ABSTRACT
INTRODUCTION: The Andalusian Registry of Pregnancies in patients with multiple sclerosis is the largest Spanish registry on multiple sclerosis (MS) and family planning. For the first time, it includes information on the fertility of men with MS. The influence of the use of a disease-modifying treatment (DMT) on the health of the foetus/newborn and the impact of breastfeeding on MS are also analysed. SUBJECTS AND METHODS: This is a multicentre, prospective and observational study. Recruitment of patients took place between December 2018 and December 2020. Women were followed up for one year after delivery. Altogether 100 women and 16 men were included, with a total of 103 newborn infants. RESULTS: The annualised relapse rate of the women with MS decreased significantly during pregnancy (from 0.23 to 0.065). A total of 11.2% of patients resorted to assisted reproductive techniques in order to conceive a child. No association was found between the use of a DMT at conception and/or pregnancy and the risk of miscarriage, prematurity or low birth weight. Over half the women with MS (54.2%) chose to breastfeed (26.7% of them while on a DMT). CONCLUSIONS: MS does not affect the fertility of men. Neither does the use of a DMT at the time of conception affect their fertility or their children's health. Assisted reproductive techniques did not have a negative impact on the course of MS. Breastfeeding is a common practice among women with MS and there is no evidence of positive or negative effects on disease progression.
TITLE: Planificación familiar en hombres y mujeres con esclerosis múltiple. Análisis del Registro Andaluz (2018-2022).Introducción. El Registro Andaluz de Embarazos en pacientes con esclerosis múltiple (EM) es el mayor registro español sobre EM y planificación familiar. Por primera vez se incluye información sobre la fertilidad de hombres con EM. También se analizan la influencia del uso de un tratamiento modificador de la enfermedad (TME) en la salud del feto o recién nacido y el impacto de la lactancia materna en la EM. Sujetos y métodos. Es un estudio observacional, prospectivo y multicéntrico. El reclutamiento de pacientes se hizo entre diciembre de 2018 y diciembre de 2020. El seguimiento de las mujeres tras el parto fue de un año. Se incluyó a 100 mujeres y 16 hombres, con un total de 103 recién nacidos. Resultados. La tasa anualizada de brotes de las mujeres con EM descendió durante el embarazo de forma significativa (de 0,23 a 0,065). Un 11,2% de los pacientes recurrieron a técnicas de reproducción asistida para conseguir la gestación. No se encontró relación entre el uso de un TME en la concepción y/o embarazo y el riesgo de aborto, prematuridad o bajo peso al nacer. El 54,2% de las mujeres con EM optaron por dar lactancia (el 26,7% de ellas usando un TME). Conclusiones. La EM no afecta a la fertilidad de los hombres. Tampoco influye en ésta, ni en la salud de sus hijos, el uso de un TME en el momento de la concepción. Las técnicas de reproducción asistida no impactaron negativamente en la evolución de la EM. La lactancia se impone como una práctica habitual entre las mujeres con EM y no se evidencian efectos positivos o negativos sobre la evolución de la enfermedad.
