Effect of Rituximab Compared with Natalizumab and Fingolimod in Patients with Relapsing-Remitting Multiple Sclerosis: A Cohort Study.

The objective of this study was to evaluate the clinical files of patients with RRMS who started rituximab (RTX) compared with a second-line treatment (natalizumab (NTZ) or fingolimod (FTY)). This was a historical cohort study. We compared the effect according to the Expanded Disability Status Scale (EDSS) and the number of relapses in RRMS patients receiving these treatments after a mean period of 12 months. We found a statistically significant difference (p < 0.001) when comparing the EDSS scores and the annual relapse rates of patients receiving RTX with those receiving NTZ or FTY. This study is essential for our clinical practice, since patients with limited treatment options represent a challenge with regard to the management of their medical care. However, clinical trials and prospective studies with long follow-up periods are necessary to provide sufficient evidence on the efficacy of RTX and thus include this treatment in the therapeutic profile of patients with MS.

El liderazgo del estudiante de enfermería Mexicano y su importancia en la investigación / The Leadership of the Mexican Nursing Student and its Importance in Research

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Clinical practice patterns in multiple sclerosis management: Mexican consensus recommendations.

BACKGROUND: Multiple sclerosis affects more than 2 million people. Clinical decisions are performed under evidence-based medicine. The appearance of new disease-modifying therapies and changes in diagnostic criteria complicates the decision-making process in clinical practice. OBJECTIVES: To characterize the criteria for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), and relapsing-remitting multiple sclerosis (RRMS) by Mexican neurologists in a real-world setting. METHODS: A two-round modified Delphi method (RAND/UCLA) was applied. RESULTS: In RIS, LP, spinal cord MRI and VEP should be included in diagnostic testing; DMT initiation is not necessary. A follow-up MRI within 3 months are recommended. In CIS, corticosteroid therapy should be initiated at first relapse; both simple and Gd-enhanced MRI is mandatory. LP, selective blood tests, and NMO-IgG/AQP4 antibodies should be performed as complementary. IFN beta or GA were the most suitable DMTs for treating high-risk CIS. Patients with RRMS should begin with DMT at diagnosis, include a follow-up MRI if a patient had 2 relapses within 6 months. GA and oral DMTs are the most eligible DMTs for mild RRMS. Monoclonal antibodies-based therapy is chosen when disability is present. Radiological criteria for switching DMT included >1 Gd+ lesion and >2 new T2 lesions. CONCLUSIONS: Although many coincidences, there are still many hollows in the medical attention of MS in Mexico. This consensus recommendation could be helpful to implement better evidence-based recommendations and guidelines in a real-world setting.

Recomendaciones para la atención de pacientes con diabetes mellitus con factores de riesgo o enfermedad cardiovascular establecida y SARS-CoV-2 / Recommendations for the care of patients with diabetes mellitus with risk factors or established cardiovascular disease and SARS-CoV-2

Resumen Se realiza una revisión sobre el riesgo de los pacientes que padecen diabetes mellitus en el contexto de morbimortalidad general y relacionada a infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2). Así mismo se repasan las recomendaciones generales, de alimentación y de la prevención de las comorbilidades que más frecuentemente padecen dichos enfermos. Finalmente se hace una revisión de las recomendaciones farmacológicas sobre el tratamiento tanto oral como parenteral en el paciente ambulatorio, en la hospitalización y en estados críticos infectados por el SARS-CoV-2.

Abstract A review is carried out to examine the risk of patients suffering from diabetes mellitus in the context of general morbidity and mortality and related to infection by SARS-CoV-2. Likewise, the general recommendations for food and the prevention of comorbidities that most these patients suffer most frequently are also studied. Finally, a review of the pharmacological recommendations on both oral and parenteral treatment in the outpatient, in hospitalization and in critical states infected with SARS-CoV-2 is made.

Air Pollution, Multiple Sclerosis and its Relevance to Mexico City.

Long-term exposure to air pollution has been linked with the development of neurodegenerative diseases. The proposed mechanisms include neuroinflammation and brain oxidative stress. Multiple sclerosis (MS) is a neurodegenerative disease with an auto-immune physiopathology and some studies have associated it with long-term exposure to airborne particulate matter. In this opinion we discuss the current body of knowledge regarding air pollution and the risk of MS as well as MS relapses. Also, its relevance in the case of Mexico City is discussed.

The genetics of multiple sclerosis in Latin America.

