Behavior of neuropathy symptom score and neuropathy disability score in patients with and without peripheral diabetic neuropathy: A retrospective cohort study.

BACKGROUND: This study aimed to stablish cut-off of early diagnosis of diabetic polyneuropathy (PDN) based on neuropathy symptom score (NSS) and neuropathy disability score (NDS); to determine the behavior of NDD and NDS in patients with and without PDN; and to verify the association between clinical and demographic variables with both tests. METHODS: This retrospective cohort included 86 patients with diabetes. The NSS and NDS evaluations were collected in medical records in two moments: initial (entry into service) and final (after three years). Individuals were categorized in three groups: G1- PDN in both evaluations (N = 27); G2- PDN only in the final evaluation (N = 16); G3-individuals without PDN (N = 43). A ROC curve was performed to evaluate the sensitivity and specificity of NSS and NDS for PDN diagnosis. ANOVA was used to compare NSS and NDS between groups and evaluations, and multiple regression was performed to find predictors of PDN. RESULTS: The NSS and NDS showed excellent sensitivity and specificity (NDS ≥1.5 and NSS ≥6.5) for PDN diagnosis. There was a significant difference between groups in initial (p = 0.000) and final (p = 0.000) NDS and NSS evaluations. There was an association between peripheral arterial disease (PAD) and increase in NSS (p = 0.024) in G2; and association between loss of protective sensation (LOPS) and increase in NSS in G3 (p < 0.001). CONCLUSION: NSS and NDS tests showed excellent sensitivity and specificity for early PDN diagnosis. Behavior of both tests can differ patients with and without PDN. Furthermore, PAD and LOPS can be a predictor of PDN evolution.

Decreased functional mobility in individuals with mild to moderate expanded disability status from relapsing multiple sclerosis: Analysis of the Glittre-ADL test.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease that significantly limits an individual's activities of daily living (ADLs) and negatively affects their social participation as it progresses. The impact of activities and participation must be continuously assessed, and the Glittre-ADL is a validated test for MS to assess functional capacity in tasks similar to ADLs. OBJECTIVE: To evaluate whether the Glittre-ADL test is a valid method for assessing functional mobility in individuals with MS and moderate disability or those who use assistive devices. METHODS: This cross-sectional study enrolled 30 individuals in two groups: 1) MS group (n = 15); and 2) healthy control group (n = 15). The MS group underwent three functional mobility tests: 1) Glittre-ADL; 2) Timed 25-Foot Walk (T25FWT); and 3) Timed Up and Go (TUG) while the healthy group underwent only the Glittre-ADL test. RESULTS: An association was found between the Glittre-ADL time and T25FWT (r = 0.78, p < .001) and TUG (r = 0.56, p = .030) times. In the MS group, statistically significant differences were found in time (F = 2.88, p = .038) and speed (F = 5.17, p = .024) between laps. A statistically significant difference was observed between the total time in the MS and control groups (Area Under Curve - AUC: 0.982, p < .0001). A total time > 46.0s represents the reduction of functional performance during ADLs in individuals with MS (sensitivity: 93.3%; specificity: 92.2%). CONCLUSION: The Glittre-ADL test is a valid tool for assessing functional mobility in individuals with MS and mild to moderate disability (EDSS score ≤ 6.5).

Progressive multifocal leukoencephalopathy triggered by COVID-19 in a previously asymptomatic person living with undiagnosed HIV infection.

This report presents the case of a 47-year-old male patient who worked as a mathematics teacher and experienced the sudden onset of disorientation, aphasia, and acalculia during an online class. The current study reveals the first documented case of HIV and progressive multifocal leukoencephalopathy with the detection of SARS-CoV-2 and human polyomavirus 2 (previously known as John Cunningham virus) in the cerebrospinal fluid. Furthermore, serum analysis revealed elevated concentrations of interleukin (IL)-6, IL-17, and IL-8, which are potential factors known to reduce the expression of tight junctions and adhesion molecules in the extracellular matrix, thereby affecting the permeability of the blood-brain barrier. Finally, the study discusses whether SARS-CoV-2 triggers or exacerbates progressive multifocal leukoencephalopathy.

Migraine with aura and stroke - the role of warning signs in the context of secondary headaches: case report / Enxaqueca com aura e acidente vascular cerebral ­ o papel dos sinais de alerta no contexto das cefaleias secundárias: relato de caso

Introduction: Headache is a very common complaint in doctors' offices, with primary causes being the majority in relation to secondary ones. Despite this, the identification of secondary headaches is very relevant in clinical practice, since these can be a life-threatening condition, functionality or even a reversible cause. However, imaging screening for all individuals with headache is costly and unrewarding. Therefore, it is important to know the warning signs that, together with the clinical context, lead to a more precise indication of these exams and early and well-targeted therapeutic interventions. Clinical case: This is a 60-year-old man, previously dyslipidemic and smoker, with migraine with aura reported since childhood, who underwent treatment with sodium valproate, with headache attack suppression. About 4 months before admission, he presented with an alteration in the pain pattern, amaurosis fugax in the right eye, dizziness and mild paresis and hypoesthesia in the left side of the body, primarily treated by him as migraine crises, without improvement with the use of triptans. A new outpatient investigation was carried out, which showed multiple small infarcts in the right hemisphere secondary to atheromatous plaque in the right carotid bulb with an obstruction of approximately 85%. Diagnostic and therapeutic arteriography was performed, with stent implantation, uneventfully. Conclusion: The differential diagnosis between migraine with aura and a cerebrovascular event has already been widely reported in the literature and constitutes a pitfall in the routine of headaches, since a serious and potentially disabling condition can be overlooked. The joint evaluation of the alarm signs with the global context becomes an important tool in the propaedeutics of these patients, with knowledge of this casuistry being something relevant within clinical practice.

