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Computational basis of decision-making impairment in multiple sclerosis
No full textBackground: Multiple sclerosis (MS) is commonly associated with decision-making, neurocognitive impairments, and mood and motivational symptoms. However, their relationship may be obscured by traditional scoring methods.
Objectives: To study the computational basis underlying decision-making impairments in MS and their interaction with neurocognitive and neuropsychiatric measures.
Methods: Twenty-nine MS patients and 26 matched control subjects completed a computer version of the Iowa Gambling Task (IGT). Participants underwent neurocognitive evaluation using an expanded version of the Brief Repeatable Battery. Hierarchical Bayesian Analysis was used to estimate three established computational models to compare parameters between groups.
Results: Patients showed increased learning rate and reduced loss-aversion during decision-making relative to control subjects. These alterations were associated with: (1) reduced net gains in the IGT; (2) processing speed, executive functioning and memory impairments; and (3) higher levels of depression and current apathy.
Conclusion: Decision-making deficits in MS patients could be described by the interplay between latent computational processes, neurocognitive impairments, and mood/motivational symptoms.Fil: Fernández, Rodrigo S. Universidad de Buenos Aires; Argentina.Fil: Crivelli, Lucía. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Pedreira, María E. Universidad de Buenos Aires; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina
High-resolution magnetic resonance neurography and anatomy of the cervical plexus
No full textResumen no disponibleFil: Cejas, Claudia Patricia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Osa Sanz, Emilia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina
Bloqueo nervioso corticoideo-bupivacaína: ¿La mejoría post-procedimiento inmediato predice el éxito terapéutico a mediano plazo?
Full text linkObjetivo Establecer la relación entre la reducción inmediata de los síntomas post bloqueo nervioso lumbar guiado por tomografía computada (TC) y la mejoría tras un lapso de tiempo de un mes.
Materiales y métodos Se analizaron datos sobre 46 procedimientos de bloqueos lumbares radiculares y epidurales guiados por TC realizados entre diciembre de 2018 y marzo de 2019. Los pacientes firmaron consentimiento informado y el Comité de Ética en Investigación de nuestra institución aprobó el estudio. Se colectó, mediante un cuestionario dicotómico, información acerca de los síntomas iniciales, los cambios inmediatos al procedimiento y los síntomas tras un mes del mismo.
Resultados Inmediatamente post-bloqueo, 30 pacientes (65%) mostraron mejoría o ausencia de síntomas y seis de ellos manifestaron persistencia de los síntomas al mes. Post-procedimiento inmediato, 16 pacientes (34%) no presentaron ningún cambio en la sintomatología. De estos, siete presentaron mejoría al mes. La razón de momios para la persistencia del efecto analgésico al mes en los casos en los que el paciente manifestó alivio inmediato después del procedimiento fue de 5,1 (95% IC 1.128 a 24.031). La prueba de McNemar para determinar si esta diferencia en la proporción de pacientes con alivio inmediato posterior a la punción y persistencia del efecto analgésico arrojó un p value de 0,08.
