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Wound Healing by Allogeneic Transplantation of Specific Subpopulation From Human Umbilical Cord Mesenchymal Stem Cells
No full textIn normal physiological conditions, restoration of a functional epidermal barrier is highly efficient; nevertheless, when it fails, one of the main consequences is a chronic ulcerative skin defect, one of the most frequently recognized complications of diabetes. Most of these chronic venous ulcers do not heal with conventional treatment, leading to the appearance of infections and complications in the patient. Treatments based on the use of autologous mesenchymal stem cells (MSC) have been successful; however, its implementation entails complications. The umbilical cord offers an unlimited source of adult MSC (ucMSC) from the Wharton’s jelly tissue with the same relevant features for clinical applicability and avoiding difficulties. It has recently been characterized by one specific subpopulation derived from ucMSC, the differentiated mesenchymal cells (DMCs). This subpopulation expresses the human leukocyte antigen-G (HLA-G) molecule, a strong immunosuppressive checkpoint, and vascular endothelial growth factor (VEGF), the most potent angiogenic factor. Considering the importance of developing a more effective therapy for wound treatment, especially ulcerative skin lesions, we analyzed DMC safety, efficacy, and therapeutic potential. By immunohistochemistry, umbilical cords HLA-G and VEGF positive were selected. Flow cytometry revealed that 90% of the DMC subpopulation are HLA-G+, CD44+, CD73+, CD29+, CD105+, CD90+, and HLA-DR−. Reverse transcription-polymerase chain reaction revealed the expression of HLA-G in all of DMC subpopulations. Upon co-culture with the DMC, peripheral blood mononuclear cell proliferation was inhibited by 50%. In a xenograft transplantation assay, DMC improved wound healing with no signs of rejection of the transplanted cells in immunocompetent mice. This study confirms that HLA-G allows allogeneic cell transplantation, and VEGF is fundamental for the restoration of the failure in blood supply. DMC population has positive effects on wound healing by promoting local angiogenesis in skin lesions. DMC could play a very important role in regenerative medicine and could be a novel allogeneic cell-therapeutic tool for wound healing.Fil: Palma, María Belén. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Luzzani, Carlos. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Andrini, Laura B. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina.Fil: Riccillo, Fernando. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Cátedra de Histología y Embriología Animal; Argentina.Fil: Buero, Guillermo. Sanatorio Mater Dei; Argentina.Fil: Pelinski, Pablo. Hospital Español; Argentina.Fil: Inda, Ana M. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina. Comisión de Investigaciones Científicas; Argentina.Fil: Errecalde, Ana Lía. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina.Fil: Miriuka, Santiago. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Carosella, Edgardo D. Saint-Louis Hospital; Francia.Fil: Garcia, Marcela N. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Cátedra de Citología, Histología y Embriología; Argentina
El impacto de CoViD-19 en la hipertensión arterial pulmonar
No full textLa enfermedad por coronavirus 2019 (CoViD-19) está causada por el virus del síndrome respiratorio agudo
severo por coronavirus 2 (SARS-CoV-2), siendo particularmente perjudicial para los pacientes con enfermedad
cardiovascular subyacente, y provocando una causa de morbilidad y mortalidad significativas en todo el mundo.
Este virus lleva a una neumopatía, al tiempo que causa lesiones agudas de miocardio y daño crónico al sistema
cardiovascular. Como consecuencia del daño del parénquima pulmonar y de la circulación pulmonar alterada, puede
desarrollarse hipertensión pulmonar (HP), con su respectiva consecuencia. La fisiopatología de este tipo de HP es
compleja y multifactorial, considerándose factores potenciales para las alteraciones de la circulación pulmonar.
En estudios recientes, la prevalencia evidenciada de HP en pacientes con CoViD-19 es de alrededor del 12%, pero
su evolución aún no está clara.
La pandemia de CoViD-19 ha tenido un impacto significativo en todos los aspectos de la HP, desde el diagnóstico y
manejo hasta la observación de un mayor riesgo de muerte en pacientes con hipertensión arterial pulmonar (HAP). En
una encuesta de 77 centros de atención médica integral de HAP, la incidencia de infección por CoViD-19 fue de 2,1
casos por cada 1000 pacientes con HAP, similar a la incidencia de infección por CoViD-19 en la población general.
