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Structural brain abnormalities in schizophrenia in adverse environments: examining the effect of poverty and violence in six latin american cities
Get PDFBackground
Social and environmental factors such as poverty or violence, modulate the risk and course of schizophrenia, but how they affect the brain in patients with psychosis remains unclear. We here studied how they are related to brain structure in schizophrenia and healthy controls in Latin America, where these factors are large and unequally distributed.
Methods
This is an MRI multi-center study in patients with schizophrenia and healthy controls from six Latin American cities: Buenos Aires, Medellin, Mexico City, Santiago, Sao Paulo and Porto Alegre. Total and voxel-level gray matter volumes obtained from T1-weighted MRI images and their relationship with income and homicide rates were analyzed using a general linear model.
Results
334 patients with schizophrenia and 262 controls were included. Income was differentially related to total gray matter volume in the two groups (P=0.006). Controls showed a positive correlation between total gray matter volume and income (R=0.14, P=0.02). Surprisingly, this relationship was not present in schizophrenia (R=-0.076, P=0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.
Discussion
Our results highlight the interplay between the environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as those from low and middle-income countries: potentially less brain vulnerability (less gray matter loss) is sufficient to become unwell in adverse (poor) environments. The development of algorithms exploring clinically-useful information from structural brain images in psychosis should include representative samples from low and middle-income countries.Fil: Crossley, Nicolas. Pontificia Universidad Católica de Chile; Chile.Fil: Zugman, Andre. Universidade Federal de São Paulo; Brasil.Fil: Reyes-Madrigal, Francisco. Instituto Nacional de Neurología y Neurocirugía; México.Fil: Czepielewski, Leticia. Universidade Federal do Rio Grande do Sul; Brasil.Fil: Castro, Mariana Nair. Fleni. Instituto de Neurociencias FLENI-CONICET; Argentina. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina.Fil: Diaz-Zuluaga, Ana María. Universidad de Antioquía; Colombia.Fil: Pineda-Zapata, Julián. Instituto de Alta Tecnología Médica; Colombia.Fil: Reckziegel, Ramiro. Universidade Federal do Rio Grande do Sul; Brasil.Fil: Gadelha, Ary. Universidade Federal de São Paulo; Brasil.Fil: Jackowski, Andrea. Universidade Federal de São Paulo; Brasil.Fil: Noto, Cristiano. Universidade Federal de São Paulo; Brasil.Fil: Alliende Serra, Luz Maria. Pontificia Universidad Católica de Chile; Chile.Fil: Iruretagoyena, Bárbara. Pontificia Universidad Católica de Chile; Chile.Fil: Guinjoan, Salvador Martín. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fleni. Servicio de Psiquiatría; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Psiquiatría y Salud Mental; Argentina.Fil: Ossandon, Tomas. Pontificia Universidad Católica de Chile; Chile.Fil: Ramirez-Mahaluf, Juan Pablo. Pontificia Universidad Católica de Chile; Chile.Fil: Castañeda, Carmen Paz. Instituto Psiquiátrico Dr. José Horwitz Barak; Chile.Fil: Gonzalez-Valderrama, Alfonso. Instituto Psiquiátrico Dr. José Horwitz Barak; Chile.Fil: Nachar, Rubén. Instituto Psiquiátrico Dr. José Horwitz Barak; Chile
Absence of latitudinal gradient in oligoclonal bands prevalence in Argentina
No full textBackground: Like MS prevalence, oligoclonal bands (OCB) frequency seems to follow a latitudinal gradient. Argentina is extensive, latitude-wise, and previous studies have not found an MS prevalence latitudinal gradient. Our aim is to describe OCB prevalence in MS, clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) patients included in the Argentinean MS and NMOSD registry (RelevarEM) and to investigate if it follows a latitudinal gradient.
Methods: For each province, an average latitude was calculated, and OCB frequency was investigated. Multivariate logistical regression analysis and linear correlation were performed. Statistical analysis was repeated after excluding patients from centers using isoelectric focusing (IEF) in less than 95% of patients (CwIEF<95).
