Misdiagnosis in multiple sclerosis in a Brazilian reference center: Clinical, radiological, laboratory profile and failures in the diagnostic process-Cohort study.

BACKGROUND: Multiple sclerosis misdiagnosis remains a problem despite the well-validated McDonald 2017. For proper evaluation of errors in the diagnostic process that lead to misdiagnosis, it is adequate to incorporate patients who are already under regular follow-up at reference centers of demyelinating diseases. OBJECTIVES: To evaluate multiple sclerosis misdiagnosis in patients who are on follow-up at a reference center of demyelinating diseases in Brazil. METHODS: We designed an observational study including patients in regular follow-up, who were diagnosed with multiple sclerosis at our specialized outpatient clinic in the Hospital of Clinics in the University of Sao Paulo, from 1996 to 2021, and were reassessed for misdiagnosis in 2022. We evaluated demographic information, clinical profile, and complementary exams and classified participants as "established multiple sclerosis," "non-multiple sclerosis, diagnosed," and "non-multiple sclerosis, undiagnosed." Failures in the diagnostic process were assessed by the modified Diagnostic Error Evaluation and Research tool. RESULTS: A total of 201 patients were included. After analysis, 191/201 (95.02%) participants were confirmed as "established multiple sclerosis," 5/201 (2.49%) were defined as "non-multiple sclerosis, diagnosed," and 5/201 (2.49%) were defined as "non-multiple sclerosis, undiagnosed." CONCLUSIONS: Multiple sclerosis misdiagnosis persists in reference centers, emphasizing the need for careful interpretation of clinical findings to prevent errors.

How to choose initial treatment in multiple sclerosis patients: a case-based approach.

BACKGROUND: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. OBJECTIVE: To discuss the state of art of selecting the initial therapy for relapsing MS patients. METHODS: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. RESULTS: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. CONCLUSION: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision.

How to choose initial treatment in multiple sclerosis patients: a case-based approach / Como escolher o tratamento inicial na esclerose múltipla: uma abordagem baseada em casos

ABSTRACT Background: Immunotherapy dramatically changed the natural history of multiple sclerosis (MS), which was classically associated with severe disability. Treatment strategies advocate that early control of disease activity is crucial to avoid progressive disability, and the use of high efficacy drugs may be beneficial, but safety is a concern. Choosing the disease-modifying therapy is challenging in clinical practice and should be further discussed. Objective: To discuss the state of art of selecting the initial therapy for relapsing MS patients. Methods: We used a case-based approach followed by clinical discussion, exploring therapeutic options in different MS settings. Results: We presented clinical cases profile compatible with the use of MS therapies, classified into moderate and high efficacy. In the moderate efficacy group, we discussed interferons, glatiramer acetate, teriflunomide and dimethyl fumarate, while in the high efficacy group we discussed fingolimod, cladribine, natalizumab, ocrelizumab, alemtuzumab and ofatumumab. Conclusion: Advances in MS treatment are remarkable. Strong evidence supports the use of early high efficacy therapy. However, biomarkers, clinical and radiologic prognostic factors, as well as patients' individual issues, should be valued and considered for a personalized treatment decision.

RESUMO Antecedentes: A imunoterapia mudou drasticamente a história natural da esclerose múltipla (EM), doença esta que era classicamente associada a grandes incapacidades. Sabe-se hoje que o controle precoce da atividade de doença é crucial para evitar incapacidade progressiva, e o uso de terapias de alta eficácia pode ser benéfico. Apesar disso, a segurança ainda é uma preocupação dos pacientes e médicos. A escolha da terapia modificadora da doença é um desafio na prática clínica e suas particularidades devem ser mais discutidas. Objetivo Discutir o estado da arte da seleção da terapia inicial para pacientes com EM remitente recorrente. Métodos Utilizamos uma abordagem baseada em casos clínicos, com discussão das diversas opções terapêuticas em diferentes contextos de EM. Resultados: Foram apresentados casos clínicos compatíveis com o uso das principais terapias para EM, divididas em moderada e alta eficácia. No grupo de moderada eficácia discutimos sobre os interferons, acetato de glatirâmer, teriflunomida e fumarato de dimetila enquanto que no de alta eficácia falamos sobre fingolimode, cladribina, natalizumabe, ocrelizumabe, alentuzumabe e ofatumumabe. Conclusão Os avanços no tratamento da EM são notáveis. Fortes evidências suportam que o uso de terapia de alta eficácia de forma precoce possa ser benéfica. No entanto, biomarcadores, fatores prognósticos clínicos e radiológicos, bem como questões individuais dos pacientes, devem ser valorizados e considerados para uma decisão de tratamento personalizado.

