Multiple Sclerosis Patient Management During the COVID-19 Pandemic: Practical Recommendations From the Portuguese Multiple Sclerosis Study Group (GEEM)

The spread of the COVID-19 pandemic has imposed significant challenges on healthcare provision, requiring changes in the conventional patient management, particularly in chronic diseases like multiple sclerosis (MS). To increase patient safety and reduce the risk of infection, while ensuring an appropriate and regular follow-up, tele-medicine gained prominence as a valid alternative to face-to-face appointments. However, the urgency of the implementation and the lack of experience in most MS centers led to "ad hoc" and extremely diverse approaches, which now merit to be standardized and refined. Indeed, while tele-consultation cannot fully replace face-to-face visits, it certainly can, and will, be incorporated as part of the routine care of MS patients in the near future. Bearing this in mind, the Portuguese Multiple Sclerosis Study Group (GEEM) has developed a set of recommendations for the usage of tele-medicine in the management of MS patients, both during the pandemic and in the future. The consensus was obtained through a two-step modified Delphi methodology, resulting in 15 recommendations, which are detailed in the manuscript.info:eu-repo/semantics/publishedVersio

Late Onset Neuromyelitis Optica Spectrum Disorders (LONMOSD) from a Nationwide Portuguese Study: Anti-AQP4 Positive, Anti-MOG Positive and Seronegative Subgroups

Introduction: Several neuroimmunological disorders have distinct phenotypes according to the age of onset, as in multiple sclerosis or myasthenia gravis. It is also described that late onset NMOSD (LONMOSD) has a different phenotype. Objective: To describe the clinical/demographic characteristics of the LONMOSD and distinguish them from those with early onset (EONMOSD). Methods: From a nationwide Portuguese NMOSD study we analyzed the clinical/demographic characteristics of the LONMOSD. Results: From the 180 Portuguese patients 45 had disease onset after 50 years old, 80% were female. 23 had anti-AQP4 antibodies (51.1%), 13 anti-MOG antibodies (28.9%) and 9 were double seronegative (20.0%). The most common presenting phenotypes in LONMOSD were transverse myelitis (53.3%) and optic neuritis (26.7%), without difference from EONMOSD (p = 0.074). The mean EDSS for LONMOSD was 6.0 (SD=2.8), after a mean follow-up time of 4.58 (SD=4.47) years, which was significantly greater than the mean EDSS of EONMOSD (3.25, SD=1.80)(p = 0.022). Anti-AQP4 antibodies positive LONMOSD patients had increased disability compared to anti-MOG antibodies positive LONMOSD (p = 0.022). The survival analysis showed a reduced time to use a cane for LONMOSD, irrespective of serostatus (p<0.001). Conclusions: LONMOSD has increased disability and faster progression, despite no differences in the presenting clinical phenotype were seen in our cohort.info:eu-repo/semantics/publishedVersio

Neuromyelitis Optica Spectrum Disorders: a Nationwide Portuguese Clinical Epidemiological Study

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. Objective: To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. Methods: This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included. Results: A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome. Conclusion: Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries.info:eu-repo/semantics/publishedVersio

Recurrence of primary sclerosing cholangitis after liver transplantation – analysing the European Liver Transplant Registry and beyond

Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4–18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9–9.1) and patient survival (HR 2.3; 95% CI 1.5–3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7–4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival

Trattamento delle lesioni iatrogene maggioridella via biliare

The appropriate treatment of major bile duct injuries is mandatory in order to avoid serious complica- tions, such as bile peritonitis or secondary biliary liver cirrhosis. In the last fourthy years, surgical, endoscopic or radiologic techniques of cure have been proposed, but in our opinions, the preferred option is given by Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Creating an anastomosis on narrow bile duct could be difficult; in the- se really rare cases, the jejunal loop could be secured by a second suture to the hilar plate with satisfactory long-term results

Perforazione della vena porta in corso di pancreatite emorragica.

La pancreatite acuta rappresenta una malattia che si manifesta con un quadro clinico ed istopatologico ampiamente variabile. Nel 20% dei casi, assume una gravita tale da mettere seriamente a rischio la vita dei pazienti principalmente per le complicanze della malattia, precoci (ipotensione grave, sconvolgimento metabolico, sequestro di liquidi) e tardive (sepsi, deficit multiplo d'organo). Il caso riportato è quello di un uomo che giunge alla nostra osservazione con un quadro di pancreatit

Crosslinked chitosan/poly(vinyl alcohol)-based polyelectrolytes for proton exchange membranes

