ABSTRACT
Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.
Subject(s)
Multiple Sclerosis/therapy , Biomarkers , Cognition Disorders/etiology , Cognition Disorders/psychology , Congresses as Topic , Disease Progression , Humans , Immunoglobulin G/therapeutic use , Immunologic Factors/therapeutic use , Latin America , Magnetic Resonance Imaging , Meta-Analysis as Topic , Multiple Sclerosis/diagnosis , Prognosis , Randomized Controlled Trials as Topic , Risk Assessment , Steroids/therapeutic useABSTRACT
We report on a 53-year-old patient in whom the aortic and mitral valves had been replaced. This patient developed Candida albicans sepsis with mycotic aneurysms of the tibial arteries as well as cerebral emboli under immunosuppression. Dispensing with a valve replacement operation, a sustained freedom from recurrence (period of observation currently 24 months) could be attained with antimycotic therapy with amphotericin B and flucytosine i.v. and subsequent long-term therapy with fluconazole p.o. as well as surgical and interventional clearance of the mycotic aneurysms.
Subject(s)
Aneurysm, Infected/etiology , Aortic Valve Insufficiency/surgery , Candidiasis/etiology , Endocarditis/etiology , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Postoperative Complications/etiology , Tibial Arteries , Adult , Aneurysm, Infected/diagnosis , Aneurysm, Infected/drug therapy , Angiography , Antifungal Agents/administration & dosage , Candidiasis/diagnosis , Candidiasis/drug therapy , Endocarditis/diagnosis , Endocarditis/drug therapy , Humans , Intracranial Embolism/diagnosis , Intracranial Embolism/drug therapy , Intracranial Embolism/etiology , Long-Term Care , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/drug therapyABSTRACT
A sensitive, versatile and precise method for quantitative analysis of individual faecal bile acids in humans by thin-layer chromatography with direct scanning fluorimetry is described. The method enables convenient quantitative measurements of faecal bile acids in larger series of samples for routine applications in gastroenterology. The overall coefficient of variation (including stool preparation and extraction) for the five predominant bile acids of human stool specimens (cholic acid, chenodeoxycholic acid, deoxycholic acid, lithocholic acid and ursodeoxycholic acid) was 3.4-4.9%. Recoveries of free bile acids added to the faeces ranged from 91% to 106%. An excellent and linear correlation between this method and fused-silica column gas chromatography with temperature programming was established (r = 0.91-0.99). In clinical practice this thin-layer chromatographic method constitutes a reliable, simple and time-saving alternative to gas chromatography.