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OBJECTIVE: To evaluate the efficacy of treatments based on GnRH, GnRH-PGF2α, and/or intense exposure to novel rams to induce fertile estrus without the use of steroid hormones in seasonally anestrous Suffolk ewes. METHODS: In the first experiment, ewes were treated with one injection of GnRH, two injections of GnRH administered 7 days apart, or a sequence of GnRH-PGF2α-GnRH. In the second experiment anestrous ewes were exposed, for 36 days starting on the day of weaning, to groups of four rams of three different breeds that were alternated every day. Besides exposure to the males, the ewes were injected with saline solution (ME group, n=20), with GnRH (ME-GnRH group, n=20) or with a sequence of GnRH-PGF2α-GnRH (ME-GPG group, n=20). The rams used for male-effect were fitted with aprons to prevent mating, and ewes detected in estrus were bred to selected fertile rams. Ovarian activity was monitored by progesterone determinations in both experiments. RESULTS: In the first experiment sustained induction of ovarian activity was not achieved and no ewe was detected in estrus. In the second experiment induction of sustained ovarian activity was achieved in all groups. Most of the ewes were detected in estrus, 76.7 % of the ewes were mated during a 36-d breeding period and 71.7 % of all the ewes became pregnant during that period. No significant differences between groups were found for any of these variables. However, estrus detection efficiency was higher in the ME-GnRH group than in the ME group (p<0.05). CONCLUSION: An intense male-effect, that included the continuous presence and frequent alternation of several rams of different breeds, was sufficient to induce ovarian activity and fertile estrus in Suffolk ewes during the period of deep anestrus without the use of hormones, although addition of GnRH improved the efficiency of estrus detection.
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OBJECTIVE: The first international consensus criteria for optic neuritis (ICON) were published in 2022. We applied these criteria to a prospective, global observational study of acute optic neuritis (ON). METHODS: We included 160 patients with a first-ever acute ON suggestive of a demyelinating CNS disease from the Acute Optic Neuritis Network (ACON). We applied the 2022 ICON to all participants and subsequently adjusted the ICON by replacing a missing relative afferent pupillary defect (RAPD) or dyschromatopsia if magnetic resonance imaging pathology of the optical nerve plus optical coherence tomography abnormalities or certain biomarkers are present. RESULTS: According to the 2022 ICON, 80 (50%) patients were classified as definite ON, 12 (7%) patients were classified as possible ON, and 68 (43%) as not ON (NON). The main reasons for classification as NON were absent RAPD (52 patients, 76%) or dyschromatopsia (49 patients, 72%). Distribution of underlying ON etiologies was as follows: 78 (49%) patients had a single isolated ON, 41 (26%) patients were diagnosed with multiple sclerosis, 25 (16%) patients with myelin oligodendrocyte glycoprotein antibody-associated disease, and 15 (9%) with neuromyelitis optica spectrum disorder. The application of the adjusted ON criteria yielded a higher proportion of patients classified as ON (126 patients, 79%). INTERPRETATION: According to the 2022 ICON, almost half of the included patients in ACON did not fulfill the requirements for classification of definite or possible ON, particularly due to missing RAPD and dyschromatopsia. Thorough RAPD examination and formal color vision testing are critical to the application of the 2022 ICON.
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BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a rare entity with severe inflammatory demyelinating events of the central nervous system with debilitating sequelae. Its global prevalence ranges between 0.5 and 4/100,000 individuals, with variations by region and ethnicity. Latin America lacks epidemiological data on the disease, and Colombian prevalence is unknown. OBJECTIVE: Prevalence of NMOSD in Colombia was estimated between 2017 and 2021 using the official Ministry of Health administrative database (SISPRO). METHODS: This is an observational, cross-sectional retrospective study, using data between January 2017 and December 2021 in the SISPRO database using the International Classification of Disease code for NMOSD G36.0. Prevalence by gender, age and geographic distribution was estimated using official government statistics for 2019. World Health Organization (WHO) standard population was used to adjust using the direct method. RESULTS: 2,650 patients were diagnosed with NMOSD; the average age was 44.9 years with an overall unadjusted prevalence of 5.3/100,000 individuals, higher for females (7.8) than for males (2.8). No significant changes (from 5.3 to 5.4) were seen after adjusting to the WHO standard. CONCLUSION: According to this study Colombia has one of the highest prevalence rates of NMOSD in Latin America, further studies are needed to elucidate the contributing factors.
