The socioeconomic impact of multiple sclerosis in France: Results from the PETALS study.

Background: Multiple sclerosis (MS) places a considerable financial burden on the society. However, data quantifying the contemporary cost burden in France are lacking. Objective: This cost-of-illness study aimed to estimate the direct and indirect costs associated with MS in France. Methods: Between October 2020-November 2020, 208 French adults with a confirmed diagnosis of MS were recruited via MSCopilot® (a new MS self-assessment digital solution) and several MS patient networks. Indirect costs were estimated using a combination of top-down and bottom-up approaches. Direct costs were retrieved from Assurance Maladie (i.e. national system of health insurance) publications. Out-of-pocket expenses (OOPEs) incurred by MS patients were also reported. All costs were expressed in €2020. Data from the survey were extrapolated to the overall French MS population. Results: MS exerted an annual cost burden of €2.7 billion on the French society (indirect costs: €1.3 billion; direct costs: €1.4 billion). Mean annual costs were €27,164.7 per-patient, with indirect and direct costs accounting for 48.1% and 51.9% of the total annual costs, respectively. OOPEs contributed over €90 million to the total annual costs. Conclusions: MS imposes a substantial cost burden on the French society, with approximately half of the total annual costs driven by indirect costs.

Cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia com fios de sutura à base de quitosana, categute cromado e poliglactina 910 / [Healing of the rectus abdominis muscle in rabbits submitted to laparorrhaphy with suture-based chitosan, chromic catgut and polyglactin 910]

Objetivou-se, com este estudo, avaliar o processo de cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia, utilizando-se o fio de sutura à base de quitosana, comparando-o aos fios de categute cromado e poliglactina 910. Foram utilizados 24 coelhos adultos, divididos aleatoriamente em quatro grupos: quitosana e categute 15 dias (QC-15dias), quitosana e categute 30 dias (QC-30 dias), quitosana e poliglactina 910 15 dias (QP-15 dias) e quitosana e poliglactina 910 30 dias (QP-30 dias). Cada grupo foi composto por seis coelhos, nos quais foram realizadas duas incisões, uma do lado direito e outra do lado esquerdo e, posteriormente, a laparorrafia, com o fio de quitosana de um lado e o categute cromado ou poliglactina 910 do outro. Realizou-se análise clínico-cirúrgica, histológica e avaliação de achados de necropsia, além de testes de citotoxicidade e de mecânica no fio de quitosana. Ele apresentou baixa resistência mecânica e citotóxica. O fio de quitosana não proporcionou uma cicatrização satisfatória em coelhos, pois desencadeou uma resposta inflamatória acentuada.(AU)

The objective of this study was to evaluate the healing process of the recto-abdominal muscles in rabbits submitted to laparorrhaphy using chitosan-based suture yarn, comparing it to chrome catgut and polyglactin 910 yarns. Twenty-four adult rabbits were divided in to four random groups: chitosan and polyglactin 910 15 days (QP-15 days) and chitosan and polyglactin 910 30 days (QC-30 days), chitosan and polyglactin 910 15 days (QP-15 days) QP-30 days). Each group consisted of six rabbits, in which two incisions were made, one on the right side and one on the left side, and later the laparorraphy with the chitosan yarn on one side and chromed catgut or polyglactin 910 on the other. Clinical-surgical, histological and necropsy findings were evaluated, as well as cytotoxicity and mechanical tests on the chitosan wire. It presented low mechanical and cytotoxic resistance. Chitosan thread did not provide satisfactory healing in rabbits, as it triggered a marked inflammatory response.(AU)

All-cause hospitalizations in multiple sclerosis patients. / Causas de hospitalizacion en pacientes con esclerosis multiple.

INTRODUCTION: There is poor knowledge on current hospitalizations in the multiple sclerosis (MS) population. The purpose of this study was to determine hospitalization causes and outcomes in a MS hospital-based cohort. PATIENTS AND METHODS: A retrospective chart review was performed on all patients admitted at our centre between August, 2009 and July, 2015, excluding those with no previous established diagnosis. RESULTS: 308 hospitalizations were included, representing a total of 155 patients (female, 67.5%). Median age at hospitalizations was 47 years, with median disease duration of 12 years. The most common overall reason for hospitalization was infectious diseases (22.1%), followed by MS relapses (12.7%) and neurogenic bladder (11%). The median length of hospitalization for all patients was 5 days and the progressive subtype of MS had longer lengths of hospitalization than the relapsing-remitting MS. Intensive care unit admission occurred in 23 cases (7.5%) and were associated with increased mortality and length of hospitalization. Of the 308 hospitalizations, 9 (2.9%) resulted in death. CONCLUSION: Infections are the most common cause of hospitalizations in our study, although MS relapses or complications related to MS continue to be significant causes of morbidity. Almost 8% of all MS hospitalizations required intensive care unit admission and these were related to longer admission lengths and higher death rates.

