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Optic tract and internal capsule lesion in a patient with Wernicke-Korsakoff syndrome
No full textA 72-year-old man, presented with a one-week history of confusion and an anterograde amnesic disorder accompanied by confabulation, with lack of insight to his symptoms.
Medical history included alcohol abuse and admitted twenty-years of alcohol ingestion (approximately 186 gr/day).
Neurologic examination was notable for slightly decreased consciousness, disorientation to time, severe anterograde amnesia and unsteadiness of stance and gait with four limb ataxia.
A metabolic blood panel including liver profile showed alanine aminotransferase mildly elevated (66 UI/L) with elevated gamma-glutamyl-transpeptidase (gGT: 426 UI/L). Tests for HIV, syphilis and vitamin B12 levels were negative.
Review of initial brain MRI showed a symmetrical, increased fluid-attenuated inversion recovery (FLAIR) signal lesion extending through the hypothalamus, periaqueductal area, mamillary bodies, bilateral anterior thalami, chiasm, both optic tracts and posterior limbs of both internal capsules with restricted diffusion and patchy contrast enhancement (figure 1 1a-1b).
A possible Wernicke-Korsakoff syndrome diagnosis was achived. Following the initial examination, the patient was initiated on prophylactic parenteral thiamine reposition.
CSF analysis showed elevated proteins (174 mg/dl) and lactate concentration (2.9 mmol/L). Cytologic and immunocytochemical study showed no neoplastic processes. Screening of autoimmune antibodies in CSF and paraneoplastic antibodies in serum were negative.
EEG and full-body CT scans were unremarkable.
Thiamine serum levels were normal (16,5 ug/L) (blood sample collected previous to reposition).
Finally, a neurocognitive test indicated malperformance in tasks related to immediate and delayed recall and disturbances in recent and remote memory with confabulation.
A new brain MRI after supplementation showed regression of the previous lesion (figure 1 2a-2b).
He was discharged one month later with residual anterograde amnesia and gait instability that are still present eleven months later, at the last follow up.Fil: Varela, Francisco José. Fleni. Departamento de Neurología; Argentina.Fil: Bensi, Catalina. Fleni. Departamento de Neurología; Argentina.Fil: Hernández, Micaela Anahí. Fleni. Departamento de Neurología; Argentina
Assessment of Ataxia Rating Scales and Cerebellar Functional Tests: Critique and Recommendations
No full textBackground: We assessed the clinimetric properties of ataxia rating scales and functional tests, and made recommendations regarding their use.
Methods: A systematic literature search was conducted to identify the instruments used to rate ataxia symptoms. The identified rating scales and functional ability tests were reviewed and ranked by the panel as "recommended," "suggested," or "listed" for the assessment of patients with discrete cerebellar disorders, using previously established criteria.
Results: We reviewed 14 instruments (9 rating scales and 5 functional tests). "Recommended" rating scales for the assessment of symptoms severity were: for Friedreich's ataxia, the Friedreich's Ataxia Rating Scale, the International Cooperative Ataxia Rating Scale (ICARS), and the Scale for the Assessment and Rating of Ataxia (SARA); for spinocerebellar ataxias, ICARS and SARA; for ataxia telangiectasia: ICARS and SARA; for brain tumors, SARA; for congenital disorder of glycosylation-phosphomannomutase-2 deficiency, ICARS; for cerebellar symptoms in multiple sclerosis, ICARS; for cerebellar symptoms in multiple system atrophy: Unified Multiple System Atrophy Rating Scale and ICARS; and for fragile X-associated tremor ataxia syndrome, ICARS. "Recommended" functional tests were: for Friedreich's ataxia, Ataxia Functional Composite Score and Composite Cerebellar Functional Severity Score; and for spinocerebellar ataxias, Ataxia Functional Composite Score, Composite Cerebellar Functional Severity Score, and SCA Functional Index.