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Equine placentitis is characterized by infection and inflammation of the placenta. Different biomarkers associated with this inflammatory response have been evaluated in experimentally induced equine placentitis, but not in pregnant mares with spontaneous placentitis. The aim of the current study was to determine the concentration of eIL-1ß and the activity of proMMP-2 and proMMP-9 in the serum of healthy mares and mares with placentitis on days 240 and 320 of gestation to explore whether these biomarkers are associated with equine maternal placentitis and/or with the birth of an infected or inviable foals. Serum samples were collected from sixteen pregnant English Thoroughbred mares, retrospectively classified as follows: (1) healthy mares with full-term gestation; and (2) mares with ultrasonographic signs of placentitis. The health of each foal was examined at birth, and it was decided to classify the cases into four groups: (1) healthy mares delivering a healthy foals (HM-HF, n = 6); (2) mares with USP delivering a healthy foal (USP-HF, n = 3); (3) mares with USP delivering a live septic foal (USP-LSeF, n = 4); and (4) mares with USP delivering a dead foal (USP-DF, n = 3). eIL-1ß was quantified by ELISA, and proMMP-2 and proMMP-9 activity by gelatin zymography electrophoresis. In healthy mares, the serum concentrations of eIL-1ß underwent a significant 16.5-fold increase from day 240 to day 320 of gestation. Although similar results were found in the mares with ultrasonographic signs of placentitis that delivered a healthy foal, those delivering a live septic or nonviable foal exhibited much higher concentrations of eIL-1ß. proMMP-2 and proMMP-9 activity was not associated with maternal placentitis, foal infection, or death. Hence, the presence of placentitis severe enough to affect the health of the foal can be confirmed or discarded by determining the eIL-1ß concentration in mares that have shown ultrasonographic signs of placentitis.
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BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.
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Neuromielite Óptica , Neurite Óptica , Adulto , Feminino , Humanos , Masculino , Aquaporina 4 , Modelos Logísticos , Neuromielite Óptica/terapia , Neurite Óptica/terapia , Troca Plasmática , Plasmaferese , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Neuromyelitis Optica spectrum disorder (NMOSD) is an inflammatory disease, which manifests mostly as recurrent episodes of optic neuritis or myelitis that cause important disability. Early diagnosis and prompt initiation of immunosuppressive therapy are crucial in reducing relapses, disability, and mortality. Even though, there are few prospective randomized controlled trials, several drugs have proved to be both effective and safe. Azathioprine and Rituximab represent the standard of care and are used as first-line treatment agents worldwide. However, recent studies have unveiled new therapies, such as monoclonal antibodies. To make treatment recommendations and management guidelines, it is imperative to define an appropriate standard of care. METHODS: A systematic literature review was performed in MEDLINE, EMBASE, and LILACS databases using the following terms: "(NMO OR Devic OR Neuromyelitis Optica) AND (Azathioprine OR Prednisone OR Rituximab OR Tocilizumab OR Bortezomib OR Inebilizumab OR Eculizumab OR Satralizumab)" including both, randomized clinical trials and observational studies published between January 2006 and January 2021. The inclusion criteria comprised patients aged 18 or older, NMOSD diagnosis following the Wingerchuck criteria, two or more therapies been compared, and the evaluation of both efficacy and safety outcomes. All studies comparing treatment only with placebo were excluded. Quality was assessed according with the design of the study, and results were synthesized through comparative tables for each outcome evaluated, differentiating the results of randomized and non-randomized studies. RESULTS: Thirteen studies with 1447 patients were included. Twelve studies evaluated the expanded disability status scale (EDSS) before and after treatment; in five of seven evaluating rituximab, it outperformed its comparators in improving the disability degree. Eleven studies assessed the annual relapse rate (ARR). Again, in six of seven evaluating rituximab, it was superior to other therapies. Time to relapse (TTR) was reported in five studies. The three studies that included Rituximab revealed a longer time to relapse in this arm of treatment. Finding were consistent in randomized and non-randomized studies. The new molecules Satralizumab, Eculizumab and Tocilizumab were evaluated in one study each, proving to be highly effective and safe. The safety profile analysis showed a higher number of adverse events for Azathioprine. DISCUSSION: This systematic review demonstrates a superiority tendency of Rituximab upon the other treatments strengthening the available evidence about NMOSD management. Superiority in EDSS outcomes, annual relapse rate, time to first relapse and relapses during treatment time was evidenced in the Rituximab group compared to other medications, with lower rates of adverse events. New molecules Tocilizumab, Eculizumab and Satralizumab also showed superiority in the evaluated results, especially in the relapses during treatment time outcome, although with subtle differences in EDSS and ARR outcomes. CONCLUSION: Our results suggest that monoclonal antibodies are highly effective and safe for the treatment of NMOSD; Rituximab showed better performance on multiple outcomes and has more evidence available. New molecules: Eculizumab, Tocilizumab, Satralizumab are good options for treatment. Drugs like Azathioprine and Mycophenolate are effective, but with a worse risk-benefit ratio, therefore, they are useful alternatives in places that do not have access to monoclonal antibodies.
