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Patients with multiple sclerosis (MS) who present coronavirus disease 2019 (COVID-19) are of particular interest to neurologists. These patients have a neuroimmune disease and receive immunomodulatory or immunosuppressive therapies in the long-term. We present here data from 73 patients with MS and a confirmed diagnosis of COVID-19 from five Latin American countries. Fifteen patients (20.5%) were hospitalized and two patients died. The use of anti-CD20 therapies was the only risk factor associated to hospitalization and death. Despite the small sample size, this study highlights the awareness regarding therapeutic options for MS during the pandemic.
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COVID-19 , Esclerose Múltipla , Humanos , América Latina/epidemiologia , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/epidemiologia , Pandemias , SARS-CoV-2RESUMO
INTRODUCTION: Patients with Parkinson's disease (PD) present a variety of oral disease that can be worsened by xerostomia and sialorrhea. The patients' physical limitations, for example rigidity and tremor, add to the difficulty of oral care by the general dental surgeon. The objective of the present review was to organize a list of evidence-based recommendations for the oral care of patients with PD. METHODS: A systematic review of the literature was carried out by specialists who selected the relevant papers and created a list of recommendations based upon the literature. RESULTS: Fourteen papers (data reported in 16 articles) were included in this review. Patients with PD had reduced quality of oral health and hygiene, and high prevalence of gingival recession, periodontal disease, dental calculus, tooth decay, tooth mobility and loss, drooling, xerostomia, dysphagia and temporomandibular disorders. Most studies offered class IV evidence, while one paper had class II evidence. CONCLUSION: Patients with PD present poor oral health with conditions that are mostly preventable.
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BACKGROUND: Fingolimod is an effective therapy for multiple sclerosis (MS). Isolated reports of very aggressive MS rebound after discontinuation of fingolimod are drawing neurologists' attention to this potentially severe complication of the drug. OBJECTIVE: Our objective was to collect literature data on cases of MS rebound following fingolimod withdrawal. In addition, we report six new cases of this adverse event in Brazil. METHODS: We carried out a systematic review of published data on cases of MS rebound after fingolimod was discontinued. In addition, the study reports a retrospective data series of Brazilian patients presenting this rebound reaction. RESULTS: Twenty papers have been published reporting on 52 patients with severe MS rebound after fingolimod withdrawal. Six new patients are included in the present paper, all of them with aggressive rebound and accumulated disability sequelae. CONCLUSION: We recommend gradual discontinuation of fingolimod with replacement by other treatment. The washout period should not exceed 4 weeks.
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Cloridrato de Fingolimode/efeitos adversos , Imunossupressores/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Adulto , Brasil , Progressão da Doença , Feminino , Cloridrato de Fingolimode/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla/fisiopatologia , Estudos Retrospectivos , Síndrome de Abstinência a SubstânciasRESUMO
The use of biosimilar drugs for multiple sclerosis (MS) has become widespread in Latin America, with the goal of reducing costs of treatments, promoting the sustainability of healthcare systems, and improving patient access to these therapies. There is currently a need to define and comply with requirements to guarantee the efficacy, safety, and quality of these drugs. Thus, the objective of the present study was to compile up-to-date information from each Latin American country assessed on (a) approval of biosimilar drugs by regulatory agencies; (b) use of biosimilar drugs, pharmacovigilance plans, risk management; and (c) update in the knowledge on different molecules. To do so, a group of experts from Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela met to discuss the current situation regarding good practices and risks associated with the use of biosimilar drugs in their respective countries. Regulation, risk management plans, and pharmacovigilance in the whole continent must guide the strategies on the commercialization and access of biosimilar drugs and copies of complex molecules. Current regulations must be implemented for the registration of biosimilar drug products and complex molecules. It is paramount to ensure that new products follow the best quality standards at all stages beyond being safe and efficient. Uncontrolled interchangeability between original biological and biosimilar should be avoided. Latin America requires the implementation and full use of strong pharmacovigilance programs. National and multinational clinical studies are required to demonstrate the similarity in safety, efficacy, and immunogenicity profiles of complex molecules, as well as biological and biosimilar products. Plain language summary available for this article.