Results: We included 2866 patients. OCB where positive in 73.9% of patients. No association or correlation were found between OCB and latitude of residence, even after excluding patients from (CwIEF<95).
Conclusion: OCB positivity does not follow a latitudinal gradient in Argentina. Also, OCB positivity is lower than described in other world regions.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Negrotto, Laura. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Fiol, Marcela Paula. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Gaitán, María Inés. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Ysrraelit, María Célica. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Vrech, Carlos. Sanatorio Allende. Departamento de Enfermedades desmielinizantes; Argentina.Fil: Pappolla, Agustín. Hospital Italiano de Buenos Aires. Servicio de Neurología; Argentina.Fil: Miguez, Jimena. Hospital Italiano de Buenos Aires. Servicio de Neurología; Argentina.Fil: Patrucco, Liliana. Hospital Italiano de Buenos Aires. Servicio de Neurología; Argentina.Fil: Cristiano, Edgardo. Centro de esclerosis múltiple de Buenos Aires; Argentina.Fil: Rojas, Juan I. Centro de esclerosis múltiple de Buenos Aires; Argentina. Hospital Universitario de CEMIC. Servicio de Neurología; Argentina.Fil: Carrá, Adriana. Hospital Británico. Sección de Enfermedades Desmielinizantes; Argentina. Fundación Favaloro/INECO. Instituto de Neurociencias; Argentina.Fil: Chertcoff, Aníbal. Fundación Favaloro/INECO. Instituto de Neurociencias; Argentina.Fil: Steinberg, Judith. Hospital Británico. Sección de Enfermedades Desmielinizantes; Argentina.Fil: Martinez, Alejandra D. Hospital Británico. Sección de Enfermedades Desmielinizantes; Argentina.Fil: Curbelo, María Celeste. Hospital Británico. Sección de Enfermedades Desmielinizantes; Argentina.Fil: Cohen, Leila. Hospital Dr. J. M. Ramos Mejía. Centro Universitario de Esclerosis Múltiple; Argentina.Fil: Alonso, Ricardo. Hospital Dr. J. M. Ramos Mejía. Centro Universitario de Esclerosis Múltiple; Argentina.Fil: Garcea, Orlando. Hospital Dr. J. M. Ramos Mejía. Centro Universitario de Esclerosis Múltiple; Argentina
Recomendaciones para el uso de tromboprofilaxis en pacientes hospitalizados por COVID-19 en la Argentina
No full textSi bien la incidencia es incierta, algunos reportes de caso sugieren que la infección por COVID 19 se asocia con un aumento del riesgo de tromboembolismo venoso. Sugerimos iniciar tromboprofilaxis a todos los pacientes hospitalizados por síntomas asociados con una infección por COVID-19, a menos que esté contraindicado, con enoxaparina 40 mg SC diariamente si el clearance de creatinina es mayor a 30 ml/min.Fil: Vazquez, Fernando F. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica; Argentina.Fil: Korin, Jorge. Sanatorio Los Arcos. Argentina; Argentina.Fil: Baldessari, Enrique M. Fundación Favaloro. Departamento de Medicina Interna; Argentina.Fil: Capparelli, Federico Javier. Fleni. Departamento de Medicina Interna; Argentina.Fil: Gutierrez, Paula. