The role of teriflunomide in Multiple Sclerosis patient: an observational study.

Teriflunomide is a drug with immunosuppressive and selective immunomodulatory action, characterized by anti-inflammatory and antiproliferative properties. Several clinical studies have demonstrated the efficacy and safety of this drug in Multiple Sclerosis, estimating a significant improvement in cognitive performance.The aim of our study is to evaluate the effects of teriflunomide by analysing the correlation between brain atrophy and the general cognitive profile and evaluating long-term changes. The effect of teriflunomide was studied in 30 patients with multiple sclerosis and 30 control subjects. Patients underwent a full cognitive profile assessment using the Brief Repeatable Battery of Neuropsychological Tests and a neuroimaging examination with a 3.0 T working scanner.Our results suggested that treatment with teriflunomide could potentially not only slow down the accumulation of microstructural tissue damage in Grey Matter and With Matter, but also better preserve the cognitive profile, particularly by highlighting the benefits in the memory domain. Thanks to drug therapy, brain volume in our patients has remained constant, leading to improvements in memory, indicating teriflunomide as a neuroprotective potential and further strengthening the evidence of a link between loss of brain volume and cognitive impairment.

Brain morphologic abnormalities in migraine patients: an observational study.

BACKGROUND: Migraine is a common neurological disorder characterized by a complex physiopathology. We assessed brain morphologic differences in migraine and the possible pathogenetic mechanism underlying this disease. METHODS: We analyzed brain morphologic images of migraine patients, 14 with aura (MwA) [the mean (SD) age was 42.36 (2.95) years (range, 37-47)] and 14 without aura (MwoA) [the mean (SD) age was 43.5 (3.25) years (range, 39-50)] during episodic attack compared with health subjects balanced (HS) [the mean (SD) age was 42.5 (5.17) years (range, 34-51)]. All subjects underwent a Magnetic Resonance Imaging (MRI) examination with a scanner operating at 3.0 T and voxel based morphometry (VBM) approach was used to examine the gray matter volume (GMV). The statistical analysis to compare clinicl characteristics was performed using unpaired t-test an one-way Anova. RESULTS: Total cerebral GMV showed a significant difference between MwA and HS (p = 0.02), and between MwoA and HS (p = 0.003). In addition, not significative differences were found between MwA and MwoA groups (p = 0.17). We found three clusters of regions which showed significant GMV reduction in MwA compared with MwoA. MwA subjects showed a less of GMV in 4 clusters if compared with HS, and MwoA subjects showed a less of GMV in 3 clusters if compared with HS. We observed that MwA and MwoA patients had a significant reduction of GMV in the frontal and temporal lobe and the cerebellum, if compared to HS. The bilateral fusiform gyrus and the cingulate gyrus were increase in MwoA patients compared with HS. CONCLUSION: Our findings could provide a approach to understand possible differences in the pathogenesis of two type of migraine.

Liver transplantation in hemophilia A and von Willebrand disease type 3: perioperative management and post-transplant outcome.

INTRODUCTION: infection with the hepatitis C virus (HCV) causes significant morbidity and mortality in patients with hemophilia. Finally, patients are considered for a liver transplantation (LT) due to cirrhosis and/or hepatocellular carcinoma (HCC). CASE REPORT: we report the cases of congenital coagulopathy and HCV infection that underwent LT in our institution. There were three patients with hemophilia A and one patient with von Willebrand disease (vWD) type 3. The coagulopathy outcome, perioperative management, factor and blood product usage and post-transplant survival were assessed. The deficient factor was initially administered in a direct bolus one hour before surgery with a target level of 100 IU/dl, which was sustained until stable hemostasis was reached. All three patients with hemophilia A were cured of their coagulopathy following transplantation. Factor VIII (FVIII) was 93 IU/dl at eleven years, 59 IU/dl at 13 months and 109 IU/dl at nine months post-transplant, in each case. The mean perioperative usage of FVIII concentrates was 175 IU/kg; concentrates were infused for an average of 36 hours post-transplant. The natural course of the bleeding symptoms of the patient with type-3 vWD was attenuated, with no detectable hemostatic levels of von Willebrand factor antigen (vWF:Ag) after transplantation. DISCUSSION: after transplantation, hemophilia A cure and improved bleeding phenotype of type-3 vWD reduced morbidity and mortality. However, potential graft reinfection with HCV and relapsing HCC cast a shadow over these optimum results.