Implementation of a Regional Network for ST-Segment-Elevation Myocardial Infarction (STEMI) Care and 30-Day Mortality in a Low- to Middle-Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST).

BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; P<0.001), and more patients were transferred to the referral center (44.7%-76.3%; P=0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy. CONCLUSIONS: Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.

[Influence of socioeconomic factors on the quality of life of elderly hypertensive individuals]. / Influência de fatores socioeconômicos na qualidade de vida de idosos hipertensos.

This study sought to evaluate the association between socioeconomic variables and the quality of life of elderly hypertensive patients treated under the Family Health Program in the city of Montes Claros, Minas Gerais, Brazil. An analytical cross study was conducted in a representative sample of 294 elderly hypertensive patients. Data were collected using a questionnaire on socioeconomic characteristics and quality of life (MINICHAL). The data were analyzed using the nonparametric Mann-Whitney and Kuskall-Wallis tests. The results showed that marital status, religion and education affect the quality of life of elderly hypertensive patients in a statistically significant way. Elderly hypertensive patients who were single/divorced/widowed, evangelical, spiritualist and belonging to other religious bodies, illiterate achieved lower scores in terms of quality of life. For the remaining variables, there was no statistical association. The conclusion, drawn is that socioeconomic factors such as marital status, education and religion influence the quality of life of elderly hypertensive patients.

Influência de fatores socioeconômicos na qualidade de vida de idosos hipertensos / Influence of socioeconomic factors on the quality of life of elderly hypertensive individuals

O presente estudo teve como objetivo analisar a associação entre fatores socioeconômicos e qualidade de vida de idosos hipertensos atendidos pelo Programa Saúde da Família na cidade de Montes Claros, Minas Gerais, Brasil. Consistiu em um estudo transversal analítico conduzido em amostra representativa de 294 idosos hipertensos. Os dados foram coletados por meio de questionário de caracterização socioeconômica e de qualidade de vida (Minichal). Foram analisados por meio de testes não paramétricos de Mann-Witney e Kuskall-Wallis. Os resultados, por sua vez, mostraram que o estado conjugal, a religião e a escolaridade afetam de maneira estatisticamente significativa a qualidade de vida de idosos hipertensos. Idosos hipertensos solteiros/divorciados/viúvos, evangélicos, espíritas e pertencentes a outras entidades religiosas, e analfabetos apresentaram menores escores de qualidade de vida. Para as demais variáveis analisadas, não houve associação estatística. Conclui-se que os fatores socioeconômicos como estado conjugal, escolaridade e religião influenciam na qualidade de vida de idosos hipertensos.

This study sought to evaluate the association between socioeconomic variables and the quality of life of elderly hypertensive patients treated under the Family Health Program in the city of Montes Claros, Minas Gerais, Brazil. An analytical cross study was conducted in a representative sample of 294 elderly hypertensive patients. Data were collected using a questionnaire on socioeconomic characteristics and quality of life (MINICHAL). The data were analyzed using the nonparametric Mann-Whitney and Kuskall-Wallis tests. The results showed that marital status, religion and education affect the quality of life of elderly hypertensive patients in a statistically significant way. Elderly hypertensive patients who were single/divorced/widowed, evangelical, spiritualist and belonging to other religious bodies, illiterate achieved lower scores in terms of quality of life. For the remaining variables, there was no statistical association. The conclusion, drawn is that socioeconomic factors such as marital status, education and religion influence the quality of life of elderly hypertensive patients.