The preparation of polyelectrolytes based on crosslinked poly(vinyl alcohol) (PVA) and chitosan (CS) was considered as a feasible alternative to develop highly functionalised, cost-effective and eco-friendly membranes for proton exchange fuel cell technologies. CS/PVA-based membranes were combined with sulfosuccinic acid (SSA) as crosslinking and sulfonating agent, and glycerol (GL) to promote flexibility and favour their manageability. The chemical structure, the thermo-oxidative behaviour, the ethanol uptake, the electric, the proton conductivity, and the performance in direct ethanol fuel cell (DEFC) were assessed. In general, all the CS/PVA-based polyelectrolytes showed a synergetic increase of thermo-oxidative stability, appropriate absorption and diffusion of ethanol and good proton conductivity, suitable for the typical service conditions of fuel cells. The GL in the membranes reacted with SSA, reduced the ethanol absorption, the diffusion coefficient and the proton conductivity, but acted as a plasticiser that increased the ductile manageability of the polyelectrolytes to be mounted on the membrane-electrode assembly (MEA). Higher presence of CS and higher proportion of GL in the polyelectrolyte, improved the material performance in the DEFC. In particular, the crosslinked polyelectrolyte 40CS/PVA/SSA/20GLwith a 40%wt. of CS referred to PVA, and a 20%wt. of GL referred to CS, showed a suitable behaviour in the DEFC test, with a maximum value of power density of 746 mW\ub7cm 122

Crosslinked chitosan/poly(vinyl alcohol)-based polyelectrolytes for proton exchange membranes

[EN] The preparation polyelectrolytes based on crosslinked poly(vinyl alcohol) (PVA) and chitosan (CS) was considered as a feasible alternative to develop highly functionalised, cost-effective and eco-friendly membranes for proton exchange fuel cell technologies. CS/PVA-based membranes were combined with sulfosuccinic acid (SSA) as crosslinking and sulfonating agent, and glycerol (GL) to promote flexibility and favour their manageability. The chemical structure, the thermo-oxidative behaviour, the ethanol uptake, the electric, the proton conductivity, and the performance in direct ethanol fuel cell (DEFC) were assessed. In general, all the CS/PVA-based polyelectrolytes showed a synergetic increase of thermo-oxidative stability, appropriate absorption and diffusion of ethanol and good proton conductivity, suitable for the typical service conditions of fuel cells. The GL in the membranes reacted with SSA, reduced the ethanol absorption, diffusion coefficient and proton conductivity, but acted as a plasticiser that increased the ductile manageability of the polyelectrolytes to be mounted on the membrane-electrode assembly (MEA). Higher presence of CS and higher the proportion of GL in the polyelectrolyte, improved the material performance in the DEFC. In particular, the crosslinked polyelectrolyte 40CS/PVA/SSA/20GLwith a 40 %wt. of CS referred to PVA, and a 20 %wt. of GL referred to CS, showed a suitable behaviour in the DEFC test, with a maximum value of power density of 746 mW·cm-2.The Spanish Ministry of Economy, Industry and Competitiveness is acknowledged for the projects ENE2017-86711-C3-1-R and UPOV13-3E-1947. The Spanish Ministry of Education, Culture and Sports is thanked for the pre-doctoral FPU grant for O. Gil-Castell (FPU13/01916)Gil-Castell, O.; Teruel-Juanes, R.; Arenga, F.; Salaberria, AM.; Baschetti, M.; Labidi, J.; Badia, J.... (2019). Crosslinked chitosan/poly(vinyl alcohol)-based polyelectrolytes for proton exchange membranes. Reactive and Functional Polymers. 142:213-222. https://doi.org/10.1016/j.reactfunctpolym.2019.06.00321322214

The Impact of the COVID-19 Outbreak on Patients’ Adherence to PCSK9 Inhibitors Therapy

PCSK9 inhibitors (PCSK9i) are monoclonal antibodies that have been shown to be effective in reducing both LDL cholesterol (LDL-C) values and major cardiovascular events in patients at high cardiovascular risk. Adherence to PCSK9i is critical for the success of the treatment. The aim of the present study is to evaluate patients’ adherence to PCSK9i during the COVID-19 pandemic. Patients referred to the Cardiac Diagnostic Unit of the University of Campania “Luigi Vanvitelli” Naples, taking PCSK9i, and who missed the cardiological follow-up visit during the first national COVID-19 lockdown (9 March–17 May 2020), were included. Each patient underwent medical teleconsultation to collect current clinical conditions, adherence to drug treatments, and lipid profile laboratory tests. Among 151 eligible patients, 20 were excluded for missing or untraceable telephone numbers and one for refusing to join the interview. The selected study population consisted of 130 patients (64 ± 9 years, 68% males), of whom 11 (8.5%) reported a temporary interruption of the PCSK-9 therapy for a mean period of 65 ± 1.5 days. The non-adherent patients showed a marked increase in LDL-C than in the pre-pandemic period (90.8 ± 6.0 vs. 54.4 ± 7.7 mg/dL, p &lt; 0.0001), and 82% of patients moved out of the LDL-C therapeutic range. The non-adherent group was more likely to have a very high cardiovascular risk compared to the adherent group (81.8 vs. 33.6%, p &lt; 0.001). Causes of interruption included drug prescription failure (63.6%) due to temporary interruption of the non-urgent outpatient visits and failure in drug withdrawal (36.4%) due to patients’ fear of becoming infected during the pandemic. The COVID-19 lockdown caused a remarkable lack of adherence to PCSK9i therapy, risking negative implications for the health status of patients at high cardiovascular risk. Facilitating patients’ access to PCSK9i and enhancing telemedicine seem to be effective strategies to ensure the continuity of care and appropriate management of these patients