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Objective: Involuntary hospitalization for acute psychiatry cases can be acceptable when there is potential harm. However, there are few reasons for a patient committed on these grounds to stay in an institution for a long period. The objective of the present study was to identify the profile and costs of compulsory hospitalizations over 20 days in a public psychiatric hospital in the coastal region of the state of São Paulo. Methods: Retrospective data were collected from the medical records of 1,064 patients admitted between July 2013 and June 2016 from an intensive mental healthcare unit in Santos, state of São Paulo, Brazil. Results: Records were found of 527 patients who had been hospitalized for at least 21 days during the study period. Long-term hospitalization related to judicial mandates represented 5.9% of the total sample. These patients stayed in the hospital for an average period of 142 days, while patients hospitalized for any other reason stayed an average period of 35 days (p < 0.001). The cost of a long-term court-ordered hospitalization averaged US$ 21,311 per patient. Conclusion: Judicial mandate has been an important reason for the long-term hospitalization of chronic psychiatric patients in Santos, Brazil.
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Humanos , Masculino , Feminino , Adulto , Hospitalização/economia , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Transtornos Mentais/economia , Admissão do Paciente , Transtornos Psicóticos/economia , Brasil , Estudos Retrospectivos , Unidades de Terapia Intensiva , Tempo de Internação , Transtornos Mentais/terapiaRESUMO
OBJECTIVE: Involuntary hospitalization for acute psychiatry cases can be acceptable when there is potential harm. However, there are few reasons for a patient committed on these grounds to stay in an institution for a long period. The objective of the present study was to identify the profile and costs of compulsory hospitalizations over 20 days in a public psychiatric hospital in the coastal region of the state of São Paulo. METHODS: Retrospective data were collected from the medical records of 1,064 patients admitted between July 2013 and June 2016 from an intensive mental healthcare unit in Santos, state of São Paulo, Brazil. RESULTS: Records were found of 527 patients who had been hospitalized for at least 21 days during the study period. Long-term hospitalization related to judicial mandates represented 5.9% of the total sample. These patients stayed in the hospital for an average period of 142 days, while patients hospitalized for any other reason stayed an average period of 35 days (p < 0.001). The cost of a long-term court-ordered hospitalization averaged US$ 21,311 per patient. CONCLUSION: Judicial mandate has been an important reason for the long-term hospitalization of chronic psychiatric patients in Santos, Brazil.
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Hospitalização/economia , Hospitais Psiquiátricos , Hospitais Públicos/estatística & dados numéricos , Transtornos Mentais/economia , Adulto , Brasil , Feminino , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Admissão do Paciente , Transtornos Psicóticos/economia , Estudos RetrospectivosAssuntos
Febre de Chikungunya/epidemiologia , Coinfecção/virologia , Dengue/epidemiologia , Doença Aguda , Adulto , Anticorpos Antivirais/sangue , Encéfalo/diagnóstico por imagem , Brasil , Vírus Chikungunya , Coinfecção/diagnóstico por imagem , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Multiple sclerosis (MS) is a central nervous system disease associated with irreversible progression of disability, which imposes a substantial socioeconomic onus. The objective of this study was to determine the economic impact of multiple sclerosis from the Brazilian household and healthcare system perspectives. Secondary objectives were to assess the impact of fatigue on daily living and health-related quality of life (HRQL) of MS patients. METHODS: This is a cross-sectional study in which Brazilian eligible patients attending eight major MS specialized sites answered an interview capturing data on demographics, disease characteristics and severity, comorbidities, resource utilization, fatigue, utilities and health-related quality of life from November/2011 to May/2012 . Costs were assessed considering a prevalence-based approach within 1 year of resource consumption and were estimated by multiplying the amount used by the corresponding unit cost. Patients were classified as having mild, moderate or severe disability according to the Expanded Disability Status Scale (EDSS). RESULTS: In total, 210 patients who met eligibility criteria were included, 40 % had mild, 43 % moderate and 16 % severe disability; disability level was missing for 1 %. The average total direct cost per year was USD 19,012.32 (SD = 10,465.96), and no statistically significant differences were not observed according to MS disability level (p = 0.398). The use of disease modifying therapies (DMTs) corresponded to the majority of direct expenditures, especially among those patients with lower levels of disability, representing around 90 % of total costs for mild and moderate MS patients. It was also observed that expenses with medical (except DMTs) and non-medical resources are higher among patients with more severe disease. Worsening disability also had an important influence on health-related quality of life and self-perceived impact of fatigue on daily living. CONCLUSION: Our data demonstrates the significant economic impact of MS on both Brazilian household and health system, in terms of DMTs and other disease management costs. When patients move upwards on the disease severity scale, costs with health resources other than drugs are significantly increased.
