ABSTRACT
BACKGROUND: Different retrospective studies compared natalizumab and fingolimod in relapsing-remitting multiple sclerosis (RRMS), with conflicting results. We aimed to explore the prescriptive attitude and the clinical outcome of the two therapies. METHODS: We retrospectively included all RRMS patients treated with natalizumab (n=101) or fingolimod (n=78) as their first second-line therapy with at least 24-month follow-up. Demographic and clinical features were recorded to calculate the propensity score (PS). Outcomes of interest were annualized relapse rate (ARR), risk of relapse, and change in the EDSS RESULTS: At baseline, natalizumab patients were younger and had a shorter disease duration, a higher number of relapse in 1 year (1yR) and 2 years (2yR) and overall (ARR-PT) pretherapy, compared to fingolimod patients. On therapy, the proportion of relapsing patients and the mean RR were similar in the two groups. However, the change in the ARR was higher in natalizumab than in fingolimod group (P<.002), but, using PS as a covariate, it was comparable (P=.960). Similarly, the change in EDSS was significantly different for the two groups (P<.004), but not after adjusting for the PS (P=.321). CONCLUSION: We observed a comparable efficacy on ARR reduction and on EDSS progression with natalizumab and fingolimod correcting through PS, suggesting that the efficacy difference observed before correction might derive from the clinical attitude in prescribing natalizumab in more active MS patients in real life.
Subject(s)
Fingolimod Hydrochloride/therapeutic use , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Natalizumab/therapeutic use , Adolescent , Adult , Child , Female , Fingolimod Hydrochloride/administration & dosage , Fingolimod Hydrochloride/adverse effects , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Natalizumab/administration & dosage , Natalizumab/adverse effects , Retrospective StudiesABSTRACT
BACKGROUND AND PURPOSE: Cardiovascular risk factors can increase the risk of multiple sclerosis (MS) and modify its course. However, such factors possibly interact, determining a global cardiovascular risk. Our aim was to compare the global cardiovascular risk of subjects with and without MS with the simplified 10-year Framingham General Cardiovascular Disease Risk Score (FR) and to evaluate its importance on MS-related outcomes. METHODS: Age, gender, smoking status, body mass index, systolic blood pressure, type II diabetes and use of antihypertensive medications were recorded in subjects with and without MS to estimate the FR, an individualized percentage risk score estimating the 10-year likelihood of cardiovascular events. RESULTS: In total, 265 MS subjects were identified with 530 matched controls. A t test showed similar FR in cases and controls (P = 0.212). Secondary progressive MS presented significantly higher FR compared to relapsing-remitting MS (P < 0.001). Linear regression analysis showed a direct relationship between FR and Expanded Disability Status Scale (P < 0.001) and MS Severity Scale (P < 0.001). CONCLUSION: The FR, evaluating the global cardiovascular health by the interaction amongst different risk factors, relates to MS disability, severity and course.
Subject(s)
Cardiovascular Diseases/epidemiology , Multiple Sclerosis, Chronic Progressive/epidemiology , Multiple Sclerosis, Relapsing-Remitting/epidemiology , Risk , Adolescent , Adult , Aged , Case-Control Studies , Comorbidity , Disease Progression , Female , Humans , Male , Middle Aged , Severity of Illness Index , Young AdultABSTRACT
We report our experience in the treatment of cranio-facial traumas. The collaboration between neurosurgeons and maxillofacial surgeons is highlighted as well as the importance of the combined approaches, the use of Rigid Internal Fixations and bone grafting techniques in the immediate treatment of complex craniofacial fractures.
Subject(s)
Facial Bones/injuries , Skull Fractures/surgery , Bone Transplantation/methods , Facial Bones/surgery , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , Fractures, Comminuted/surgery , Frontal Bone/injuries , Frontal Bone/surgery , Humans , Joint Dislocations/surgery , Maxillofacial Injuries/surgery , Neurosurgery , Orbital Fractures/surgery , Patient Care Team , Skull Base/injuries , Skull Base/surgery , Surgery, OralABSTRACT
Head and neck injuries due to sports and games represent 22.7% of all injuries admitted to the E.N.T. Department of the University of Perugia between 1980 and 1988. Epidemiological and causative factors of these injuries are examined by the authors, together with their treatment: the majority of accidents occurred during soccer games as a consequence of collisions between players. In these cases the most frequently recorded lesion was a nasal fracture. Other sporting activities were responsible for more serious injuries to the maxillo-facial bony, cartilaginous and soft tissue structures. Good results were achieved both on the anatomical and functional planes, except for a few cases of facial disruption and multiple mandibular fractures. The authors stress the importance of preventive measures, consisting of periodical medical check-ups, an adequate level of umpiring and the wearing of protective equipment, such as helmets and masks.