Subject(s)
Family Planning Services , Multiple Sclerosis , Child , Infant , Male , Infant, Newborn , Pregnancy , Humans , Female , Prospective Studies , Registries , Breast FeedingABSTRACT
In the One Health context, Integrated Wildlife Monitoring (IWM) merges wildlife health monitoring (WHM) and host community monitoring to early detect emerging infections, record changes in disease dynamics, and assess the impact of interventions in complex multi-host and multi-pathogen networks. This study reports the deployment and results obtained from a nationwide IWM pilot test in eleven sites representing the habitat diversity of mainland Spain. In each study site, camera-trap networks and sampling of indicator species for antibody and biomarker analysis were used to generate information. The results allowed identifying differences in biodiversity and host community characteristics among the study sites, with a range of 8 to 19 relevant host species per point. The Eurasian wild boar (Sus scrofa) was the most connected and central species of the host communities, becoming a key target indicator species for IWM. A negative relationship between biodiversity and disease risk was detected, with a lower number and prevalence of circulating pathogens in the sites with more species in the community and larger network size. However, this overall trend was modified by specific host-community and environmental factors, such as the relative index of wild boar - red deer interactions or the proximity to urban habitats, suggesting that human-driven imbalances may favour pathogen circulation. The effort of incorporating wildlife population monitoring into the currently applied WHM programs to achieve effective IWM was also evaluated, allowing to identify population monitoring as the most time-consuming component, which should be improved in the future. This first nationwide application of IWM allowed to detect drivers and hotspots for disease transmission risk among wildlife, domestic animals, and humans, as well as identifying key target indicator species for monitoring. Moreover, anthropogenic effects such as artificially high wildlife densities and urbanisation were identified as risk factors for disease prevalence and interspecific transmission.
Subject(s)
Humans , Female , Child, Preschool , Paralysis/etiology , Poliomyelitis/etiology , Central Nervous System Viral Diseases/diagnosis , Central Nervous System Viral Diseases/drug therapy , Muscle Hypotonia , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/therapy , Respiratory Tract Infections , Disease Outbreaks , MyelitisABSTRACT
We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7-97.8) in the MCC study, 80.2% (95% CI: 16.9-95.3) in the TNCC design and 89.4% (95% CI: 64.6-96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.
Subject(s)
Cholera Vaccines/administration & dosage , Cholera/epidemiology , Cholera/prevention & control , Administration, Oral , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Cohort Studies , Female , Humans , Immunization Programs , Infant , Male , Vaccination/methods , Young Adult , Zambia/epidemiologyABSTRACT
Objetivo. Valorar la capacidad diagnóstica de la 18F-FDG PET/TC con contraste intravenoso (PET/TCciv) en la detección de recidivas asintomáticas de pacientes con linfoma. Material y métodos. Se realizó una PET/TCciv en pacientes con linfoma para seguimiento estandarizado y en remisión completa clínica. Tanto la 18F-FDG PET como la TCciv fueron evaluadas de forma independiente por 2 observadores y clasificadas como positiva o negativa para recurrencia. Adicionalmente se realizó una valoración combinada de ambas exploraciones. El diagnóstico final se estableció por análisis histopatológico o seguimiento clínico superior a 6 meses. Se calcularon los parámetros diagnósticos estadísticos y los niveles de concordancia entre ambas técnicas diagnósticas. Resultados. Se analizaron un total de 114 exploraciones pertenecientes a 90 