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Neuromielite Óptica , Adolescente , Adulto , Anticorpos Monoclonais Humanizados , Azatioprina/uso terapêutico , Humanos , Neuromielite Óptica/tratamento farmacológico , Estudos Prospectivos , Rituximab/uso terapêuticoRESUMO
BACKGROUND: Neuromyelitis optica spectrum disorders (NMOSD) is an increasing diagnostic and therapeutic challenge in Latin America (LATAM). Despite the heterogeneity of this population, ethnic and socioeconomic commonalities exist, and epidemiologic studies from the region have had a limited geographic and population outreach. Identification of some aspects from the entire region are lacking. OBJECTIVES: To determine ethnic, clinical characteristics, and utilization of diagnostic tools and types of therapy for patients with NMOSD in the entire Latin American region. METHODS: The Latin American Committee for Treatment and Research in MS (LACTRIMS) created an exploratory investigational survey addressed by Invitation to NMOSD Latin American experts identified through diverse sources. Data input closed after 30 days from the initial invitation. The questionnaire allowed use of absolute numbers or percentages. Multiple option responses covering 25 themes included definition of type of practice; number of NMOSD cases; ethnicity; utilization of the 2015 International Panel criteria for the diagnosis of Neuromyelitis optica (IPDN); clinical phenotypes; methodology utilized for determination of anti-Aquaporin-4 (anti- AQP4) antibodies serological testing, and if this was performed locally or processed abroad; treatment of relapses, and long-term management were surveyed. RESULTS: We identified 62 investigators from 21 countries reporting information from 2154 patients (utilizing the IPDN criteria in 93.9% of cases), which were categorized in two geographical regions: North-Central, including the Caribbean (NCC), and South America (SA). Ethnic identification disclosed Mestizos 61.4% as the main group. The most common presenting symptoms were concomitant presence of optic neuritis and transverse myelitis in 31.8% (p=0.95); only optic neuritis in 31.4% (more common in SA), p<0.001); involvement of the area postrema occurred in 21.5% and brain stem in 8.3%, both were more frequent in the South American cases (p<0.001). Anti-AQP4 antibodies were positive in 63.9% and anti-Myelin Oligodendrocyte Glycoprotein (MOG) antibodies in 4.8% of total cases. The specific laboratorial method employed was not known by 23.8% of the investigators. Acute relapses were identified in 81.6% of cases, and were treated in 93.9% of them with intravenous steroids (IVS); 62.1% with plasma exchange (PE), and 40.9% with intravenous immunoglobulin-G (IVIG). Therapy was escalated in some cases due to suboptimal initial response. Respondents favored Rituximab as long-term therapy (86.3%), whereas azathioprine was also utilized on 81.8% of the cases, either agent used indistinctly by the investigators according to treatment accessibility or clinical judgement. There were no differences among the geographic regions. CONCLUSIONS: This is the first study including all countries of LATAM and the largest cohort reported from a multinational specific world area. Ethnic distributions and phenotypic features of the disease in the region, challenges in access to diagnostic tools and therapy were identified. The Latin American neurological community should play a determinant role encouraging and advising local institutions and health officials in the availability of more sensitive and modern diagnostic methodology, in facilitating the the access to licensed medications for NMOSD, and addressing concerns on education, diagnosis and management of the disease in the community.
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Neuromielite Óptica , Aquaporina 4 , Autoanticorpos , Humanos , América Latina/epidemiologia , Glicoproteína Mielina-Oligodendrócito , Recidiva Local de Neoplasia , Neuromielite Óptica/epidemiologia , Neuromielite Óptica/terapiaRESUMO
INTRODUCTION: Multiple sclerosis is a chronic inflammatory demyelinating disease associated with neurological disability. Clinical features include motor, cerebellar, visual, and sensory function alterations, as well as psychiatric comorbidities, such as depression, anxiety, and irritability. There is little literature available on the quality of life of patients and their caregivers. OBJECTIVE: To assess the quality of life of patients with multiple sclerosis and their caregivers in Colombia given that there is no information on the subject in this particular population to establish comprehensive management plans. MATERIALS AND METHODS: We used the MusiQol and CareQol questionnaires and the Beck Depression Inventory. A prospective analytical observational protocol was designed to include patients aged 18 to 65 years with a diagnosis of relapsing-remitting multiple sclerosis between October, 2014, and October, 2015, at the Hospital Universitario San Ignacio. We evaluated quantitative variables and Spearman correlations. The data analysis was carried out with Student t and Mann-Whitney U tests. RESULTS: A total of 55 patients with relapsing-remitting multiple sclerosis participated in the study. Chronic fatigue was the most common comorbidity in 27%. The MusiQol questionnaire revealed a good basal quality of life, which remained at similar levels in the follow-ups at six and 12 months. Quality of life was good during the study since there were no statistically significant differences between baseline and follow-up MusiQol scores. Good quality of life was also observed in caregivers. CONCLUSIONS: The quality of life of several Colombian patients diagnosed with multiple sclerosis was very good. This positive result was also observed in caregivers as evidenced by the results of the CareQol questionnaire. We also observed and indicated an inversely proportional correlation between the Expanded Disability Status Scale and the quality of life indexes.