Conclusión Existió asociación positiva entre la mejoría inmediata y la ausencia de síntomas al mes. Sin embargo, el análisis estadístico de antes y después insinúa que estos resultados pudieron ser por el azar.Fil: Cobeñas, Ricardo. CEMIC. Departamento de Imágenes; Argentina.Fil: Flórez, Juan. CEMIC. Departamento de Imágenes; Argentina.Fil: Chiaradia , Pablo. CEMIC. Departamento de Imágenes; Argentina.Fil: Ruiz Salgado, Kelly. CEMIC. Departamento de Imágenes; Argentina.Fil: De Vedia, María. CEMIC. Departamento de Imágenes; Argentina.Fil: Paba, Mariángela. CEMIC. Departamento de Imágenes; Argentina.Fil: Hernández Pinzón, Jairo. CEMIC. Departamento de Imágenes; Argentina. Fleni. Departamento de Diagnóstico por Imágenes; Argentina
Neurobiological substrates underlying corpus callosum hypoconnectivity and brain metabolic patterns in the valproic acid rat model of autism spectrum disorder
No full textAtypical connectivity between brain regions and altered structure of the corpus callosum (CC) in imaging studies support the long-distance hypoconnectivity hypothesis proposed for autism spectrum disorder (ASD). The aim of this study was to unveil the CC ultrastructural and cellular changes employing the valproic acid (VPA) rat model of ASD. Male Wistar rats were exposed to VPA (450 mg/kg i.p.) or saline (control) during gestation (embryonic day 10.5), and maturation, exploration and social behavior were subsequently tested. Myelin content, ultrastructure and oligodendroglial lineage were studied in the CC at postnatal day 15 (infant) and 36 (juvenile). As a functional outcome, brain metabolic activity was determined by positron emission tomography. Concomitantly with behavioral deficits in juvenile VPA rats, the CC showed reduced myelin basic protein, conserved total number of axons, reduced percentage of myelinated axons and aberrant and less compact arrangements of myelin sheath ultrastructure. Mature oligodendrocytes decreased and oligodendrocyte precursors increased in the absence of astrogliosis or microgliosis. In medial prefrontal and somatosensory cortices of juvenile VPA rats, myelin ultrastructure and oligodendroglial lineage were preserved. VPA animals exhibited global brain hypometabolism and local hypermetabolism in brain regions relevant for ASD. In turn, the CC of infant VPA rats showed reduced myelin content but preserved oligodendroglial lineage. Our findings indicate that CC hypomyelination is established during infancy and prior to oligodendroglial pattern alterations, which suggests that axon-oligodendroglia communication could be compromised in VPA animals. Thus, CC hypomyelination may underlie white matter alterations and contribute to atypical patterns of connectivity and metabolism found in ASD.Fil: Uccelli, Nonthué Alejandra. Universidad de Buenos Aires. Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis". Argentina.Fil: Codagnone, Martín Gabriel. Universidad de Buenos Aires. Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacología; Argentina.Fil: Traetta, Marianela Evelyn. Universidad de Buenos Aires. Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacología; Argentina.Fil: Levanovich, Nadia. Fleni. Departamento de Diagnóstico por Imágenes. Centro de Imágenes Moleculares; Argentina.Fil: Rosato Siri, María Victoria. Universidad de Buenos Aires. Instituto de Química y Fisicoquímica Biológica; Argentina.Fil: Urrutia, Leandro. Fleni. Departamento de Diagnóstico por Imágenes. Centro de Imágenes Moleculares; Argentina.Fil: Falasco, Germán. Fleni. Departamento de Diagnóstico por Imágenes. Centro de Imágenes Moleculares; Argentina.Fil: Vázquez, Silvia. Fleni. Departamento de Diagnóstico por Imágenes. Centro de Imágenes Moleculares; Argentina.Fil: Pasquini, Juana María. Universidad de Buenos Aires. Instituto de Química y Fisicoquímica Biológica; Argentina.Fil: Reinés, Analía Gabriela. Universidad de Buenos Aires. Instituto de Biología Celular y Neurociencia "Prof. E. De Robertis"; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Farmacología. Cátedra de Farmacología; Argentina
Spanish version of the Frontotemporal Dementia Knowledge Scale: adaptation and validation
No full textBackground: Frontotemporal dementia (FTD) is a neurodegenerative disease and is one of the most common causes of dementia in people under 65. There is often a significant diagnostic delay, as FTD can be confused with other psychiatric conditions. A lack of knowledge regarding FTD by health professionals is one possible cause for this diagnostic confusion.
Objectives: The aim of this study was to adapt and validate the Frontotemporal Dementia Knowledge Scale (FTDKS) in Spanish.
Methods: A translation was done, following cross-cultural adaptation guidelines, which consisted of forward translation, blind back translation, and an analysis by a committee of experts. For the present study, 134 professionals from different health areas responded the Spanish version of the FTDKS. The statistical analysis was performed using R version 4.0.0 "Arbor day" and the Psych, sjPlot packages.
Results: The Spanish version of the FTDKS had good reliability and internal consistency (Cronbach alpha 0.74.). The sample's mean score was 19.78 (range = 4-32, SD 6.3) out of a maximum of 36 points.
