No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South.

Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South / Não foi observada correlação entre os níveis séricos de vitamina D e a incapacidade em pacientes com esclerose múltipla entre as latitudes Sul 18° e 30°

ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

RESUMO Objetivo: Vitamina D assumiu um papel central na pesquisa e tratamento da esclerose múltipla (EM). O objetivo deste estudo foi avaliar os níveis séricos de vitamina D de pacientes com EM e controles que residem em uma área tropical. Métodos: Foram analisados dados de 535 pacientes com EM e 350 indivíduos controle em 14 cidades próximas ao Trópico de Capricórnio. Resultados: O valor médio da determinação de 25-OH vitamina D foi 26,07 ± 10,27 ng/mL para controles e 28,03 ± 12,19 ng/mL para pacientes com EM. Não houve correlação entre os níveis de vitamina D e o grau de incapacidade ao longo da duração da doença. Conclusão: Pelo menos na região que cerca o Trópico de Capricórnio, os níveis séricos de vitamina D estão entre valores de 20 a 30 ng/mL tanto para controles quanto para pacientes com EM.

We know how to prescribe natalizumab for multiple sclerosis, but do we know how to withdraw it?

Natalizumab is a potent immunosuppressive monoclonal antibody used for the treatment of multiple sclerosis (MS). While definite guidelines for the safety of natalizumab prescriptions are available in all countries, there are no specific recommendations on how to withdraw the drug if the need arises. There are reports describing MS complications after natalizumab infusions were stopped. Most neurologists seem to stop natalizumab treatment according to their idea on how to best carry out the withdrawal. The present study shows the very different manners in which expert neurologists from 14 MS units in Brazil stopped natalizumab in their patients. The authors concluded that pharmacovigilance on natalizumab must persist after the drug is withdrawn in order to have enough data for adequate recommendations.

Dressing wear time after reduction mammaplasty: a randomized controlled trial.

BACKGROUND: This randomized controlled trial was designed to assess whether dressing wear time could influence surgical-site infection rates and skin colonization. Patients' perception at self-assessment was also analyzed. METHODS: Seventy patients undergoing reduction mammaplasty were randomly allocated to group I (dressing removed on postoperative day 1) or group II (dressing removed on postoperative day 6). Surgical-site infections were defined by standard criteria from the Centers for Disease Control and Prevention. Skin colonization was assessed by a culture of samples collected at predefined time points. Patients scored dressing wear time in regard to safety, comfort, and convenience. RESULTS: Nine patients (12.9 percent) had an infection, seven from group I and two from group II (p = 0.09). There was no difference between the groups in regard to skin colonization before dressing, but on postoperative day 6, there was higher skin colonization by coagulase-negative staphylococci in group I (p = 0.000). If they had the choice, 66 percent of the patients in group I would choose to keep the dressing for 1 day, whereas 83 percent of the patients in group II would prefer to keep the dressing for 6 days (p = 0.000). Patients in group II also considered keeping the dressing for 6 days a safer choice (p < 0.05). CONCLUSIONS: There was no difference in surgical-site infection rates between groups, but higher colonization levels were observed in group I on postoperative day 6. Most of the patients would choose to keep dressing for 6 days postoperatively, which was perceived as a safer choice. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures.

BACKGROUND: Preoperative showering with antiseptic skin cleansers is common in elective operations, although the value of this procedure in reducing surgical wound infections has not been established. The authors designed a prospective study to assess the influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures. METHODS: Patients older than 18 years scheduled for elective and clean plastic surgery procedures on the thorax or abdomen were assigned randomly to the povidone-iodine group (n = 57) or to a control group (n = 57). Patients allocated to the povidone-iodine group took a shower with liquid detergent-based povidone-iodine 10% 2 hours before surgery. For the control group, no special instructions for showering were implemented before surgery. Quantitative skin cultures were obtained just before the preoperative scrub in the operating room. Samples were plated on hypertonic mannitol agar, blood agar, Sabouraud agar with chloramphenicol, and eosin-methylene blue agar. Samples were collected and processed, and results were assessed by blinded investigators. RESULTS: Staphylococcal skin colonization was significantly lower in the povidone-iodine group (p < 0.001). No microorganism growth was observed on 33 percent of the postshower skin cultures from patients in the povidone-iodine shower group compared with 0 percent of the cultures from patients in the control group. Colonies of fungi and enterobacteria were recovered in small amounts in both groups, and povidone-iodine showers did not significantly reduce skin colonization by these microorganisms. CONCLUSION: Single preoperative povidone-iodine showers are effective in reducing staphylococcal skin colonization before elective clean plastic surgical procedures on the thorax and abdomen.