Towards establishing MS prevalence in Latin America and the Caribbean.

A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

[LACTRIMS consensus document for the pharmacological treatment of the multiple sclerosis and its clinical variants]. / Documento de consenso de LACTRIMS para el tratamiento farmacologico de la esclerosis multiple y sus variantes clinicas.

INTRODUCTION. Multiple sclerosis (MS) it is not considered any more a rare disease in Latin America. Most of the Latin American countries have reported moderate or lower prevalence data. However only very few countries have developed therapeutic guidelines. LACTRIMS prepared this consensus document with specific recommendations for the treatment of the disease. DEVELOPMENT. Experts on treatment and clinical research on MS were invited by LACTRIMS in order to generate a initial document to be discussed in Quito, Ecuador. Several groups were organized in relation of the different clinical variants. These groups were coordinated by experts leaders and prepared a preliminary document that was discussed in Quito during July 8th and 9th, 2011. Finally the final version was submitted to the members and delegates of LACTRIMS in most of the Latin American countries who were able to make modifications and suggest changes to the final manuscript. CONCLUSIONS. Based on the different evidence levels and the AGREE criteria, the clinical variants were reviewed and recommendations were made for the use of drugs and different modifying disease therapeutic agents.

Influence of glucocorticoid and betamimetic therapy on milk secretory IgA concentration produced by mothers delivering preterm infants.

A prospective study was performed to find the possible difference in secretory IgA concentration in milk of mothers with term pregnancy labors and those delivering at earlier gestational ages. Since tocolytic drugs and/or glucocorticoid agents are usually given in cases of threatened premature labor, the pre-term group was divided into mothers with or without medication. Thirty two mothers were distributed in three groups: Group I, mothers with preterm labors without any medication; Group II, preterm labors with previous treatment with betamimetics and glucocorticoids; Group III, term labors (see Tab. I). In each of the three groups, three periods were studied: colostral (4 to 5 days postpartum), transitional (8 to 10 days), and mature (14 to 15 days). All mothers were healthy, with good nutritional state, without local inflammation and membranes had been ruptured 12 hours or less before labor. There was no significant difference in the proportion of primiparas and multiparas in both groups. The gestational age was evaluated by amenorrhea and neonatal examination. In all mothers milk was extracted with a vacuum pump to empty the mammary gland. The determinations were made using a specific antibody against the secretory component. The concentration of free secretory component in these milks was practically insignificant. No differences were found in the concentration of secretory IgA among the three groups (Tab. II, Fig. 1) in the periods that were studied, colostral, transitional or mature. The farther away from labor that milk extraction was made, in the periods considered in our study, there is a progressive decrease in the concentration of secretory IgA (Fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Familial spastic ataxia associated with Ehlers-Danlos syndrome with platelet dysfunction.

Four members of a family with consanguineous relationships, the proband and his three children (2 sons and 1 daughter) are affected with Familial Spastic Ataxia and with Ehlers-Danlos' Syndrome with platelet aggregation dysfunction. In the four cases, this exceptional association appears remarkably homogeneous both in clinical and laboratory studies. The two syndromes are of dominant-autosomic transmission and probably originated in a new mutation which presumably maintained a genetic linkage. Spastic ataxia is characterized by a precocious onset and a slow evolution. The first-born son shows a dominant pyramidal syndrome with mild ataxia suggesting that it is a transitional form of familial spastic paraplegia. The Ehlers-Danlos syndrome pertains to form II or "mitis" with moderate skin hyperelasticity and joint hypermobility. The abnormal platelet aggregation curves have the same profile in all the patients. The first-born son also presents a mitral valve prolapsus as we may find either in Ehlers-Danlos syndrome or in spastic ataxia. The neurophysiological, tomographical, histological, ultrastructural and biochemical studies attempt to accomplish a better definition of these associated nosological entities.

Biosynthesis of glycoproteins in the intestinal mucosa. II. Influence of diets.

