Marcos Aurélio Moreira

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

This study has tested the validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM), a diagnostic assessment instrument for delirium developed by Inouye et al. (1990). The sample was formed by 100 patients with 60 and more years of age, admitted at the emergency service of Santa Casa de São Paulo, in the time periods between July and August, 1996, November and December, 1996 and February and March, 1997. The sensibility was 94.1% and specificity 96.4%. The assessors reliability in a sample of the 24 patients resulted in a kappa = 0.70. We have concluded that CAM is an adequate instrument to assess the presence of delirium, reliable to assess elderly patients at the emergency services.

The prevalence of multiple sclerosis in the city of São Paulo, Brazil, 1997.

July 1, 1997 was stipulated as the day for estimating the prevalence of multiple sclerosis within the city of São Paulo. The patients were identified via various sources, including associated universities and magnetic resonance services of the city of São Paulo. The area covered by the study has a population of 9,380,000, mainly white and of European origin, with a large number of immigrants from Spain and Portugal. The patients were classified in accordance with the criteria of Poser et al. (1983), and only those with defined multiple sclerosis were registered. The study gave a prevalence of 15.0/105 inhabitants, or three times the value obtained in a similar study in 1990. This increase reveals the larger number of cases encompassed by the study, and is attributed to the use of more detailed recording methods, improvements in diagnosis, and better conditions for treatment.

Esclerose múltipla: estudo descritivo de suas formas clínicas em 302 casos

Multiple sclerosis (MS) is one of the most common causes of chronic neurologic disability in young adults. We evaluate, through retrospective study, the epidemiological characteristics, the manifestations ways, the clinical manifestations, the evolution and the level of physical disability of MS in 302 patients. The average patients age was 37.7 and the relation between genders was 3.13F:1M. The average age at the beginning of MS was 29.6; 283 patients were white (94%), 15 patients were black (5%) and 4 patients were yellow; 220 patients (72%) presented relapsing-remmiting clinical form; 82 patients (28%) presented the progressive form (50% secondary form and 50% primarily progressive form). The most common initial symptoms were sensitive (31.7%) and optical (26.8%). The most common evolutive symptoms were pyramidal (72.5%) and of the spinal cord (64.9%). The average of the final EDSS was 3.37 and final NRS was 85.17. The index of the annual outbreak was 0.45. Our findings coincide to the ones in the worldwide literature, however it is important to point out that 60 patients (19.8%) presented benign MS of prognostic value.

Effect of the treatment with methylprednisolone on the cerebrospinal fluid and serum levels of CCL2 and CXCL10 chemokines in patients with active multiple sclerosis

Background –  Several experimental and human studies suggest that the chemokines CCL2 and CXCL10 may play a role in the pathogenesis of multiple sclerosis (MS). Here, we evaluated the effect of intravenous methylprednisolone (IVMP) therapy on the levels of CCL2 and CXCL10 in the cerebrospinal fluid (CSF) and serum of patients with active MS.

Depressão na esclerose multipla forma remitente-recorrente

A possibilidade de correlacao entre depressao e esclerose multipla (EM) e conhecida ha muitos anos, porem os estudos de prevalencia nao sao conclusivos. No nosso meio a prevalencia deste sintoma na EM permanece desconhecida. O objetivo deste estudo e verificar a prevalencia da depressao em pacientes com EM, estudando a sua correlacao com a incapacidade funcional, o sexo, a idade e o tempo de doenca. Foram avaliados 84 pacientes com EM remitente-recorrente (EMRR). A depressao foi avaliada atraves da Escala de Beck e da Escala para Ansiedade e Depressao (HAD), e a incapacidade funcional pela Escala de Incapacidade Funcional Expandida (EDSS). A depressao estava presente em 17,9% e a ansiedade em 34,5% dos pacientes com EMRR. Os maiores escores das escalas de depressao correlacionaram-se com maior incapacidade funcional (p=0,0002), porem nao estao associados ao tempo de doenca, ao sexo ou a idade dos pacientes. Nossos dados indicam que a depressao e frequente nos pacientes com EM e sugerem haver correlacao entre a depressao e a incapacidade funcional.

Teste de destreza manual da caixa e blocos em indivíduos normais e em pacientes com esclerose múltipla

ABSTRACT - Recently new disease-modifying treatments for multiple sclerosis (MS) were introduced wich canchange the natural course of the disease. In clinical trials with these new agents the Expanded DisabilityStatus Scale (EDSS) is often used as a primary outcome instrument to measure neurological impairment anddisability. A number of limitations have been identified when using the EDSS, some of wich are because theEDSS is an ordinal scale that is heavily biased to locomotor function. In this study we applied the box andblock test of manual dexterity in normal subjects and relapsing-remitting MS patients. The results were that64.8% of the female and 80.7% of the male patients had significant changes on this task compared withnormal subjects, and as this test is easily applied and is sensitive in detecting upper extremity functionalability, we recommend its use in clinical trials to evaluate new drugs in MS patients.KEY WORDS: box and block test of manual dexterity, multiple sclerosis, disability scales.

Chemokines in the cerebrospinal fluid of patients with active and stable relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the human central nervous system. Although its etiology is unknown, the accumulation and activation of mononuclear cells in the central nervous system are crucial to its pathogenesis. Chemokines have been proposed to play a major role in the recruitment and activation of leukocytes in inflammatory sites. They are divided into subfamilies on the basis of the location of conserved cysteine residues. We determined the levels of some CC and CXC chemokines in the cerebrospinal fluid (CSF) of 23 relapsing-remitting MS patients under interferon-ss-1a therapy and 16 control subjects using ELISA. MS patients were categorized as having active or stable disease. CXCL10 was significantly increased in the CSF of active MS patients (mean +/- SEM, 369.5 +/- 69.3 pg/mL) when compared with controls (178.5 +/- 29.1 pg/mL, P < 0.05). CSF levels of CCL2 were significantly lower in active MS (144.7 +/- 14.4 pg/mL) than in controls (237.1 +/- 16.4 pg/mL, P < 0.01). There was no difference in the concentration of CCL2 and CXCL10 between patients with stable MS and controls. CCL5 was not detectable in the CSF of most patients or controls. The qualitative and quantitative differences of chemokines in CSF during relapses of MS suggest that they may be useful as a marker of disease activity and of the mechanisms involved in the pathogenesis of the disease.

Fadiga na forma remitente recorrente da esclerose múltipla

In 95 patients with the remitting-relapsing form of multiple sclerosis we investigated fatigue. All of them were evaluated with the Fatigue Severity Scale and we found it in 64 patients (67.4%). Gender, age, depression and fuctional incapacity was not predictive of fatigue occurrence, while anxiety and time of disease seems to be correlated with it. When we analysed the fatigue severity, a correlation between the EDSS and the increasing fatigue severity was found.

CONSENSO EXPANDIDO DO BCTRIMS PARA O TRATAMENTO DA ESCLEROSE MÚLTIPLA III. Diretrizes baseadas em evidências e recomendações

There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.

Recomendações quanto ao uso de drogas imunomoduladoras na esclerose múltipla: o consenso do BCTRIMS

After brief considerations about clinical course and diagnosis in multiple sclerosis, the members of the BCTRIMS present some recommendations for the use of the immunomodulatory drugs in the treatment of this disease.Apos breves consideracoes a respeito da evolucao clinica e diagnostico na esclerose multipla, os membros do BCTRIMS fazem algumas recomendacoes no uso de drogas imunomoduladoras no tratamento desta doenca.