Departamento de meteorologia

Resum

Manejo de doenças desmielinizantes do sistema nervoso central na pandemia de doença do coronavírus 2019: uma abordagem prática

Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.Introdução: A mais recente pandemia causada pelo coronavírus SARS-CoV-2 (COVID-19, do inglês coronavirus disease 2019) representa uma ameaça potencial para pacientes com doenças autoimunes, incluindo esclerose múltipla (EM) e transtorno do espectro de neuromielite óptica (NMOSD, do inglês neuromyelitis optica spectrum disorders). Esses pacientes são geralmente tratados com medicamentos imunomoduladores ou imunossupressores que podem alterar a resposta normal do organismo a infecções. Até o momento, não há consenso sobre como o manejo dos pacientes com EM e NMOSD deve ser realizado durante a pandemia. Objetivo: Discutir estratégias para manejar esses pacientes. Métodos: Focamos em como 1) reduzir o risco de infecção por COVID-19, como distanciamento social, telemedicina e exames laboratoriais e de imagem em intervalos mais amplos; 2) manejo de surtos, incluindo evitar tratamento de surto leve e uso de corticoide oral; 3) gerenciar terapias modificadoras de doença, como a preferência por medicamentos associados a menor risco de infecção (interferons, glatirâmer, teriflunomida e natalizumabe) e infusão em intervalo estendido de natalizumabe, quando seguro; 4) individualizar a escolha da terapia de indução para EM (anticorpos monoclonais anti-CD20, alentuzumabe e cladribina); 5) manejar terapias preventivas de NMOSD, incluindo seleção inicial de terapia e manutenção do tratamento atual; 6) manejar pacientes com EM/NMOSD que foram infectados por COVID-19. Conclusão: No futuro, séries de casos de pacientes com MS/NMOSD infectados com COVID-19 nos ajudará a definir as melhores estratégias de manejo. Por enquanto, contamos com a experiência e orientação especializadas

Renal oncocytoma – an incidentaloma

Renal oncocytoma account for 3 to 7% of primary renal tumors. It is usually diagnosed incidentally and typically has a benign behavior. No currently used imaging techniques can reliably distinguish it from malignant lesions. Similarly, the microscopic diagnosis of oncocytoma remains a challenge. We present a case of an asymptomatic elderly, hypertensive, diabetic and with moderate chronic renal insufficiency, who underwent radical nephrectomy for a solid exophytic lesion of 4.7 cm in the renal pole, detected accidentally. Pathological examination revealed a renal oncocytoma. In this situation, partial nephrectomy would be the preferred surgical treatment, avoiding the long‐term risk of living with a single kidney. The lack of diagnostic tools that reliably differentiate between benign and malignant lesions makes this an important area of study, in order to reduce the number of surgical interventions and the associated morbidity

Chuvas Intensas na Região Sudeste do Brasil: Aspectos Climáticos

Using the monthly rainfall of the period between 1970 and 1980, caught from the metheorological stations from South east of Brazil, the mean deviation normalized was determinated, established by the precipitation of a hundred and fifteen stations. After that, it was applied an analysis of the main components from the selected months (august and december), and was defined, with the daily precipitation values, the number of significatives eigenvectors on the region, trying a caracterization of the rainy and dry months.Utilizando-se os dados de precipitação mensais do pe ríodo compreendido entre 1970 e 1980, obtidos em estações meteo rológicas da região sudeste do Brasil, foi determinado o desvio médio normalizado com base nas precipitações de cento e quinze estações. Em seguida, aplicou-se a análise de componentes principais dos meses selecionados '(agosto e dezembro), e foi definido, com os valores diários de precipitação, o número de autovetores significativos na região, tentando uma caracterização dos meses chuvosos e secos

Oncocitoma renal – um incidentaloma

ResumoO oncocitoma renal representa cerca de 3‐7% dos tumores renais primários. É geralmente diagnosticado acidentalmente e apresenta tipicamente um comportamento benigno. Atualmente, as técnicas de imagem disponíveis não permitem diferenciá‐lo de forma segura de neoplasias renais malignas. De igual modo, o diagnóstico histológico de oncocitoma continua a ser um desafio. Apresentamos um caso clínico de um idoso assintomático, hipertenso, diabético tipo 2 e com insuficiência renal crónica moderada, submetido a uma nefrectomia radical por uma formação nodular sólida exofítica de 4,7cm no polo renal, detetada de forma acidental. O exame anatomopatológico revelou um oncocitoma renal. Nesta situação, a nefrectomia parcial seria o tratamento cirúrgico mais desejável, evitando‐se o risco a longo prazo de viver com um único rim. A ausência de meios de diagnóstico que permitam diferenciar com segurança entre lesões renais benignas e malignas torna necessário o investimento nesta área, de modo a poder diminuir o número de intervenções cirúrgicas e a morbilidade associada.AbstractRenal oncocytoma account for 3 to 7% of primary renal tumors. It is usually diagnosed incidentally and typically has a benign behavior. No currently used imaging techniques can reliably distinguish it from malignant lesions. Similarly, the microscopic diagnosis of oncocytoma remains a challenge. We present a case of an asymptomatic elderly, hypertensive, diabetic and with moderate chronic renal insufficiency, who underwent radical nephrectomy for a solid exophytic lesion of 4.7cm in the renal pole, detected accidentally. Pathological examination revealed a renal oncocytoma. In this situation, partial nephrectomy would be the preferred surgical treatment, avoiding the long‐term risk of living with a single kidney. The lack of diagnostic tools that reliably differentiate between benign and malignant lesions makes this an important area of study, in order to reduce the number of surgical interventions and the associated morbidity

Optical coherence tomography evaluation of retinal nerve fiber layer in longitudinally extensive transverse myelitis

OBJECTIVE: To compare optical coherence tomography (OCT) measurements on the retinal nerve fiber layer (RNFL) of healthy controls and patients with longitudinally extensive transverse myelitis (LETM) without previous optic neuritis. METHOD: Twenty-six eyes from 26 patients with LETM and 26 control eyes were subjected to automated perimetry and OCT for comparison of RNFL measurements. RESULTS: The mean deviation values from perimetry were significantly lower in patients with LETM than in controls (p<0.0001). RNFL measurements in the nasal quadrant and in the 3-o'clock segment were significantly smaller in LETM eyes than in controls. (p=0.04 and p=0.006, respectively). No significantly differences in other RNFL measurements were found. CONCLUSION: Patients with LETM may present localized RNFL loss, particularly on the nasal side of the optic disc, associated with slight visual field defects, even in the absence of previous episodes of optic neuritis. These findings emphasize the fact that patients with LETM may experience attacks of subclinical optic nerve damage

Núcleos de Ensino da Unesp: artigos 2007

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq