Multiple Sclerosis In South America: Month Of Birth In Different Latitudes Does Not Seem To Interfere With The Prevalence Or Progression Of The Disease [esclerose Múltipla Na América Do Sul: Mês De Nascimento Em Diferentes Latitudes Não Parece Interferir Com A Prevalência Ou Progressão Da Doença]

Objective: To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life. Methods: Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression. Results: Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0-10; 11-20; 21-30; and 31-40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band. Conclusion: The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.719:00 AM573579Templer, D.I., Trent, N.H., Spencer, D.A., Season of birth in multiple sclerosis (1992) Acta Neurol Scand, 85, pp. 107-109Bharanidharan, P., Monthly distribution of multiple sclerosis patients' births (1997) Int J Biometeorol, 40, pp. 117-118Salemi, G., Ragonese, P., Aridon, P., Is season of birth associated with multiple sclerosis? (2000) Acta Neurol Scand, 101, pp. 381-383Salzer, J., Svenningsson, A., Sundström, P., Season of birth and multiple sclerosis in Sweden (2010) Acta Neurol Scand, 122, pp. 70-73Bayes, H.K., Weir, C.J., O'Leary, C., Timing of birth and risk of multiple sclerosis in the Scottish population (2010) Eur Neur, 63, pp. 36-40Saastamoinen, K.P., Auvinen, M.K., Tienari, P.J., Month of birth is associated with multiple sclerosis but not with HLA-DR15 in Finland (2012) Mult Scler, 18, pp. 563-568Fernandes de Abreu, D.A., Babron, M.C., Rebeix, I., Season of birth and not vitamin D receptor promoter polymorphisms is a risk factor for multiple sclerosis (2009) Mult Scler, 15, pp. 1146-1152Willer, C.J., Dyment, D.A., Sadovnick, A.D., Timing of birth and risk of multiple sclerosis: Population based study (2005) BMJ, 330, p. 120. , Canadian Collaborative Study GroupDeussing, E.C., Jankosky, C.J., Clark, L.L., Estimated incidence of multiple sclerosis among United States Armed Forces personnel using the Defense Medical Surveillance System (2012) Mil Med, 177, pp. 594-600Staples, J., Ponsonby, A.L., Lim, L., Low maternal exposure to ultraviolet radiation in pregnancy, month of birth, and risk of multiple sclerosis in offspring: Longitudinal analysis (2010) BMJ, 340, p. 1640Givon, U., Zeilig, G., Dolev, M., The month of birth and the incidence of multiple sclerosis in the Israeli population (2012) Neuroepidemiology, 38, pp. 64-68Fragoso, Y.D., Shearer, K.D., Adoni, T., Month of birth does not seem to interfere with the development of multiple sclerosis later in life in Brazilian patients (2012) Neuroepidemiology, 39, pp. 70-71Koch, M., de Keyser, J., Tremlett, H., Timing of birth and disease progression in multiple sclerosis (2008) Mult Scler, 14, pp. 793-798Tremlett, H.L., Devonshire, V.A., Does the season or month of birth influence disease progression in multiple sclerosis? (2006) Neuroepidemiology, 26, pp. 195-198Poser, C.M., Paty, D.W., Scheinberg, L., New diagnostic criteria for multiple sclerosis: Guidelines for research protocols (1983) Ann Neurol, 13, pp. 227-231McDonald, W.I., Compston, A., Edan, G., Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the diagnosis of multiple sclerosis (2001) Ann Neurol, 50, pp. 121-127Polman, C.H., Reingold, S.C., Edan, G., Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria" (2005) Ann Neurol, 58, pp. 840-846Kurtzke, J.F., Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS) (1983) Neurology (Cleveland), 33, pp. 1444-1452Damasceno, A., von Glehn, F., de Deus-Silva, L., Monthly variation of multiple sclerosis activity in the Southern hemisphere: Analysis from 996 relapses in Brazil (2012) Eur J Neurol, 19, pp. 660-662Altmann, D.M., Review series on helminths, immune modulation and the hygiene hypothesis: Nematode coevolution with adaptive immunity, regulatory networks and the growth of inflammatory diseases (2009) Immunology, 126, pp. 1-2Correale, J., Farez, M.F., The impact of environmental infections (parasites) on MS activity (2011) Mult Scler, 17, pp. 1162-1169Watson, P.E., McDonald, B.W., Seasonal variation of nutrient intake in pregnancy: Effects on infant measures and possible influence on diseases related to season of birth (2007) Eur J Clin Nutr, 61, pp. 1271-1280Melcon, M., Melcon, C., Bartoloni, L., Towards establishing MS prevalence in Latin America and the Caribbean (2013) Mult Scler, 19, pp. 145-152. , The "Grupo Colaborativo Multicéntrico para el Estudio de la Esclerosis Multiple en America Latina y el Caribe" (GEEMAL)Taylor, B.V., Pearson, J.F., Clarke, G., MS prevalence in New Zealand, an ethnically and latitudinally diverse country (2010) Mult Scler, 16, pp. 1422-1431Dobson, R., Giovannoni, G., Ramagopalan, S., The month of birth effect in multiple sclerosis: Systematic review, meta-analysis and effect of latitude (2013) J Neurol Neurosurg Psychiatry, 84, pp. 427-43

Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE

Systolic blood pressure and mortality in acute symptomatic pulmonary embolism

BACKGROUND: The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined. METHODS: To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). RESULTS: There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP 190 mmHg). Consistent findings were also observed for 30-day PE-related death. CONCLUSIONS: In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP <70 mmHg.status: publishe