Conclusions: We identified some "recommended" scales and functional tests for the assessment of patients with major hereditary ataxias and other cerebellar disorders. The main limitations of these instruments include the limited assessment of patients in the more severe end of the spectrum and children. Further research in these populations is warranted. © 2020 International Parkinson and Movement Disorder Society.Fil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Perez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CAECIHS-UAI, CONICET); Argentina. Universidad Católica Argentina. Facultad de Medicina; Argentina. Unicersidad de Buenos Aires. Facultad de Medicina; Argentina.Fil: Van de Warrenburg, Bart. Radboud University Medical Center. Center of Expertise for Parkinson and Movement Disorders. Donders Institute for Brain, Cognition and Behavior, Department of Neurology; Países Bajos.Fil: Rodríguez Blázquez, Carmen. Institute of Health Carlos III and CIBERNED. National Centre of Epidemiology; España.Fil: Zesiewicz, Theresa. University of South Florida. Department of Neurology; Estados Unidos.Fil: Saute, Jonas A M. Hospital de Clínicas de Porto Alegre (HCPA). Medical Genetics Division; Brasil. Hospital de Clínicas de Porto Alegre (HCPA). Neurology Division; Brasil. Universidade Federal do Rio Grande do Sul. Medical Sciences. Postgraduate Program in Medicine; Brasil. Universidade Federal do Rio Grande do Sul. Medical Sciences. Department of Internal Medicine; Brasil.Fil: Durr, Alexandra. University Hospital Pitié-Salpêtrière. Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), AP-HP, INSERM, CNRS; Francia.Fil: Nishizawa, Masatoyo. Niigata University. Brain Research Institute; Japón.Fil: Martínez Martín, Pablo. Carlos III Institute of Health. Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED); España.Fil: Stebbins, Glenn T. Rush University Medical Center. Department of Neurological Sciences; Estados Unidos.Fil: Schrag, Anette. Royal Free Campus. UCL Institute of Neurology. Department of Clinical Neurosciences; Reino Unido.Fil: Skorvanek, Matej. P. J. Safarik University. Faculty of Medicine. Department of Neurology; Eslovaquia. University Hospital L. Pasteur. Department of Neurology; Eslovaquia
Sex Differences Among Participants in the Latin American Stroke Registry.
No full textBackground Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods and Results Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short-term follow-up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in-hospital stay of 8 days (interquartile range, 5-8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outcome (modified Rankin scale, 3-6) was present in 1662 (34.7%) patients and 38.2% of women (P<0.001). Mortality was present in 6.8% of the registry, with 7.8% in women compared with 6.0% in men (P=0.01). Death and poor functional outcome for all-type stroke showed a higher risk in female patients (hazard ratio, 1.3, P=0.03; and hazard ratio, 1.1, P=0.001, respectively). Conclusions A worse functional outcome and higher mortality rates occurred in women compared with men in the LASE, confirming sex differences issues at short-term follow-up.https://doi.org/10.1161/JAHA.119.013903Fil: Ameriso, Sebastián Francisco. Fleni. Centro Integral de Neurología Vascular; Argentina.Fil: Pujol Lereis, Virginia Andrea. Fleni. Centro Integral de Neurología Vascular; Argentina.Fil: Serrano, Fabiola. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez. Stroke Department; México.Fil: Arauz-Gongora, Antonio. Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez. Stroke Department; México.Fil: Flores, Alan. Universidad Nacional de Asunción. Facultad de Ciencias Medicas. Neurology Department; Paraguay.Fil: Bayona, Hernán. Hospital Universitario Fundación Santa Fe de Bogotá. Stroke Center Neurology Department; Colombia.Fil: Fernández, Huberth. Hospital Dr. Rafael Calderón Guardia (CCSS) San José Costa Rica. Neurosciences Department; Costa Rica.Fil: Castillo, Alejandro. Hospital General 450 Durango. Neurology Department; México.Fil: Ecos, Rosa. Instituto Nacional de Ciencias Neurológicas. Neurology Department; Perú.Fil: Vazquez, Jorge. Hospital Regional PEMEX . Internal Medicine Department; Perú.Fil: Amaya, Pablo. Fundación Clínica Valle del Lili/Universidad