TITLE: Causas de hospitalizacion en pacientes con esclerosis multiple.Introduccion. Existe un escaso conocimiento actual sobre las hospitalizaciones en la poblacion con esclerosis multiple (EM). El proposito de este estudio fue determinar las causas y resultados de la hospitalizacion en una cohorte hospitalaria de pacientes con EM. Pacientes y metodos. Se realizo un estudio retrospectivo de los registros clinicos de todos los pacientes ingresados en nuestro centro entre agosto de 2009 y julio de 2015, excluyendo a los que no tenian un diagnostico previo establecido. Resultados. Se incluyeron 308 hospitalizaciones, lo que representa un total de 155 pacientes (mujeres, 67,5%). La mediana de edad en las hospitalizaciones fue de 47 años, con una duracion media de la enfermedad de 12 años. La principal razon para la hospitalizacion fueron las enfermedades infecciosas (22,1%), seguidas de los brotes (12,7%) y la vejiga neurogena (11%). La duracion media de la hospitalizacion para todos los pacientes fue de cinco dias, y el subtipo progresivo de la EM tuvo una mayor duracion de la hospitalizacion que la EM remitente recurrente. El ingreso en la unidad de cuidados intensivos ocurrio en 23 casos (7,5%), que se asociaron con mayor mortalidad y duracion de la hospitalizacion. Del total de hospitalizaciones, nueve (2,9%) acabaron en muerte. Conclusiones. Las infecciones son la causa mas frecuente de hospitalizacion, aunque las recaidas de la EM o las complicaciones relacionadas siguen siendo causas importantes de morbilidad. Casi el 8% de todas las hospitalizaciones por EM requirio ingreso en la unidad de cuidados intensivos, lo que se relaciono con una mayor duracion de la estancia y mayores tasas de mortalidad.

Avaliação biomecânica e dimensional do fio de sutura à base de quitosana / Biomechanics and dimensional evaluation of the suture based on chitosan

A resistência à tração e o diâmetro são características de grande importância na avaliação da qualidade de fios de sutura, estando relacionados à capacidade destes de suportar o estresse promovido pelas forças atuantes em determinados tecidos. Desta forma, objetivou-se com este estudo avaliar as propriedades mecânica e dimensional de fios de sutura à base de quitosana, comparando-as com as preconizadas pela norma NBR 13904/2003. Tais propriedades foram avaliadas usando-se uma máquina de ensaio universal e um micrômetro digital. Os parâmetros mecânico e dimensional analisados foram a resistência quanto à tração, a deformação, bem como o diâmetro, respectivamente. O valor médio do diâmetro dos fios de quitosana apresentou variação e observou-se resistência à tração ligeiramente abaixo da norma preconizada, com rápida deformação. O fio de quitosana, na forma em que foi produzido, apresentou variabilidade dimensional e baixa resistência à tração, havendo a necessidade de melhorias no método de fabricação dele.(AU)

Tensile strength and diameter are very important characteristics in assessing the quality of suture, being related to their ability to withstand the stress caused by forces acting in certain tissues. Thus, the aim of this study was to evaluate the mechanical and dimensional properties of chitosan-based suture, comparing them with those recommended by the NBR 13904/2003. These properties were evaluated by using a universal testing machine and a digital micrometer. The mechanical and dimensional parameters analyzed were resistance to traction, deformation and diameter, respectively. The average diameter of the chitosan showed variation and yarn tensile strength was observed slightly below the recommended standard, with rapid deformation. The chitosan yarn in the form in which it was produced, presented dimensional variability and low tensile strength, there is a need for improvements in the method of manufacturing the same.(AU)

Cognitive impairment and magnetic resonance imaging correlates in primary progressive multiple sclerosis.