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica; Argentina.Fil: Pale, Carlos. Sanatorio Las Lomas. Clínica Médica; Argentina.Fil: Bocanegra, Florencia. Hospital Italiano de Buenos Aires. Clínica Médica; Argentina.Fil: Grand, Beatriz. Hospital Juan A. Fernández. Departamento Materno Infantil; Argentina.Fil: Penchasky, Diana. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica. Sección Hematología; Argentina.Fil: González Alcantara, Maria Mónica. Hospital Juan A. Fernández. División Obstetricia; Argentina.Fil: Prémoli, María Sol. Hospital Español de Rosario; Argentina.Fil: Tabares, Aldo. Hospital Privado Universitario de Córdoba. Servicio de Medicina Vascular y Trombosis; Argentina.Fil: Wainsztein, Néstor Adrián. Fleni. Departamento de Medicina Interna; Argentina.Fil: Odetto, Diego. Hospital Italiano de Buenos Aires. Servicio de Ginecología. Sección de Oncología Ginecológica; Argentina.Fil: Vaccaro, Carlos. Hospital Italiano de Buenos Aires. Servicio de Cirugía General; Argentina.Fil: Martínez Aquino, Eleno. Sanatorio Franchin. Servicio de Clínica Médica; Argentina.Fil: Cumpian, Olga. Hospital Español de Mendoza. Servicio de Hematología; Argentina.Fil: Falabella, Verónica. Sanatorio Santa Isabel. Clínica Médica; Argentina.Fil: García, Santiago Antuel. Clínica 25 de Mayo. Hematología y Hemoterapia; Argentina.Fil: Saadi, José. Hospital Italiano de Buenos Aires. Servicio de Ginecología. Sección de Oncología Ginecológica; Argentina.Fil: Siccardi, Mariana. Hospital Español de Rosario; Argentina.Fil: Gándara, Esteban. Hospital Privado de la Comunidad. Servicio de Clínica Médica; Argentina
Early data on long-term efficacy and safety of inotersen in patients with hereditary transthyretin amyloidosis: a 2-year update from the open-label extension of the NEURO-TTR trial
Get PDFBackground and purpose: Hereditary transthyretin (hATTR) amyloidosis causes progressive polyneuropathy resulting from transthyretin (TTR) amyloid deposition throughout the body, including the peripheral nerves. The efficacy and safety of inotersen, an antisense oligonucleotide inhibitor of TTR protein production, were demonstrated in the pivotal NEURO-TTR study in patients with hATTR polyneuropathy. Here, the long-term efficacy and safety of inotersen are assessed in an ongoing open-label extension (OLE) study.
Methods: Patients who completed NEURO-TTR were eligible to enroll in the OLE (NCT02175004). Efficacy assessments included the modified Neuropathy Impairment Score plus seven neurophysiological tests composite score (mNIS + 7), the Norfolk Quality of Life - Diabetic Neuropathy (Norfolk QOL-DN) questionnaire total score and the Short-Form 36 Health Survey (SF-36) Physical Component Summary (PCS) score. Safety and tolerability were also assessed.
Results: Overall, 97% (135/139) of patients who completed NEURO-TTR enrolled in the OLE. Patients who received inotersen for 39 cumulative months in NEURO-TTR and the OLE continued to show benefit; patients who switched from placebo to inotersen in the OLE demonstrated improvement or stabilization of neurological disease progression by mNIS + 7, Norfolk QOL-DN and SF-36 PCS. No new safety concerns were identified. There was no evidence of increased risk for grade 4 thrombocytopenia or severe renal events with increased duration of inotersen exposure.