Introducción. La esclerosis múltiple es una enfermedad desmielinizante inflamatoria crónica asociada con discapacidad neurológica que afecta la función motora, cerebelosa, visual y sensorial, y se presenta con comorbilidades psiquiátricas como depresión, ansiedad e irritabilidad. Hay escasa literatura disponible sobre la calidad de vida de los pacientes y sus cuidadores. Objetivo. Evaluar la calidad de vida de los pacientes con esclerosis múltiple y sus cuidadores en Colombia dado que no hay información sobre el tema en esta población en particular para establecer planes de manejo integral. Materiales y métodos. Se utilizaron los cuestionarios MusiQol, CareQol y el inventario de depresión de Beck. Se diseñó un protocolo observacional analítico prospectivo para pacientes de 18 a 65 años con diagnóstico de esclerosis múltiple remitente recurrente entre octubre de 2014 y octubre de 2015 en el Hospital Universitario San Ignacio. Se evaluaron variables cuantitativas y las correlaciones de Spearman. El análisis de datos se hizo mediante la prueba t de Student y la U de Mann-Whitney. Resultados. Participaron 55 pacientes diagnosticados con esclerosis múltiple remitente recurrente. En el 27 % de ellos la fatiga crónica fue la comorbilidad más frecuente. El cuestionario MusiQol reveló una buena calidad de vida de base, que se mantuvo en niveles similares en los seguimientos a los seis y los 12 meses. La calidad de vida fue buena durante el estudio y sin diferencias estadísticamente significativas entre las puntuaciones de base del cuestionario MusiQol y las de seguimiento. Se observó una buena calidad de vida en los cuidadores. Conclusiones. La calidad de vida de los pacientes colombianos participantes en el estudio con diagnóstico de esclerosis múltiple fue muy buena, así como la de los cuidadores según los resultados del cuestionario CareQol. Se observó una correlación inversamente proporcional entre la Expanded Disability Status Scale y los índices de calidad de vida.
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Cuidadores/psicologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Antirreumáticos/uso terapêutico , Ansiedade/epidemiologia , Sobrecarga do Cuidador/epidemiologia , Sobrecarga do Cuidador/psicologia , Colômbia/epidemiologia , Comorbidade , Depressão/epidemiologia , Escolaridade , Síndrome de Fadiga Crônica/epidemiologia , Feminino , Humanos , Masculino , Casamento , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Multiple sclerosis (MS) is the most prevalent chronic inflammatory disease of the central nervous system (CNS), affecting more than 2 million people worldwide. It is characterized by brain and spinal cord involvement. There are the relapsing remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS) phenotypes. There is a subgroup of RRMS patients who have a more aggressive disease course marked by a rapid accumulation of physical and cognitive deficit, despite treatment with 1 or more disease modifying drugs (DMTs). In the past, this disease phenotype was called "aggressive" MS (AMS); it is now called highly active MS (HAMS). It is generally agreed that the severe nature of this phenotype requires different treatment decisions. Unfortunately, there is no consensus on the definition of AMS or the treatment algorithm. In this article we review HAMS in relation to its definition and the treatments available.
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Sistema Nervoso Central/patologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/terapia , Humanos , Esclerose Múltipla/patologiaRESUMO
BACKGROUND: Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. OBJECTIVE: The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. METHODS: A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. RESULTS: Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. CONCLUSION: Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.
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Epidemiological studies in both humans and animals conducted in Mexico have shown that the isolation frequency of Escherichia coli O157 : H7 is low. In a previous study, IgG antibodies against E. coli O157, O7 and O116 LPS were found in serum samples from children and adults with no previous history of E. coli O157 : H7 infection. The present study was designed to determine whether a similar immune response against E. coli O157 : H7 and other antigenically related bacteria was present in bovine serum samples. A total of 310 serum samples from different herds in Mexico was analysed by microagglutination assays against different enterobacterial antigens, including E. coli O157. Microagglutination assays were positive against E. coli O7 (55 %), O116 (76 %) and O157 (36 %), Escherichia hermannii (15 %), Salmonella enterica serotype Urbana (14 %) and Salmonella enterica subsp. arizonae (40 %). These results were confirmed using a specific ELISA with purified LPS. A positive reaction was observed against the LPS of E. coli O7 (29 %), O116 (12 %) and O157 (22 %), E. hermannii (4 %), Salmonella Urbana (13 %) and S. enterica subsp. arizonae (12 %). Serum absorption studies of positive serum samples indicated the existence of at least three common epitopes shared by the LPS of E. coli O7, O116 and O157, and two others between E. coli O157 and Salmonella Urbana and S. enterica subsp. arizonae. A bactericidal assay against E. coli O157 : H7 using 31 bovine serum samples was performed, and 22 (71 %) of these serum samples gave positive results. The data demonstrated that bovine serum showed a response against different enterobacteria, including E. coli O157, and that this response could be due to the presence of shared epitopes in the LPS of these organisms.