OBJECTIVES: To characterize cognitive impairment in primary progressive multiple sclerosis (PPMS) and to correlate the pattern of cognitive deficits with brain magnetic resonance imaging (MRI) volumetric data. MATERIALS AND METHODS: In a multicenter cross-sectional study, we recruited consecutive patients with PPMS as well as age, sex, and education level-matched healthy controls (HC). All participants underwent neuropsychological (NP) assessment, and brain MRI was performed in patients with PPMS for analysis of lesion load, subcortical GM volumes, and regional cortical volumes. RESULTS: We recruited 55 patients with PPMS and 36 HC. Thirty-six patients were included in the MRI analysis. Patients with PPMS performed significantly worse than HC in all NP tests. Subcortical GM volume was significantly correlated with all NP tests, except for Stroop Test, with the largest effect for the thalamus (r=-.516 [BVMT-R DR, P=.016 FDR-corrected] to r=.664 [SDMT, P<.001 FDR-corrected]). In the stepwise linear regression model, thalamic volume was the only predictor of performance in all NP tests. CONCLUSION: Cognitive impairment is common in PPMS and affects all evaluated cognitive domains. Subcortical GM volume, particularly of the thalamus, is a strong predictor of cognitive performance, suggesting it has a central role in the pathophysiology of PPMS-related cognitive dysfunction.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A3 and COL4A4 mutations and clinical characterization of 25 families.

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in >50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A5 mutations and clinical characterization of 22 families.

Alport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies.

The efficacy and safety of natalizumab for the treatment of multiple sclerosis in Portugal: a retrospective study.

INTRODUCTION: Studies have shown that natalizumab is an effective treatment for relapsing-remitting multiple sclerosis (RRMS). To date, no data are available in Portuguese patients. AIM: To determine the efficacy and safety of natalizumab in patients with RRMS in routine clinical practice in Portugal. PATIENTS AND METHODS: Clinical data for adult patients with RRMS treated with natalizumab at specialist neurology centres in Portugal were entered retrospectively into a database for analysis between October 2010 and February 2012. Changes in annualized relapse rates (ARR), Expanded Disability Status Scale (EDSS) scores and disability status were analysed. RESULTS: A total of 383 patients from 20 centres were included. Prior to starting natalizumab, the baseline median EDSS score was 4 and the mean ARR was 1.64. Most patients had previously received multiple sclerosis treatment (93.0%). Median natalizumab treatment duration was 12 months. Natalizumab treatment was associated with significant (p < 0.001) reductions from baseline in the mean ARR and EDSS scores in patients treated with natalizumab for >= 12 months (n = 288) and for >= 24 months (n = 160). Natalizumab was more effective in patients with less disability (EDSS < 3) and in those who had not previously received disease-modifying treatments. Two cases of progressive multifocal leukoencephalopathy were reported. No new unexpected adverse events occurred. CONCLUSION: Natalizumab is well tolerated, and is effective in reducing relapse rate and stabilising disease in patients with RRMS in the clinical practice setting in Portugal. Its efficacy persists with continued treatment, and it may be particularly effective in patients with less disability and without prior disease modifying therapy.

TITLE: Estudio retrospectivo de la eficacia y seguridad del natalizumab en el tratamiento de la esclerosis multiple en Portugal.Introduccion. Los estudios han demostrado que el natalizumab constituye un tratamiento eficaz contra la esclerosis multiple remitente recurrente (EMRR). Hasta la fecha, no habia datos de pacientes portugueses. Objetivo. Determinar la eficacia y la seguridad del natalizumab en pacientes con EMRR atendidos en la practica clinica ordinaria en Portugal. Pacientes y metodos. Los datos clinicos de adultos con EMRR tratados con natalizumab en centros especializados de neurologia en Portugal se introdujeron de forma retrospectiva en una base de datos para llevar a cabo un analisis entre octubre de 2010 y febrero de 2012. Se analizo el cambio en la tasa anualizada de brotes (TAB), en las puntuaciones de la escala ampliada de discapacidad (EDSS) y en el estado de discapacidad. Resultados. Se admitio un total de 383 pacientes atendidos en 20 centros. Antes de iniciar el tratamiento con natalizumab, la mediana inicial de la EDSS era de 4,0 y la TAB media, de 1,64. La mayor parte de los pacientes ya habia recibido tratamiento contra la esclerosis multiple (93,0%). La duracion media del tratamiento con natalizumab era de 12 meses. El tratamiento propicio reducciones significativas (p < 0,001) de los valores iniciales de la TAB media y de las puntuaciones EDSS en los tratados con el anticuerpo durante >= 12 meses (n = 288) y durante >= 24 meses (n = 160). El natalizumab resulto mas eficaz en los pacientes que presentaban un menor grado de discapacidad (EDSS < 3,0) y en los que no habian recibido ningun tratamiento modificador de la enfermedad. Se notificaron dos casos de leucoencefalopatia multifocal progresiva. No hubo efectos adversos inesperados. Conclusion. El natalizumab presenta una tolerabilidad satisfactoria y se muestra eficaz en la reduccion de las recidivas y la estabilizacion de la EMRR en el marco de la practica clinica ordinaria en Portugal. Conserva su eficacia con el tratamiento continuado y podria ser eficaz especialmente en los pacientes con menos discapacidad y en aquellos que no han recibido ningun tratamiento modificador de la enfermedad hasta el momento.

