Flávia Borges Carapina Santos’s research while affiliated with Federal University of Goiás and other places

Objective: To trace the profile of patients with MS who experienced TF and, subsequently, identify TF predictors. Methods: The medical records of 289 patients were reviewed retrospectively and longitudinally. The patients were divided into two groups (target population [1st group, TF ≥ 1, n = 46] and the control [2nd group, without TF, n = 46]); the groups were compared. Results: There were significant differences between the groups in terms of diagnosis, pulse therapy/1st relapse, number of drugs administered, severity of initial symptoms, disability sequelae, imaging characteristics, number of relapses in the first two years of MS, and annual relapse rate. The 1st group has an increased chance of 18.5% of developing a worse prognosis (EDSS > 4.0). The worst prognoses were associated with male sex and a diagnosis age of ≥ 30 years. Conclusion: Compared to the controls, 46 patients in the target population had at least one TF (16.6%), with an increased risk (2x) of secondary progressive multiple sclerosis, depression, and increased disability (2x). The initial features of the disease, as well as the annual relapse rate, can be an early indicator of TF.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is the second most frequently demyelinating, autoimmune, and inflammatory Central Nervous System (CNS) disease, and its prevalence varies greatly according to geography and ethnicity. Objective: To determine the prevalence and phenotype of NMOSD at a reference center for demyelinating diseases in Goiás State. Methods: This was a cross-sectional study, approved under CAAE number 8380.9317.9.0000.5078. All patients fulfilled the 2015 international consensus criteria. Results: Our study showed NMOSD as 9.37% of all demyelinating diseases registered in. It occurred predominantly in women (81%) and non-white individuals (83.4% had self-declared mixed skin color), and the median age at onset was 48 years. Amerindian ancestry was significantly higher (68.75%) than others. Longitudinally extensive transverse myelitis (LETM) alone ≥3 vertebral segments (35%) and optic neuritis (ON) alone (35%) were the most common onset manifestations. The median length of time from disease beginning to study enrollment was 48 months. A relapsing course and moderate disability (Expanded Disability Status Scale (EDSS) 3.0-4.0) were most commonly observed. The worst neurological impairments, characterized by EDSS>4.5, occurred more frequently in males (44.5% among men versus 20.5% among women). The majority of the patients had been receiving immunosuppressive treatment with azathioprine since the diagnosis of NMSOD: 77% (37) had a good therapeutic response. The prevalent outcome (84%) was permanent disability: 52% became physically handicapped; 54% had permanent visual impairment (25% with bilateral and 75% with unilateral amaurosis) and 30% had sphincter disability (82% with neurogenic bladder and 18% with ostomy). Conclusion: The estimated prevalence of NMOSD in Goiás is 0.79/per 100,000 inhabitants. The predominant phenotype comprises women, non-whites, onset in the fourth decade of life, relapsing course, and permanent moderate disability. Our study was the first on the epidemiology of NMOSD in Goiás, where NMOSD predominantly correlates with Amerindian ancestry.

A hérnia de disco caracteriza-se como sendo o deslocamento do núcleo gelatinoso de um disco vertebral, levando a compressão da medula espinhal, podendo ocorrer fortes dores em seus portadores. Este estudo de caso descreve a evolução de uma paciente do sexo feminino, 67 anos, que apresenta hérnia de disco, porém com inúmeras comorbidades que dificultam o tratamento. Este relato de caso foi elaborado com informações obtidas de revisão de prontuários e registro de exames diagnósticos aos quais a paciente foi submetida. As queixa de fortes dores cervicais e lombares, levaram a realização de exames de imagens, o qual diagnosticou um quadro de severa osteoartrite de coluna, com hérnias de disco e pinçamentos, principalmente, em coluna cervical (C3 a C6) e lombar (L2 a L4). O tratamento utilizado, para modulação da dor, se ateve à associação entre os fármacos duloxetina, pregabalina e gabapentina, além do aconselhamento para a perda de peso, de no mínimo 20 kg, a fim de diminuir a compressão sobre os discos vertebrais causado pelo excessivo peso da paciente. Atualmente as dores da paciente estão sendo suprimidas pelo tratamento medicamentoso, e a mesma mostra-se dedicada para a perda de peso, embora suas comorbidades dificultem o progresso do tratamento.

Acidente Vascular Cerebral Isquêmico (AVCI) em lobo frontal à esquerda, provavelmente secundário a baixo débito associado à nova queda de hematimetria, manifesta-se clinicamente por uma pluralidade de síndromes, à proporção que a parte atingida deve ter sido o córtex motor que está relacionada com a motricidade voluntária. Este estudo de caso descreve a evolução de um paciente do sexo masculino, 89 anos, coronariopata grave com cirurgia de revascularização miocárdica, antecedente de diverticulite e hemorragia digestiva baixa de repetição. Apresentou hemoglobina no valor de 6,7 no ictus, sendo então realizada investigação de sangramento, que não foi identificado, transfusão sanguínea e prescrito o uso de folifer antes das refeições para reposição de ferro, ainda assim apresentou os valores de ferro e ferrita abaixo dos valores de referência. Após o AVCI foi optado pela utilização de dupla antiagregação plaquetária (clopidogrel + Somalgin cardio). Apontando o AVCI decorrente de anemia ferropriva idiopática.