emerged to improve reproducibility. Objetives: to know the level of intra and interobserver agreement when reporting the different capillaroscopic patterns in individuals with different levels of training. Materials and methods: cross section study. Specialist rheumatologists and those in training who had previously completed a virtual capillaroscopy training course participated. They received 40 capillaroscopic images projected in a PowerPoint presentation and had to issue their response through a digital questionnaire. Concordance of intra and interobserver responses was evaluated. Results: a high level of global agreement was found with a kappa 0.66 CI 95% (0.63-0.70) p<0.0000, also in other groups such as rheumatologists in training: kappa 0.65 CI 95% (0.60-0.71) p=0.0000, physicians rheumatologists: kappa 0.67 95% CI (0.62-0.72) p=0.0000. Conclusions: the level of agreement found was globally high, regardless of the level of training of the professionals, and whether or not they were a rheumatologist. Concordance was higher when compared to those who had more than 4 years of experience performing videocapillaroscopy.


Subject(s)
Microscopic Angioscopy , Rheumatology , Multiple Sclerosis
12.
Biomédica (Bogotá) ; 42(supl.2): 78-99, oct. 2022.
Article in Spanish | LILACS | ID: biblio-1403615

ABSTRACT

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.


Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.


Subject(s)
Vaccines , Coronavirus , Multiple Sclerosis , Sarcoidosis , Guillain-Barre Syndrome , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , Natalizumab
13.
Rev. peru. med. exp. salud publica ; 39(4): [442-449], oct. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1424344

ABSTRACT

Objetivos. Determinar los factores sociodemográficos, clínicos y radiológicos asociados al tiempo de progresión de discapacidad en pacientes con esclerosis múltiple (EM). Materiales y métodos. Estudio transversal analítico, basado en registros de la historia clínica de pacientes del Instituto Neurológico de Colombia, entre el 2013 y 2021. La progresión a discapacidad de los pacientes con EM se definió como el tiempo hasta un aumento de por lo menos 0,5 puntos en el valor de la EDSS (del inglés Expanded Disability Status Scale), sostenido por al menos seis meses. Se usó un modelo de regresión de Cox para estimar la función de supervivencia y los hazard ratios (HR) con sus intervalos de confianza de 95% (IC 95%). Resultados. Se incluyeron 216 pacientes, de los cuales el 25% progresó a discapacidad, la mediana de supervivencia fue de 78 meses (RIC 95%: 70−83), las lesiones activas (HR = 1,94; IC 95%: 1,10−3,44), el sexo masculino (HR = 2,5; IC 95%: 1,32−4,73), y las enfermedades neurológicas (HR = 2,18; IC95%: 1,03−4,61) se asociaron en el modelo multivariado. Conclusiones. La mediana de tiempo de progresión hacia la discapacidad fue de 72 meses. Las lesiones activas captadas en resonancia magnética y el sexo masculino se asociaron con mayor progresión de la discapacidad, con resultados estadísticamente significativos en el modelo multivariado.


Objectives. To determine the sociodemographic, clinical and radiological factors associated with time to disability progression in patients with multiple sclerosis (MS). Materials and methods. Cross-sectional descriptive study with an analytical component, based on clinical records of patients at the Neurological Institute of Colombia, between 2013 and 2021. Progression to disability in MS patients was defined as the time to an increase of at least 0.5 points in the EDSS (Expanded Disability Status Scale) score, sustained for at least six months. A Cox regression model was used to estimate the survival function and Hazard Ratios (HR) with their 95% confidence intervals (95% CI). Results. We included 216 patients, of whom 25% progressed to disability, median survival was 78 months (95% CI: 70-83), active lesions (HR = 1.94; 95% CI: 1.10-3.44), cerebellar complications (HR = 2.03; 95% CI: 0. 99-4.16), being male (HR = 2.5; 95% CI: 1.32-4.73), and having neurological diseases (HR = 2.18; 95% CI: 1.03-4.61) were associated as risk factors. While relapsing remitting MS (HR = 0.63; 95% CI: 0.31-1.26) and age at diagnosis less than 40 years (HR = 0.96; 95% CI: 0.53-1.76) were associated as protective factors. Conclusions. Progression is affected by many factors, and there is no single independent factor.


