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The combined application of electric fields and ultrasonic waves has shown promise in controlling cell membrane permeability, potentially resulting in synergistic effects that can be explored in the biotechnology industry. However, further clarification on how these processes interact is still needed. The objective of the present study was to investigate the atomic-scale effects of these processes on a DPPC lipid bilayer using molecular dynamics simulations. For higher electric fields, capable of independently forming pores, the application of an ultrasonic wave in the absence of cavitation yielded no additional effects on pore formation. However, for lower electric fields, the reduction in bilayer thickness induced by the shock wave catalyzed the electroporation process, effectively shortening the mean path that water molecules must traverse to form pores. When cavitation was considered, synergistic effects were evident only if the wave alone was able to generate pores through the formation of a water nanojet. In these cases, sonoporation acted as a mean to focus the electroporation effects on the initial pore formed by the nanojet. This study contributes to a better understanding of the synergy between electric fields and ultrasonic waves and to an optimal selection of processing parameters in practical applications of these processes.
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Electroporación , Membrana Dobles de Lípidos , Simulación de Dinámica Molecular , Ondas Ultrasónicas , Membrana Dobles de Lípidos/química , Electroporación/métodos , Electricidad , Permeabilidad de la Membrana Celular , 1,2-Dipalmitoilfosfatidilcolina/químicaRESUMEN
Hybrid vesicles consisting of natural phospholipids and synthetic amphiphilic copolymers have shown remarkable material properties and potential for biotechnology, combining the robustness of polymers with the biocompatibility of phospholipid membranes. To predict and optimize the mixing behavior of lipids and copolymers, as well as understand the interaction between the hybrid membrane and macromolecules like membrane proteins, a comprehensive understanding at the molecular level is essential. This can be achieved by a combination of molecular dynamics simulations and experiments. Here, simulations of POPC and PBD22-b-PEO14 hybrid membranes are shown, uncovering different copolymer configurations depending on the polymer-to-lipid ratio. High polymer concentrations created thicker membranes with an extended polymer conformation, while high lipid content led to the collapse of the polymer chain. High concentrations of polymer were further correlated with a decreased area compression modulus and altered lateral pressure profiles, hypothesized to result in the experimentally observed improvement in membrane protein reconstitution and resistance toward destabilization by detergents. Finally, simulations of a WALP peptide embedded in the bilayer showed that only membranes with up to 50% polymer content favored a transmembrane configuration. These simulations correlate with previous and new experimental results and provide a deeper understanding of the properties of lipid-copolymer hybrid membranes.
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Fosfolípidos , Polímeros , Polímeros/química , Fosfolípidos/química , Sustancias Macromoleculares , Simulación de Dinámica Molecular , Proteínas de la Membrana , Membrana Dobles de Lípidos/químicaRESUMEN
BACKGROUND AND AIMS: In eastern Neotropical South America, the Cerrado, a large savanna vegetation, and the Atlantic Forest harbour high biodiversity levels, and their habitats are rather different from each other. The biomes have intrinsic evolutionary relationships, with high lineage exchange that can be attributed, in part, to a large contact zone between them. The genomic study of ecotypes, i.e. populations adapted to divergent habitats, can be a model to study the genomic signatures of ecological divergence. Here, we investigated two ecotypes of the tree Plathymenia reticulata, one from the Cerrado and the other from the Atlantic Forest, which have a hybrid zone in the ecotonal zone of Atlantic Forest-Cerrado. METHODS: The ecotypes were sampled in the two biomes and their ecotone. The evolutionary history of the divergence of the species was analysed with double-digest restriction site-associated DNA sequencing. The genetic structure and the genotypic composition of the hybrid zone were determined. Genotype-association analyses were performed, and the loci under putative selection and their functions were investigated. KEY RESULTS: High divergence between the two ecotypes was found, and only early-generation hybrids were found in the hybrid zone, suggesting a partial reproductive barrier. Ancient introgression between the Cerrado and Atlantic Forest was not detected. The soil and climate were associated with genetic divergence in Plathymenia ecotypes and outlier loci were found to be associated with the stress response, with stomatal and root development and with reproduction. CONCLUSIONS: The high genomic, ecological and morphophysiological divergence between ecotypes, coupled with partial reproductive isolation, indicate that the ecotypes represent two species and should be managed as different evolutionary lineages. We advise that the forest species should be re-evaluated and restated as vulnerable. Our results provide insights into the genomic mechanisms underlying the diversification of species across savanna and forest habitats and the evolutionary forces acting in the species diversification in the Neotropics.
