A high prevalence of depression and anxiety, and a higher rate of suicidal ideation were identified in MS patients compared to the general population. The presence of depressive symptoms appeared to have a direct influence on the risk of suicide.
CONTEXT AND OBJECTIVE: Multiple sclerosis (MS) is a chronic, immune-mediated and degenerative central nervous system (CNS) disease with well-established diagnostic criteria. Treatment can modify the course of the disease. The objective of this study was to describe the initial symptoms of multiple sclerosis in a Brazilian medical center. DESIGN AND SETTING: Descriptive study, conducted in a Brazilian reference center for multiple sclerosis treatment. METHODS: Data on 299 patients with confirmed diagnoses of MS were included in the study. Their medical files were evaluated and the data were analyzed.
RESULTS:The most common symptom involved the cranial nerves (50.83%) and unifocal manifestation was presented by the majority of this population (73.91%). The mean time between the first symptom and the diagnosis was 2.84 years. Unifocal symptoms correlated with longer time taken to establish the diagnosis, with an average of 3.20 years, while for multifocal symptoms the average time taken for the diagnosis was 1.85 years. Unifocal onset was related to greater diagnostic difficulty. CONCLUSIONS: MS is a heterogeneous disease and its initial clinical manifestation is very variable.
RESUMO
CONTEXTO E OBJETIVO:A esclerose múltipla (EM) é uma doença crônica do sistema nervoso central (SNC) imunomediada e degenerativa, com critérios diagnósticos bem estabelecidos. O tratamento pode modificar o curso da doença. O objetivo deste estudo foi descrever os sintomas iniciais da esclerose múl-tipla em um centro médico brasileiro. TIPO DE ESTUDO E LOCAL: Estudo descritivo, conduzido em um centro médico de referência no tratamento de EM no Brasil. MÉTODOS: Foram incluídos no estudo dados de 299 pacientes com diagnóstico confirmado de EM. Seus prontuários foram avaliados e os dados foram analisados. RESULTADOS: O sintoma mais comum encontrado envolveu nervos cranianos (50,83%) e a manifestação unifocal foi apresentada pela maioria da população estudada (73,91%). O tempo médio entre o primeiro sintoma e o diagnóstico foi de 2,84 anos. O sintoma unifocal foi relacionado com maior tempo para o estabelecimento do diagnóstico, com uma média de 3,20 anos; enquanto para os sintomas multifocais, a mé-dia foi de 1,85 anos para o diagnóstico. O início unifocal foi relacionado a maior dificuldade de diagnóstico. CONCLUSÕES: EM é uma doença heterogênea e sua manifestação clínica inicial é muito variável.
BackgroundNeurofilament Light (NfL) chain levels in both cerebrospinal fluid (CSF) and serum have been correlated with the reduction of axonal damage in multiple sclerosis (MS) patients treated with Natalizumab (NTZ). However, little is known about the function of plasmacytoid cells in NTZ-treated MS patients.ObjectiveTo evaluate CSF NfL, serum levels of soluble-HLA-G (sHLA-G), and eventual tolerogenic behavior of plasmacytoid dendritic cells (pDCs) in MS patients during NTZ treatment.MethodsCSF NfL and serum sHLA-G levels were measured using an ELISA assay, while pDCs (BDCA-2+) were accessed through flow cytometry analyses.ResultsCSF levels of NfL were significantly reduced during NTZ treatment, while the serum levels of sHLA-G were increased. Moreover, NTZ treatment enhanced tolerogenic (HLA-G+, CD274+, and HLA-DR+) molecules and migratory (CCR7+) functions of pDCs in the peripheral blood.ConclusionThese findings suggest that NTZ stimulates the production of molecules with immunoregulatory function such as HLA-G and CD274 programmed death-ligand 1 (PD-L1) which may contribute to the reduction of axonal damage represented by the decrease of NfL levels in patients with MS.
Improvement to the efficiency of pre-salt well delivery was achieved by implementing detailed planning with cross discipline teams who developed a complete vibration mitigation program that became indispensable in critical wells, such as the ones in Ultra Deep Water Pre-Salt. For this study, it was analyzed a critical well that was drilled in a pre-salt field in Brazil, with 1700m of salt section. This paper discusses the development and deployment of a successful drilling optimization methodology and the application of new technologies and solutions to improve the drilling efficiency in a critical presalt well. The ability to rapidly analyze conditions and respond effectively was based on multiple solutions such as: engineering simulators and workflows, vibration mitigation through surface and downhole measurements, optimization of specific energy, use of a bit reamer and an anti-stall tool on BHA to attenuate torsional vibrations, applied fluid optimization, salt creep control, real time monitoring and integrated services.For vibration mitigation improvement it was used a specific tool to attenuate torsional vibration downhole and the fast Fourier transform software, that analyses surface parameters every second and identify the torsional vibration faster than the downhole sensors. The Mechanical Specific Energy (MSE) concept was extremely important to identify any excess of energy input that could cause damage to the downhole tools and drill string. This concept also helped to identify formation changes (anhydrite and halite), very important for casing point (geo-stopping at basal anhydrite). The use of bit reamer also showed to be a very helpful tool to keep the well in gauge and avoid salt creeping near the bit. The "Profibus" protocol was implemented to permit a real time monitoring of the pilot hole and riserless sections.The successful implementation of this methodology depended on the integration of disciplines and professionals involved setting a common goal for all stakeholders. This resulted in the salt section being drilled with high penetration rates in only one run, identifying every formation change and responding appropriately and the ability to stop in the desired section at the top of reservoir. As a result of the drilling optimization, the total depth was reached 60 days ahead of the planned time establishing a new benchmark for the pre-salt field.
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