Introdução: A cefaleia é uma queixa muito comum nos consultórios médicos, sendo as causas primárias majoritárias em relação às secundárias. Apesar disso, a identificação de cefaleias secundárias é muito relevante na prática clínica, uma vez que estas podem ser uma condição potencialmente fatal, funcional ou mesmo uma causa reversível. No entanto, o rastreio imagiológico para todos os indivíduos com cefaleias é dispendioso e pouco recompensador. Portanto, é importante conhecer os sinais de alerta que, juntamente com o contexto clínico, levam a uma indicação mais precisa destes exames e a intervenções terapêuticas precoces e bem direcionadas. Caso clínico: Trata-se de um homem de 60 anos, previamente dislipidémico e fumador, com queixa de enxaqueca com aura desde a infância, que realizou tratamento com valproato de sódio, com supressão das crises de cefaleia. Cerca de 4 meses antes da internação apresentou alteração do padrão álgico, amaurose fugaz em olho direito, tontura e leve paresia e hipoestesia no lado esquerdo do corpo, tratada por ele primariamente como crises de enxaqueca, sem melhora com o uso de triptanos. Foi realizada nova investigação ambulatorial que evidenciou múltiplos pequenos infartos no hemisfério direito secundários a placa de ateroma no bulbo carotídeo direito com obstrução de aproximadamente 85%. Foi realizada arteriografia diagnóstica e terapêutica, com implante de stent, sem intercorrências. Conclusão: O diagnóstico diferencial entre enxaqueca com aura e evento cerebrovascular já foi amplamente relatado na literatura e constitui uma armadilha na rotina das cefaleias, uma vez que uma condição grave e potencialmente incapacitante pode ser negligenciada. A avaliação conjunta dos sinais de alarme com o contexto global torna-se uma ferramenta importante na propedêutica destes pacientes, sendo o conhecimento desta casuística algo relevante dentro da prática clínica.

Role of Cytokines, Chemokines and IFN-γ+ IL-17+ Double-Positive CD4+ T Cells in Patients with Multiple Sclerosis.

Multiple sclerosis is mediated by self-reactive myelin T and B cells that lead to axonal and myelin damage. The immune response in multiple sclerosis involves the participation of CD4+ T cells that produce cytokines and chemokines. This participation is important to find markers for the diagnosis and progression of the disease. In our work, we evaluated the profile of cytokines and chemokines, as well as the production of double positive CD4+ T cells for the production of IFNγ IL-17 in patients with multiple sclerosis, at different stages of the disease and undergoing different treatments. We found that relapsing-remitting patients had a significant increase in IL-12 production. About IL-5, its production showed significantly higher levels in secondarily progressive patients when compared to relapsing-remitting patients. IFN-γ production by PBMCs from secondarily progressive patients showed significantly higher levels. This group also had a higher percentage of CD4+ IFNγ+ IL-17+ T cells. The combination of changes in certain cytokines and chemokines together with the presence of IFNγ+ IL-17+ double positive lymphocytes can be used to better understand the clinical forms of the disease and its progression.

Multiple sclerosis starting before the age of 18 years: the Brazilian experience.

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil.

Multiple sclerosis starting before the age of 18 years: the Brazilian experience / Esclerose multipla com inicio antes dos 18 anos de idade: a experiencia brasileira

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil. .

Esclerose múltipla (EM) com início na infância e adolescência constitui um desafio para o diagnóstico e manejo da doença. A proposta do presente estudo foi avaliar as características da EM de início precoce em pacientes brasileiros. Métodos Coleta de dados retrospectiva de arquivos de unidades especializadas em atendimento da EM. Resultados A partir de 20 unidades de EM de nove estados brasileiros, foram coletados 117 casos de EM com início antes dos 18 anos de idade. Estes pacientes tinham uma média de 10 anos de duração da doença, de maneira geral apresentavam pouca incapacidade , com um surto a cada dois anos e meio. A média de idade no início da doença era 13,7 anos. Conclusão O presente estudo apresenta uma grande série de casos brasileiros de EM pediátrica. Embora alguns pacientes tenham apresentado forma grave de EM, de maneira geral o grupo de pacientes cuja EM iniciou-se na infância ou adolescência apresentou uma forma relativamente leve da doença no Brasil. .

Neuromyelitis optica and pregnancy.

Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO.

Acute Chagas' disease in postrenal transplant and treatment with benzonidazole.

Transplanted organs may act as a route of transmission of infectious diseases, such as Chagas' disease. The aim of this study was to describe the transmission of the Trypanosoma cruzi through a renal transplant and the anatomo-clinical evolution of the patient after treatment with benzonidazole. The patient was a 31-year-old white male from the State of Minas Gerais in Brazil. He had renal failure secondary to diabetes and later received a kidney from a cadaveric donor. The patient was undergoing immunosuppression therapy with azathioprine, cyclosporine A, and prednisone. After the transplant, he developed an acute phase of Chagas' disease and complications from diabetes and died 2 months later. In the autopsy, T cruzi amastigotes were found in the transplanted kidney, heart, bladder, liver, and pancreas. An important reduction in the parasitemia was obtained through the treatment of the infection with benzonidazole; however, the patient died due to complications from diabetes associated with tissue lesions caused by T cruzi.