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Pradera , Árboles , Árboles/genética , Bosques , Ecosistema , Genómica , Genética de PoblaciónRESUMEN
Electroporation is a cell-level phenomenon caused by an ionic imbalance in the membrane, being of great relevance in various fields of knowledge. A dependence of the pore formation kinetics on the environmental conditions (temperature and pressure) of the cell membrane has already been reported, but further clarification regarding how these variables affect the pore formation/resealing dynamics and the transport of molecules through the membrane is still lacking. The objective of the present study was to investigate the temperature (288-348 K) and pressure (1-5000 atm) effects on the electroporation kinetics using coarse-grained molecular dynamics simulations. Results shown that the time for pore formation and resealing increased with pressure and decreased with temperature, whereas the maximum pore radius increased with temperature and decreased with pressure. This behavior influenced the ion migration through the bilayer, and the higher ionic mobility was obtained in the 288 K/1000 atm simulations, i.e., a combination of low temperature and (not excessively) high pressure. These results were used to discuss some experimental observations regarding the extraction of intracellular compounds applying this technique. This study contributes to a better understanding of electroporation under different thermodynamic conditions and to an optimal selection of processing parameters in practical applications which exploit this phenomenon.
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Membrana Dobles de Lípidos , Simulación de Dinámica Molecular , Membrana Celular/metabolismo , Electroporación , Membrana Dobles de Lípidos/metabolismo , TemperaturaRESUMEN
The Cerrado, the largest Neotropical savanna, and the Brazilian Atlantic Forest form large ecotonal areas where savanna and forest habitats occupy adjacent patches with closely related species occurring side by side, providing opportunities for hybridization. Here, we investigated the evolutionary divergence between the savanna and forest ecotypes of the widely distributed tree Plathymenia reticulata (n = 233 individuals). Genetic structure analysis of P. reticulata was congruent with the recognition of two ecotypes, whose divergence captured the largest proportion of genetic variance in the data (F CT = 0.222 and F ST = 0.307). The ecotonal areas between the Cerrado and the Atlantic Forest constitute a hybrid zone in which a diversity of hybrid classes was observed, most of them corresponding to second-generation hybrids (F2) or backcrosses. Gene flow occurred mainly toward the forest ecotype. The genetic structure was congruent with isolation by environment, and environmental correlates of divergence were identified. The observed pattern of high genetic divergence between ecotypes may reflect an incipient speciation process in P. reticulata. The low genetic diversity of the P. reticulata forest ecotype indicate that it is threatened in areas with high habitat loss on Atlantic Forest. In addition, the high divergence from the savanna ecotype suggests it should be treated as a different unit of management. The high genetic diversity found in the ecotonal hybrid zone supports the view of ecotones as important areas for the origin and conservation of biodiversity in the Neotropics.
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The interaction between metal and metal oxides at the nanoscale is of uttermost importance in several fields, thus its enhancement is highly desirable. In catalysis, the performance of the nanoparticles is dependent on a wide range of properties, including its shape that is commonly considered stable during the catalytic reaction. In this study, highly reducible CeO2-x nanoparticles are synthesized aiming to provide Cu/CeO2-x nanoparticles, which are classically active catalysts for the CO oxidation reaction. It is observed that the Cu nanoparticles shape changes during reduction treatment (prior to the CO oxidation reaction) from a nearly spherical 3D to a planar 2D shape, then enhances the Cu-CeO2-x interaction. The spread of the Cu nanoparticles over the CeO2-x surface during the reduction treatment occurs due to the minimization of the total system energy. The shape change is accompanied by migration of O atoms from CeO2 surface to the border of the Cu nanoparticles and the change from the Cu0 to Cu+1 state. The spreading of the Cu nanoparticles influences on the reactivity results toward the CO oxidation reaction since it changes the local atomic order around Cu atoms. The results show a timely contribution for enhancing the interaction between metal and metal oxide.
