OBJETIVO: Estima-se que haja aproximadamente 50.000 pessoas com a forma remitente-recorrente da esclerose múltipla na América Latina. Os algoritmos de tratamento norte-americanos e europeus não levam em consideração nossas peculiaridades regionais, nem a dificuldade no acesso ao tratamento por parte dos pacientes. MÉTODOS: O Fórum Latino-americano de Esclerose Múltipla é um grupo de especialistas independente e suprainstitucional, que avaliou as mais recentes evidências científicas sobre a eficácia e a segurança das drogas modificadoras do curso da doença. Foram avaliados também o acesso ao tratamento e os programas de farmacovigilância de cada um dos oito países representados no Fórum. RESULTADOS: Uma lista específica de recomendações baseadas em evidências científicas foi estabelecida para a América Latina. Também foram discutidas perspectivas de futuros tratamentos para esclerose múltipla. CONCLUSÕES: O presente estudo representou um esforço dos representantes de oito países latino-americanos em discutir um assunto que não pode ser adaptado para uso em nossa região diretamente a partir de recomendações de tratamento europeias ou norte-americanas.

OBJECTIVE: It is estimated that circa 50,000 individuals have relapsing-remitting multiple sclerosis in Latin America. European and North-American algorithms for the treatment of multiple sclerosis do not foresee our regional difficulties and the access of patients to treatment. METHODS: The Latin American Multiple Sclerosis Forum is an independent and supra-institutional group of experts that has assessed the latest scientific evidence regarding efficacy and safety of disease-modifying treatments. Accesses to treatment and pharmacovigilance programs for each of the eight countries represented at the Forum were also analyzed. RESULTS: A specific set of guidelines based upon evidence-based recommendations was designed for Latin America. Future perspectives of multiple sclerosis treatment were also discussed. CONCLUSIONS: The present paper translated an effort from representatives of eight countries discussing a matter that cannot be adapted to our region directly from purely European and North-American guidelines for treatment.

The effect of casein concentration, Ca2+ concentration, temperature and pH on the amount and size of protein aggregates (fines) in the whey produced by enzimic coagulation of nonfat milk was studied in laboratory conditions. Casein concentrations about 0.3 g/L showed a minimal amount of caseins in the whey, with presence of small aggregates of casein micellles. Ca2+ concentrations higher than 5 mM were neccesary to reduce the whey protein to a minimum constituted by protein particles smaller than casein micelles. The coagulation temperature, in the 35 - 45oC range, produced almost no variations in the whey proteins. The obtention of a minimum amount of whey proteins was possible only in a narrow pH range around 6.4. These results pointed to casein concentration and pH as important variables to be controlled in connection with the process yield.

Tendo a oportunidade de estudar fragmentos de pele retirados de diversas regiões, algumas providas de abundante revestimento capilar, em um caso de autopsia de doente com sindromo bolhoso do grupo pênfigo, chamaram a nossa atenção as alterações histologicas dos folículos pilo-sebaceso, sôbre as quais não encontramos referencia especial na literatura que nos foi dado consultar.

Several skin fragments were available for histological study some of them from hairy regions in a case of pemphigus vulgaris observed in Asunción, Paraguay, which came to autopsy. The lesions on the skin are similar to those described in "fogo selvagem", a subtype of pemphigus which is endemic and sometimes epidemic in South America. The hair follicle shows hyperplasia of the outer sheath (acanthosis), acantholysis, dyskeratosis as well as necrosis of epithelial cells, dilatation of its mouth, loosening and loos of the hair. The first changes mentioned are more or less similar to those described in the epidermis. The striking finding, however, is the presence in some of them of intranuclear inclusion bodies in most cells of the outer sheath. The enlarged nuclei show thickening of the nuclear membrane and condensation of most intranuclear structures in acidophilic corpuscles of irregular shape, sometimes single, other times multiple, always separated from the nuclear membrane by a clear space apparently deprived of structure. Remaining portions of the linin reticulum are sometimes recognised besides the inclusion bodies. Minute granules suggestive of elementary corpuscles appear scattered in other nuclei faintly blue stained (advanced stages of the intranuclear inclusion bodies?). Intranuclear inclusion bodies could be demonstrated also in the epithelial cells of sebaceous glands which presented changes similar to those found in the hair follicles, but never in the cells of the epidermis. The histological changes in the epidermis however were quite similar to those just mentioned in the above structures.