BACKGROUND: In today's globalised world, the heterogeneity of diseases such as multiple sclerosis has been studied since it has been suggested that ethnic differences, in conjunction with geographical and environmental factors, influence its incidence and prevalence. AIM: Based on this, an attempt has been made to identify the genetic factors that may confer risk or protection, not only for developing multiple sclerosis but also for determining the course of its evolution. RESULTS: In Latin America we have some data about this, which have been replicated in different populations in the entire region, with very different results compared with other regions, which could explain not only the different frequencies in some populations, such as Caucasians, but also the course of the disease and the response to actual treatments. However, in addition to these findings, other associated epigenetic mechanisms have also been found in our populations, such as levels of vitamin D, parasitic diseases, and indigenous populations. Therefore, the study of epigenetics plays a crucial role in understanding the physiopathology of multiple sclerosis. It must be studied in each population, especially in Latin America, due to its broad heterogeneity. CONCLUSION: It is very important to understand not only the genetic and external factors with these very specific effects in multiple sclerosis patients, but also the way they interact and are able to explain the frequency and some specific phenotypes of the disease in our populations besides the posibility to be a very specific treatment target.

Physical Activity Protects Men but Not Women for Sarcopenia Development.

Objective: Sarcopenia is among the most deleterious effects of aging. The objective of this study was to analyze the relationship between performance tests and muscular volume over the life span of male and female participants. Method: A correlation study was conducted with healthy individuals (50 males and 47 females) between the ages of 20 and 94; the study group included active older people, sedentary younger people, and young athletes. Muscular volume was determined by tomography and muscular performance (4-meter speed tests [4 MSTs], chair test, and handgrip test), and a correlation analysis between the groups was performed. Results: Sex-related differences were observed between the variables; in males, muscle volume and functional parameters were closely related with age and physical activity, whereas in females, they were not related at all. Conclusion: Male and female muscle volume and performance demonstrate strong differences, which should be considered during clinical evaluations of sarcopenia.

[The absence of a relation between apolipoprotein E genotypes and the severity of multiple sclerosis in Mexican patients]. / Ausencia de relación entre los genotipos de apolipoproteína E y la gravedad de la esclerosis múltiple en pacientes mexicanos.

INTRODUCTION: The clinical course of multiple sclerosis (MS) varies widely. The natural history of the disease has shown that approximately 50% of patients that begin with a relapsing-remitting clinical course will have a progressive course about 10 years after disease onset and will need some kind of aid to walk. The expression of apolipoprotein E (ApoE) increases in nerve tissue undergoing regeneration and the ApoE epsilon-4 allele is associated with abnormal neural repair. Several different reports indicate that the ApoE epsilon-4 allele is associated with a greater progression of disability in patients with MS, although this is still a matter of debate. PATIENTS AND METHODS: We analyse the clinical characteristics of 99 patients diagnosed with MS, we describe the correlation between the presence or absence of the ApoE epsilon-4 allele and the age of onset, clinical subtype, progression of the disease, score on the Expanded Disability Status Scale and the relapse rate. We explore the impact of the presence of the epsilon-2 allele on the progress of the disease. RESULTS: In patients under 21 years of age, we observed a higher frequency of the presence of the epsilon-4 allele (p = 0.057). Nevertheless, no association was found between any of the ApoE alleles and the indices of disease progression. CONCLUSIONS: Our results do not suggest any association between the presence of the ApoE epsilon-4 allele and the progression of disability in patients with MS in our sample.

Ausencia de relación entre los genotipos de apolipoproteína E y la gravedad de la esclerosis múltiple en pacientes mexicanos / The absence of a relation between apolipoprotein E genotypes and the severity of multiple sclerosis

Introducción. El curso clínico de la esclerosis múltiple (EM) es muy variable. La historia natural de la enfermedad ha enseñado que aproximadamente el 50% de los pacientes que inician con un curso clínico brote-remisión tendrá un curso progresivo después de unos 10 años de evolución de la enfermedad y necesitará alguna ayuda para deambular. La expresión de la apolipoproteína E (ApoE) aumenta en el tejido nervioso en regeneración, y el alelo ApoE épsilon-4 está asociado con reparación neural anómala. Diversas comunicaciones indican que el alelo ApoE épsilon4 se asocia a una mayor progresión de la discapacidad en pacientes con EM, aunque es controvertido. Pacientes y métodos. Analizamos las características clínicas de 99 pacientes con diagnóstico de EM, describimos la correlación de la presencia o ausencia del alelo épsilon-4 de la ApoE con la edad de inicio, subtipo clínico, progresión de la enfermedad, puntuación de la Expanded Disability Status Scale y tasa de recaídas. Exploramos el impacto de la presencia del alelo épsilon-2 con la evolución de la enfermedad. Resultados. En pacientes menores de 21 años observamos una mayor frecuencia de la presencia del alelo épsilon-4 (p = 0,057), pero no encontramos ninguna asociación entre algún alelo de ApoE y los índices de progresión de la enfermedad. Conclusiones. Nuestros resultados no indican alguna asociación entre la presencia del alelo ApoE épsilon-4 en la progresión de discapacidad en pacientes con EM en nuestra muestra (AU)