Icesi. Neurology Department; Colombia.Fil: Ruíz, Angélica. Hospital Juárez. Neurology Department; México.Fil: López, Minerva. Hospital General. Neurology Department; México.Fil: Zapata, Carlos. Hospital Nacional Guillermo Almenara Irigoyen. Neurology Department; Perú.Fil: Roa, Luis. Hospital Universitario Mayor Mederi. Neurology Department; Colombia.Fil: Marquez-Romero, Juan Manuel. Hospital General de Zona 2-IMSS. Neurology Department; México.Fil: Morelos, Eugenia, Juan Manuel. Hospital Regional del ISSSTE. Neurology Department; México.Fil: Ochoa, Marco A. Juan Manuel. Hospital Regional del ISSSTE. Neurology Department; México.Fil: Leon, Carolina. Juan Manuel. Hospital Regional Dr. Valentín Gómez Farías-ISSSTE. Neurology Department; México.Fil: Romero, Felipe. Juan Manuel. Hospital Pablo Arturo Suarez. Neurology Department; Ecuador
Laminoplastia cervical con foraminotomía unilateral C4-C5: nota técnica y serie de casos
No full textObjetivo: La laminoplastía «open door» es una técnica ampliamente utilizada para el tratamiento de la mielopatía cervical multinivel. A pesar de presentar resultados funcionales y
radiológicos satisfactorios a largo plazo, la parálisis de C5 postoperatoria continúa siendo
una complicación severa e invalidante con una incidencia variable en la literatura. El objetivo
del presente trabajo es describir e ilustrar la técnica quirúrgica paso a paso con el agregado
de la foraminotomía unilateral C4-5, y evaluar los resultados obtenidos hasta el momento,
haciendo especial énfasis en la parálisis de C5.
Material y métodos: Estudio retrospectivo de 20 pacientes intervenidos por mielopatía cervical
mediante la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral,
para la cual se detallan los pasos.
Resultados: Entre enero de 2013 y abril de 2019 se trataron 20 pacientes con «laminoplastia
cervical extendida». Un solo paciente agregó déficit de C5 postoperatorio (5%). El porcentaje
de recuperación del Japanese Orthopaedic Association score (JOA modificado) postoperatorio
fue del 54,5%, siendo similar a lo observado en otras series.
Conclusión: Se desarrolló e ilustró la técnica de laminoplastia cervical «extendida» con foraminotomía unilateral de C4-5 para la prevención de la parálisis de C5. Se analizaron los
resultados, y se obtuvo una incidencia de parálisis de C5 coincidente con el menor porcentaje reportado en la literatura. Sería de utilidad un estudio prospectivo y aleatorizado para
valorar el rol de la foraminotomía preventiva C4-5 unilateral.
Material and methods: Retrospective study of 20 patients operated on for cervical myelopathy using the "extended" laminoplasty technique, which is described step by step.
Results: Between January 2013 and April 2019, 20 patients were operated on using the extended laminoplasty technique. Only one patient (5%) presented postoperative C5 palsy. The postoperative recovery rate of the modified JOA (Japanese Orthopaedic Association) score was 54.5%, similar to that observed in other series.
Conclusion: The extended cervical laminoplasty technique with unilateral C4-5 foraminotomy was developed and demonstrated for the prevention of C5 palsy. The results were analysed and an incidence of C5 palsy coinciding with the lowest percentage reported in the literature was obtained. A prospective randomised study would be useful to assess the role of preventive unilateral C4-5 foraminotomy.Fil: Marcó del Pont, Francisco. Fleni. Departamento de Neurocirugía; Argentina.Fil: Giovannini, Sebastián Juan María. Fleni. Departamento de Neurología; Argentina.Fil: Ries Centeno, Tomás. Fleni. Departamento de Neurología; Argentina.Fil: Lorefice, Fernando. Fleni. Departamento de Neurología; Argentina.Fil: Caffaratti, Guido. Fleni. Departamento de Neurología; Argentina.Fil: Cervio, Andrés Eduardo. Fleni. Departamento de Neurocirugía; Argentina
Characteristics of Recurrent Ischemic Stroke After Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial
No full textImportance: The concept of embolic stroke of undetermined source (ESUS) unifies a subgroup of cryptogenic strokes based on neuroimaging, a defined minimum set of diagnostic tests, and exclusion of certain causes. Despite an annual stroke recurrence rate of 5%, little is known about the etiology underlying recurrent stroke after ESUS.