Conclusion: Inotersen slowed disease progression and reduced deterioration of quality of life in patients with hATTR polyneuropathy. Early treatment with inotersen resulted in greater long-term disease stabilization than delayed initiation. Routine platelet and renal safety monitoring were effective; no new safety signals were observed.Fil: Barroso, Fabio Adrián. Fleni. Departamento de Neurología. Sección de Enfermedades Neuromusculares; Argentina.Fil: Brannagan, Thomas H. Columbia University Medical Center; Estados Unidos.Fil: Wang, Annabel K. University of California; Estados Unidos.Fil: Coelho, Teresa. Centro Hospitalar do Porto; Portugal.Fil: Waddington Cruz, Marcia. Federal University of Rio de Janeiro. Amyloidosis Referral Center. CEPARM; Brasil.Fil: Polydefkis, Michael J. Johns Hopkins University; Estados Unidos.Fil: Dyck, Peter J. Mayo Clinic; Estados Unidos.Fil: Plante-Bordeneuve Violaine. CHU Henri Mondor; Francia.Fil: Berk, John L. Boston University; Estados Unidos.Fil: Merlini, Giampaolo. University of Pavia. IRCCS Policlinico San Matteo. Amyloidosis Center; Italia.Fil: Conceição, Isabel. Universidade de Lisboa. Hospital Santa Maria and Faculdade de Medicina. CHULN; Portugal.Fil: Hughes, Steven G. Ionis Pharmaceuticals, Inc; Estados Unidos.Fil: Kwoh, Jesse. Ionis Pharmaceuticals, Inc; Estados Unidos.Fil: Jung, Shiangtung W. Ionis Pharmaceuticals, Inc.; Estados Unidos.Fil: Guthrie, Spencer. Aurora Bio; Estados Unidos.Fil: Pollock, Michael. Akcea Therapeutics, Inc.; Estados Unidos.Fil: Benson, Merrill D. Indiana University School of Medicine; Estados Unidos.Fil: Gertz, Morie. Mayo Clinic; Estados Unidos
Towards the Journal of Applied Cognitive Neuroscience
No full textIn his book The Structure of Science Evolution, Thomas Khum defines a paradigmas “a set of beliefs, values and accepted techniques that define the exercise of a scientific discipline”. A new paradigm is a change of vision, a reconstruction of our knowledge in the light of discoveries; in the words of Socratics, “all cognition is a recognition”.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Roman, Fabián. Red Iberoamericana de Neurociencia Cognitiva; Argentina.Fil: Barceló-Martínez, Ernesto. Universidad de la Costa; Colombia
Intermediate phenotype of ATP13A2 mutation in two Chilean siblings: Towards a continuum between parkinsonism and hereditary spastic paraplegia
No full textFil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Miranda, Marcelo. Fundación Diagnosis; Chile. Clinica Las Condes. Department of Neurology; Chile.Fil: Harmuth, Florian. University of Tuebingen. Institute of Medical Genetics and Applied Genomics; Alemania.Fil: Bustamante, M Leonor. Fundación Diagnosis; Chile. University of Chile. Faculty of Medicine. Biomedical Sciences Institute. Human Genetics Program; Chile. University of Chile. Faculty of Medicine. Department of Psychiatry and Mental Health, North Division; Chile.
, ,Fil: Sturm, Marc. University of Tuebingen. Institute of Medical Genetics and Applied Genomics; Alemania.Fil: Magnusson, Ólafur Th. eCODE Genetics; Islandia.Fil: Bauer, Peter. University of Tuebingen. Institute of Medical Genetics and Applied Genomics; Alemania.Fil: Klockgether, Thomas. University of Bonn. Department of Neurology; Alemania. German Center for Neurodegenerative Diseases (DZNE); Alemania.Fil: Ramirez, Alfredo. German Center for Neurodegenerative Diseases (DZNE); Alemania. University of Bonn. Department of Neurodegenerative Diseases and Geriatric Psychiatry; Alemania. University of Cologne. Department of Psychiatry and Psychotherapy. Division of Neurogenetics and Molecular Psychiatry; Alemania
Bilateral posterior semicircular canal dysfunction: a new finding with video head impulse test
No full textDevelopment of the video head impulse test (vHIT) assessing all three semicircular canals in both labyrinths has uncovered the existence of new vestibular failure patterns and made bilateral posterior canal dysfunction detection possible. We conducted a retrospective analysis of 41 patients with bilateral posterior semicircular canal failure and compared results to 37 controls, with normal posterior semicircular canal function. Mean calculated gain showed significant difference between patients and controls in right [0.54 (SD 0.016)] and left [0.57 (SD 0.014)] posterior semicircular canals. There was a peak in prevalence between 71 and 80 years. Presentation was chronic in 78% of patients, and gait instability was the most common complaint. Sixty eight percent of cases were classified as idiopathic. Significant difference between groups was seen regarding the presence of Meniere's disease, presbycusis, and positional down-beat nystagmus (posDBN). This new vHIT pattern is most often seen in elderly patients, mainly of idiopathic etiology and presents together with sensorineural hearing loss and posDBN. Our findings suggest idiopathic cases may well contribute to the so-called "presbyastasis".Fil: Gualtieri, Francisco José. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina.Fil: Lerchundi, Florencia. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina.Fil: Laffue, Alfredo Hernán. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina.Fil: Olivier, Marina. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina
Multinodular and Vacuolating Neuronal Tumor of the Cerebrum (MVNT): A case series and review of the literature
No full textBACKGROUND AND PURPOSE:
Multinodular and Vacuolating Neuronal Tumor of the cerebrum (MVNT) is a benign -seizure associated- lesion affecting mostly adults. This new entity has been included in the 2016 World Health Organization classification of tumors of the central nervous system. Its pathologic hallmark consist of a subcortical cluster of nodular lesions located on the subcortical white matter. We aim to report a series of cases of presumed MVNT observed in our institution and review the literature.
