INCIDENCE OF MULTIPLE SCLEROSIS IN URUGUAY. A PROSPECTIVE POPULATION-BASED STUDY.

Background The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5-10 cases per 100,000 person-years and is probably increasing. In 2014, a previous study estimated the incidence of multiple sclerosis in Uruguay at 1.2 cases per 100.000 person-years. Objectives We conducted an observational, prospective, population-based study to determine MS incidence from diagnosis in Uruguay. Methods The population studied included people older than 18 years of age, who were living in Uruguay between July 1, 2019, and June 30, 2021. The diagnosis was based on 2017 McDonald criteria. Multiple data sources were employed including neurologists, magnetic resonance imaging centers, laboratories performing oligoclonal band testing, neurophysiology laboratories, neurorehabilitation centers, the institution Fondo Nacional de Recursos, and the MS Patients' Association of Uruguay (EMUR). The capture-recapture method was used to estimate incidence. Results 155 new MS cases were confirmed after review. The median age was 35 (range 18-62). Thirteen patients (8.38%) were diagnosed with late onset MS. The crude incidence rate was 2.89 cases per 100,000 person-years, 3.95 among female and 1.72 among male patients. The incidence rate estimated using the capture-recapture method was 3.18 (95% CI 3.02-3.34). Conclusions According to the Atlas of MS, Uruguay has a low incidence rate (2.0-3.99), even though it is one of the highest in Latin America. Our country aligns with the global trend of increasing incidence. Age and sex distribution were similar to other studies, with a high incidence of patients with late onset multiple sclerosis. The capture-recapture method confirms the exhaustivity of our investigation.

A Delphi consensus to identify the key screening tests/questions for a digital neurological examination for epidemiological research.

BACKGROUND: Most neurological diseases have no curative treatment; therefore, focusing on prevention is key. Continuous research to uncover the protective and risk factors associated with different neurological diseases is crucial to successfully inform prevention strategies. eHealth has been showing promising advantages in healthcare and public health and may therefore be relevant to facilitate epidemiological studies. OBJECTIVE: In this study, we performed a Delphi consensus exercise to identify the key screening tests to inform the development of a digital neurological examination tool for epidemiological research. METHODS: Twelve panellists (six experts in neurological examination, five experts in data collection-two were also experts in the neurological examination, and three experts in participant experience) of different nationalities joined the Delphi exercise. Experts in the neurological examination provided a selection of items that allow ruling out neurological impairment and can be performed by trained health workers. The items were then rated by them and other experts in terms of their feasibility and acceptability. RESULTS: Ten tests and seven anamnestic questions were included in the final set of screening items for the digital neurological examination. Three tests and five anamnestic questions were excluded from the final selection due to their low ratings on feasibility. CONCLUSION: This work identifies the key feasible and acceptable screening tests and anamnestic questions to build an electronic tool for performing the neurological examination, in the absence of a neurologist.

Consumo de alcohol, relación con el trauma y su severidad / Relationship between alcohol consumption and trauma. Severity of traumatic injury / Consumo de álcool, relação com o trauma e sua gravidade

Introducción: Uruguay no cuenta con estudios que reporten resultados de alcoholemias en traumatizados y menos aún su asociación con la severidad del trauma. Desde el año 2016 nuestro país cuenta con la llamada ley de tolerancia cero en base al supuesto de que la alcoholemia positiva representa un factor de riesgo para la severidad del trauma. Objetivos: describir el perfil epidemiológico de los traumatizados y estudiar la asociación existente entre el consumo de alcohol y la severidad del trauma. Material y método: estudio transversal; se incluyeron todos los pacientes que presentaron un evento traumático y fueron asistidos en el Departamento de Emergencia del Hospital de Clínicas durante el período 1 de marzo al 31 de agosto de 2017. Los datos se recopilaron prospectivamente y se extrajo muestra de alcoholemia a cada uno de los pacientes. Se consideraron diversas variables relacionadas con los pacientes y la severidad del traumatismo Se analizó la asociación entre las alcoholemias positivas y la severidad del trauma. Resultados: se incluyeron 121 pacientes, 28% presentaron alcoholemia positiva y 27% presentaron trauma severo. La alcoholemia positiva se asoció con la severidad del trauma (p < 0,0001). No se encontró asociación entre el nivel de alcoholemia y la severidad del trauma (p = 0,323). Conclusiones: el consumo de alcohol se asocia significativamente con la severidad del trauma. Nuestro estudio muestra que los traumatismos son severos solo por el hecho de presentar alcoholemias positivas independientemente de su nivel, apoyando la implementación de la ley de tolerancia cero.