Utilização do filme de quitosana na reparação de tendão em coelhos / Use of the film of chitosan in the repair of tendons in rabbits

Com este trabalho objetivou-se avaliar o processo de cicatrização do tendão em coelhos, utilizando-se no grupo tratamento o filme de quitosana, por meio de uma análise clínico-cirúrgica e histológica. Foram utilizados 12 coelhos adultos, separados em grupo controle (GC) e grupo tratamento (GT), nos quais se realizou uma secção parcial do tendão gastrocnêmio de ambos os membros pélvicos. A avaliação clínica baseou-se na presença de reação inflamatória, infecção, dor e deiscência da sutura. Para a avaliação histológica, foi realizado um estudo comparativo do processo cicatricial por meio do tipo de células, da quantidade de tecido conjuntivo e da organização das fibras colágenas entre os grupos e os momentos. Nas feridas cirúrgicas, não foram observadas secreção, dor ou deiscência. Na histologia comparativa entre os grupos, o GC apresentou melhor processo cicatricial em relação ao GT, aos 60 dias. Aos 90 dias, no GT a cicatrização já esboça recuperação do tendão, com reorganização da celularidade e das fibras colágenas no tecido conjuntivo denso modelado. Concluiu-se que a quitosana estimula rápido crescimento celular, mas de forma desorganizada, e que a cicatrização completa só ocorre após 90 dias da sua implantação no tecido...

This work aimed to evaluate the process of tendon healing in rabbits, using the treatment group in chitosan film through a clinical, surgical and histological analysis. In the experiment, 12 adult rabbits were used, divided into control group (CG) and treatment group (TG), which were held in the partial section of the gastrocnemius tendon of both limbs. Clinical assessment was based on the presence of inflammation, infection, pain and suture dehiscence. For histological evaluation a comparative study of the healing process through the cell type, amount of connective tissue and collagen fiber organization was performed between groups and times. In surgical wounds no secretion, pain or dehiscence were observed. In the comparative histology between groups, the CG showed better healing compared to TG, at 60 days. On day 90 the TG already outlines tendon recovery with reorganization of cellularity and collagen fibers in the dense connective tissue modeled. It was concluded that chitosan stimulates faster cell growth, but it is haphazardly, and that complete healing occurs after 90 days of their implantation in tissue...

Use of chitosan and ß-tricalcium phosphate, alone and in combination, for bone healing in rabbits.

The aim of this research was to evaluate the process of bone regeneration in rabbits, using chitosan and beta-tricalcium phosphate (ß-TCP) independently and in combination. A total of 12 New Zealand rabbits of both sexes, with average weight of 3.0 ± 0.57 kg were used. Animals were randomly divided into two experimental time points, with six animals euthanized 45 days after surgery and six euthanized 90 days after surgery. We performed two osteotomies in each tibia. The left tibia was used for the chitosan (QUI) and control groups, and the right tibia was used for the ß-TCP alone and in combination with chitosan (QUI+TCP) groups. Tomographic evaluation showed no statistically significant difference among groups; however radiopacity was higher in the treated groups. Comparative descriptive histological evaluation found that treatment groups stimulated a more pronounced tissue repair reaction and accelerated bone repair. Morphometric analysis showed that treatment groups presented statistically higher bone formation compared with the control group.