Conclusions: The results obtained show that the Spanish version has good psychometric properties. The FTDKS is applicable in our environment and can be a useful tool to evaluate the knowledge of health professionals regarding frontotemporal dementia.Fil: Magrath Guimet, Nahuel. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Clínica de Demencia Frontotemporal; Argentina. University of California; Estados Unidos.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Clínica de Demencia Frontotemporal; Argentina.Fil: Bagnati, Pablo M. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Wynn, Matthew. Washington University in St. Louis; Estados Unidos.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina
Changes in the Care of Neurological Diseases During the First Wave of the COVID-19 Pandemic: A Single Private Center Study in Argentina
No full textIntroduction: Healthcare systems are struggling to cope with the rapid evolution of the COVID-19 pandemic. In Argentina, the pandemic is advancing despite prolonged lockdown measures. We aim to analyze the impact of the easing of lockdown measures in the number of visits to the emergency department (ED), and outpatient consultations (OC) to a tertiary neurological center. Methods: We compared the number of ED visits with the social mobility overtime. We also compared the number of OC, and the geographic distribution of patients' addresses between 2019 and 2020. Results: ED visits decreased 48.33% (n = 14,697 in 2019 vs. n = 7,595 in 2020). At the beginning of the lockdown, the social mobility decreased in pharmacies/groceries, and workplaces, along with a reduction in the number of ED visits. With the easing of lockdown restrictions, the social mobility decreased in residential places, slightly increased in workplaces and almost return to normal in pharmacies/groceries. Variations in ED visits correlate better with social mobility in workplaces (coef. =0.75, p < 0.001) than in groceries/pharmacies (coef. =0.68, p < 0.001). OC decreased 43%. Fourteen percent of OC were tele consults. This was associated with an increase of the geographical area of influence of our center (standard distance of 109 km in 2019 and 127 km in 2020). Conclusions: Despite an increase in social mobility, the number of ED visits and OC to an Argentinian tertiary neurological center remain worrisomely low. The pandemic catalyzed the introduction of telemedicine in our country. This has also allowed patients from distant zones to gain access to specialized neurological care.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Hawkes, Maximiliano Alberto. University of Nebraska Medical Center; Estados Unidos.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina
Síndrome miasteniforme de Lambert-Eaton
No full textIntroducción. El síndrome miasteniforme de Lambert-Eaton (LEMS) es una patología paraneoplásica (T-LEMS) o idiopática autoinmunitaria (NT-LEMS) ocasionada por autoanticuerpos contra los canales de calcio dependientes del voltaje presinápticos de la unión neuromuscular. El 60% de los T-LEMS se asocia a carcinoma de pulmón de células pequeñas. Una puntuación Dutch-English LEMS Tumor Association Prediction (DELTA-P) mayor de 3 denota un riesgo elevado de dicha asociación. El diagnóstico precoz fundado en los hallazgos clínicos, estudios neurofisiológicos y dosificación de títulos de anticuerpos en el suero permite iniciar tempranamente el tratamiento sintomático y la búsqueda oncológica. Son escasos los informes de pacientes con LEMS en Latinoamérica.
Objetivo. Describir las características de pacientes con LEMS de un centro privado de Buenos Aires, Argentina, y compararlas con las de otras series publicadas.
Pacientes y métodos. Se revisaron historias clínicas de 13 pacientes con LEMS con hallazgos clínicos, electromiograma compatible y/o anticuerpos positivos. Se realizó seguimiento hasta descartar o confirmar una neoplasia asociada de acuerdo con los algoritmos recomendados.
Resultados. Cuatro pacientes presentaron diagnóstico de T-LEMS, dos de ellos con carcinoma de pulmón de células pequeñas. De los nueve pacientes con NT-LEMS, cinco presentaron una puntuación DELTA-P de 3 y 4. Nueve pacientes presentaron la tríada clínica clásica desde el inicio. Todos los pacientes presentaron en el electromiograma hallazgos compatibles con defecto de placa neuromuscular presináptico. El 70% mejoró sintomáticamente con piridostigmina.
Conclusiones. Los hallazgos clínicos, junto con los estudios neurofisiológicos compatibles, resultan suficientes para el diagnóstico de LEMS. No pudo replicarse la relación entre puntuación DELTA-P y riesgo de carcinoma de pulmón de células pequeñas. El tratamiento sintomático con piridostigmina representa una alternativa terapéutica eficaz.Fil: Hernández, Micaela Anahí. Fleni. Departamento de Neurología; Argentina.Fil: Köhler, Alejandro Alfredo. Fleni. Departamento de Neurología; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Lautre, Andrea Rosana. Fleni. Departamento de Neurología; Argentina.Fil: Brand, Patricio. Fleni. Departamento de Neurología; Argentina.Fil: Nogués, Martín. Fleni. Departamento de Neurología; Argentina.Fil: Barroso, Fabio Adrián. Fleni. Departamento de Neurología. Sección de Enfermedades Neuromusculares; Argentina
Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study
No full textObjective: To compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only.