pacientes. Solo 4 pacientes fueron diagnosticados de recurrencia asintomática durante el seguimiento. La 18F-FDG PET/TCciv, la 18F-FDG PET y la TCciv mostraron asociación con el diagnóstico final (p=0,002 y χ2=11,96; p<0,001 y χ2=15,60; p=0,001 y χ2=11,96, respectivamente). La concordancia entre la 18F-FDG PET y la TCciv fue moderada/alta y significativa (kappa=0,672; p<0,001). Se obtuvo una sensibilidad y especificidad del 50 y 88% para la 18F-FDG PET/TCciv, del 50 y 93% para la 18F-FDG PET y del 50 y 91% para la TCciv. Conclusión. El uso combinado de la 18F-FDG PET/TCciv no ofreció ventaja con respecto a ambas técnicas por separado en la detección de recidiva asintomática por linfoma
Aim. To assess the diagnostic accuracy of 18F-FDG PET/contrast enhanced computed tomography (ceCT) in the detection of asymptomatic recurrences in patients with lymphoma. Material and methods. Patients with lymphoma and clinical complete remission underwent 18F-FDG PET/ceCT for standard follow-up.18F-FDG PET and ceCT were evaluated blindly by two independent observers, and classified as positive or negative for recurrence. Additionally a combined evaluation of both techniques was performed. The final diagnosis was established by histopathological analysis or a clinical follow-up longer than 6 months. Statistical diagnostic parameters and concordance levels between both diagnostic techniques were calculated. Results. A total of 114 explorations on 90 patients were analyzed. Only 4 patients were diagnosed as asymptomatic recurrence during the follow-up. 18F-FDG PET/ceCT, 18F-FDG PET and ceCT showed an association with the final diagnosis (p=0.002 and χ2=11.96; p<0.001 and χ2=15.60; p=0.001 and χ2=11.96, respectively). The concordance between 18F-FDG PET and ceCT was moderate/high and significant (kappa=0.672; p<0.001). A sensitivity and specificity of 50% and 88% was obtained for the 18F-FDG PET/ceCT civ, 50% and 93% for the 18F-FDG PET, and 50% and 91% for the ceCT. Conclusion. The combined use of 18F-FDG PET/ceCT did not offer any advantage compared to any isolated diagnostic technique in the detection of asymptomatic lymphoma recurrence
Subject(s)
Humans , Male , Female , Lymphoma/diagnostic imaging , Positron-Emission Tomography/methods , Fluorine Radioisotopes/administration & dosage , Fluorodeoxyglucose F18 , Follow-Up Studies , Radiopharmaceuticals , Retrospective Studies , Sensitivity and Specificity , Single-Blind Method , Remission Induction , Recurrence , Asymptomatic DiseasesABSTRACT
AIM: To assess the diagnostic accuracy of 18F-FDG PET/contrast enhanced computed tomography (ceCT) in the detection of asymptomatic recurrences in patients with lymphoma. MATERIAL AND METHODS: Patients with lymphoma and clinical complete remission underwent 18F-FDG PET/ceCT for standard follow-up.18F-FDG PET and ceCT were evaluated blindly by two independent observers, and classified as positive or negative for recurrence. Additionally a combined evaluation of both techniques was performed. The final diagnosis was established by histopathological analysis or a clinical follow-up longer than 6 months. Statistical diagnostic parameters and concordance levels between both diagnostic techniques were calculated. RESULTS: A total of 114 explorations on 90 patients were analyzed. Only 4 patients were diagnosed as asymptomatic recurrence during the follow-up. 18F-FDG PET/ceCT, 18F-FDG PET and ceCT showed an association with the final diagnosis (p=0.002 and χ2=11.96; p<0.001 and χ2=15.60; p=0.001 and χ2=11.96, respectively). The concordance between 18F-FDG PET and ceCT was moderate/high and significant (kappa=0.672; p<0.001). A sensitivity and specificity of 50% and 88% was obtained for the 18F-FDG PET/ceCT civ, 50% and 93% for the 18F-FDG PET, and 50% and 91% for the ceCT. CONCLUSION: The combined use of 18F-FDG PET/ceCT did not offer any advantage compared to any isolated diagnostic technique in the detection of asymptomatic lymphoma recurrence.