Objective: To identify the stroke subtype of recurrent ischemic strokes after ESUS, to explore the interaction with treatment assignment in each category, and to examine the consistency of cerebral location of qualifying ESUS and recurrent ischemic stroke.
Design, setting, and participants: The NAVIGATE-ESUS trial was a randomized clinical trial conducted from December 23, 2014, to October 5, 2017. The trial compared the efficacy and safety of rivaroxaban and aspirin in patients with recent ESUS (n = 7213). Ischemic stroke was validated in 309 of the 7213 patients by adjudicators blinded to treatment assignment and classified by local investigators into the categories ESUS or non-ESUS (ie, cardioembolic, atherosclerotic, lacunar, other determined cause, or insufficient testing). Five patients with recurrent strokes that could not be defined as ischemic or hemorrhagic in absence of neuroimaging or autopsy were excluded. Data for this secondary post hoc analysis were analyzed from March to June 2019.
Interventions: Patients were randomly assigned to receive rivaroxaban, 15 mg/d, or aspirin, 100 mg/d.
Main outcomes and measures: Association of recurrent ESUS with stroke characteristics.
Results: A total of 309 patients (205 men [66%]; mean [SD] age, 68 [10] years) had ischemic stroke identified during the median follow-up of 11 (interquartile range [IQR], 12) months (annualized rate, 4.6%). Diagnostic testing was insufficient for etiological classification in 39 patients (13%). Of 270 classifiable ischemic strokes, 156 (58%) were ESUS and 114 (42%) were non-ESUS (37 [32%] cardioembolic, 26 [23%] atherosclerotic, 35 [31%] lacunar, and 16 [14%] other determined cause). Atrial fibrillation was found in 27 patients (9%) with recurrent ischemic stroke and was associated with higher morbidity (median change in modified Rankin scale score 2 [IQR, 3] vs 0 (IQR, 1]) and mortality (15% vs 1%) than other causes. Risk of recurrence did not differ significantly by subtype between treatment groups. For both the qualifying and recurrent strokes, location of infarct was more often in the left (46% and 54%, respectively) than right hemisphere (40% and 37%, respectively) or brainstem or cerebellum (14% and 9%, respectively).
Conclusions and relevance: In this secondary analysis of randomized clinical trial data, most recurrent strokes after ESUS were embolic and of undetermined source. Recurrences associated with atrial fibrillation were a minority but were more often disabling and fatal. More extensive investigation to identify the embolic source is important toward an effective antithrombotic strategy.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Veltkamp, Roland C. Imperial College London. Division of Brain Sciences; Reino Unido. Alfried Krupp Krankenhaus. Department of Neurology; Alemania.Fil: Pearce, Lesly A. Biostatistics Consultant; Canadá.Fil: Korompoki, Eleni. Imperial College London. Division of Brain Sciences; Reino Unido. National and Kapodistrian University of Athens. Department of Clinical Therapeutics; Grecia.Fil: Sharma, Mukul. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.Fil: Kasner, Scott E. University of Pennsylvania. Department of Neurology; Estadosm Unidos.Fil: Toni, Danilo. Sapienza University of Rome. Department of Human Neurosciences; Italia.Fil: Mundl, Hardi. Bayer AG; Alemania.Fil: Tatlisumak, Turgut. Sahlgrenska Academy at University of Gothenburg. Institute of Neurosciences and Physiology. Department of Clinical Neuroscience; Suecia. Sahlgrenska University Hospital. Department of Neurology; Suecia.Fil: Hankey, Graeme J. University of Western Australia. Medical School. Faculty of Health and Medical Sciences; Australia.Fil: Lindgren, Arne. Lund University. Department of Clinical Sciences and Neurology; Suecia. Skåne University