Introduction: our country has not conducted studies to report results on blood alcohol levels in traumatized patients or on its association with the severity of the traumatic injury. Objective: to describe the epidemiological profile of trauma patients and to study the relationship between alcohol consumption and the severity of the traumatic injury. Method: transversal study including all patients who suffered a traumatic event and were assisted at the Emergency Department of the Clínicas Hospital between March 1, 2017 and August 31, 2017. Data was prospectively collected and a blood alcohol level sample was taken from each one of the patients. Several patient related variables were considered, as well as the severity of the traumatic injury. Results: 121 patients were included in the study, 28% showed positive blood alcohol levels and 27% presented severe traumatic injuries. Positive blood alcohol levels were associated to severity of the traumatic injury (p < 0.0001). No association was found between blood alcohol levels and the severity of the traumatic injury (p = 0.323). Conclusions: alcohol consumption is significantly associated to the severity of trauma. Our study shows that traumas are severe simply because blood alcohol levels are positive, regardless of the alcohol level, what supports the Zero Tolerance Law.

Introdução: no Uruguai não existem estudos que mostrem não somente os resultados de alcoolemia em traumatizados como também sua associação com a gravidade do trauma. Desde 2016 conta com a Lei de Tolerância 0 baseada no princípio de que a alcoolemia positiva é um fator de risco para a gravidade do trauma. Objetivos: descrever o perfil epidemiológico dos traumatizados e estudar a associação existente entre o consumo de álcool e a gravidade do trauma. Materiais e métodos: estudo transversal que incluiu todos os pacientes que apresentaram um evento traumático e foram atendidos no Departamento de Emergência do Hospital de Clínicas no período 1 de março - 31 de agosto de 2017. Os dados foram levantados prospectivamente e uma amostra de alcoolemia foi coletada a todos os pacientes. Foram incluídas variáveis relacionadas aos pacientes e à gravidade do traumatismo. A associação entre as alcoolemias positivas e a gravidade do trauma foi analisada. Resultados: foram incluídos 121 pacientes; 28% apresentaram alcoolemia positiva e 27% apresentaram trauma severo. As alcoolemias positivas estavam associadas com a gravidade do trauma (p < 0,0001). Os resultados não mostraram associação entre o nível de alcoolemia e a gravidade do trauma (p = 0,323). Conclusões: o consumo de álcool está significativamente associado com a gravidade do trauma. Nosso estudo mostra que os traumatismos são graves somente pela presença de alcoolemias positivas independentemente de seu nível o que respalda a implementação da Lei de Tolerância 0.

Ataque cerebrovascular isquémico en Uruguay: comunicación de los primeros 34 casos trombolizados en el Hospital de Clínicas / Ischemic stroke in Uruguay. First 34 cases of thrombolized patients at the Clinicas Hospital

Introducción: el ataque cerebrovascular (ACV) constituye un problema de salud en Uruguay y en el mundo. Se ha comprobado que la trombolisis intravenosa disminuye la morbimortalidad y las secuelas en los pacientes con ACV isquémicos agudos (nivel de evidencia IA). Objetivos: analizar los casos de ACV isquémico trombolizados en el Hospital de Clínicas y valorar la utilidad de un score de predicción de sangrado intracraneano sintomático en esta población. Material y método: estudio descriptivo, observacional y prospectivo. Población: pacientes trombolizados en el Hospital de Clínicas en el período 2010-2013. Se aplicó score predictivo de hemorragia sintomática a toda la población de trombolizados. Tests estadísticos: test de chi cuadrado, test de student, test de Wilcoxon, se consideraron diferencias estadísticamente significativas aquellas con una p < 0,05. Resultados: treinta y cuatro pacientes trombolizados, promedio de edad 67 años, mayoría mujeres, alto porcentaje de ACV graves, National Institute of Health Stroke Scale (NIHSS) promedio al ingreso: 11, con mejoría estadísticamente significativa al alta. Etiología principal: cardioembolia. Tiempo síntoma aguja promedio: 170 minutos. Hemorragia intracraneana: ocho pacientes (23,5%), fallecieron cuatro de ellos. El puntaje del score de sangrado no predijo el sangrado intracraneano. Conclusiones: en el Hospital de Clínicas, desde la inauguración de la Unidad de ACV, el porcentaje de infartos cerebrales trombolizados ha ido en aumento, siendo actualmente comparable a cifras internacionales. El tiempo síntoma-aguja es menor que en otros estudios. La trombolisis generó un beneficio estadísticamente significativo en la escala de NIHSS. El porcentaje de sangrados fue similar al descrito en la literatura...