Subject(s)
Lymphoma/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Asymptomatic Diseases , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Male , Radiopharmaceuticals , Recurrence , Remission Induction , Retrospective Studies , Sensitivity and Specificity , Single-Blind MethodABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Orthostatic Intolerance/complications , Orthostatic Intolerance , Dizziness/complications , Leukoaraiosis/complications , Leukoaraiosis , Aspirin/therapeutic use , Lorazepam/therapeutic use , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods , Primary Health Care/methods , Dizziness/etiology , Neurophysiology/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Meningoencephalitis/etiology , Behcet Syndrome/complications , Brain Stem , Magnetic Resonance SpectroscopySubject(s)
Adenocarcinoma/diagnostic imaging , Adenocarcinoma/secondary , Colonic Neoplasms/pathology , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Multimodal Imaging/methods , Positron-Emission Tomography/methods , Radiopharmaceuticals , Tomography, X-Ray Computed/methods , Adenocarcinoma/drug therapy , Adenocarcinoma/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colectomy , Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Neoadjuvant TherapySubject(s)
Behcet Syndrome/complications , Brain Stem/pathology , Meningoencephalitis/etiology , Acyclovir/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Behcet Syndrome/drug therapy , Behcet Syndrome/pathology , Ceftriaxone/therapeutic use , Dexamethasone/therapeutic use , Humans , Leukocytosis/etiology , Magnetic Resonance Imaging , Male , Meningoencephalitis/drug therapy , Meningoencephalitis/pathology , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Neuroimaging , Calcinosis/physiopathology , Cerebrum/pathology , Tomography, X-Ray Computed/methods , Calcium Metabolism Disorders/physiopathologyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Anesthesia, Epidural/adverse effects , Paresis/chemically induced , Abducens Nerve , Abducens Nerve Injury/chemically induced , Diplopia/etiologySubject(s)
Antipsychotic Agents/adverse effects , Dibenzothiazepines/adverse effects , Iodine Radioisotopes/metabolism , Nortropanes/metabolism , Parkinsonian Disorders/chemically induced , Parkinsonian Disorders/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Aged , Antipsychotic Agents/therapeutic use , Depression/drug therapy , Dibenzothiazepines/therapeutic use , Female , Humans , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/pathologyABSTRACT
AIM: To define the utility of intravenous contrast administration in the PET-CT (PET-CTc) in patients with lymphoma in order to determine its possible indications. MATERIAL AND METHODS: 78 patients with lymphoma were prospectively evaluated. All underwent simultaneous PET-CTc scans in a hybrid system for staging (8), evaluation of response to treatment (29), suspicion of recurrence (9) and complete remission control (48). The PET scan was acquired by a conventional method and the diagnostic CT scan was performed according to radiological protocol. Both examinations were evaluated blinded and independently, analyzing 28 anatomical locations in order to determine the degree of agreement. Final diagnosis was established by the clinician based on the histological study, results of other diagnostic techniques or clinical follow-up. RESULTS: The final result of both techniques were concordant in 87/94 studies (92.5%). A total of 158 (36 FP) pathological locations were detected with PET-CT and 189 (71 FP) with CTc, with 72 locations being discordant between both techniques. Global sensitivity, specificity, PPV and NPV were 93%, 98%, 77% and 99%; and 94%, 97%, 62% and 99%, respectively. CONCLUSIONS: Administration of intravenous contrast does not seem to provide any advantage in the determination of nodal and extranodal disease in lymphoma patients. The low prevalence of disease probably accounts for the limited PPV of both techniques. An increase of our sample size, with a greater homogeneity of the groups, should offer more reliable results.
Subject(s)
Contrast Media/administration & dosage , Lymphoma/diagnosis , Positron-Emission Tomography , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Injections, Intravenous , Male , Middle Aged , Prospective Studies , Young AdultABSTRACT