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Custos e Análise de Custo , Esclerose Múltipla/economia , Adulto , Brasil , Efeitos Psicossociais da Doença , Estudos Transversais , Características da Família , Fadiga , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Recursos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Qualidade de VidaRESUMO
Natalizumab is a potent immunosuppressive monoclonal antibody used for the treatment of multiple sclerosis (MS). While definite guidelines for the safety of natalizumab prescriptions are available in all countries, there are no specific recommendations on how to withdraw the drug if the need arises. There are reports describing MS complications after natalizumab infusions were stopped. Most neurologists seem to stop natalizumab treatment according to their idea on how to best carry out the withdrawal. The present study shows the very different manners in which expert neurologists from 14 MS units in Brazil stopped natalizumab in their patients. The authors concluded that pharmacovigilance on natalizumab must persist after the drug is withdrawn in order to have enough data for adequate recommendations.
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Anticorpos Monoclonais Humanizados/uso terapêutico , Imunossupressores/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Padrões de Prática Médica , Humanos , NatalizumabRESUMO
INTRODUCTION: Multiple sclerosis (MS) mainly affects women of fertile age. To date, the only recommendation for women with MS intending to become pregnant is to stop all treatment. This recommendation reflects the concerns about the effects of disease-modifying drugs (DMDs) on the offspring. The objective of the present study was to assess the potential long-term effects of maternal exposure to DMDs on the offspring. METHOD: This was a retrospective study revising medical data on the offspring of women with MS. These women now have children aged at least 1 year and include a group of patients that were not exposed to any DMDs for at least 3 months prior to pregnancy and during the whole gestation (control group). Another group of patients had at least 2 weeks of exposure to DMDs, mainly to interferon beta or glatiramer acetate RESULTS: The women with MS participating in this study have children currently aged, on average, 6.6 years (range 1-39 years). There was no pattern of drug-related adverse events or complications in the children whose mothers were exposed to DMDs. No specific long-term adverse events were observed in the offspring of women with MS who were exposed to drugs during pregnancy. The profile of relevant diagnoses in their children was similar to that of children whose mothers had not been exposed to DMDs. CONCLUSIONS: The present retrospective study did not show a specific profile of long-term deleterious drug effects on children born from mothers who were exposed to drugs for MS treatment.
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Fatores Imunológicos/efeitos adversos , Interferon beta/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Peptídeos/efeitos adversos , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Acetato de Glatiramer , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/uso terapêutico , Lactente , Interferon beta/administração & dosagem , Interferon beta/uso terapêutico , Peptídeos/administração & dosagem , Peptídeos/uso terapêutico , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Estudos Retrospectivos , Adulto JovemRESUMO
The aim of the present study was to assess the relationship between temporomandibular joint disorder (TMJD) and headache in children and adolescents. A prospective cross-sectional cohort study was carried out involving 93 children and adolescents (6 to 14 years of age) at the outpatient service of a dental school. All participants underwent a clinical examination involving Axis 1 of the Research Diagnostic Criteria for Temporomandibular Disorders, along with a characterization of headache and an anthropometric evaluation. Statistical analysis involved the chi-squared test for quantitative variables and the Student's t-test, ANOVA and Tukey's test for quantitative data. An adjusted logistic regression model was used to determine significant associations among gender, age, TMJD and headache. Mild TMJD was identified in 35.8% of the sample and was not associated the presence of headache. Moderate TMJD was found in 25.8% of patients and severe TMJD was found in 11.8%; both forms of TMJD were associated with headache. A significant correlation was found between the intensity of TMJD and the risk of headache. The present findings demonstrate a positive correlation between TMJD and headache in children and adolescents, independently of gender and age.