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Anticorpos Antibacterianos/sangue , Doenças dos Bovinos/imunologia , Infecções por Enterobacteriaceae/veterinária , Enterobacteriaceae/imunologia , Epitopos/imunologia , Lipopolissacarídeos/imunologia , Testes de Aglutinação/métodos , Animais , Bovinos , Reações Cruzadas , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/imunologia , Ensaio de Imunoadsorção Enzimática/métodos , México/epidemiologia , Viabilidade Microbiana , Estudos Soroepidemiológicos , Soro/imunologiaRESUMO
Nine jennies were monitored daily by ultrasonography during three complete ovarian cycles in order to evaluate if the timing of luteolysis and the growth pattern of the ovulatory follicle (OVF) before, during and after luteolysis are related to the length of the interovulatory interval (IOI). Blood samples for progesterone determination were obtained daily during one of the cycles of each jenny. The cycles were classified according to the length of the IOI into three groups: Short IOI (21.2 ± 0.3 d, n = 10), medium IOI (23.9 ± 0.4 d, n = 7), and long IOI (26.2 ± 0.3 d, n = 10). Neither the time of luteolysis onset nor the time of luteolysis completion were significantly different between groups. The length of the IOI was mainly determined by the duration of the follicular phase, as the intervals from luteolysis onset to ovulation and from luteolysis completion to ovulation were directly correlated with the length of the IOI (p < 0.001 and p < 0.01 respectively). Multiple regression analysis revealed that the length of the IOI was negatively correlated with the size of the OVF at day 13 (p < 0.01), with its growth rate from day 13 to day 15 (p < 0.05) and with its growth rate from day 15 to day 18 (p < 0.01), and positively correlated with the final diameter of the OVF (p < 0.01). The correlation between the observed IOIs and those predicted by the multiple regression equation was highly significant (r = 0.91, p < 0.001), but the predictive ability of a simplified equation using only the diameter of the OVF at day 18 was almost as good (r = 0.89, p < 0.001). Estrus signs lasted longer and were more intense as the length of the IOI increased, and this was associated with a longer period of low progesterone concentrations during the follicular phase of jennies with longer cycles. It is concluded that the length of the luteal phase in jennies is relatively constant, and that most of the variation in the length of the IOI is associated with differences in the size of the OVF at the time of luteolysis onset and with its growth rate during the following five days.
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Equidae/fisiologia , Ciclo Estral/fisiologia , Ovário/fisiologia , Animais , Feminino , Hormônio Luteinizante/sangue , Luteólise , Ovário/diagnóstico por imagem , Ovulação/fisiologia , Progesterona/sangue , Fatores de TempoRESUMO
Seventy six ewes were treated with 7.5, 12.5, 25 or 50µg of cloprostenol on day 6 or 9 post-estrus to compare the luteolytic efficiency of the PGF2α analogue at each stage and to evaluate if progesterone concentrations at the time of treatment affect such efficiency. Blood samples were obtained before cloprostenol administration and 12, 24, 48, and 72h thereafter. There was an effect of dose (p<0.05) but not of day post-estrus on the proportion of animals completing luteolysis. As the dose increased, the proportion of ewes completing luteolysis also increased. Also, as the dose increased from 7.5 to 25µg, more ewes showed a transient progesterone decline instead of an absence of response, indicating that in some ewes reduced doses initiated luteolysis but were not able to finish the process. Since the dose of 25µg resulted in close to 50% luteolytic efficacy, this group was used to study the effects of progesterone concentrations at the time of treatment on the response to cloprostenol. Pre-treatment progesterone concentrations were higher (p<0.01) in ewes experiencing luteolytic failure than in those that completed luteolysis. There was a negative correlation between initial progesterone concentrations and their reduction by 12h post-treatment. It is concluded that high progesterone concentrations are associated with a reduction in sensitivity to small doses of cloprostenol. Possible mechanisms and implications of this luteoprotective effect are discussed.