Lifestyle Can Exert a Significant Impact on the Development of Metabolic Complications and Quality Life in Patients with Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBDs) are associated with an increased risk of metabolic comorbidities. There is a lack of data regarding the relationship between lifestyle and metabolic diseases in IBD patients. A cross-sectional study on consecutive IBD outpatients was conducted. Adherence to the Mediterranean diet (MD) was assessed using a 14-item questionnaire from the PREDIMED study, and physical activity was evaluated using the GODIN-Leisure score. Body composition was studied based on body mass index and waist-hip ratio (WHR), while quality of life was assessed using a nine-item short questionnaire. Among the 688 evaluated IBD patients, 66% were overweight or obese, 72.7% did not lead an active lifestyle and 70.1% did not adhere to the MD. Metabolic syndrome was associated with age (OR = 1.07, p = 0.019), overweight/obesity (OR = 12.987, p < 0.001) and the inflammatory behavior of Crohn's disease (OR = 6.172, p = 0.001). Type 2 diabetes mellitus or prediabetes was associated with age (OR = 1.063 p = 0.016), overweight/obesity (OR = 3.861, p < 0.001) and the inflammatory behavior of Crohn's disease (OR = 4.716, p = 0.001). Overweight /obesity (OR = 5.494, p < 0.001), a high WHR (OR = 2.564, p = 0.005) and a non-active lifestyle (OR = 2.202, p = 0.0003) were associated with metabolic dysfunction-associated steatotic liver disease. Lifestyle, body composition and not solely systemic inflammation might exert a significant influence on the emergence of metabolic comorbidities such as MASLD, type 2 diabetes mellitus and metabolic syndrome in patients with IBD.

A propósito de una nueva clasificación del embarazo a término. Resultados neonatales en una clínica de tercer nivel de atención en Cali, Colombia. Un estudio de corte transversal / In view of a new classification of term pregnancy. Neonatal outcomes in a level III clinic in Cali, Colombia. A cross-sectional study

Objetivo: Aplicar la clasificación del parto a término del American College of Obstetricians and Gynaecologists (ACOG); describir la frecuencia de las diferentes categorías y hacer un análisis exploratorio de los resultados neonatales entre los grupos. Materiales y métodos: Estudio de corte transversal. Se incluyeron gestantes consideradas inicialmente sanas, con embarazo a término definido según última menstruación confiable y ecografía en la primera mitad de la gestación, de una clínica privada de tercer nivel, de Cali (Colombia), año 2013. Los partos se clasificaron como parto a término temprano, a término y a término tardío. Se describen las características sociodemográficas maternas y los resultados perinatales, así como la frecuencia de cada categoría; la comparación de grupos se estableció a través de análisis de varianza (ANOVA), Kruskal-Wallis o chi cuadrado. Resultados: De 502 nacimientos, fueron clasificados como embarazos a término temprano 200 (39,8 %), completo 254 (50,6 %) y tardío 48 (9,6 %). Hubo mayor frecuencia de aseguramiento contributivo de la madre y embarazos de alto riesgo en el grupo a término temprano. Se observaron diferencias estadísticamente significativas en bajo peso al nacer y peso promedio del neonato en el grupo a término temprano, y mayor asfixia neonatal en el grupo a término tardío. No hubo diferencias en cuanto a síndrome de dificultad respiratoria y tiempo de hospitalización. Conclusión: La nueva clasificación de embarazo a término de la ACOG es factible de aplicar. La frecuencia de parto a término temprano es alta en Colombia. No se evidenciaron diferencias significativas en los resultados neonatales entre los tres grupos excepto en la asfixia neonatal, que fue mayor en el grupo a término tardío.

Objective: To apply the classification of term delivery of the American College of Obstetricians and Gynaecologists, describe the frequency of the various categories, and explore neonatal outcomes among groups. Materials and methods: A cross-sectional study including pregnant women considered initially healthy with a term pregnancy defined on the basis of the last reliable menstruation and ultrasound performed in the first half of the gestation period in a private, Level III clinic, in Cali, Colombia, in 2013. Deliveries were classified as early term, term and late term. Social and demographic characteristics of the mothers and perinatal outcomes are described. The frequency of each category is described and group comparisons are performed using the variance analysis (ANOVA),and the Kruskal-Wallis or Chi-square test. Results: Of 502 births, 200 (39.8 %) were classified as early term, 354 (50.6 %) as full term, and 48 (9.6 %) as late term. There was a higher frequency of contributive insurance coverage and high risk pregnancies in the early term group. Statistically significant differences were observed in terms of low birth weight and average neonatal weight in the early term group, whereas neonatal asphyxia was higher in the late term group. There were no differences in terms of respiratory distress syndrome or length of stay. Conclusion: It is feasible to apply the new ACOG term pregnancy classification. The frequency of early term delivery is high in Colombia. There was no evidence of significant differences in neonatal outcomes between the three groups except for higher neonatal asphyxia in the late term group.