Subject(s)
Humans , Male , Female , Multivariate Analysis , Disabled Persons , Multiple Sclerosis , Patients , Survivorship
14.
Dement. neuropsychol ; 16(3): 276-283, July-Sept. 2022. tab
Article in English | LILACS | ID: biblio-1404470

ABSTRACT

ABSTRACT Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognition is not routinely assessed in patients with MS though they frequently have cognitive complaints or dysfunction. Objective: The aim of this study was to compare the cognitive status of patients with MS with age, sex, and schooling matched controls and to evaluate the potential influence of clinical parameters on cognition. Methods: A total of 35 patients with MS (mean±SD age 37.9 years±11.44, M/F: 12/23) and 33 healthy controls (mean±SD age 38.8 years±12.6, M/F: 12/21) were enrolled in this study. All subjects underwent a structured clinical assessment and the cognitive tools are as follows: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, and Verbal Fluency Tests (letters F, A, and S and animal category). Psychopathology was assessed with the Mini International Neuropsychiatric Interview and the Beck Depression Inventory (BDI). The Expanded Disability Status Scale (EDSS) was used for patients. Results: Patients performed worse than controls in almost all tests, with approximately 70% of patients presenting cognitive impairment. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed (22.8%). SDMT was inversely correlated with disease severity, as assessed by the EDSS. Depression did not influence cognitive performance in this cohort. Conclusions: Cognitive dysfunction is common among patients with MS. While motor impairment was associated with information processing speed, depression did not influence cognitive performance.


RESUMO A esclerose múltipla (EM) é a doença desmielinizante mais comum do sistema nervoso central. A cognição não é rotineiramente avaliada nos pacientes apesar da ocorrência frequente de queixas ou disfunção cognitivas. Objetivo: Comparar o perfil de pacientes com EM com controles pareados por idade, sexo e escolaridade e investigar a potencial influência de parâmetros clínicos na cognição. Métodos: Trinta e cinco pacientes com EM (idade média±desvio padrão [DP] 37,9 anos±11,44, H/M: 12/23) e 33 controles saudáveis (idade média±DP 38,8 anos±12,6, H/M: 12/21) foram incluídos neste estudo. Todos os participantes passaram por avaliação clínica estruturada e por testagem cognitiva com os seguintes instrumentos: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span e testes de fluências verbais (letras F, A e S e categoria-animais). A psicopatologia foi investigada com a Mini International Neuropsychiatric Interview e com o Beck Depression Inventory (BDI). A Expanded Disability Status Scale (EDSS) foi aplicada nos pacientes. Resultados: Pacientes tiveram desempenho pior que os controles na maioria dos testes — 70% deles tiveram déficit cognitivo. A função cognitiva mais frequentemente afetada foi memória episódica (45,7%), seguida por fluência verbal (42,8%) e velocidade de processamento (22,8%). A pontuação no SDMT correlacionou-se inversamente com a gravidade da doença, medida pela EDSS. A depressão não influenciou o desempenho cognitivo nesta série de pacientes. Conclusões: Declínio cognitivo é comum em pacientes com EM. Enquanto o déficit motor se associou com a velocidade de processamento, a depressão não influenciou o desempenho cognitivo.


Subject(s)
Humans , Adult , Multiple Sclerosis , Central Nervous System Diseases
15.
Medicentro (Villa Clara) ; 26(3): 673-690, jul.-set. 2022.
Article in Spanish | LILACS | ID: biblio-1405663