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Cloprostenol/farmacologia , Luteolíticos/farmacologia , Progesterona/sangue , Ovinos , Animais , Cloprostenol/administração & dosagem , Sincronização do Estro , Feminino , Luteolíticos/administração & dosagemRESUMO
INTRODUCCIÓN: La enfermedad asociada a anticuerpos contra la glucoproteína del oligodendrocito asociado a la mielina (MOG) es una entidad infrecuente y prácticamente nueva en la medicina. En países en desarrollo, aún hay importantes limitaciones para la detección de los anticuerpos anti-MOG mediante ensayo basado en células, por lo que conocer las características clínicas de los diferentes fenotipos y sus diferencias con otras patologías desmielinizantes del sistema nervioso es fundamental, y con ello realizar un abordaje diagnóstico y terapéutico adecuado de los pacientes. OBJETIVO: Presentar una actualización en cuanto a las características clínicas del espectro de la enfermedad. Éste es el primer artículo en castellano que reúne los fenotipos más frecuentes y brinda una descripción clara de lo que se debe tener en cuenta en cada uno de ellos. DESARROLLO: Esta entidad se caracteriza por tener un curso monofásico o recurrente. La neuritis óptica es el fenotipo de presentación más frecuente en la población general, y la encefalomielitis aguda diseminada, la más frecuente en los niños. Otros fenotipos que se describen en la presente revisión son la mielitis transversa, la encefalitis cortical y los síndromes de tallo cerebral, así como los criterios propuestos para el diagnóstico de la enfermedad asociada a anticuerpos anti-MOG. CONCLUSIONES: En la actualidad no existen estudios que busquen caracterizar a la población hispanoparlante con esta enfermedad ni artículos de revisión en lengua castellana, por lo que es importante difundir conocimiento y desarrollar investigación en esta área
INTRODUCTION: Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a rare and practically new entity in medicine. In developing countries, there are still important limitations for the detection of anti-MOG antibodies by cell-based assay, so knowing the clinical characteristics of the different phenotypes and their differences with other demyelinating pathologies of the central nervous system is essential in order to make a proper diagnostic and therapeutic approach of the patients. AIM: To present an update regarding the clinical characteristics of the disease spectrum, being the first article in Spanish that gathers the most frequent phenotypes and provides a clear description of what should be considered to identify each of these phenotypes. DEVELOPMENT: This disease is characterized by having a monophasic or recurrent course, with optic neuritis being the most frequent presentation phenotype in general population and disseminated acute encephalomyelitis the most frequent in children. Other phenotypes described in this review are transverse myelitis, focal cortical encephalitis and cerebral stem syndromes, as well as the proposed criteria for the diagnosis of the disease associated with MOG antibody disease. CONCLUSION: Currently there are no studies that seek to characterize the Spanish-speaking population with this disease, or review articles in Spanish, so it is important to disseminate knowledge and develop research in this area
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Humanos , Glicoproteína Oligodendrócito-Mielina/análise , Encefalite/epidemiologia , Neurite Óptica/epidemiologia , Mielite Transversa/diagnóstico , Encefalite/diagnóstico , Glicoproteína Oligodendrócito-Mielina/imunologia , Mielite Transversa/imunologia , Encefalomielite Aguda Disseminada/tratamento farmacológico , Metilprednisolona/administração & dosagemRESUMO
Introduction: Multiple sclerosis is a chronic inflammatory demyelinating disease associated with neurological disability. Clinical features include motor, cerebellar, visual, and sensory function alterations, as well as psychiatric comorbidities, such as depression, anxiety, and irritability. There is little literature available on the quality of life of patients and their caregivers. Objective: To assess the quality of life of patients with multiple sclerosis and their caregivers in Colombia given that there is no information on the subject in this particular population to establish comprehensive management plans. Materials and methods: We used the MusiQol and CareQol questionnaires and the Beck Depression Inventory. A prospective analytical observational protocol was designed to include patients aged 18 to 65 years with a diagnosis of relapsing-remitting multiple sclerosis between October, 2014, and October, 2015, at the Hospital Universitario San Ignacio. We evaluated quantitative variables and Spearman correlations. The data analysis was carried out with Student t and Mann-Whitney U tests. Results: A total of 55 patients with relapsing-remitting multiple sclerosis participated in the study. Chronic fatigue was the most common comorbidity in 27%. The MusiQol questionnaire revealed a good basal quality of life, which remained at similar levels in the follow-ups at six and 12 months. Quality of life was good during the study since there were no statistically significant differences between baseline and follow-up MusiQol scores. Good quality of life was also observed in caregivers. Conclusions: The quality of life of several Colombian patients diagnosed with multiple sclerosis was very good. This positive result was also observed in caregivers as evidenced by the results of the CareQol questionnaire. We also observed and indicated an inversely proportional correlation between the Expanded Disability Status Scale and the quality of life indexes.
