Multiple sclerosis, disease-modifying therapies and COVID-19: A systematic review on immune response and vaccination recommendations

Understanding the risks of COVID-19 in patients with Multiple Sclerosis (MS) receiving disease-modifying therapies (DMTs) and their immune reactions is vital to analyze vaccine response dynamics. A systematic review on COVID-19 course and outcomes in patients receiving different DMTs was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Emerging data on SARS-CoV-2 vaccines was used to elaborate recommendations. Data from 4417 patients suggest that MS per se do not portend a higher risk of severe COVID-19. As for the general population, advanced age, comorbidities, and higher disability significantly impact COVID-19 outcomes. Most DMTs have a negligible influence on COVID-19 incidence and outcome, while for those causing severe lymphopenia and hypogammaglobulinemia, such as anti-CD20 therapies, there might be a tendency of increased hospitalization, worse outcomes and a higher risk of re-infection. Blunted immune responses have been reported for many DMTs, with vaccination implications. Clinical evidence does not support an increased risk of MS relapse or vaccination failure, but vaccination timing needs to be individually tailored. For cladribine and alemtuzumab, it is recommended to wait 3–6 months after the last cycle until vaccination. For the general anti-CD20 therapies, vaccination must be deferred toward the end of the cycle and the next dose administered at least 4–6 weeks after completing vaccination. Serological status after vaccination is highly encouraged. Growing clinical evidence and continuous surveillance are extremely important to continue guiding future treatment strategies and vaccination protocols

Finding hens in a haystack: Consistency of movement patterns within and across individual laying hens maintained in large groups

\ua9 2018, The Author(s). We sought to objectively quantify and compare the recorded movement and location patterns of laying hens within a commercial system. Using a custom tracking system, we monitored the location within five zones of a commercial aviary for 13 hens within a flock of 225 animals for a contiguous period of 11 days. Most hens manifested a hen-specific pattern that was (visually) highly consistent across days, though, within that consistency, manifested stark differences between hens. Three different methods were used to classify individual daily datasets into groups based on their similarity: (i) Linear Discriminant Analysis based on six summary variables (transitions into each zone) and total transitions; (ii) Hierarchical Clustering, a na\uefve clustering analysis technique, applied to summary variables and iii) Hierarchical Clustering applied to dissimilarity matrices produced by Dynamic Time Warping. The three methods correctly classified more than 85% of the hen days and provided a unique means to assess behaviour of a system indicating a considerable degree of complexity and structure. We believe the current effort is the first to document these location and movement patterns within a large, complex commercial system with a large potential to influence the assessment of animal welfare, health, and productivity

Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.

OBJECTIVE: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.info:eu-repo/semantics/publishedVersio

Five-Year Outcome in Stroke Patients Submitted to Thrombolysis

BACKGROUND AND PURPOSE: Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). METHODS: Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. RESULTS: Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. CONCLUSIONS: One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome

A Variational Method in Out of Equilibrium Physical Systems

A variational principle is further developed for out of equilibrium dynamical systems by using the concept of maximum entropy. With this new formulation it is obtained a set of two first-order differential equations, revealing the same formal symplectic structure shared by classical mechanics, fluid mechanics and thermodynamics. In particular, it is obtained an extended equation of motion for a rotating dynamical system, from where it emerges a kind of topological torsion current of the form $\epsilon_{ijk} A_j \omega_k$, with $A_j$ and $\omega_k$ denoting components of the vector potential (gravitational or/and electromagnetic) and $\omega$ is the angular velocity of the accelerated frame. In addition, it is derived a special form of Umov-Poynting's theorem for rotating gravito-electromagnetic systems, and obtained a general condition of equilibrium for a rotating plasma. The variational method is then applied to clarify the working mechanism of some particular devices, such as the Bennett pinch and vacuum arcs, to calculate the power extraction from an hurricane, and to discuss the effect of transport angular momentum on the radiactive heating of planetary atmospheres. This development is seen to be advantageous and opens options for systematic improvements.Comment: 22 pages, 1 figure, submitted to review, added one referenc

Vascular Training Does Matter in the Outcomes of Saphenous High Ligation and Stripping