Si bien, esta pandemia ha alterado el estándar de atención médica de rutina y de manejo agudo, particularmente, en
aquellos pacientes con HAP, los riesgos asociados con CoViD-19 son significativos, presentándose nuevos desafíos
en el cuidado de pacientes con HP. Dado que los pacientes con HAP han demostrado tener peores resultados en
el ámbito de esta pandemia, es esencial trabajar de manera proactiva para disminuir el riesgo de infección por
CoViD-19, mientras se continúa brindando un alto nivel de atención médica.
El impacto de CoViD-19 en la prestación de atención médica y en la sociedad en general requirió que se establecieran
nuevos protocolos para el tratamiento de HAP para disminuir el riesgo de exposición o transmisión de CoViD-19.
De manera similar, ha habido una disminución en las pruebas de pacientes estables. Actualmente, la forma en que
brindamos la atención médica se evidencia en un aumento de las visitas de telemedicina, una menor exposición a
los entornos de atención médica para los pacientes y los profesionales de la salud, ayudando a nuestra necesidad
continua de brindar servicios a los pacientes dentro del entorno de CoViD-19 y adaptándonos a una forma diferente
de interactuar, ampliando nuestra comprensión de la mejor manera de cuidar a nuestros pacientes.Fil: Bevacqua, Raúl J. Hospital General de Agudos “Dr. J. M. Ramos Mejía”; Argentina.Fil: Perrone, Sergio Victor. Fleni. Servicio de Cardiología; Argentina. Instituto Argentino de Diagnóstico y Tratamiento; Argentina. Hospital de Alta Complejidad en Red “El Cruce” Néstor Kirchner; Argentina
Accuracy of Central Neuro-Imaging Review of DIPG Compared with Histopathology in the International DIPG Registry
No full textBackground
Diffuse intrinsic pontine glioma (DIPG) remains a clinico-radiologic diagnosis without routine tissue acquisition. Reliable imaging distinction between DIPG and other pontine tumors with potentially more favorable prognoses and treatment considerations is essential.
Methods
Cases submitted to the International DIPG registry (IDIPGR) with histopathologic and/or radiologic data were analyzed. Central imaging review was performed on diagnostic brain MRIs (if available) by two neuro-radiologists. Imaging features suggestive of alternative diagnoses included non-pontine origin, <50% pontine involvement, focally exophytic morphology, sharply-defined margins, and/or marked diffusion restriction throughout.
Results
Among 286 patients with pathology from biopsy and/or autopsy, 23 (8%) had histologic diagnoses inconsistent with DIPG, most commonly non-diffuse low-grade gliomas and embryonal tumors. Among 569 patients with centrally-reviewed diagnostic MRIs, 40 (7%) were classified as non-DIPG, alternative diagnosis suspected. The combined analysis included 151 patients with both histopathology and centrally-reviewed MRI. Of 77 patients with imaging classified as characteristic of DIPG, 76 (99%) had histopathologic diagnoses consistent with DIPG (infiltrating grade II-IV gliomas). Of 57 patients classified as likely DIPG with some unusual imaging features, 55 (96%) had histopathologic diagnoses consistent with DIPG. Of 17 patients with imaging features suggestive of an alternative diagnosis, eight (47%) had histopathologic diagnoses inconsistent with DIPG (remaining patients were excluded due to non-pontine tumor origin). Association between central neuro-imaging review impression and histopathology was significant (p<0.001), and central neuro-imaging impression was prognostic of overall survival.