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Cerio , Nanopartículas , Catálisis , Oxidación-Reducción , ÓxidosRESUMEN
BACKGROUND AND OBJECTIVES: To describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS: The Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described. RESULTS: Among the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8-77), with disease onset at 31 years (range 4-69) and disease duration of 6 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection. DISCUSSION: Most NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.
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COVID-19/fisiopatología , Hospitalización/estadística & datos numéricos , Neuromielitis Óptica/fisiopatología , Adolescente , Adulto , Anciano , Brasil/epidemiología , COVID-19/epidemiología , COVID-19/terapia , Niño , Progresión de la Enfermedad , Femenino , Humanos , Inmunosupresores/uso terapéutico , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neuromielitis Óptica/tratamiento farmacológico , Neuromielitis Óptica/epidemiología , Recurrencia , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Carbon nanothread-derived nanomeshes are highly flexible two-dimensional (2D) structures with tunable pore size and shape, which allows fine control of their transport properties when applied as membranes. In this work, we use molecular dynamics simulations to investigate the performance of several nanomesh structures as membranes for water desalination through reverse osmosis. Results show that these membranes can operate in a wide range of water flow rate, with an optimal point that yields 100% NaCl rejection and water permeability as high as 106 L·cm-2·day-1·MPa-1, higher than other nanoporous 2D materials reported in the literature. This promising performance is partially due to the elliptical pores of strained nanomeshes, which allow the passage of rotated water molecules while rejecting hydrated salt ions. Our results show that carbon nanothread-derived nanomeshes have great potential for application in water desalination processes and emphasize the importance of engineering pore shape in 2D materials when applied as reverse osmosis membranes.
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Membranas Artificiales , Agua , Carbono , Ósmosis , Cloruro de SodioRESUMEN
Carbon nanothreads are one-dimensional materials obtained by controlled compression of aromatic molecules. Benzene and other six-membered ring molecules are normally used as precursors, but recent experiments have shown that carbon nanothreads can also be synthesized from five-membered ring heterocyclic compounds such as thiophene and furan, with an improved control of the structure of the final material and potentially easier scalability. In this work we use Density Functional Theory calculations to unveil the structural, electronic and mechanical properties of carbon nanothreads derived not only from thiophene and furan, but also from pyrrole, aiming to encourage experimental efforts towards the synthesis of equivalent 1D materials. Our results show that these new structures are remarkably stable when compared to similar nanothreads derived from benzene and pyridine. The presence of heteroatoms may lead to significant variations on the electronic band gap of these materials compared to conventional nanothreads, without compromising their mechanical properties. These findings suggest that nanothreads derived from five-membered rings are suitable for the same applications proposed for conventional NTs and potential candidates for new ones.
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BACKGROUNDS AND AIMS: Dimorphandra wilsonii Rizzini, a critically endangered and protected tree, has a restricted distribution in the ecotone between the Cerrado and the Atlantic Forest in south-eastern Brazil. In this area, it co-occurs with D. mollis Benth., a common tree from the Cerrado, and D. exaltata Schott., a rare tree from the Atlantic Forest. Previous studies of D. wilsonii indicated heterozygosity excess at the individual level. Field observation of some intermediate phenotypes between D. wilsonii and both congeners suggests hybridization of D. wilsonii with D. mollis and/or D. exaltata. Here, we tested the hypothesis that D. wilsonii may have originated from hybridization between D. exaltata and D. mollis. We also performed cytogenetic analysis to examine if the heterozygosity excess could be explained by polyploidy in D. wilsonii. METHODS: We evaluated the genetic diversity and population structure of D. wilsonii using 11 nuclear simple sequence repeats (SSRs) genotyped in 152 individuals sampled across the taxon's range. We performed comparative genetic analyses using overlapping SSR markers between D. wilsonii and previously published SSR data in D. mollis and D. exaltata to subsequently perform a series of allelic comparisons, multivariate and Bayesian analysis. KEY RESULTS: Our results suggest that D. wilsonii individuals are most likely to correspond to F1 hybrids between D. exaltata and D. mollis. Cytogenetic analysis indicated that D. wilsonii is diploid with the same chromosome number as D. mollis (2n = 2x = 28). CONCLUSIONS: Our study raises questions about the taxonomic status and the evolutionary future of D. wilsonii. We suggest that the conservation and management strategy for D. wilsonii should be revised and that it should take into account both parental Dimorphandra species in the ecotone, with special emphasis on the threatened D. exaltata. Finally, this study highlights the value of genetic information for the design of conservation strategies.