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Cefaleia/etiologia , Transtornos da Articulação Temporomandibular/complicações , Adolescente , Fatores Etários , Criança , Estudos de Coortes , Estudos Transversais , Humanos , Má Oclusão/complicações , Mordida Aberta/complicações , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Transtornos da Articulação Temporomandibular/diagnóstico , Desgaste dos Dentes/complicaçõesRESUMO
BACKGROUND: Glatiramer acetate is a US FDA category B drug with regard to use by pregnant women with multiple sclerosis (MS). There are no data currently available for the continuous use of glatiramer acetate during pregnancy. OBJECTIVE: To assess the risks and benefits of glatiramer acetate used throughout pregnancy among women with active MS. DESIGN: Retrospective and multicentre case series. SETTINGS: Outpatient services of academic and private institutions caring for patients with MS in Brazil. PATIENTS: Eleven women with MS and their children were assessed. INTERVENTION: Retrospective evaluation of women with MS who received glatiramer acetate continuously for at least 7 months during pregnancy. This evaluation was performed by the neurologist responsible for the patient. Children aged 1 year and over, born to mothers who received glatiramer acetate during pregnancy, were assessed using the Denver II developmental screening test. MAIN OUTCOME MEASUREMENTS: Obstetric, neonatal and developmental outcomes. RESULTS: No drug-related obstetric complications were observed. No specific drug-related malformations, neonatal complications or developmental abnormalities were observed in the children. Postnatal MS relapse rates remained significantly lower than antenatal rates in these patients. CONCLUSIONS: No deleterious effects from glatiramer acetate were observed in these pregnant women with MS or in their offspring. No increment in postnatal relapse rate was observed. However, the use of glatiramer acetate during pregnancy should be restricted to the most difficult cases, in which the benefits clearly outweigh the risks.
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Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Peptídeos/efeitos adversos , Peptídeos/uso terapêutico , Adolescente , Adulto , Feminino , Acetato de Glatiramer , Humanos , Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
O objetivo deste estudo foi observar a capacidade de crianças de 7 a 11 anos de idade em descrever sua cefaléia na anamnese. Para tanto, foram feitas duas avaliações de 94 crianças em entrevistas individuais pela mesma pediatra, com intervalo de seis a oito semanas, sem a presença de adultos. As características da dor de cabeça destas crianças puderam ser avaliadas nestas entrevistas, não havendo dados significativamente conflitantes entre as duas sessões. Embora habitualmente descrita e valorizada pelo adulto que acompanha a consulta, a cefaléia da infância deveria ser informada pelo próprio paciente. Neste grupo de crianças de 7 a 11 anos as informações foram obtidas sem dificuldade quando se permitiu à criança que usasse suas próprias palavras, no tempo que fosse necessário.
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Humanos , Masculino , Feminino , Criança , Cefaleia/diagnóstico , Anamnese , Distribuição por Idade , Coleta de Dados , Cefaleia/fisiopatologia , Cefaleia/psicologia , Distribuição por SexoRESUMO
The aim of the present study was to observe the ability of children aged 7 to 11 in describing their headache during anamnesis. For this purpose, two evaluations of 94 children were performed in individual assessments, done by the same Pediatrician, within a six to eight week interval, without the presence of adults. The characteristics of headache in these children could be properly evaluated during the interviews. There were no remarkable conflicting information between the two interviews. Although the headache of the child is usually described by the accompanying adult during the consultation, childhood headache should really be informed by the patient. In this group of young children (7 to 11 years old), information could be obtained without difficulty since we allowed the child enough time and the use of his (her) own words.