Fratura de patela com ruptura do tendão patelar em um cão: relato de caso / Patella fracture with rupture of the patellar tendon in a dog: case report

Relatou-se a ocorrência de fratura patelar associada à ruptura do tendão patelar em um cão sem raça definida, macho, atendido em um hospital veterinário escola. A técnica utilizada foi a combinação de fixação óssea com fio de Kirschner e aplicação de banda de tensão, recomendada em fraturas transversais da patela. Para reparar a lesão do tendão patelar, realizou-se a sutura tipo Kessler modificada com fio de náilon 0,80mm. No retorno do paciente, 150 dias após o procedimento cirúrgico, havia processo cicatricial ósseo avançado da patela. Concluiu-se que as medidas adotadas para reparação da lesão foram eficazes.

It is reported the occurrence of patellar fracture associated with rupture of the patellar tendon in a mongrel male dog referred to a Teaching Veterinary Hospital. The used technique was the combination of bone fixation with Kirschner wire and application of tension band recommended in most transverse fractures of the patella. To repair the damage to the patellar tendon, the modified Kessler suture with nylon 0.80mm was performed. When the patient returned 150 days after surgery, advanced bone healing process was observed in patella. It was concluded that the measures taken to repair the injury were effective.

Use of increasing doses of a degradable Deslorelin implant to enhance uterine involution in postpartum lactating dairy cows.

Holstein cows received, subcutaneously 1 (1DESL, n=15) or 2 (2DESL, n=12) degradable implant containing 2.1mg of the GnRH agonist Deslorelin or no implant (CON, n=18) within 1.5 days postpartum (dpp). Previous pregnant (PPH) and non-pregnant (PNPH) uterine horns were determined by palpation per rectum. Cows were examined by ultrasonography at 8dpp, 15dpp, 22dpp, 29dpp, and 36dpp (S.E.=1 day) to record ovarian structures, cervical diameter, uterine horns cross-section and lumen diameters, myometrial and endometrial widths. Uterine tone was recorded before ultrasonography. Vaginoscopy was conducted just after ultrasonography for cervical discharge score. At 44dpp cows were inserted with a CIDR followed 7 days later by its removal and injection of PGF(2alpha) 8h later, followed by the Ovsynch 10 days after for timed artificial insemination (TAI). Plasma was analyzed for PGFM daily from parturition to 14dpp and for P(4) trice weekly until 44dpp. Additionally, strategic blood samples were collected during the synchronization protocol to determine whether estrous cyclicity was occurring and ovulation status before and after TAI, respectively. Cows in 1DESL and 2DESL groups had more class 1 follicles (P<0.01), less class 2 (P<0.01) and class 3 follicles (P<0.01) compared with CON. First increase of P(4), indicative of ovulation, occurred in CON (55.5%) cows at 28dpp (S.E.=9 days) and in 1DESL (13.3%) treated cows at 43dpp (S.E.=3). Plasma concentrations of P(4) were suppressed completely in all 2DESL-treated cows before initiation of estrous synchronization. Diameters of PPH (P<0.01), PNPH (P<0.01), uterine horn lumens (P<0.01) were less in the 1DESL and 2DESL groups with greater uterine tone (P=0.07). Frequency distribution of cervical discharge categories did not differ among groups. Proportion of cows with estrous cycles and having ovulations was less (P<0.01) in DESL implant cows compared with CON that was to a greater (P<0.01) extent in the 2DESL. Treatment with Deslorelin during postpartum (1) suppressed follicular development, (2) enhanced physical involution of the uterus, (3) increased tone of the uterine wall, (4) delayed first ovulation and reduced responsiveness to a synchronization of ovulation protocol. Future research should focus in GnRH agonist delivery systems to restrict duration of treatment to optimize uterine involution and avoid a prolonged period of anovulation.

In vivo behavior of zirconia hydroxyapatite (ZH) ceramic implants in dogs: a clinical, radiographic, and histological study.

The main goal of this study is to evaluate potential applications of two zirconia-hydroxyapatite composites, Z4H6 and Z6H4, as bone substitutes. Composite plugs were implanted into the distal femoral metaphysis and also onto the longissimus dorsi of 18 adult mixed-breed dogs in order to assess in vivo biocompatibility by immediate clinical and radiographic evaluation 30, 90, and 120 days after implantation. Radiographic examination revealed radiolucency on the defect site. However, a progressive increase in bone density was observed over time, reaching a radiopacity similar to that of bone 120 days after implantation. Histological study revealed that a thin layer of fibroblasts was observed at the implant-bone interface in addition to osteoblastic activity 30 days after implantation, whereas bone neoformation around the implants was detected for the subsequent implantation times (90 and 120 days). Otherwise, the histological evaluation of the implant-muscle interface showed the presence of an initially thick fibrous tissue layer 30 days after implantation, which decreased with longer investigation times (90 and 120 days). The numbers of plasmocytes, lymphocytes, and macrophages gradually reduced as a function implantation time, being completely absent 120 days after implantation with a resulting complete osteointegration process. The zirconia phase content did not affect the bioactive behavior of the implants investigated and did not induce bone formation when implanted into muscle either.