Enfermedades priónicas en el ser humano en Uruguay: registro de los últimos 25 años / Prion diseases in humans in Uruguay: a study of the last 25 years

Introducción: las enfermedades priónicas son enfermedades de carácter degenerativo del sistema nervioso central de curso progresivo y desenlace fatal que presentan largos períodos deincubación antes de manifestarse clínicamente siendo hoy de gran interés científico dado que responden a un modelo autorreplicante proteico sin intervención de ácidos nucleicos. Asimismo tienen un carácter simultáneo de aparición esporádico, hereditario e infectante. La aparición de la encefalopatía bovina espongiforme y su consecuencia en el ser humano, la variante de la enfermedad de Creutzfeldt-Jacob, subrayan la necesidadde un control epidemiológico estricto en la materia.Objetivo: describir la realidad de estas enfermedades en Uruguay en el período que media entre 1984 y 2009 inclusive.Material y método: se realizó una revisión descriptiva y retrospectivade casos clínicos de enfermedades priónicas diagnosticadas en nuestro país.Resultados: se lograron identificar 42 casos de enfermedad de Creutzfeldt-Jakob en Uruguay (8 formas hereditarias y 34 formas esporádicas). La tasa de incidencia estimada globalfue de 0,7 casos por millón de habitantes por año, considerandolas formas probables y definitivas.Conclusiones: en este trabajo se han detectado exclusivamente casos esporádicos y familiares de Creutzfeldt-Jacob, no se han detectado casos vinculados a la variante relacionadacon la encefalopatía espongiforme bovina, ni a otros tipos de enfermedades priónicas que afectan a los seres humanos. Dadas las características de la enfermedad y la distribución de neurólogos en todo el país, es posible realizar un relevamiento y una vigilancia epidemiológica bastante estricta deestas enfermedades en nuestro medio.

Introduction: prion diseases are progressive neurodegenerativedisorders that may result in death and are distinguished by long incubation periods before presenting a clinical manifestation. Today they are scientifically interesting since they follow a protein auto-replicant modelwithout the participation of nucleic acids.These diseases appear sporadically, they are hereditary and infectious as well. The appearance of bovinespongiform encephalopathy and its consequences on human beings and Creutzfeldt-Jacob disease variationsreinforce the need for a strict epidemiological control in the field.Objective: to describe the reality of these diseases in Uruguay from 1984 through 2009.Method: we conducted a retrospective, descriptive review of clinical cases of prion diseases diagnosed in our country.Results: we managed to identify 43 cases of Creutzfeldt-Jacob disease in Uruguay (8 hereditary forms and34 sporadic forms). Global incidence estimated rate was 0.7 cases per million inhabitants, considering both probableand definitive forms.Conclusions: we have exclusively identified sporadic and hereditary cases of Creutzfeldt-Jacob disease, we have not identified variations in connection with bovine spongiform encephalopathy or other kinds of prion diseases affecting human beings. Given the characteristics of the disease and the distribution of neurologists in the country enable a rather strict survey and epidemiological surveillance of thesediseases in our country.

Introdução: as doenças priônicas são enfermidades de caráter degenerativo do sistema nervoso central decurso progressivo y desenlace fatal que apresentam longos períodos de incubação antes de manifestar-seclinicamente sendo hoje de grande interesse científico, pois respondem a um modelo autorreplicante proteicosem intervenção de ácidos nucleicos. Têm ademais um caráter simultâneo de aparição esporádica, hereditária e infectante. O aparecimento da encefalopatia bovina espongiforme, a variante da doença de Creutzfeldt-Jacob e suas consequências nos seres humanos, destacam a necessidade de um controle epidemiológico estrito.Objetivo: descrever a realidade destas doenças no Uruguai no período 1984-2009 inclusive.Material e método: realizou-se uma revisão descritiva y retrospectiva de casos clínicos das doenças priônicasdiagnosticadas no nosso pais.Resultados: identificaram-se 42 casos de doença de Creutzfeldt-Jakob no Uruguai (8 formas hereditárias e34 formas esporádicas).Ataxa de incidência global estimada foi de 0,7 casos por milhão de habitantes por ano,considerando as formas prováveis e definitivas.Conclusões: neste trabalho detectaram-se exclusivamente os casos esporádicos e familiares de Creutzfeldt-Jacob; não se identificaram casos vinculados à variante relacionada com a encefalopatia espongiforme bovina, nem a outros tipos de doenças priônicas que afetam a los seres humanos.Considerando as características desta patologia e a distribuição de neurologistas no país, é possível realizarum relevamento e uma vigilância epidemiológica bastante estrita de estas doenças no nosso meio.

