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Neurologia (Engl Ed) ; 35(6): 357-362, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32591152

RESUMO

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.


Assuntos
Algoritmos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Imunossupressores/administração & dosagem , Esclerose Múltipla/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial , Doenças Assintomáticas , COVID-19 , Teste para COVID-19 , Lista de Checagem , Técnicas de Laboratório Clínico , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Suscetibilidade a Doenças , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Programas de Rastreamento/métodos , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase , Pulsoterapia , Quarentena , Medição de Risco , SARS-CoV-2 , Avaliação de Sintomas , Telemedicina
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