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Cefaleia/diagnóstico , Anamnese , Distribuição por Idade , Criança , Coleta de Dados , Feminino , Cefaleia/fisiopatologia , Cefaleia/psicologia , Humanos , Masculino , Distribuição por SexoRESUMO
El objetivo de este estudio fue describir la respuesta de gabapentina como tratamiento profiláctico para migraña en varios centros de Latinoamérica y Miami. Se estudió un total de 101 pacientes con migraña, que recibieron gabapentina a diferentes dosis, iniciando con 300 mg/día hasta reducción de la frecuencia de migraña o hasta dosis tolerable. Despúes de un mes de tratamiento con dosis de mantenimiento, se determinó la respuesta de cada paciente de acuerdo a la reducción de la frecuencia de las crisis de la migraña (excelente: >75 por ciento, buena: 50-75 por ciento, regular: 25-50 por ciento y pobre: 25 por ciento). La mayoría de los pacientes (84 por ciento) tuvo una respuesta excelente (53 por ciento) o buena (32 por ciento). En estos pacientes, la mayoría recibió una dosis de 600 mg/día. Cincuenta y cinco por ciento de los pacientes no describieron eventos adversos. Los eventos adversos más frecuentes fueron somnolencia y fatiga. Aproximadamente la mitad de estos eventos fueron leves y sólo 9 pacientes (8.9 por ciento) los describieron como severos. Se puede concluir que la gabapentina puede ser útil en el tratamiento preventivo de la migraña, y se amerita un futuro estudio para demostrar la eficacia y seguridad de gabapentina a dosis bajas (600 mg/día) y dosis altas, contra placebo. Palabras claves: gabapentina, migraña, profilaxis de migraña, tratamiento.
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Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Adolescente , Anticonvulsivantes , Cefaleia , Costa RicaRESUMO
Objetivo: Relatar um caso de Hemicrania Contínua em uma jovem de 17 anos que apresentava esse tipo de cefaléia há 9 anos, sem diagnóstico. Embora essa seja uma cefaléia primária relativamente rara, a imediata resposta ao tratamento com indometacina justifica que seja uma entidade melhor conhecida. Métodos: Relato do caso de uma adolescente que apresentava Hemicrania Continua há anos, sem diagnóstico e sem tratamento específico. Revisäo da literatura médica a respeito, através de Medline. Resultados: O tratamento clínico com baixas doses de indometacina determinou o desaparecimento completo da cefaléia. Conclusäo: A Hemicrania Contínua deve ser considerada entre as hipóteses diagnosticas de pacientes que apresentam cefaléia contínua, hemicrania, sem alteraçöes ao exame clínico, neurológico e exames subsidiários, independentemente da idade de aparecimento. Este é o caso da paciente mais jovem com Hemicrania Contínua e foi trazido para discussäo por um acadêmico de medicina, alertado para essa possibilidade diagnóstica
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Humanos , Feminino , Adolescente , Cefaleia , Indometacina/uso terapêutico , Transtornos de EnxaquecaRESUMO
Many are the theories regarding the physiopatolhogy of migraine and some blood alterations found in migranous patients still await explanation. Migraine has already been considered a "platelet disorder", and drugs affecting platelet aggregation have always had a place in migraine therapy. Chronic use of heparin and warfarin has been reported to improve the frequency and intensity of migraine attacks. The present work is a review of haematologic alterations in migraine, discussing the possible role of platelets and basophils on the genesis and perpetuation of attacks in this chronic and often incapacitating headache.
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Humanos , Plaquetas , Transtornos de Enxaqueca/sangue , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Agregação Plaquetária , Varfarina/uso terapêuticoRESUMO
Crianças, adolescentes e adultos jovens com no mínimo um ataque de cefaléia todo mês e com distúrbios visuais característicos de migrânea foram entrevistados por estudantes de medicina. Não houve nenhuma dificuldade especial para obter informações das crianças com idade entre 7-14 anos. Quando perguntamos sobre os sintomas que acompanhavam os ataques de cefaléia, o mais prevalente foi a sensação de mal estar durante a crise. Náuseas, tonturas, parestesias, foto e fonobia foram frequentes. Uma relação temporal típica entre a aura e cefaléia não ficou clara em metade dos casos, emboras as crises fossem tipicamente de migrânea. Quando vistas por médicos, muitas destas crianças foram consultadas por Oftalmologistas. Apesar dos sintomas de migrânea, esta não foi considerada como possibilidade diagnóstica em nenhum indivíduo abaixo dos 26 anos de idade.