Introduction. The clinical course of multiple sclerosis (MS) varies widely. The natural history of the disease has shown that approximately 50% of patients that begin with a relapsing-remitting clinical course will have a progressive course about 10 years after disease onset and will need some kind of aid to walk. The expression of apolipoprotein E (ApoE) increases in nerve tissue undergoing regeneration and the ApoE epsilon-4 allele is associated with abnormal neural repair. Several different reports indicate that the ApoE epsilon-4 allele is associated with a greater progression of disability in patients with MS, although this is still a matter of debate. Patients and methods. We analyse the clinical characteristics of 99 patients diagnosed with MS, we describe the correlation between the presence or absence of the ApoE epsilon-4 allele and the age of onset, clinical subtype, progression of the disease, score on the Expanded Disability Status Scale and the relapse rate. We explore the impact of the presence of the epsilon-2 allele on the progress of the disease. Results. In patients under 21 years of age, we observed a higher frequency of the presence of the epsilon-4 allele (p = 0.057). Nevertheless, no association was found between any of the ApoE alleles and the indices of disease progression. Conclusions. Our results do not suggest any association between the presence of the ApoE epsilon-4 allele and the progression of disability in patients with MS in our sample (AU)

[Immediate and long-term results of implantation of the new platinum coronary stent (atlas stent) in patients with coronary artery disease]. / Resultados inmediatos y a largo plazo del implante de un nuevo stent coronario de platino (stent Atlas) en pacientes con enfermedad arterial coronaria.

BACKGROUND AND OBJECTIVES: We evaluated the technical and clinical results of implantation of the Atlas stent, the hospital stay, and the short and long-term clinical and angiographic outcome. PATIENTS AND METHOD: The study included 169 patients (60.1 10.8 year-old), 60.3% of which had acute coronary syndromes and complex lesions. Immediate success was achieved in 98% of cases. The clinical follow-up in 85.7% of the patients at 14.3 6.8 months, revealed that 89% remained free of adverse events and most (94.4%) were functional class I of the CCS. Angiographic follow-up at 8.4 4.1 months of 40.9% of the cases revealed restenosis in 27.9%. There were 2 cases of subacute thrombosis. CONCLUSIONS: The application of the Atlas stent in patients with a diverse clinical spectrum demonstrated good immediate and long term results, with a rate of restenosis similar to that of other stents available on the market.

Resultados inmediatos y a largo plazo del implante de un nuevo stent coronario de platino (stent Atlas) en pacientes con enfermedad arterial coronaria / Immediate and long-term results of implantation of the new platinum coronary stent (Atlas stent) in patients with coronary artery disease

Introducción y objetivos. Evaluamos el resultado técnico y clínico de la aplicación del stent coronario de platino, la evolución hospitalaria, así como la evolución clínica y angiográfica, tanto a corto como a largo plazo. Pacientes y método. Incluimos a 169 pacientes consecutivos de 60,1 +/- 10,8 años, en su mayoría (60,3 por ciento) con síndromes isquémicos agudos y lesiones complejas. Se obtuvo éxito inmediato en el 98 por ciento de los casos. El seguimiento clínico en el 85,7 de los pacientes a los 14,3 +/- 6,8 meses reveló qu el 89 por ciento se mantuvo libre de acontecimientos adversos y la mayoría (94,4 por ciento) en clase funcional I. El seguimiento angiográfico a los 8,4 +/- 4,1 meses en 40,9 por ciento de los casos puso de manifiesto reestenosis en el 27,9 por ciento. Hubo 2 casos de trombosis subaguda. Conclusiones. La aplicación del sten Atlas TM en pacientes con espectro clínico diverso demostró buenos resultados inmediatos y tras el seguimiento, con tasas de reestenosis similares a las obtenidas con otros stents disponibles en el mercado (AU)