Conclusions
The accuracy and important role of central neuro-imaging review in confirming the diagnosis of DIPG is demonstrated.Fil: Lazow, Margot A. Cincinnati Children's Hospital Medical Center; Estados Unidos.Fil: Fuller, Christine. Upstate Medical University; Estados Unidos.Fil: DeWire, Mariko. Cincinnati Children's Hospital Medical Center; Estados Unidos.Fil: Lane, Adam. Cincinnati Children's Hospital Medical Center; Estados Unidos.Fil: Bandopadhayay, Pratiti. Harvard Cancer Center; Estados Unidos.Fil: Bartels, Ute. The Hospital for Sick Children; Estados Unidos.Fil: Bouffet, Eric. The Hospital for Sick Children; Estados Unidos
AISYF: first national, prospective, multicenter study of young patients with stroke in Argentina
No full textUp to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, overweight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5%, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.Fil: Bonardo, Pablo. Hospital Británico de Buenos Aires; Argentina.Fil: León Cejas, Luciana. Hospital Británico de Buenos Aires; Argentina.Fil: Mazziotti, Julieta. Hospital Británico de Buenos Aires; Argentina.Fil: Zinnerman, Alberto. Hospital Posadas; Argentina.Fil: Fernández Pardal, Manuel. Hospital Británico de Buenos Aires; Argentina.Fil: Martínez, Alejandra. Hospital Posadas; Argentina.Fil: Riccio, Patricia. Fundación Favaloro; Argentina.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Bendersky, Eduardo. INAREPS; Argentina.Fil: Nofal, Pedro. Sanatorio Parque Tucumán; Argentina.Fil: Cairola, Patricia. Hospital Durand; Argentina.Fil: Jure, Lorena. Sanatorio Parque Rosario; Argentina.Fil: Sotelo, Andrea. Sanatorio Adventista del Plata; Argentina.Fil: Casas Parera, Ignacio. Instituto de Oncología Ángel H. Roffo; Argentina.Fil: Sánchez Luceros, Analía. Academia Nacional de Medicina; Argentina.Fil: Sposato, Luciano. Fundación Favaloro; Argentina.Fil: Reisin, Ricardo C. Hospital Británico de Buenos Aires; Argentina
Interleukin-35 is a critical regulator of immunity during helminth infections associated with multiple sclerosis
No full textMultiple sclerosis (MS) is currently thought to arise by interactions between genetic susceptibility and environmental factors. Infections in general trigger autoimmune responses causing clinical manifestations of disease. However, as a result of regulatory T (Treg)- and regulatory B (Breg)-cell induction, helminth infections tend to dampen disease activity. IL-35, the newest member of the IL-12 family, is an inhibitory cytokine composed of an EBI3β chain subunit, and an IL-12p35 subunit. The aim of this study was to investigate the role of IL-35 during parasite infections occurring in individuals with MS. Numbers of IL-35-producing Breg cells are higher in CSF from helminth-infected than from uninfected MS subjects, a finding associated with decreased MRI disease activity. Interestingly, stimulation of CD19+ B cells with IL-35 promotes conversion of these cells to Breg cells producing both IL-35 and IL-10. Coculture of B cells from helminth-infected MS patients inhibits proliferation of Th1 and Th17 myelin peptide-specific T cells, as well as production of IFN-γ and IL-17. Following activation, CD4+ CD25+ Treg cells significantly upregulate expression of EBI3 and IL-12p35 mRNA. Furthermore, CD4+ CD25- T cells activated in the presence of IL-35 induce a population of cells with regulatory function, known as iTR35. Finally, B cells from normal individuals cultured in vitro in the presence of the helminth antigen SEA increase expression of the transcription BATF, IRF4 and IRF8, acquiring a pattern similar to that of IL-35 Breg cells. These data highlight the important immunoregulatory effects of IL-35 on both Breg and Treg cells, observed in helminth-infected MS subjects.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Marrodan, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Carnero Contentti, Edgar. Hospital Alemán; Argentina
Coping with Antarctic demands: Psychological implications of isolation and confinement
No full textWorking in extreme environments requires a wide range of cognitive, psychological and social competences. Antarctica represents one of the most challenging habitats to work in due to its aridity, extremely cold weather, and isolated conditions. This study aimed to assess mood variations and coping strategies, as well as their possible modulation by group dynamics in a crew at the Belgrano II Argentine Antarctic Station throughout 1 year of confinement. Thirteen members of the Argentine Army completed emotional, coping and social dynamics questionnaires bimonthly in March, May, July, September and November. Results showed a significant decline in social dynamics scales, evidenced by decreases in perceived peer and hierarchical support. Additionally, coping strategies displayed a drop in mature defence throughout the expedition. A positive correlation was found between social support and recovery from stress. Our results highlight the importance of interpersonal relationships in psychological adjustment to isolation and extreme environments.Fil: Abulafia, Carolina. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Universidad Católica Argentina; Argentina.Fil: Tortello, Camila. Universidad Nacional de Quilmes. Laboratorio de Cronobiología; Argentina. Universidad Católica Argentina; Argentina.Fil: Folgueira, Agustín. Armada de la República Argentina. Hospital Naval Central. Departamento de Neurología; Argentina.Fil: Nicolas, Michel. University of Bourgogne Franche-Comté. Laboratory Psy-DREPI (EA 7458); Francia.Fil: Cuiuli, Juan Manuel. Fuerzas Armadas Argentinas. Comando Conjunto Antártico; Argentina.Fil: Cairoli, Germán. Fuerzas Armadas Argentinas. Comando Conjunto Antártico; Argentina.Fil: Crippa, Valeria. Fuerzas Armadas Argentinas. Comando Conjunto Antártico; Argentina.Fil: Barbarito, Marta. Instituto Antártico Argentino; Argentina.Fil: Golombek, Diego Andrés. Universidad Nacional de Quilmes. Laboratorio de Cronobiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Vigo, Daniel Eduardo. Universidad Católica Argentina; Argentina. Katholieke Universiteit Leuven. Faculty of Psychology and Educational Sciences; Bélgica.Fil: Plano, Santiago Andrés. Universidad Católica Argentina; Argentina. Universidad Nacional de Quilmes. Laboratorio de Cronobiología; Argentina
Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial
No full textBackground and purpose: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial.