Tau protein seems not to be a useful routine clinical marker of axonal damage in multiple sclerosis.

BACKGROUND: The descriptions of early axonal damage in patients with multiple sclerosis (MS) prompted the search of body fluid markers. However, the studies addressing this issue in MS present conflicting results. AIM: To assess the levels of tau protein in patients with definite MS. PATIENTS AND METHODS: Cerebrospinal fluid (CSF) samples from 50 patients with definite diagnosis of MS (33 F, 17 M; mean age: 33.6 years) and from 19 age-matched individuals without organic neurological diseases (11 F, 8 M), entered this study. With regard to the clinical course, the MS patients were classified as follows: 32 relapsing-remitting (RR); two secondary progressive (SP), and four primary progressive (PP). Twelve patients had clinical isolated syndromes (CIS). The mean duration was 36.1 months (range: 15 days to 20 years). Tau protein was measured in the CSF by double antibody sandwich ELISA. RESULTS: The median tau and the cut-off values of the controls were 104.9 and 175.3 pg/mL, respectively. We found that most MS patients presented normal values. In addition, the clinical features - course, duration, Expanded Disability Status Scale (EDSS) value, Poser index of progression, Multiple Sclerosis Severity Score - did not significantly influence the tau levels in the MS group. CONCLUSION: Our study showed similar CSF tau concentrations in MS patients with different clinical characteristics. This suggests that tau protein does not seem to be a useful routine clinical marker of axonal damage.

Implantes de resina de poliuretana vegetal (Ricinus communis) na tração linear, fixação e fusão vertebral no cão: estudo experimental / Implants of Ricinus communis polyurethane resin in distraction, fixation and vertebral fusion in dogs: experimental study

Placa e espaçador de polímero derivado do óleo de mamona (PDOM) (Ricinus communis) foram avaliados clínica, radiográfica e histologicamente na tração linear, fixação e fusão vertebral cervical em 20 cães adultos, sem raça definida, pesando entre 17 e 22kg. Foram sacrificados quatro animais aos 10, 30, 60, 90 e 120 dias de pós-operatório. Após exposição da coluna cervical, por acesso ventral, o disco intervertebral de C4-C5 foi fenestrado e a abordagem ao canal medular foi feita por meio de fenda óssea. Um espaçador de PDOM foi colocado preenchendo o defeito ósseo. Os corpos vertebrais C4-C5 foram fixados com placa do mesmo material, utilizando-se dois parafusos corticais em cada corpo vertebral. Apenas um animal apresentou déficit neurológico no pós-operatório imediato. Radiograficamente as vértebras mostravam-se normais e alinhadas, sem colapso do espaço intervertebral, porém não houve neoformação óssea entre as vértebras. Ao exame mielográfico, não houve compressão da medula espinhal. Os implantes foram efetivos em manter a tração linear e fixação das vértebras cervicais e não ocorreu a fusão vertebral.

Dendritic changes in the hippocampal formation of AIDS patients: a quantitative Golgi study.

We have previously shown that in the hippocampal formation of patients with acquired immunodeficiency syndrome (AIDS) there is neuronal atrophy, without cell loss. Because reductions in neuronal size are suggestive of associated neuritic alterations, we decided to study the dendritic trees of the main neuronal populations in the hippocampal formation. Material was obtained in five male AIDS patients and five male controls. After Golgi impregnation, the dendritic arborizations of dentate granule and hilar basket cells, and of CA3 and CA1 pyramidal cells, were hand traced, and their segments classified, counted and measured. We found an impoverishment of the dendritic trees in all neuronal populations in the AIDS group, which was more striking in the hilus and CA3 field. Specifically, hilar neurons had fewer dendritic segments, and reduced branching density and dendritic extent; in CA3 pyramids there was a decrease in the number of terminal segments in the basal trees, and a reduction in the total number of segments, number of medium order terminals, dendritic branching density and dendritic extent in the apical trees. In CA1 pyramids, the terminals were shorter in the apical trees and the dendritic spine density decreased in the basal trees, whereas in granule cells only the dendritic spine density was reduced in AIDS patients. Subtle signs suggestive of dendritic reorganization were observed. These results point to a regional vulnerability of the hippocampal formation to HIV infection, and might contribute to explaining the occurrence of dementia, as a consequence of overall reduction in the hippocampal neuronal receptive surface.

