DIA MUNDIAL DA DOENÇA DE PARKINSON

Revisão sobre a lesão na substância branca em doenças desmielinizantes-Nature Reviews Neurology

Exploring the origins of grey matter damage in multiple sclerosis

• Massimiliano Calabrese,
• Roberta Magliozzi,
• Olga Ciccarelli,
• Jeroen J. G. Geurts,
• Richard Reynolds
• & Roland Martin

Nature Reviews Neuroscience

16,147–158(2015) doi:10.1038/nrn3900

Multiple sclerosis is characterized at the gross pathological level by the presence of widespread focal demyelinating lesions of the myelin-rich white matter. However, it is becoming clear that grey matter is not spared, even during the earliest phases of the disease. Furthermore, grey matter damage may have an important role both in physical and cognitive disability. Grey matter pathology involves both inflammatory and neurodegenerative mechanisms, but the relationship between the two is unclear. Histological, immunological and neuroimaging studies have provided new insight in this rapidly expanding field, and form the basis of the most recent hypotheses on the pathogenesis of grey matter damage.

Revisão Sistemática sobre o tratamento da Neurosífilis

Treatment of SyphilisA Systematic Review

Meredith E. Clement, MD1; N. Lance Okeke, MD1; Charles B. Hicks, MD2

JAMA. 2014;312(18):1905-1917. doi:10.1001/jama.2014.13259.

Importance  The incidence of syphilis in the United States is increasing; it is estimated that more than 55 000 new infections will occur in 2014. Treatment regimens are controversial, especially in specific populations, and assessing treatment response based on serology remains a challenge.

Objective  To review evidence regarding penicillin and nonpenicillin regimens, implications of the “serofast state,” and treatment of specific populations including those with neurosyphilis or human immunodeficiency virus (HIV) infection and pregnant women.

Evidence Review  We searched MEDLINE for English-language human treatment studies dating from January 1965 until July 2014. The American Heart Association classification system was used to rate quality of evidence.

Findings  We included 102 articles in our review, consisting of randomized trials, meta-analyses, and cohort studies. Case reports and small series were excluded unless they were the only studies providing evidence for a specific treatment strategy. We included 11 randomized trials. Evidence regarding penicillin and nonpenicillin regimens was reviewed from studies involving 11 102 patients. Data on the treatment of early syphilis support the use of a single intramuscular injection of 2.4 million U of benzathine penicillin G, with studies reporting 90% to 100% treatment success rates. The value of multiple-dose treatment of early syphilis is uncertain, especially in HIV-infected individuals. Less evidence is available regarding therapy for late and late latent syphilis. Following treatment, nontreponemal serologic titers should decline in a stable pattern, but a significant proportion of patients may remain seropositive (the “serofast state”). Serologic response to treatment should be evident by 6 months in early syphilis but is generally slower (12-24 months) for latent syphilis. Evidence defining treatment for HIV-infected persons and for pregnant women is limited, but available data support penicillin as first-line therapy.

Conclusions and Relevance  The mainstay of syphilis treatment is parenteral penicillin G despite the relatively modest clinical trial data that support its use.

Para sempre Alice: Uma boa opção para aprender e discutir sobre a Doença de Alzheimer precoce. Nos cinemas!