SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry.

OBJECTIVE: To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. METHODS: Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. RESULTS: Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. CONCLUSIONS: This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.

Conocimiento de la enfermedad vascular cerebral en la población de Zaragoza / Knowledge of cerebrovascular disease in the population of Zaragoza

Introducción. El ictus es una de las principales causas de invalidez y mortalidad en nuestra sociedad, con importantes repercusiones socioeconómicas y sanitarias. La asistencia precoz puede mejorar el pronóstico de los pacientes. Actualmente, existen tratamientos en fase aguda, que consiguen reperfundir el tejido isquémico en riesgo y revertir la sintomatología, pero son pocos los pacientes que se benefician, por el retraso en su atención, debido a la falta de reconocimiento de los síntomas y la escasa percepción de gravedad. Objetivo. Analizar el conocimiento de la población de nuestra área de salud sobre el ictus. Sujetos y métodos. La muestra analizada ha sido la población del sector III de la provincia de Zaragoza, con selección aleatoria. La herramienta utilizada ha sido una encuesta telefónica estructurada (total de 583). Resultados. Un 63,5% de los encuestados desconoce los síntomas del ictus, y un 48%, los factores de riesgo vascular. Sólo un 9% reconoce al menos dos síntomas y dos factores de riesgo. En cuanto a la actitud, un 56% actuaría correctamente frente a un 44% que no. El análisis multivariante mostró que los factores más relacionados con el conocimiento fueron el nivel cultural y la edad joven. Vivir en un pueblo y sexo femenino se relacionaron con la mejor actitud. Conclusiones. El conocimiento del ictus es escaso, con una baja percepción de urgencia. Los factores que implican un mejor conocimiento son la edad joven y el nivel cultural alto (AU)

Introduction. Acute cerebrovascular disease is a major cause of disability and mortality, with important socio-economic and health impacts. Early stroke care can reduce mortality and improve prognosis. Right now, we can apply treatments in the acute phase, with capacity to reverse the symptoms, but few patients who benefit not reach the hospital soon. One reason for this delay is the lack of recognition of symptoms and poor perception of gravity. Aim. To find out the knowledge of the public about the stroke. Subjects and methods. The sample analyzed was the population of Sector III of Zaragoza, with random selection. The tool used was a telephone survey structured. We analyzed 583 surveys. Results. 63.5% of respondents did not know any symptoms of stroke. 48% do not know any vascular risk factor. Only 9% recognized at least two symptoms and two risk factors. Regarding the attitude, 56% act properly against 44% who do not. Multivariate analysis showed that the factors more related to knowledge are the cultural level and young age. Living in town, and female, they are associated with the best attitude. Conclusions. Knowledge about stroke is poor, with a low sense of urgency. The factors most associated with the best knowledge are young age and cultural level (AU)

Neuralgia occipital como primer síntoma de un hepatocarcinoma / Occipital neuralgia as the first symptom of a hepatocarcinoma

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Estudio de concordancia diagnóstica en cefalea entre neurología y atención primaria / Study of the diagnostic agreement on headaches between neurology and primary care

Introducción. La cefalea como síntoma es una patología frecuente y uno de los principales motivos de consulta por parte de atención primaria. Objetivo. Analizar las características de los pacientes derivados desde atención primaria a la consulta de neurología general con cefalea o neuralgia como motivo de consulta, y la concordancia diagnóstica. Pacientes y métodos. Estudio descriptivo transversal de todos los pacientes remitidos desde atención primaria; se recogieron variables demográficas/clínicas y se compararon las hipótesis diagnósticas de atención primaria y neurología, determinando su concordancia. Resultados. Se remitieron desde atención primaria 2.514 pacientes (588 de ellos con carácter preferente); en 378 casos el motivo de la consulta fue cefalea o neuralgia (42,46 años de media; el 77,8%, mujeres). En 139 pacientes se estableció tan sólo un diagnóstico semiológico y en el resto predominaron la migraña episódica (49,79%), la cefalea tensional crónica (18,41%) y la neuralgia del trigémino (12,13%). Desde neurología, los diagnósticos más frecuentes fueron, respectivamente, 33,86%, 24,05% y 18,67%. Se obtuvo un coeficiente kappa de 0,543 (p < 0,05), compatible con una concordancia moderada al considerar sólo los pacientes remitidos desde atención primaria con un diagnóstico concreto. Conclusiones. Las cefaleas constituyen un motivo de consulta desde atención primaria muy frecuente (15%). La concordancia diagnóstica es moderada en nuestro sector sanitario, por lo que es necesario diseñar programas de formación que ayuden a perfilar los criterios de derivación al especialista y mejorar la atención a nuestros pacientes (AU)

Introduction. Headache as a symptom is a very common disease and one of the main reasons for consultation in primary care. Aim. To analyze the characteristics of patients referred from primary care to general neurology whose chief complaint was headache and/or neuralgia and diagnostic agreement. Patients and methods. Cross-sectional study of all patients referred from primary care; demographic/clinical variables were collected and diagnostic hypothesis by primary care and general neurology were compared by determining their agreement. Results. 2,514 were referred from primary care patients (588 of them on a preferential basis); in 378 cases the reason for consultation was headache and/or neuralgia (average 42.46 years; 77.8% female). In 139 patients it was established only a semiological diagnostic and other episodic migraine predominated (49.79%), chronic tension headache (18.41%) and trigeminal neuralgia (12.13%). Since general neurology, the most common diagnoses were, respectively, 33.86%, 24.05% and 18.67%. A compatible kappa coefficient of 0.543 (p < 0.05) with a moderate agreement when considering only those patients referred from primary care to a specific diagnosis was obtained. Conclusions. Headaches are a very common reason for consultation in primary care (15%). The diagnostic agreement is moderate in our health sector so it is necessary to design training programs to help outline the criteria for referral to specialists and improve care for our patients (AU)

Valor de la tomografía de coherencia óptica en el estudio del nervio óptico de pacientes con esclerosis múltiple / No disponible

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