Objective: Varicose vein (VV) surgery is frequently performed by surgeons without formal vascular training. We aimed to compare the outcomes of the procedure based on the background of the surgeon. Methods: All patients registered with VV surgery between 2004 and 2016 in Portuguese public hospitals were included in the study. Intrahospital outcomes were assessed from this administrative database. A random multicenter sample of 315 patients submitted to saphenous high ligation and stripping (175 patients from six vascular surgery departments and 140 patients from five general surgery divisions) were further queried over the phone, whereby additional nonregistered outcomes were evaluated: preoperative venous ultrasound, impact on quality of life by the 14-item Chronic Venous Insufficiency Quality of Life Questionnaire, visual analogue scale evaluation (score of 1 to 5) of the aesthetic results and general satisfaction, work absence days, and time to return to physical activities. Results: In 13 years, there were 153,382 patients submitted to VV surgery. Of these, 49% were operated on by general surgeons and 40% by vascular surgeons; in 11%, it was not possible to identify the specialty performing the operation. Twenty-three deaths were registered (no differences between groups). In the general surgery group, 14% of patients were hospitalized for more than one night compared with 3% in the vascular group (P < .001). Reintervention rate during the period analyzed was significantly higher in the general surgery group (13.5% vs 8.2%; P < .001). Rate of outpatient surgery was higher in the vascular surgery group (60% vs 36%; P < .001). Phone query revealed similar overall satisfaction and improvement in quality of life in both groups (4.2 vs 4.0 [P = .275] and 35% vs 36% [P = .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P = .007), higher number of residual VVs (2.4 vs 1.7; P = .006), and higher number of days absent from work (40 vs 27 days; P = .005) and took longer to resume physical activities (60 vs 41 days; P = .001). Conclusions: Despite that the majority of VV surgery in Portugal is executed by general surgeons, this study highlights important advantages when it is performed by surgeons with vascular training.info:eu-repo/semantics/publishedVersio

Tiapride in the treatment of alcohol-dependent patients: what is the evidence?

Introdução: A dependência alcoólica repre- senta uma das mais prevalentes perturbações psiquiátricas, constituindo um importante problema de Saúde Pública. O tiaprida é um dos fármacos com indicação clínica nas per- turbações do comportamento na abstinência alcoólica. Objetivo: Esclarecer se a utilização do tiapri- da é fundamentada pela evidência científica no tratamento da dependência alcoólica (sín- drome de abstinência e manutenção da absti- nência). Métodos: Pesquisa bibliográfica em diferen - tes bases de dados utilizando os termos MeSH: alcoholism e tiapride. Limitou-se a pesquisa a artigos publicados nos últimos 20 anos, em inglês, português ou espanhol. Os níveis de evidência e forças de recomendação foram atribuídos segundo a escala Strength of Rec- ommendation Taxonomy (SORT) da Amer- ican Family Physician. Resultados: De um total de 22 artigos identi- ficados, foram incluídos cinco ensaios clínicos controlados e aleatorizados. Da análise dos ar- tigos, dois mostraram que o tiaprida poderia ser uma opção eficaz no tratamento da sín - drome de abstinência alcoólica. Em relação à manutenção da abstinência, os resultados fo- ram contraditórios, com um estudo a mostrar superioridade e dois inferioridade em relação ao placebo. Conclusões: A evidência científica mos- trou benefício para a utilização do tiapri- da na síndrome de abstinência alcoólica (SORT B), embora esta recomendação seja suportada apenas por dois estudos hetero- géneos. Em relação à manutenção da abs- tinência, o uso do tiaprida não é suporta- do pela evidência científica mais recente (SORT B). Contudo, são necessários mais estudos científicos de boa qualidade meto- dológica que avaliem se o tiaprida é de facto uma terapêutica efetiva no tratamento da dependência alcoólica

Macular Edema Secondary to Retinal Vein Occlusion in a Real-Life Setting: a Multicenter, Nationwide, 3-Year Follow-Up Study

Purpose: To evaluate the presence of macular edema secondary to retinal vein occlusion (RVO)-both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-3 years after diagnosis in patients who underwent intravitreal therapy and to identify potential prognostic factors and biomarkers of persistent macular edema. Methods: National multicenter, observational, exploratory, retrospective cohort study of 104 consecutive patients with macular edema secondary to RVO diagnosed from January 2014 to December 2015 with minimum 3-year follow-up time. Data analyzed included best-corrected visual acuity (BCVA), clinical and demographic data, and spectral domain optical coherence tomography parameters. Results: At final observation, median baseline central retinal thickness significantly improved from baseline 538 to 290 μm (p < 0.001) and complete macular edema resolution was achieved in 51.0% of patients (56.3% and 42.5% in BRVO and CRVO patients, respectively). BCVA also improved (p < 0.01). Logistic regression analysis revealed a relationship between recurrence of macular edema and disorganization of retinal inner layers (DRIL) at baseline (odds ratio = 2.88; p = 0.013). Conclusion: Good long-term anatomical and functional outcomes are achieved with intravitreal treatments in RVO patients. Anatomical success and visual gains seen in the first year were maintained throughout the entire follow-up, though DRIL is a major risk factor for recurrence.info:eu-repo/semantics/publishedVersio