Methods: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics.
Results: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26-115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack (P0 (P<0.001), and current tobacco use (P=0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS.
Conclusions: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories.Fil: Sharma, Mukul. McMaster University; Canadá.Fil: Smith, Eric E. University of Calgary; Canadá.Fil: Pearce, Lesly A. St. Catharines; Canadá.Fil: Shoamanesh, Ashkan. McMaster University; Canadá.Fil: Perera, Kanjana S. McMaster University; Estados Unidos.Fil: Coutts, Shelagh B. University of Calgary; Canadá.Fil: Damgaard, Dorte. Aarhus University Hospital; Dinamarca.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Rha, Joung-Ho. Inha University Hospital; Corea del Sur.Fil: Modrau, Boris. Aalborg University Hospital; Dinamarca.Fil: Yoon, Byung-Woo. Seoul National University Hospital; Corea del Sur.Fil: Romano, Marina. Clinicas "Dr. N. Quirno"; Argentina.Fil: Messé, Steven R. University of Pennsylvania; Estados Unidos.Fil: Barlinn, Jessica. Technische Universitat Dresden; Alemania.Fil: Lambeck, Johann. Universitätsklinikum Freiburg; Alemania.Fil: Saad, Feryal. University of Calgary; Canadá.Fil: Berkowitz, Scott D. Bayer AG; Alemania.Fil: Mundl, Hardi. Bayer AG; Alemania.Fil: Connolly, Stuart J. Hamilton Health Sciences; Canadá
How much time is needed in clinical practice to reach a diagnosis of clinically established Parkinson's disease?
No full textIntroduction: The implementation of accepted clinical diagnostic criteria has improved the accuracy of a clinical diagnosis of Parkinson's disease (PD). Time frames of 3-10 years have been empirically proposed to reach a diagnosis of clinically established PD.
Methods: We explored the time to a Final Clinical Diagnosis (FCD) and the factors that predict faster diagnoses in patients presenting with parkinsonism and/or tremor between 2009 and 2015 at our tertiary center. All patients underwent a standardized workout process to reach a FCD, which included an acute levodopa challenge (LDC) after the first visit.
Results: Among the 326 patients included, 215 (66%) received a FCD within the first six months after the LDC. A FCD was reached in 95% and 100% of patients in 33 and 108 months, respectively. PD was the FCD in 196 patients (60.1%). The FCD was reached faster in patients with a positive response to levodopa and when the FCD was PD.
Conclusion: The time needed to reach a final diagnosis in the clinical setting was 2.75 years in 95% of patients presenting initially with parkinsonism and/or tremor. Patients with positive responses to levodopa at the LDC, benefited from shorter delays until the FCD.Fil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Perez Lloret, Santiago. Universidad Católica de Buenos Aires; Argentina.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina
Increased risk of preneoplastic colonic lesions and colorectal carcinoma in acromegaly: multicenter case-control study
No full textPurpose: Current international guidelines recommend colonoscopy in patients with acromegaly at the time of diagnosis, even though the risk of developing colorectal neoplasm is still controversial. The main objective of this Argentine multicenter study was to analyze through screening colonoscopy the presence of advanced neoplastic lesions considered as precancerous, in patients with acromegaly compared to a control group.
Methods: This is a case-control retrospective study. Full length colonoscopy of 70 acromegalic patients and 128 control subjects were studied. Polyps were classified into non pre-cancerous lesions and advance neoplastic lesions which included advanced adenomas (preneoplastic) and colorectal carcinomas.
Results: Thirty three out of 70 acromegalic patients and 32 out of 128 subjects controls presented polyps in the colonoscopy [47.1% vs 25%, p = 0.002, OR 2.68]. Non precancerous polyps were found in 11 (15.7%) and 23 (17.9%) (p = 0.690), while advanced neoplastic lesions were found in 22 (31.4%) and 9 (7.0%) (p = 0,0001 - OR: 6.06) patients and controls respectively. Advanced adenomas and colorectal carcinomas were found in 18 (27.3%) and 9 (7.0%) (p = 0,0006-OR: 4,57), and 4 (5.7%) and 0 (0.0%) p = 0.0063) of patients and controls respectively. The presence of insulin resistance was the only statistically significant associated factor among acromegalic patients with and without colonic polyps.