ABSTRACT

RESUMEN Introducción: La Covid-19, además de propagarse de persona a persona, atenta contra la estabilidad económica y política de las naciones y ha causado infecciones respiratorias letales en humanos. Esto puede ser relevante cuando se trata de la infección de un paciente inmunocomprometido, potencialmente protegido por una respuesta inmunológica más débil contra la infección. Objetivo: Describir la relación de la Covid-19 con algunas enfermedades autoinmunes. Métodos: Se emplearon los métodos de análisis-síntesis y análisis bibliográfico y documental; los motores de búsqueda fueron Hinari, Pubmed, ClinicalKey, Scielo regional, Scielo Cuba, Google Scholar. Conclusiones: Los pacientes con enfermedades autoinmunes son catalogados como pacientes de riesgo. En caso de ser confirmados con Covid-19 se les debe suspender la mayoría de sus medicamentos y mantener solamente sus tratamientos con hidroxicloroquina e inhibidores de IL-6 en caso de artritis autoinmune, y el acetato de glatiramero en la Esclerosis Múltiple. Estas personas deben seguir estrictamente las medidas orientadas por las autoridades sanitarias.


ABSTRACT Introduction: COVID-19, in addition to spreading from person to person, threatens the economic and political stability of nations and has caused lethal respiratory infections in humans. This may be relevant when dealing with infection in an immunocompromised patient, potentially protected by a weaker immune response against infection. Objective: to describe the relationship of COVID-19 with some autoimmune diseases. Methods: the analysis-synthesis method, as well as the bibliographic and documentary analysis were used; the search engines were Hinari, Pubmed, ClinicalKey, SciELO regional, SciELO Cuba and Google Scholar. Conclusions: patients with autoimmune diseases are classified as risk patients. In case of being confirmed with COVID-19, most of their medications should be suspended and only maintain their treatments with hydroxychloroquine and IL-6 inhibitors in case of autoimmune arthritis, and glatiramer acetate in multiple sclerosis. These people must strictly follow the measures directed by the health authorities.


Subject(s)
Arthritis, Rheumatoid , Autoimmune Diseases , COVID-19 , Multiple Sclerosis
16.
Prensa méd. argent ; 108(2): 75-81, 20220000. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1368364

ABSTRACT

Introducción: A más de un año del inicio de la pandemia, el seguimiento y la atención presencial de pacientes con enfermedades desmielinizantes se ha visto modificado. Según la evidencia, pacientes con diagnóstico de esclerosis múltiple (EM), síndrome desmielinizante aislado (SDA), Síndrome Radiológico Aislado (SRA) o enfermedades del espectro de neuromielitis óptica (NMO) no parecen ser un grupo de riesgo para COVID19 por el hecho de tener la enfermedad. La presencia de ciertas condiciones puede hacerlos susceptibles de cursar infección severa. Se ha descripto una asociación de curso grave con drogas anti CD20, faltan datos sobre la respuesta a vacunas COVID19 en esta población. Objetivos: Establecer características clínico-epidemiológicas de pacientes con enfermedades desmielinizantes que han padecido COVID-19 y describir su evolución. Caracterizar población vacunada, evaluar acceso al seguimiento médico/ terapéutico durante la pandemia. Materiales y métodos: Estudio observacional descriptivo. Se revisaron las historias clínicas de 168 pacientes con EM, SDA y SRA y 33 pacientes con NMO correspondientes al Hospital de Clínicas José de San Martin. Mediante encuesta telefónica se evaluó adherencia al tratamiento, evolución clínica, infección COVID-19, vacunación y acceso durante la pandemia. Resultados: Se encontraron 49 pacientes que desarrollaron COVID-19 en el grupo de pacientes con EM, y 7 en el grupo de NMO. Del primer grupo ninguno requirió internación, mientras que en el segundo, 2 fueron hospitalizados y uno de ellos falleció. La complicación post-COVID más frecuente fue: astenia prolongada y 3 pacientes presentaron un brote de la enfermedad de base en los 3 meses posteriores. Cerca del 90% de nuestra población ya contaba con al menos 1 dosis de vacuna para SARS-CoV2. Se interrogó sobre el acceso a la consulta neurológica y casi el 70% de los pacientes otorgó máximo puntaje al acceso a consultas virtuales. Conclusión: Los pacientes con enfermedades desmielinizantes que cursaron COVID-19 no tuvieron complicaciones severas por la infección, con solamente 2 pacientes cursando un brote en los 3 meses posteriores. No observamos reacciones adversas severas post vaccinales, ni infección posterior, sólo 2 pacientes presentaron un brote en el período post aplicación. Gran cantidad de pacientes percibieron acceso fluido a sus neurólogos de manera virtual, lo que podría relacionarse con alta tasa de adherencia a sus tratamientos a pesar de la limitación a la consulta presencial.