To determine the effect of diets on the biosynthesis of glycoproteins in the intestinal mucosa, male Sprague-Dawley rats were fed, ad libitum, high-carbohydrate high-fat and high-protein diets. In in vivo methodology, the animals from each dietary group received an intraperitoneal injection of [14C]-fucose, or [14C]-galactose or [14C]-glucosamine. Incorporated radioactivity was detected in the different subcellular fractions. In in vitro methodology, five glycosyl-transferases were studied on microsomes and cell sap. In vivo, only the high-fat diet induces a decrease in the incorporation of [14C]-glucosamine in the macromolecules. In vitro, only the fucosyl-transferase activity is modified by several diets: as compared with an increase in the activity of the control with the age of the animals, high-protein diet induces a slight activation after 2 weeks of diet, while high-carbohydrate and particularly high-fat diets inhibit the enzyme activity. The inhibition is the same when high-fat diet consists of either oil mixture or triolein or oleic acid or linoleic acid and becomes significant with a supplementation rate of 10%.

Sifilis secundaria con lesiones destructivas oseas. / Secondary syphilis with destructive bone lesions

Se presenta un caso de sifilis secundaria con lesiones destructivas oseas; a proposito del cual se destaca la importancia del estudio correcto del sistema osteoarticular en la sifilis precoz. La periostitis, con su traduccion clinico-radiologica se plantea como la manifestacion mas frecuente en los primeros estadios de la sifilis y los cambios osteoliticos como una eventualidad significativamente menos frecuente

Diagnostico clinico de las categorias de sindromes vestibulares. / Clinical diagnosis of the categories of vestibular syndromes

Frente a un sindrome de alteracion del equilibrio, luego del diagnostico inicial, se establece la importancia de la consulta otoneurologica con la finalidad de diagnosticar la participacion vestibular en el mecanismo fisiopatogenico del cuadro. Se ilustran algunos ejemplos de vestibulogramas caracteristicos de acuerdo a la tecnica empleada. Se distinguen sindromes del equilibrio con participacion vestibular y sin ella. Como resultado del examen otoneurologico, estas dos categorias de sindromes orientan hacia la terapeutica respectiva, por lo que es de utilidad diagnostica.Se estudia la correlacion clinica-otoneurologica-electroencefalografica-radiologica del sindrome vestibular central, periferico y de los sindromes vertiginosos con examen otoneurologico negativo, comprobandose mayor incidencia de algunos sintomas y signos en cada grupo que pueden permitir uma orientacion diagnostica.Entre ellos se destaca la mayor frecuencia de insuficiencia circulatoria vertebro basilar electroencefalografica sindromes vestibulares centrales

Metabolismo encefalico de la dopa en la enfermedad de Parkinson. / Encephalic metabolism of dopamine in Parkinson's disease

Se estudia el metabolismo de estructuras encefalicas dopaminergicas, a traves de la dosificacion del acido homovanilico (HVA) en el liquido cefalo-raquideo (LCR) de 14 enfermos con Parkinson senil o arterioesclerotico. Se confirma que las concentraciones de HVA en tales muestras tienen un valor medio significativamente inferior al obtenido en 10 muestras de sujetos normales del mismo rango de edad. Algunos casos presentan valores que se encuentran en el rango normal. El tratamiento con L-Dopa durante 3 meses obtuvo mejorias clinicas en casi todos los casos que presentaban inicialmente niveles subnormales de HVA y que alcanzaron o sobrepasaron el nivel normal durante el tratamiento (8 9). Los casos con niveles inicialmente elevados o que mantuvieron concentraciones subnormales a pesar del tratamiento, fueron fracasos terapeuticos (05)

[Immunologic studies in polymyositis syndromes]. / Exploración inmunológica en sindromes polimiosíticos.

Sixteen cases of polymyositis were submitted to study. Out of these sixteen, nine showed no clinical or paraclinical evidences of cancer, and seven presented an associated cancer. In the first group, a normal immune response was observed, whereas in the second group this response was frankly depressed. Emphasis is laid on the significance of the immune response, not only in the diagnosis but as a fundamental factor in prognosis and treatment as well. An early treatment of polymyositis without cancer proved to be satisfactory. On the other hand, when a neoplasm was present, the course of the disease was satisfactorily modified only after the extirpation of the neoplasm.