O idoso hospitalizado: atuação do acompanhante e expectativas da equipe de enfermagem / Hospitalized elderly: the role of companions and expectations of the nursing team / El anciano hospitalizado: actuación del acompañante y las expectativas del equipo de enfermería

Este estudo objetivou descrever as atividades realizadas pelos acompanhantes de idosos hospitalizados e as expectativas da equipe de enfermagem quanto a esses acompanhantes. Estudo transversal analítico, realizado em um hospital universitário, em Montes Claros, Minas Gerais, Brasil, com 30 acompanhantes de idosos e 32 profissionais de enfermagem, teve como instrumento de coleta de dados um questionário elaborado com referenciais de autores estudiosos da temática. Utilizou-se na análise de dados o teste Qui-quadrado, para a associação de variáveis. Os resultados mostraram associação estatística nas atividades de colocar/tirar roupas, na frequência "sempre" e "quando necessário"; e fazer a cama, na frequência "sempre". Quanto a colocar/tirar roupas, na frequência "sempre", o acompanhante auxilia o idoso mais do que o esperado pela equipe, e a expectativa maior da enfermagem é a de que o acompanhante auxilie "quando necessário". Sobre o fazer a cama, na frequência "sempre", o acompanhante realiza a atividade mais do que o esperado pela equipe, e a expectativa maior da enfermagem é que o acompanhante "nunca" auxilie. Espera-se que a equipe de enfermagem compreenda a sua ação para além do cliente, abrangendo o acompanhante em seu processo de cuidar.

This study described the activities of caregivers of hospitalized elderly and the nursing team's expectations regarding those companions. It consists of an analytical cross-sectional study conducted in a university hospital in the city of Montes Claros, Minas Gerais, Brazil. The participants were 30 companions of elderly patients and 32 nursing team's. The data collection instrument was a questionnaire with reference to scholars of thematic. Used in data analysis the Chi-square test for association of variables. The results showed statistical association for the activities of dressing and undressing, in "always" and "when necessary" frequencies, and making the bed, in "always" frequency. For dressing and undressing activities, in "always" frequency, the companion assists the elderly more than expected by the nursing team, and the highest expectation of the team is that the companion assists the patient "when necessary". As for making the bed, in "always" frequency, the companion carries on the activity more often than expected by the team, and the highest expectation of the nursing team is that the companion "never" gives assistance. It is necessary that the nursing staff has a broader vision, understanding their action beyond the client, also covering the companion in their process of taking care.

Este estudio tuvo como objetivo describir las actividades de los acompañantes de ancianos hospitalizados y las expectativas del personal de enfermería, con relación a dichos acompañantes. Es un estudio transversal analítico, realizado en un hospital universitario, en Montes Claros, Minas Gerais, Brasil. Participaron 30 acompañantes de ancianos y 32 profesionales de enfermería. Tuvo, como instrumento de recolección de datos, una encuesta elaborada a partir de referencias de autores que estudian esa temática. Se utilizó en el análisis de datos prueba de Chi cuadrado para la asociación de variables. Los resultados mostraron una asociación estadística para las actividades de colocar y quitar ropas, en frecuencia "siempre" y "cuando sea necesario", y hacer la cama, con frecuencia "siempre". Para la actividad de colocar y quitar ropas, en frecuencia "siempre", el acompañante auxilia al anciano más de lo esperado por el equipo, y la expectativa mayor de la enfermería es la de que el acompañante auxilie "cuando sea necesario". Con relación a hacer la cama, en la frecuencia "siempre", el acompañante realiza la actividad más de lo que el equipo espera, y la expectativa mayor de la enfermería es que el acompañante "nunca" auxilie. Es necesario que el equipo de enfermería tenga una visión más amplia, comprendiendo su acción más allá del cliente, alcanzando también al acompañante en su proceso de cuidados.