Prevención secundaria en pacientes revascularizados coronarios en Uruguay: descripción de un programa, evaluación del control de los factores de riesgo y efecto en la mortalidad / Secondary prevention in patients with coronary revascularization in Uruguay: Description of a program, evaluation of risk factors control and effect of the program on mortality

Introducción El Fondo Nacional de Recursos financia los procedimientos de revascularización miocárdica en Uruguay. Las evaluaciones posteriores a la revascularización mostraron un inadecuado control de los factores de riesgo. Objetivos Describir el control de los factores de riesgo y el uso de fármacos cardioprotectores en los pacientes ingresados en un programa de prevención secundaria así como analizar el impacto de dicho programa en la mortalidad y en la realización de nuevos procedimientos cardiológicos invasivos. Metodología Se estudió una cohorte de pacientes del programa y se comparó la mortalidad y la realización de nuevos procedimientos a los 28 meses con una cohorte histórica de control. Resultados Ingresaron al programa 900 pacientes; en 487 se analizó el alcance de los objetivos terapéuticos a los 6 y 12 meses. Al año se alcanzó el objetivo en el 40,5% para presión arterial (<130/80mmHg), en el 73,2% para cLDL (<100mg/dl) y en el 63,8% para triglicéridos (<150mg/dl), y la prescripción de estatinas, ácido acetilsalicílico, betabloqueantes e inhibidores de la enzima convertidora de la angiotensina fue del 98,2, el 94,5, el 85,2 y el 84,6%, respectivamente. Logró abstinencia mantenida el 60,8% de los fumadores, y el 99% no tuvo recaídas. Al año, el 14,9% bajó de peso más del 5%, y el 49% adhirió al ejercicio físico regular. A los seis meses, el 56,3% de los diabéticos tuvo glucemia preprandial inferior a 130mg/dl. La mortalidad a los 28 meses fue del 1,85 y el 6,2% para el grupo en el programa y el grupo control, respectivamente. La participación en el programa (HR=0,28, p=0,01) y el sexo femenino (HR=0,07, p=0,01) fueron factores protectores para la mortalidad. Conclusiones La implementación del programa mejoró el control de los factores de riesgo, optimizó el uso de fármacos cardioprotectores y probablemente contribuyó a una disminución de la mortalidad (AU)

Introduction Revascularization procedures in Uruguay are financed by the National Resources Fund. Evaluations after revascularization have shown inadequate control of cardiovascular risk factors. Aim To describe control of risk factors and prescription of cardioprotective drugs in patients included in a secondary prevention program and to analyze the impact of the program on mortality and the incidence of new invasive cardiologic procedures. Methodology A cohort of patients admitted to the program was studied and mortality and new cardiologic procedures at 28 weeks were compared with those in a historical control group. Results The program admitted 900 patients. Attainment of therapeutic goals at 6 and 12 months was analyzed in 487 patients. At 1 year, targets were achieved for blood pressure (<130/80mmHg) in 40.5%, low-density lipoprotein-cholesterol (<100mg/dl) in 73.2% and triglycerides (<150mg/dl) in 63.8%; prescription of statins, salicylic acetyl acid, â-blockers and angiotensin-converting enzyme inhibitors was 98.2%, 94.5%, 85.2% and 84.6%, respectively. Among smokers, 60.8% maintained abstinence and 99% did not relapse. At 1 year, 14.9% had a weight loss of at least 5% and 49% performed physical activity regularly. At 6 months, 56.3% of diabetics had preprandial glycemia levels of <130mg/dl. Cumulative mortality at 28 months was 1.85% for the group in the program and was 6.2% for the control group; protective factors against mortality were participation in the program (HR=0.28; p=0.01) and female gender (HR=0.07; p=0.01).Conclusions The implementation of this program improved control of risk factors, optimized pharmacological treatment and probably contributed to a decrease in mortality (AU)