Introducción. La esclerosis múltiple es una enfermedad desmielinizante inflamatoria crónica asociada con discapacidad neurológica que afecta la función motora, cerebelosa, visual y sensorial, y se presenta con comorbilidades psiquiátricas como depresión, ansiedad e irritabilidad. Hay escasa literatura disponible sobre la calidad de vida de los pacientes y sus cuidadores. Objetivo. Evaluar la calidad de vida de los pacientes con esclerosis múltiple y sus cuidadores en Colombia dado que no hay información sobre el tema en esta población en particular para establecer planes de manejo integral. Materiales y métodos. Se utilizaron los cuestionarios MusiQol, CareQol y el inventario de depresión de Beck. Se diseñó un protocolo observacional analítico prospectivo para pacientes de 18 a 65 años con diagnóstico de esclerosis múltiple remitente recurrente entre octubre de 2014 y octubre de 2015 en el Hospital Universitario San Ignacio. Se evaluaron variables cuantitativas y las correlaciones de Spearman. El análisis de datos se hizo mediante la prueba t de Student y la U de Mann-Whitney. Resultados. Participaron 55 pacientes diagnosticados con esclerosis múltiple remitente recurrente. En el 27 % de ellos la fatiga crónica fue la comorbilidad más frecuente. El cuestionario MusiQol reveló una buena calidad de vida de base, que se mantuvo en niveles similares en los seguimientos a los seis y los 12 meses. La calidad de vida fue buena durante el estudio y sin diferencias estadísticamente significativas entre las puntuaciones de base del cuestionario MusiQol y las de seguimiento. Se observó una buena calidad de vida en los cuidadores. Conclusiones. La calidad de vida de los pacientes colombianos participantes en el estudio con diagnóstico de esclerosis múltiple fue muy buena, así como la de los cuidadores según los resultados del cuestionario CareQol. Se observó una correlación inversamente proporcional entre la Expanded Disability Status Scale y los índices de calidad de vida.
Assuntos
Qualidade de Vida , Esclerose Múltipla , Pacientes , Cuidadores , ColômbiaRESUMO
This article reviews the evolution of veterinary medicine in Mexico in order to explain the foundation of the National Council for Veterinary Medicine Education (CONEVET). This institution performs college accreditation and professional certification procedures in the country. The accreditation process for colleges of veterinary medicine in Mexico is described, and the results obtained to this point are presented. A comparative analysis of veterinary education in Mexico and the United States is also presented. The veterinary college accreditation processes of the two countries are compared and their differences analyzed.
Assuntos
Acreditação , Educação em Veterinária/normas , Acreditação/métodos , Acreditação/organização & administração , Conselhos de Planejamento em Saúde , Humanos , México , Faculdades de Medicina Veterinária , Estados UnidosRESUMO
INTRODUCTION: Approximately 85% of patients with multiple sclerosis have an initial demyelinating event. Treatment with interferon beta delays the progression of multiple sclerosis for nearly two years in patients with a clinically isolated syndrome. In Colombia, interferon is very expensive when compared to other countries. OBJECTIVE: We sought to determine the cost-effectiveness of a two-year interferon beta treatment within Colombia in patients with a clinically isolated syndrome. MATERIALS AND METHODS: Based on patient and society perspectives, a cost-effectiveness analysis was conducted using a decision tree. A variety of probabilities were defined after a systematic review of the available literature. The disease costs were calculated by reviewing medical charts at the Hospital San Ignacio University and surveys completed by multiple sclerosis patients. To control for uncertainty in these data, analysis of approximately one-thousand patients was performed using Monte Carlo methods. RESULTS: The two-year treatment cost per patient exceeds Col$ 95,000,000 (US$ 50,000). Approximately 80 % of this cost corresponds to medications (US$ 40,500). The price of relapse and indirect costs totals Col$ 41,632,149 (US$ 21,744) and Col$ 11,656,389 (US$ 6,088), respectively. Treatment represents an increase of 0.06 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio exceeds the threshold, regardless of the use of Monte Carlo methods for analysis. CONCLUSION: Administering interferon beta over the course of two years to high-risk patients with a clinically isolated syndrome is not cost-effective within Colombia.
Assuntos
Análise Custo-Benefício , Doenças Desmielinizantes/tratamento farmacológico , Doenças Desmielinizantes/economia , Interferon beta/economia , Interferon beta/uso terapêutico , Colômbia , Árvores de Decisões , Doenças Desmielinizantes/complicações , Progressão da Doença , Humanos , Esclerose Múltipla/etiologia , Esclerose Múltipla/prevenção & controle , Fatores de TempoRESUMO
RESUMEN El entendimiento de las caracteristicas clínicas del espectro de trastornos de Neuromielitis óptica (NMOSD) con mielitis parcial y neuritis óptica típica ha ampliado el diagnóstico en casos atípicos. Presentamos el caso de una mujer de 47 años que debuta con neuritis óptica atípica y mielitis parcial. Resonancia magnética cerebral y órbitas con realce de nervio óptico, quiasma óptico y tracto óptico derecho, de columna cervical y torácica contrastada con mielitis parcial a nivel C4 y T2. Fue tratada con bolos de metilprednisolona y plasmaferesis, con buena respuesta clínica. Se realizó anticuerpos aquaporina 4 sérico positivos.