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Fabaceae/genética , Teorema de Bayes , Brasil , Bosques , Repeticiones de Microsatélite/genéticaRESUMEN
The development of efficient advanced functional materials is highly dependent on properties such as morphology, crystallinity, and surface functionality. In this work, hierarchical flowerlike nanostructures of SrTiO3 have been synthesized by a simple template-free solvothermal method involving poly(vinylpyrrolidone) (PVP). Molecular dynamics simulations supported by structural characterization have shown that PVP preferentially adsorbs on {110} facets, thereby promoting the {100} facet growth. This interaction results in the formation of hierarchical flowerlike nanostructures with assembled nanosheets. The petal morphology is strongly dependent on the presence of PVP, and the piling up of nanosheets, leading to nanocubes, is observed when PVP is removed at high temperatures. This work contributes to a better understanding of how to control the morphological properties of SrTiO3, which is fundamental to the synthesis of perovskite-type materials with tailored properties.
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Identifying the environmental factors that shape intraspecific genetic and phenotypic diversity of species can provide insights into the processes that generate and maintain divergence in highly diverse biomes such as the savannas of the Neotropics. Here, we sampled Qualea grandiflora, the most widely distributed tree species in the Cerrado, a large Neotropical savanna. We analyzed genetic variation with microsatellite markers in 23 populations (418 individuals) and phenotypic variation of 10 metamer traits (internode, petiole and corresponding leaf lamina) in 36 populations (744 individuals). To evaluate the role of geography, soil, climate, and wind speed in shaping the divergence of genetic and phenotypic traits among populations, we used Generalized Dissimilarity Modelling. We also used multiple regressions to further investigate the contributions of those environmental factors on leaf trait diversity. We found high genetic diversity, which was geographically structured. Geographic distance was the main factor shaping genetic divergence in Qualea grandiflora, reflecting isolation by distance. Genetic structure was more related to past climatic changes than to the current climate. We also found high metamer trait variation, which seemed largely influenced by precipitation, soil bulk density and wind speed during the period of metamer development. The high degree of metamer trait variation seems to be due to both, phenotypic plasticity and local adaptation to different environmental conditions, and may explain the success of the species in occupying all the Cerrado biome.
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Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. METHODS Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. RESULTS The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. CONCLUSION Migraine is a frequent and disabling type of primary headache reported by patients with MS.
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Cefalea/epidemiología , Trastornos Migrañosos/epidemiología , Esclerosis Múltiple/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Cefalea/tratamiento farmacológico , Humanos , Masculino , Trastornos Migrañosos/tratamiento farmacológico , Prevalencia , Distribución por Sexo , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.
RESUMO Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.
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Humanos , Masculino , Femenino , Adulto , Adulto Joven , Cefalea/epidemiología , Trastornos Migrañosos/epidemiología , Esclerosis Múltiple/epidemiología , Brasil/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Resultado del Tratamiento , Distribución por Sexo , Evaluación de la Discapacidad , Cefalea/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológicoRESUMEN
Power induced wave collapse is one of the most fascinating phenomena in optics as it provides extremely high intensities, thus stimulating a range of nonlinear processes. For low power levels, propagation of beams in bulk media is dominated by diffraction, while above a certain threshold self-focusing is steadily enhanced by the action of a positive nonlinearity. An autocatalytic blow-up occurs, which is only stopped by saturation of the nonlinearity, material damage or the inherent medium discreteness. In the latter case, this leads to energy localization on a single site. It is commonly believed that for cubic nonlinearities, this intriguing effect requires at least two transverse dimensions to occur and is thus out of reach in fiber optics. Following the concept of synthetic dimensions, we demonstrate that mixing short and long-range interaction resembles a two-dimensional mesh lattice and features wave collapse at mW-power levels in a genuine 1D system formed by coupled fiber loops.