Methods: We selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis.
Results: Of 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms.
Conclusion: In patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS.Fil: Verboon, Christine. Erasmus MC; Países Bajos.Fil: Harbo, Thomas. Aarhus University Hospital; Dinamarca.Fil: Cornblath, David R. Johns Hopkins University; Estados Unidos.Fil: Hughes, Richard A. C. National Hospital for Neurology and Neurosurgery; Reino Unido.Fil: van Doorn, Pieter A. Erasmus MC; Países Bajos.Fil: Lunn, Michael P. National Hospital for Neurology and Neurosurgery; Reino Unido.Fil: Gorson, Kenneth C. St. Elizabeth's Medical Center; Estados Unidos.Fil: Barroso, Fabio Adrián. Fleni. Departamento de Neurología. Sección de Enfermedades Neuromusculares; Argentina.Fil: Kuwabara, Satoshi. Chiba University; Japón.Fil: Galassi, Giuliana. University Hospital of Modena; Italia.Fil: Lehmann, Helmar C. University Hospital of Cologne; Alemania.Fil: Kusunoki, Susumu. Kindai University; Japón.Fil: Reisin, Ricardo C. Hospital Británico; Argentina.Fil: Binda, Davide. University Milano-Bicocca; Italia.Fil: Cavaletti, Guido. Erasmus MC; Países Bajos.Fil: Jacobs, Bart C. Erasmus MC; Países Bajos
BTK inhibitors as potential therapies for multiple sclerosis
No full textResumen no disponibleFil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina
Lifetime use of psychedelics is associated with better mental health indicators during the COVID-19 pandemic
No full textBackground and aims: The COVID-19 pandemic and its consequences represent a major challenge to
the mental health and well-being of the general population. Building on previous work on the potential
long-term benefits of psychedelics, we hypothesized that lifetime use of these drugs could be linked to
better mental health indicators in the context of the ongoing pandemic. Methods: Two anonymous
online surveys were conducted between April and June 2020, including questions about lifetime
experience with psychedelics and other psychoactive drugs, and psychometric scales designed to
measure personality traits, anxiety, negative, and positive affect, well-being, and resilience. Principal
component analysis was applied to divide the sample into groups of subjects based on their drug use
reports. Results: Five thousand six hundred eighteen participants (29.15 ± 0.12 years, 71.97% female)
completed both surveys and met the inclusion criteria, with 32.43% of the sample reporting at least one
use of a psychedelic drug. Preliminary analyses showed that certain psychedelics were linked to
improved mental health indicators, while other psychoactive drugs exhibited the opposite behavior.
Lifetime psychedelic use was linked to increased openness and decreased conscientiousness, and to
higher scores of positive affect. The reported number of past psychedelic experiences predicted higher
scores of the secondary personality trait beta factor, which has been interpreted as a measure of
plasticity. No significant associations between lifetime use of psychedelics and indicators of impaired
mental health were observed. Conclusion: We did not find evidence of an association between lifetime
use of psychedelics and poor mental health indicators. Conversely, experience with psychedelic drugs
was linked to increased positive affect and to personality traits that favor resilience and stability in the
light of the ongoing crisis.Fil: Cavanna, Federico. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina. Fleni. Instituto de Neurociencias FLENI-CONICET; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Pallavicini, Carla. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina. Fleni. Instituto de Neurociencias FLENI-CONICET; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Milano, Virginia. El Gato y La Caja; Argentina.Fil: Cuiule, Juan. El Gato y La Caja; Argentina.Fil: Di Tella, Rocco. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina. El Gato y La Caja; Argentina.Fil: González, Pablo. El Gato y La Caja; Argentina.Fil: Tagliazucchi, Enzo. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Instituto de Física de Buenos Aires; Argentina. Universidad Adolfo Ibanez; Chile