MATERIALS AND METHODS:
In this retrospective study, a search was performed on our hospital information system. Sixteen cases were included. Demographic, clinical and radiological features were detailed in a table. All patients had an MRI acquired either on a 1.5 or a 3 Tesla scanner. Sequences performed included T1, T2, GRE/SWI, T2 FLAIR and DWI. Gadolinium enhanced T1-WI wer available in 11 patients and follow-up MRI were available in 7 patients.
RESULTS:
Patient ages ranged from 16 to 77 years (mean 42 years). Seizure and non-focal headache were by far the most common neurological complaints for which MRI was requested. All lesions consisted of clusters of multiple, discrete, round or ovoid, intra-axial, FLAIR and T2-WI hyperintense nodules. Follow-up MRI scans showed no changes between studies.
CONCLUSIONS:
MVNT is a benign, stable lesion that exhibits a typical radiological pattern that most of the times sufficed to arrive to a diagnosis, without the need of pathological confirmation. We confirm that our demographic, clinical and radiological findings are in accordance with those published in international literature.Fil: Buffa, Geraldine Belén. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Chaves, Hernán. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Serra, María Mercedes. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Stefanoff, Nadia Ivanna. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Gagliardo Cadena, Allan Salvatore. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Yañez, Paulina. Fleni. Departamento de Diagnóstico por Imágenes; Argentina
Movement Disorders in the World of COVID-19
Get PDFResumen no disponibleFil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Stoessl, A Jon. Pacific Parkinson's Research Centre & Djavad Mowafaghian Centre for Brain Health University of British Columbia; Canadá.Fil: Bhatia, Kailash P. UCL Queen Square Institute of Neurology London. Department of Clinical and Movement Neurosciences; Reino Unido
Nosology and Phenomenology of Psychosis in Movement Disorders
No full textBackground
Psychotic symptoms such as delusions and hallucinations are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less‐well‐known.
Objectives
To review psychotic symptoms present in different movement disorders.
Methods
A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis.
Results
In monogenic parkinsonisms, such as PARK‐GBA, PARK‐LRRK2, and PARK‐SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK‐LRRK2, and PARK‐SNCA, but not in PARK‐GBA. Different types of delusions and hallucinations are found in Huntington disease and other choreic disorders. In Tourette syndrome, paranoid delusions, visual, olfactory and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX‐TBP, ATX‐ATN1, ATX‐ATXN3, while it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, Neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, while it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington disease, Late‐onset Tays Sachs and Niemann‐Pick.
Conclusion
Psychosis is a frequent comorbidity in most hyperkinetic and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.Fil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Pontificia Universidad Catolica Argentina; Argentina.Fil: Farcy, Nicole. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Starkstein, Sergio E. University of Western Australia. School of Psychiatry and Clinical Neurosciences; Australia.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Pontificia Universidad Catolica Argentina; Argentina. Consejo Nacional de Investigaciones
Científicas y Técnicas; Argentina