Hospital. Department of Neurology; Suecia.Fil: Berkowitz, Scott D. Bayer; Estados Unidos.Fil: Arauz-Gongora, Antonio. Instituto Nacional de Neurologia y Neurocirugia Manual Velasco Suarez; México.Fil: Ozturk, Serefnur. Selcuk University. Faculty of Medicine. Department of Neurology; Turquía.Fil: Muir, Keith W. Queen Elizabeth University Hospital. University of Glasgow. Institute of Neuroscience and Psychology; Reino Unido.Fil: Chamorro, Ángel. University of Barcelona. Institute Reçerca Biomèdica August Pi i Sunyer. Hospital Clinic of Barcelona. Department of Neuroscience; España.Fil: Perera, Kanjana. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.Fil: Shuaib, Ashfaq. University of Alberta. Department of Medicine; Canadá.Fil: Rudilosso, Salvatore. University of Barcelona. Institute Reçerca Biomèdica August Pi i Sunyer. Hospital Clinic of Barcelona. Department of Neuroscience; España.Fil: Shoamanesh, Ashkan. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.Fil: Connolly, Stuart J. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.Fil: Hart, Robert G.. McMaster University. Department of Medicine. Population Health Research Institute; Canadá
Fibrinólisis en el infarto agudo de miocardio, ¿una reivindicación histórica?
No full textFil: García-Zamora, Sebastián. Fleni. Departamento de Cardiología; Argentina.Fil: Rosende, Andrés. Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner. Servicio de Cardiología. Unidad de Cuidados Intensivos Cardiovasculares; Argentina
Management of Advanced Therapies in Parkinson’s Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience
No full textBackground: Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19.
Objective: To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future.
Conclusion: Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Fasano, Alfonso. Toronto Western Hospital. Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre; Canadá. University of Toronto Toronto. Division of Neurology. University Health Network; Canadá. Krembil Brain Institute; Canadá. The Center for Advancing Neurotechnological Innovation to Application; Canadá.Fil: Antonini, Angelo. University of Padua. Department of Neuroscience; Italia.lia.Fil: Katzenschlager, Regina. Institute for Neuroimmunological and Neurodegenerative. Department of Neurology and Karl Landsteiner; Austria.Fil: Krack, Paul. University of Bern. Bern University Hospital. Center for Parkinson's Disease and Movement Disorders Inselspital. Department of Neurology; Suiza.Fil: Odin, Per. Lund University. Department of Clinical Sciences Lund. Division of Neurology; Suecia.Fil: Evans, Andrew H. The Royal Melbourne Hospital Victoria. Department of Neurology; Australia.Fil: Foltynie, Thomas. University College London. Institute of Neurology. Department of Clinical & Movement Neurosciences; Reino Unido.Fil: Volkmann, Jens. Universitätsklinikum Würzburg. Neurologischen Klinik; Alemania
Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF
No full textBackground: The period shortly after hospitalization for heart failure (HF) represents a high-risk window for recurrent clinical events, including rehospitalization or death.
Objectives: This study sought to determine whether the efficacy and safety of sacubitril/valsartan varies in relation to the proximity to hospitalization for HF among patients with HF with preserved ejection fraction (HFpEF).
Methods: In this post hoc analysis of PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF), we assessed the risk of clinical events and response to sacubitril/valsartan in relation to time from last HF hospitalization among patients with HFpEF (≥45%). The primary outcome was composite total HF hospitalizations and cardiovascular death, analyzed by using a semiparametric proportional rates method, stratified by geographic region.
