Innate immune cells and myelin profile in multiple sclerosis: a multi-tracer PET/MR study.

PURPOSE: Neuropathological studies have demonstrated distinct profiles of microglia activation and myelin injury among different multiple sclerosis (MS) phenotypes and disability stages. PET imaging using specific tracers may uncover the in vivo molecular pathology and broaden the understanding of the disease heterogeneity. METHODS: We used the 18-kDa translocator protein (TSPO) tracer (R)-[11C]PK11195 and [11C]PIB PET images acquired in a hybrid PET/MR 3 T system to characterize, respectively, the profile of innate immune cells and myelin content in 47 patients with MS compared to 18 healthy controls (HC). For the volume of interest (VOI)-based analysis of the dynamic data, (R)-[11C]PK11195 distribution volume (VT) was determined for each subject using a metabolite-corrected arterial plasma input function while [11C]PIB distribution volume ratio (DVR) was estimated using a reference region extracted by a supervised clustering algorithm. A voxel-based analysis was also performed using Statistical Parametric Mapping. Functional disability was evaluated by the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and Symbol Digit Modality Test (SDMT). RESULTS: In the VOI-based analysis, [11C]PIB DVR differed between patients and HC in the corpus callosum (P = 0.019) while no differences in (R)-[11C]PK11195 VT were observed in patients relative to HC. Furthermore, no correlations or associations were observed between both tracers within the VOI analyzed. In the voxel-based analysis, high (R)-[11C]PK11195 uptake was observed diffusively in the white matter (WM) when comparing the progressive phenotype and HC, and lower [11C]PIB uptake was observed in certain WM regions when comparing the relapsing-remitting phenotype and HC. None of the tracers were able to differentiate phenotypes at voxel or VOI level in our cohort. Linear regression models adjusted for age, sex, and phenotype demonstrated that higher EDSS was associated with an increased (R)-[11C]PK11195 VT and lower [11C]PIB DVR in corpus callosum (P = 0.001; P = 0.023), caudate (P = 0.015; P = 0.008), and total T2 lesion (P = 0.007; P = 0.012), while better cognitive scores in SDMT were associated with higher [11C]PIB DVR in the corpus callosum (P = 0.001), and lower (R)-[11C]PK11195 VT (P = 0.013). CONCLUSIONS: Widespread innate immune cells profile and marked loss of myelin in T2 lesions and regions close to the ventricles may occur independently and are associated with disability, in both WM and GM structures.

Neurological Manifestations of COVID-19 and the Importance of Magnetic Resonance Imaging.

A letter to the editor to discuss several uses of brain magnetic resonance imaging (MRI) in the investigation of neurological manifestations of covid-19. Described several situations in which the MRI is needed. Brain MRI is an important diagnostic method in the covid-19 scenario, to investigate possible neurological complications of the disease.

Esterilidade por salpingite e tratamento homeopático com nosódio: relato de caso / Sterility caused by salpingitis and nosode homeopathic treatment: case report

A infertilidade em casais frequentemente é multifatorial. Dentre elas alterações tubárias respondem por até 20% dessa causalidade, sendo a histerossalpingografia o exame de escolha para verificarem alterações em sua anatomia, orientando desde a opção por tratamentos mais conservadores até mesmo a salpingectomia com posterior fertilização in vitro. O relato de caso em questão trata de uma mulher que já se encontrava em tratamento para fertilidade há 3 anos e, antes da cirurgia definitiva, optou por buscar o tratamento homeopático como alternativa. Após repertorização chegou-se ao medicamento Sycotic co, um nosódio preparado com Entercococcus faecalis, agente que é um dos principais responsáveis por doenças inflamatórias pélvicas que, por sua vez, encontram-se na etiologia das salpingites. Após trinta dias de utilização a paciente consegue engravidar, demonstrando possivelmente que o organismo recuperou sua capacidade autopoiética (regenerativa) frente ao estímulo ocasionado pela medicação homeopática, embasando novos ensaios capazes de trazer maiores evidências da utilização da homeopatia como possibilidade no tratamento adjuvante da infertilidade. (AU)

Infertility in couples is often multifactorial. Tubal disorders account for up to 20% of causes, and hysterosalpingography is the test of choice to investigate anatomical changes, which orient the option for more conservative treatments or salpingectomy with subsequent in vitro fertilization. The present case report concerns a woman under fertility treatment for 3 years, but choose to seek homeopathic treatment before final surgery. Repertory analysis led to the selection of Sycotic co, a nosode prepared from Enterococcus faecalis, which is one of the main responsible pathogens associated with pelvic inflammatory disease, which is one of the causes of salpingitis. After 30 days of treatment, the patient became pregnant, which possibly shows that her body had regained its autopoietic (regenerative) ability against the stimulus represented by homeopathic medication. These findings support the need to perform new studies to gather further evidence of the use of homeopathy as possible adjuvant treatment for infertility. (AU)

Long-term effects of exposure to disease-modifying drugs in the offspring of mothers with multiple sclerosis: a retrospective chart review.

INTRODUCTION: Multiple sclerosis (MS) mainly affects women of fertile age. To date, the only recommendation for women with MS intending to become pregnant is to stop all treatment. This recommendation reflects the concerns about the effects of disease-modifying drugs (DMDs) on the offspring. The objective of the present study was to assess the potential long-term effects of maternal exposure to DMDs on the offspring. METHOD: This was a retrospective study revising medical data on the offspring of women with MS. These women now have children aged at least 1 year and include a group of patients that were not exposed to any DMDs for at least 3 months prior to pregnancy and during the whole gestation (control group). Another group of patients had at least 2 weeks of exposure to DMDs, mainly to interferon beta or glatiramer acetate RESULTS: The women with MS participating in this study have children currently aged, on average, 6.6 years (range 1-39 years). There was no pattern of drug-related adverse events or complications in the children whose mothers were exposed to DMDs. No specific long-term adverse events were observed in the offspring of women with MS who were exposed to drugs during pregnancy. The profile of relevant diagnoses in their children was similar to that of children whose mothers had not been exposed to DMDs. CONCLUSIONS: The present retrospective study did not show a specific profile of long-term deleterious drug effects on children born from mothers who were exposed to drugs for MS treatment.

Interferon beta 1-a na esclerose múltipla: experiência de um ano em 62 pacientes / Interferon beta 1-a in multiple sclerosis: experience of 1 year in 62 patients

Relatamos os resultados de estudo com o interferon beta 1-a em 62 pacientes ambulatoriais com a forma remitente-recorrente da esclerose múltipla durante um ano. Os critérios de inclusão para este tratamento foram de escore do EDSS entre 0 e 5,5 e de pelo menos relato de dois surtos nos dois últimos anos. Administramos 3 milhões de unidades internacionais de interferon beta 1-a três vezes por semana. Os objetivos deste estudo foram verificar o efeito da medicação no número de surtos e avaliar a eficácia da droga na progressão da doença. O índice anual de surtos nos pacientes que não tomaram a medicação foi 1,32 e naqueles medicados 0,63. O escore do EDSS em pacientes não medicados foi 4,7 e naqueles com medicamento 2,0. O interferon beta 1-a foi bem tolerado e 85 por cento dos pacientes completaram um ano de tratamento.