A whole genome screen for association with multiple sclerosis in Portuguese patients.

Multiple sclerosis (MS) is common in Europe affecting up to 1:500 people. In an effort to identify genes influencing susceptibility to the disease, we have performed a population-based whole genome screen for association. In this study, 6000 microsatellite markers were typed in separately pooled DNA samples from MS patients (n=188) and matched controls (n=188). Interpretable data was obtained from 4661 of these markers. Refining analysis of the most promising markers identified 10 showing potential evidence for association.

[Interface neurology/psychiatry: a case report of neurosyphilis]. / Interfaz neurología/psiquiatría: un caso de neurosífilis.

Organic diseases can occur with different psychiatric symptoms. Neurosyphilis was considered to be a landmark in the history of organic mental syndromes. The complexity of its clinical picture decreases the boundaries between Neurology and Psychiatry and requires a multidisciplinary approach. We report a case of neurosyphilis that began with psychiatric symptoms in a twenty five years old male.

AIDS does not alter the total number of neurons in the hippocampal formation but induces cell atrophy: a stereological study.

Although cognitive dysfunction is a common finding in patients with acquired immunodeficiency syndrome (AIDS) its pathogenesis remains controversial. Given the involvement of the hippocampal formation in the processing of cognitive information and the scarcity of quantitative studies in this brain region, we have examined, using stereological methods, the hippocampal formations of AIDS patients. The study was performed in ten AIDS patients and ten age-matched controls. All cases were male. The Principle of Cavalieri was applied to estimate the volume of the layers of the dentate gyrus and of the CA3 and CA1 hippocampal fields. The fractionator and the nucleator were used as estimators of the total number, and mean somatic and nuclear volumes of the neurons in the cell-containing layers of all hippocampal subdivisions. No cell death was detected in AIDS patients but the global volume of their hippocampal formations was significantly decreased due to the reduced volume of its layers, mainly the cell-containing layers. Furthermore, the somatic and nuclear volumes of the neurons in the hippocampal formation were significantly decreased in AIDS patients. No correlation was found between the estimates obtained and the presence or absence of neurological involvement. Our results show that neurons in the hippocampal formation of AIDS patients display marked morphological changes, despite the maintenance of their total number. These alterations are likely to lead to dysfunction of the hippocampal circuitries and, thus, might contribute to explaining the dementia features which occur in this condition.

[Young-onset multiple sclerosis]. / Esclerosis múltiple de inicio juvenil.

INTRODUCTION: Young onset multiple sclerosis is an infrequent situation which may present with atypical symptoms and uncertain outcome. OBJECTIVE: Our aim was to assess the clinical presentation and course in young onset multiple sclerosis, and analyze eventual data which might be helpful in establishing its prognosis. PATIENTS AND METHODS: We have retrospectively reviewed the clinical protocols of 17 patients with young onset multiple sclerosis, defined as presentation of symptoms before 21 years. Diagnosis was made according to Poser's criteria including clinical features, magnetic resonance imaging, cerebrospinal fluid findings, and evoked potentials. RESULTS: The mean age at onset was 16.9 +/- 4.4 and median time to diagnosis was four weeks. The clinical course was relapsing-remitting in 76.5% and secondary progressive in 23.5%. The mean annual exacerbation rate was 1.5 +/- 0.9 and median time to second exacerbation was 12 months. The actual Expanded Disability Status Scale score is 2.6 +/- 2 after a mean disease duration of 11.4 +/- 8.0 years. The correlation between the Expanded Disability Status Scale score and the mean disease duration was the only statistically significant result. CONCLUSIONS: These results are similar to other studies, namely, age at onset did not correlate with final neurological disability. However, we must emphasize that any primary progressive form was found in our study. We conclude that in young onset multiple sclerosis, progression is not dependent on the age of onset and does not necessarily lead to an unfavorable outcome.