Conclusions: Our findings show an increased risk of preneoplastic colonic lesions and colorectal carcinoma in patients with chronic and sustained GH excess compared to a control group. This supports the recommendation to perform screening colonoscopy at diagnosis of acromegaly.Fil: Katz, Débora Adela. Fleni. Departamento de Neurología. Servicio de Neuroendocrinología; Argentina.Fil: Slavinsky, Patricia. Fleni. Departamento de Neurología. Servicio de Neuroendocrinología; Argentina.Fil: Battistone, Maria. Hospital Carlos G. Durand. División Endocrinología; Argentina.Fil: Miragaya, Karina. Sanatorio Güemes. Servicio de Endocrinología; Argentina.Fil: Rogozinski, Amelia. Hospital Ramos Mejía. División Endocrinología; Argentina.Fil: Agüero, Monica. Hospital Tornú. Grupo de trabajo Endocrinología; Argentina.Fil: Alfieri, Analia. Hospital Nacional Profesor A. Posadas. Servicio de Endocrinología; Argentina.Fil: Ballarino, Maria Carolina. Hospital Militar Central. Servicio de Endocrinología; Argentina.Fil: Boero, Laura. Hospital de Clínicas José de San Martin. División de Endocrinología; Argentina.Fil: Danilowicz, Karina. Hospital de Clínicas José de San Martin. División de Endocrinología; Argentina.Fil: Diez, Sabrina. Hospital General de Agudos Dr. Ignacio Pirovano. Servicio de Endocrinología; Argentina.Fil: Donoso, Marina. Hospital Nacional Profesor A. Posadas. Servicio de Endocrinología; Argentina.Fil: Fainstein-Day, Patricia. Hospital Italiano. Servicio de Endocrinología; Argentina.Fil: Furioso, Alejandra. Hospital Ramos Mejía. División Endocrinología; Argentina.Fil: Garcia Basavilbaso, Natalia. Sanatorio Las Lomas. Servicio de Endocrinología; Argentina.Fil: Glerean, Mariela. Hospital Italiano. Servicio de Endocrinología; Argentina.Fil: Loto, Monica. Hospital Británico. Servicio de Endocrinología; Argentina.Fil: Mallea-Gil, Susana. Hospital Militar Central. Servicio de Endocrinología; Argentina.Fil: Sabate, María Isabel. Hospital Universitario Austral. Servicio de Endocrinología; Argentina.Fil: Servidio, Marisa. Hospital Teodoro Álvarez. Unidad de Endocrinología; Argentina
Global Impact of COVID-19 on Stroke Care and Intravenous Thrombolysis
No full textObjective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.
Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.
Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.
Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.Fil: Nogueira, Raul G. Boston University School of Medicine; Estados Unidos.Fil: Qureshi, Muhammed M. Boston Medical Center; Estados Unidos.Fil: Abdalkader, Mohamad. Boston Medical Center; Estados Unidos.Fil: Ouriques Martins, Sheila C. Osaka National Hospital; Japón.Fil: Yamagami, Hiroshi. Universidade de Lisboa; Portugal.Fil: Qiu, Zhongming. Leuven University Hospital; Belgica.Fil: Yassin Mansour, Ossama. Masaryk University; Republica Checa.Fil: Sathya, Anvitha. University of Antwerp; Belgica.Fil: Czlonkowska, Anna. Cooper University Hospital; Estados Unidos.Fil: Tsivgoulis, Georgios. Universidade de Lisboa; Portugal.Fil: Aguiar de Sousa, Diana. Leuven University Hospital; Belgica.Fil: Demeestere, Jelle. Masaryk University; Republica Checa.Fil: Mikulik, Robert. University of Antwerp; Belgica.Fil: Vanacker, Peter. Cooper University Hospital; Estados Unidos.Fil: Siegler, James E. University of Tartu; Estonia.Fil: Kõrv, Janika. Loyola University Chicago Stritch School of Medicine; Estados Unidos.Fil: Biller, Jose. Kaiser Permanente Fontana Medical Center; Estados Unidos.Fil: Liang, Conrad W. Kaiser Permanente Los Angeles Medical Center; Estados Unidos.Fil: Sangha, Navdeep S. UT Health McGovern Medical School; Estados Unidos.Fil: Pujol Lereis, Virginia Andrea. Fleni. Centro Integral de Neurología Vascular; Argentina