Introduction: More than a year after the start of the pandemic, the follow-up and face-to-face care of patients with demyelinating diseases has been modified. According to the evidence, patients with a diagnosis of multiple sclerosis (MS), isolated demyelinating syndrome (ADS), Isolated Radiological Syndrome (RAS) or neuromyelitis optica (NMO) spectrum diseases do not seem to be a risk group for COVID19 due to the fact that they have the disease. The presence of certain conditions can make them susceptible to severe infection. A severe course association with anti-CD20 drugs has been described, data on the response to COVID19 vaccines in this population are lacking. Objectives: To establish clinical-epidemiological characteristics of patients with demyelinating diseases who have suffered from COVID-19 and describe their evolution. Characterize the vaccinated population, evaluate access to medical/therapeutic follow-up during the pandemic. Materials and methods: Descriptive observational study. The medical records of 168 patients with MS, ADS and ARS and 33 patients with NMO corresponding to the Hospital de Clínicas José de San Martin were reviewed. Through a telephone survey, adherence to treatment, clinical evolution, COVID-19 infection, vaccination, and access during the pandemic were evaluated. Results: 49 patients who developed COVID-19 were found in the MS patient group, and 7 in the NMO group. Of the first group, none required hospitalization, unlike in the second, 2 were hospitalized and one of them died. The most frequent post-COVID complication was: prolonged asthenia and 3 patients presented an outbreak of the underlying disease in the following 3 months. Close to 90% of our population already had at least 1 dose of SARS-CoV2 vaccine. Access to the neurological consultation was questioned and almost 70% of the patients gave the highest score to access to virtual consultations. Conclusion: Patients with demyelinating diseases who had COVID-19 did not have severe complications from the infection, with only 2 patients having an outbreak in the subsequent 3 months. We did not observe severe post-vaccinal adverse reactions, nor subsequent infection, only 2 patients presented an outbreak in the post-application period. A large number of patients perceived fluid access to their neurologists virtually, which could be related to a high rate of adherence to their treatments despite the limitation to face-to-face consultation


Subject(s)
Humans , Clinical Evolution , Epidemiology, Descriptive , Retrospective Studies , Demyelinating Diseases/therapy , Aftercare , Treatment Adherence and Compliance , COVID-19 Vaccines , COVID-19/therapy , Multiple Sclerosis/diagnosis
17.
Int. j. morphol ; 40(1): 143-147, feb. 2022. ilus
Article in English | LILACS | ID: biblio-1385578

ABSTRACT

SUMMARY: Multiple sclerosis is a demyelinating disease of the nervous system that affects young people of working age and quickly leads to disability. Treatment of this pathology with umbilical cord mesenchymal stem cells is promising, given their immunomodulatory and neurotrophic properties. The study involved 27 patients diagnosed with multiple sclerosis, 12 of whom underwent combined treatment (intravenous and intrathecal administration) of umbilical cord multipotent mesenchymal stromal/stem cells. The effectiveness of treatment was determined by the degree of neurological deficit and spasticity. Combined treatment with umbilical cord mesenchymal stem cells significantly improves the condition of patients with multiple sclerosis and promotes the regression of neurological deficits and spasticity. This treatment is safe, but for a deeper study, it is necessary to continue research in this area.