ObjetivoDefinir la utilidad de la administración de contraste intravenoso en la PET-TAC (PET-TACc) en pacientes con linfoma, con el fin de determinar sus posibles indicaciones.Material y métodoSe ha valorado prospectivamente a 78 pacientes con linfoma, a los que se les realizó 94 estudios PET-TACc de manera simultánea en un equipo híbrido para estadiaje (8), valoración de respuesta al tratamiento (29), sospecha de recidiva (9) y control en remisión (48). El estudio PET se adquirió de forma convencional y la TACc se realizó según protocolo radiológico.Material y métodoSe valoraron ambas exploraciones, de forma independiente y ciega, analizando 28 localizaciones anatómicas con el fin de determinar la sensibilidad (S), la especificidad (E), el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN), así como el grado de concordancia. El diagnóstico final fue establecido por el clínico atendiendo a la confirmación histológica, al resultado de otras técnicas diagnósticas o al seguimiento clínico.ResultadosAmbas técnicas fueron concordantes en su resultado final en 87/94 estudios (92,5%). Se encontraron 158 (36 falsos positivos [FP]) localizaciones patológicas con PET-TAC y 189 (71 FP) con TACc, siendo 72 discordantes entre ambas técnicas.ResultadosLa S, la E, el VPP y el VPN de la PET-TAC y de la TACc fueron del 93, el 98, el 77 y el 99%, y del 94, el 97, el 62 y el 99%, respectivamente.ConclusionesLa administración de contraste intravenoso no parece aportar ventajas en la determinación de patología ganglionar ni extraganglionar en los pacientes con linfoma. La baja prevalencia de enfermedad probablemente sea la causa del limitado VPP de ambas técnicas. La ampliación de nuestra casuística, con una mayor homogeneidad de los grupos, ofrecerá resultados más fiables(AU9
AimTo define the utility of intravenous contrast administration in the PET-CT (PET-CTc) in patients with lymphoma in order to determine its possible indications.Material and methods78 patients with lymphoma were prospectively evaluated. All underwent simultaneous PET-CTc scans in a hybrid system for staging (8), evaluation of response to treatment (29), suspicion of recurrence (9) and complete remission control (48). The PET scan was acquired by a conventional method and the diagnostic CT scan was performed according to radiological protocol.Material and methodsBoth examinations were evaluated blinded and independently, analyzing 28 anatomical locations in order to determine the degree of agreement. Final diagnosis was established by the clinician based on the histological study, results of other diagnostic techniques or clinical follow-up.ResultsThe final result of both techniques were concordant in 87/94 studies (92.5%). A total of 158 (36 FP) pathological locations were detected with PET-CT and 189 (71 FP) with CTc, with 72 locations being discordant between both techniques.ResultsGlobal sensitivity, specificity, PPV and NPV were 93%, 98%, 77% and 99%; and 94%, 97%, 62% and 99%, respectively.ConclusionsAdministration of intravenous contrast does not seem to provide any advantage in the determination of nodal and extranodal disease in lymphoma patients. The low prevalence of disease probably accounts for the limited PPV of both techniques. An increase of our sample size, with a greater homogeneity of the groups, should offer more reliable results(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Positron-Emission Tomography/trends , Positron-Emission Tomography , Lymphoma , Sensitivity and Specificity , Lymphoma/pathology , Lymphoma , Contrast Media/administration & dosage , Contrast Media/pharmacokinetics , Contrast Sensitivity , Prospective Studies , Predictive Value of TestsABSTRACT
INTRODUCTION: Parkinson's disease (PD) is a chronic idiopathic neurodegenerative disorder in which there is a dopamine deficit that produces motor and other disturbances, such as autonomic, sensory and neuropsychiatric disorders, including psychosis. Psychosis in PD, which is characterised by the existence of hallucinations and delusions, is a frequent and disabling problem for the patient; it is stressing for caregivers and difficult to manage for the physician, since it predisposes the patient to higher rates of morbidity and mortality and to institutionalisation. AIM: To carry out a review of the literature on the treatment of psychosis in PD. DEVELOPMENT: In this paper we review several different aspects of psychosis in PD, such as the diagnostic criteria, pathophysiology, predisposing factors, clinical features and, above all, management, which includes the use of atypical antipsychotics (after attempts have been made to reduce the antiparkinson medication to a limit marked by the loss of motor autonomy). Additionally, we also review the evidence that is currently available on other pharmaceuticals for use to treat psychosis in PD (anticholinesterases, drugs that act on serotonin receptors and so forth). CONCLUSIONS: Psychosis in PD is a problem that is difficult to treat, with a poorly understood pathophysiology, in which the most important means of combating it (in addition to prevention and reduction of dopaminergic medication, if possible) is the use of atypical antipsychotics. Other treatments which are now offering still very preliminary, but promising, results could well end up becoming the first line of treatment for this condition in the near future.