SUMMARY The understanding of the clinical characteristics of the spectrum of optic neuromyelitis disorders (NMOSD) with partial myelitis and typical optic neuritis has extended the diagnosis in atypical cases. We present the case of a 47-year-old woman who debuts with atypical optic neuritis and partial myelitis. Magnetic resonance imaging and orbits with optic nerve enhancement, optical chiasm and right optic tract, cervical and thoracic spine contrasted with partial myelitis at level C4 and T2. I t was treated with boluses of Methylprednisolone and plasmapheresis, with good clinical response. Aquaporina 4 Serum positive antibodies were performed.
Assuntos
Neuromielite Óptica , Aquaporina 4 , Mielite , Mielite TransversaRESUMO
Introducción: La vasculitis ANCA-positiva es una patología que se caracteriza por daño en vasos de pequeño calibre secundario a auto-anticuerpos. El compromiso del sistema nervioso central es poco común, con complicaciones serias y de difícil diagnóstico. Por eso presenta-mos 3 casos de pacientes con paquimeningitis hipertrófica como manifestación neurológica de vasculitis ANCA-positiva, estudiados en el Hospital Universitario San Ignacio de Bogotá. Casos:Se tratan de dos hombres y una mujer. El hombre del primer caso presentó clínica progresiva de 1 año de evolución de dolor ocular, alteración de la agudeza visual, limitación para los movimientos oculares y disartria (Imagen 1).
Assuntos
Anticorpos Anticitoplasma de Neutrófilos , Meningite , VasculiteRESUMO
Introducción. En 85 % de los pacientes con esclerosis múltiple se presenta como manifestación inicial un primer evento desmielinizante o síndrome clínico aislado. En estos casos, el tratamiento con interferón beta retrasa hasta dos años la progresión a esclerosis múltiple. Sin embargo, en Colombia este medicamento es costoso. Objetivo. Determinar si el tratamiento del síndrome clínico aislado con interferón beta es costo-efectivo al retrasar la esclerosis múltiple en dos años. Materiales y métodos. Se realizó un análisis de costo-efectividad empleando un árbol de decisiones basado en la perspectiva del paciente y la sociedad. A partir de una revisión sistemática de la literatura y de conceptos de expertos se definieron las diversas probabilidades. Los costos de la enfermedad se calcularon por medio de la revisión de historias y la aplicación de encuestas a los pacientes atendidos en el Hospital Universitario San Ignacio. Para controlar la incertidumbre se realizó un análisis de sensibilidad mediante una simulación de Monte Carlo con mil pacientes. Resultados. El costo del tratamiento con interferón sobrepasa los Col$ 95´000.000 (US$ 50.000) por paciente durante los dos años. Aproximadamente, 80 % corresponde a los costos del medicamento. El costo de la recaída se acerca a Col$ 39´139.200 (US$ 21.744), y los costos indirectos corresponden a Col$ 10´958.400 (US$ 6.088). La tasa representativa del mercado fue de Col$ 1.800. Con el tratamiento se ganan sólo 0,06 años de vida ajustados por discapacidad (AVAD) adicionales. La razón de costo-efectividad incremental´ (sic.) supera el umbral, incluso en el análisis de sensibilidad. Conclusión. La administración de interferón beta en pacientes con síndrome clínico aislado de alto riesgo en los primeros dos años no es costo-efectiva en Colombia.
Introduction: Approximately 85% of patients with multiple sclerosis have an initial demyelinating event. Treatment with interferon beta delays the progression of multiple sclerosis for nearly two years in patients with a clinically isolated syndrome. In Colombia, interferon is very expensive when compared to other countries. Objective: We sought to determine the cost-effectiveness of a two-year interferon beta treatment within Colombia in patients with a clinically isolated syndrome. Materials and methods: Based on patient and society perspectives, a cost-effectiveness analysis was conducted using a decision tree. A variety of probabilities were defined after a systematic review of the available literature. The disease costs were calculated by reviewing medical charts at the Hospital San Ignacio University and surveys completed by multiple sclerosis patients. To control for uncertainty in these data, analysis of approximately one-thousand patients was performed using Monte Carlo methods. Results: The two-year treatment cost per patient exceeds Col$ 95,000,000 (US$ 50,000). Approximately 80 % of this cost corresponds to medications (US$ 40,500). The price of relapse and indirect costs totals Col$ 41,632,149 (US$ 21,744) and Col$ 11,656,389 (US$ 6,088), respectively. Treatment represents an increase of 0.06 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio exceeds the threshold, regardless of the use of Monte Carlo methods for analysis. Conclusion: Administering interferon beta over the course of two years to high-risk patients with a clinically isolated syndrome is not cost-effective within Colombia.