RESUMEN: La esclerosis múltiple es una enfermedad desmielinizante del sistema nervioso que afecta a los jóvenes en edad laboral y conduce rapidamente a la discapacidad. El tratamiento de esta patología con células madre mesenquimales de cordón umbilical es prometedor, debido a sus propiedades inmunomoduladoras y neurotróficas. En el estudio participaron 27 pacientes diagnosticados de esclerosis múltiple, 12 de los cuales fueron sometidos a un tratamiento combinado (administración intravenosa e intratecal) de células madre / estromales mesenquimales multipotentes del cordón umbilical. La efectividad del tratamiento estuvo determinada por el grado de déficit neurológico y espasticidad. El tratamiento combinado con células madre mesenquimales del cordón umbilical mejora significativamente la condición de los pacientes con esclerosis múltiple y promueve la regresión de los déficits neurológicos y la espasticidad. Este tratamiento es seguro, sin embargo, es necesario continuar investigando en esta area.


Subject(s)
Humans , Male , Female , Adult , Umbilical Cord/cytology , Mesenchymal Stem Cells , Multiple Sclerosis/therapy , Treatment Outcome , Combined Modality Therapy , Administration, Intravenous
18.
Arq. neuropsiquiatr ; 80(2): 168-172, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364368

ABSTRACT

ABSTRACT Background: Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS. Objective: To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey. Methods: Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D). Results: Out of the 1,068 participants, 173 (16.2%) were found to have RLS [RLS(+)] and 895 (83.8%) did not [RLS(-)]. The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p<0.001 for all variables). Conclusions: According to our data, the presence of RLS in PwMS may increase the occurrence of both anxiety and depression symptoms. Awareness and treatment of RLS in PwMS could possibly reduce the symptoms of psychiatric comorbidities originating from RLS.


RESUMO Antecedentes: Considerando-se as comorbidades que acompanham a esclerose múltipla (EM), a síndrome das pernas inquietas (SPI) é uma das mais comuns, e ansiedade e depressão são comorbidades psicológicas comuns que afetam a qualidade de vida de pacientes com EM, bem como de pacientes com SPI. Objetivo: Investigar a carga psiquiátrica da coexistência de EM e SPI por meio de uma pesquisa nacional, multicêntrica e transversal. Métodos: Os participantes foram avaliados por parâmetros demográficos e clínicos, além da versão turca das escalas de ansiedade e depressão de Hamilton (HAM-A e HAM-D). Resultados: Dos 1.068 participantes, 173 (16,2%) apresentaram SPI [SPI (+)] e 895 (83,8%) não [SPI (-)]. As pontuações médias no HAM-A e no HAM-D foram significativamente maiores em indivíduos com SPI (+) do que naqueles com SPI (-) (p <0,001 para todas as variáveis). Conclusões: De acordo com nossos dados, a presença de SPI na EM pode aumentar a ocorrência de sintomas de ansiedade e depressão. A conscientização e o tratamento da SPI na EM podem reduzir os sintomas de comorbidades psiquiátricas originadas da SPI.


Subject(s)
Humans , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/epidemiology , Multiple Sclerosis/complications , Multiple Sclerosis/epidemiology , Anxiety/epidemiology , Quality of Life , Cross-Sectional Studies , Depression
19.
Arq. neuropsiquiatr ; 80(2): 161-167, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364369

ABSTRACT

ABSTRACT Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune chronic neurological disease. Currently, there are no effective serum biomarkers to verify MS diagnosis, to assess disease prognosis, and evaluate response to MS treatment. Objective: The present study is a preliminary assessment of irisin and nesfatin-1 serum levels in patients with relapsing- remitting MS (RRMS). Methods: A total of 86 participants, 42 patients with RRMS diagnosis and 44 healthy controls were included in the study. The serum irisin and nesfatin-1 parameters of the patients and control group members were analyzed. Results: Irisin and nesfatin-1 levels of the RRMS patients were significantly lower than the controls (z: -3.82, p<0.001; z: -4.79, p<0.001, respectively) The cut-off level of irisin is 10.390 (ng/mL) (sensitivity: 84.1%, specificity: 71.4%, AUC: 0.800), and the cut-off level of nestatin-1 is 7.155 (ng/mL) (sensitivity: 68.2%, specificity: 64.3%, AUC: 0.739) in the ROC analysis. For these cut-off levels in the case-control groups, the lower irisin and nesfatin-1 levels are the independent variables for MS patients (OR 9.723, 95%CI 2.884-32.785, p<0.001; OR 3.992, 95%CI 1.336-11.928, p<0.001) respectively. Conclusion: The present study revealed lower irisin and nesfatin-1 levels in patients with RRMS. These findings suggest that the decreased levels of irisin and nesfatin-1 peptides may contribute to MS pathogenesis such as inflammation, oxidative stress, and apoptosis in MS, leading to demyelination, axonal damage with neuronal loss, and gliosis.