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Although there is a consensus among conservation biologists about the importance of genetic information, the assessment of extinction risk and conservation decision-making generally do not explicitly consider this type of data. Genetic data can be even more important in species where little other information is available. In this study, we investigated a poorly known legume tree, Dimorphandra exaltata, from the Brazilian Atlantic Forest, a hotspot for conservation. We coupled species distribution models and geospatial assessment based on herbarium records with population genetic analyses to evaluate its genetic status and extinction risk, and to suggest conservation measures. Dimorphandra exaltata shows low genetic diversity, inbreeding, and genetic evidence of decrease in population size, indicating that the species is genetically depleted. Geospatial assessment classified the species as Endangered. Species distribution models projected a decrease in range size in the near future (2050). The genetic status of the species suggests low adaptive potential, which compromises its chances of survival in the face of ongoing climatic change. Altogether, our coupled analyses show that the species is even more threatened than indicated by geospatial analyses alone. Thus, conservation measures that take into account genetic data and the impacts of climate change in the species should be implemented.
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Fabaceae/genética , Variación Genética , Árboles , Brasil , Conservación de los Recursos Naturales , Especies en Peligro de Extinción , Bosques , Genética de Población , Densidad de PoblaciónRESUMEN
Over the last few years, parity-time (PT) symmetry has been the focus of considerable attention. Ever since, pseudo-Hermitian notions have permeated a number of fields ranging from optics to atomic and topological physics, as well as optomechanics, to mention a few. Unlike their Hermitian counterparts, nonconservative systems do not exhibit a priori real eigenvalues and hence unitary evolution. However, once PT symmetry is introduced, such dissipative systems can surprisingly display a real eigenspectrum, thus ensuring energy conservation during evolution. In optics, PT symmetry can be readily established by incorporating, in a balanced way, regions having an equal amount of optical gain and loss. However, thus far, all optical realizations of such PT symmetry have been restricted to a single transverse dimension (1D), such as arrays of optical waveguides or active coupled cavity arrangements. In most cases, only the loss function was modulated-a restrictive aspect that is only appropriate for linear systems. Here, we present an experimental platform for investigating the interplay between PT symmetry and nonlinearity in two-dimensional (2D) environments, where nonlinear localization and soliton formation can be observed. In contrast to typical dissipative solitons, we demonstrate a one-parameter family of soliton solutions that are capable of displaying attributes similar to those encountered in nonlinear conservative arrangements. For high optical powers, this new family of PT solitons tends to collapse on a discrete network-thus giving rise to an amplified, self-accelerating structure.
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We experimentally demonstrate the transverse confinement of light in the presence of a longitudinally periodic photonic potential with vanishing average. In agreement with Kapitza's original findings in classical mechanics, we confirm that light undergoes a transverse localization due to the action of an effective potential proportional to the square of the first derivative of the potential. Experiments are performed based on (1+1) D synthetic dimensions realized in a fiber loop system, allowing for complete control of the transverse and longitudinal distributions of the potential.
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Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV). OBJECTIVE: To identify the serologic profile of JCV in patients with MS. METHODS: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program. RESULTS: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months. CONCLUSION: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.
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Anticuerpos Antivirales/sangre , Virus JC/inmunología , Leucoencefalopatía Multifocal Progresiva/inmunología , Esclerosis Múltiple/virología , Infecciones por Polyomavirus/inmunología , Adulto , Brasil/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Leucoencefalopatía Multifocal Progresiva/sangre , Masculino , Esclerosis Múltiple/sangre , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab/efectos adversos , Infecciones por Polyomavirus/epidemiología , Prevalencia , Seroconversión , Factores SexualesRESUMEN
The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.