RESUMO Antecedentes: A esclerose múltipla (EM) é uma doença neurológica crônica autoimune inflamatória e neurodegenerativa. Atualmente, não há biomarcadores séricos eficazes para verificar o diagnóstico de EM, para avaliar o prognóstico da doença e avaliar a resposta ao tratamento de EM. Objetivo: O presente estudo é uma avaliação preliminar dos níveis séricos de irisina e nesfatina-1 em pacientes com EM recorrente-remitente (EMRR). Métodos: Um total de 86 participantes, 42 pacientes com diagnóstico de EMRR e 44 controles saudáveis, foram incluídos no estudo. Os parâmetros séricos de irisina e nesfatina-1 dos pacientes e membros do grupo controle foram analisados. Resultados: Os níveis de irisina e nesfatina-1 dos pacientes com EMRR foram significativamente mais baixos do que os dos controles (z: -3,82, p <0,001; z: -4,79, p <0,001, respectivamente). O nível de corte de irisina é 10,390 (ng/mL) (sensibilidade: 84,1%, especificidade: 71,4%, AUC: 0,800), e o nível de corte de nestatina-1 é 7,155 (ng/mL) (sensibilidade: 68,2%, especificidade: 64,3%, AUC: 0,739) na análise ROC. Para esses níveis de corte nos grupos de caso-controle, os níveis mais baixos de irisina e nesfatina-1 são as variáveis independentes para pacientes com EM (OR 9,723, IC95% 2,884-32,785, p <0,001; OR 3,992, IC95% 1,336-11,928, p <0,001) respectivamente. Conclusão: O presente estudo revelou níveis mais baixos de irisina e nesfatina-1 em pacientes com EMRR. Esses achados sugerem que os níveis diminuídos de peptídeos irisina e nesfatina-1 podem contribuir para a patogênese da EM, como inflamação, estresse oxidativo e apoptose na EM, levando à desmielinização, dano axonal com perda neuronal e gliose.


Subject(s)
Humans , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Biomarkers , Case-Control Studies
20.
Fisioter. Bras ; 22(6): 850-858, Fevereiro 7, 2022.
Article in Portuguese | LILACS | ID: biblio-1358282

ABSTRACT

Introdução: A esclerose múltipla é uma doença inflamatória, desmielinizante, progressiva e sem cura, que afeta o sistema nervoso central e gera déficits físicos e cognitivos. É geralmente na fase grave da doença que o indivíduo procura atendimento médico devido à gravidade dos sintomas. Objetivo: Caracterizar o perfil epidemiológico de pacientes com esclerose múltipla internados em hospitais públicos do Pará entre 2008-2018. Métodos: Trata-se de um estudo realizado através de informações secundárias armazenadas na plataforma online SIS/DATASUS. Resultados: O número de internações por esclerose múltipla nos hospitais públicos do Pará foi de 96 casos. As regiões com mais internações foram as localidades fora da área metropolitana (73,96%), identificou-se maior prevalência no sexo feminino (55,21%), na faixa etária de 30 a 39 anos (32,29%), na raça parda (48,96%), a maioria das internações foram de urgência (95,83%), o tempo médio de internação foi de 10,5 dias e a taxa de mortalidade foi de 2,08%. Conclusão: Este estudo apresenta limitações por se tratar de dados secundários e pelo número limitado de estudos epidemiológicos para discussão, porém é um estudo pioneiro na área que abre um leque de possibilidades e norteia novas pesquisas. (AU)


Subject(s)
Epidemiologic Studies , Central Nervous System , Hospitals, Public , Multiple Sclerosis , Hospitalization
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