Results: Of 4,796 validly randomized patients in PARAGON-HF, 622 (13%) were screened during hospitalization or within 30 days of prior hospitalization, 555 (12%) within 31 to 90 days, 435 (9%) within 91 to 180 days, and 694 (14%) after 180 days; 2,490 (52%) were never previously hospitalized. Over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p 180 days), and 7.9 (not previously hospitalized) per 100 patient-years. Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤30 days), 4.6% (31 to 90 days), and 3.4% (91 to 180 days), whereas no risk reduction was observed in patients screened >180 days or who were never hospitalized (trend in absolute risk reduction: pinteraction = 0.050).
Conclusions: Recent hospitalization for HFpEF identifies patients at high risk for near-term clinical progression. In the PARAGON-HF trial, the relative and absolute benefits of sacubitril/valsartan compared with valsartan in HFpEF appear to be amplified when initiated in the high-risk window after hospitalization and warrant prospective validation. (PARAGON-HF; NCT01920711).Fil: Vaduganathan, Muthiah. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.Fil: Claggett, Brian L. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.Fil: Desai, Akshay S. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos.Fil: Anker, Stefan D. Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies. Division of Cardiology and Metabolism; Alemania. German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung); Alemania.Fil: Perrone, Sergio Víctor. Fleni. Departamento de Neurología. Servicio de Cardiología; Argentina.Fil: Janssens, Stefan. University Hospitals Leuven. Department of Cardiology; Bélgica.Fil: Milicic, Davor. University Hospital Center Zagreb. Department of Cardiovascular Diseases; Croacia.Fil: Arango, Juan L. Guatemalan Heart Institute; Guatemala.Fil: Packer, Milton. Baylor University Medical Center. Baylor Heart and Vascular Institute; Estados Unidos. Imperial College; Reino Unido.Fil: Shi, Victor C. Novartis Pharmaceuticals; Estados Unidos.Fil: Lefkowitz, Martin P. Novartis Pharmaceuticals; Estados Unidos.Fil: McMurray, John J.V. University of Glasgow. British Heart Foundation Cardiovascular Research Centre; Reino Unido.Fil: Solomon, Scott D. Harvard Medical School. Brigham and Women's Hospital. Cardiovascular Division; Estados Unidos
Awareness of genetic risk in the Dominantly Inherited Alzheimer Network (DIAN)
No full textIntroduction: Although some members of families with autosomal dominant Alzheimer's disease mutations learn their mutation status, most do not. How knowledge of mutation status affects clinical disease progression is unknown. This study quantifies the influence of mutation awareness on clinical symptoms, cognition, and biomarkers.
Methods: Mutation carriers and non-carriers from the Dominantly Inherited Alzheimer Network (DIAN) were stratified based on knowledge of mutation status. Rates of change on standard clinical, cognitive, and neuroimaging outcomes were examined.
Results: Mutation knowledge had no associations with cognitive decline, clinical progression, amyloid deposition, hippocampal volume, or depression in either carriers or non-carriers. Carriers who learned their status mid-study had slightly higher levels of depression and lower cognitive scores.
Discussion: Knowledge of mutation status does not affect rates of change on any measured outcome. Learning of status mid-study may confer short-term changes in cognitive functioning, or changes in cognition may influence the determination of mutation status.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Aschenbrenner, Andrew J. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos.Fil: James, Bryan D. Rush Alzheimer's Disease Center. Rush University Medical Center. Department of Internal Medicine; Estados Unidos.Fil: McDade, Eric. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos.Fil: Wang, Guoquiao. Washington University School of Medicine. Division of Biostatistics; Estados Unidos.Fil: Lim, Yen Ying. The Florey Institute of Neuroscience and Mental Health, Parkville; Australia.Fil: Benzinger, Tammie L.S. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos. Washington University School of Medicine. Department of Radiology; Estados Unidos.Fil: Cruchaga, Carlos. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos. Washington University School of Medicine. Department of Psychiatry; Estados Unidos.Fil: Goate, Alison M. Icahn School of Medicine at Mount Sinai. Department of Neuroscience; Estados Unidos.Fil: Xiong, Chengjie. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos. Washington University School of Medicine. Division of Biostatistics; Estados Unidos.Fil: Perrin, Richard J. Washington University School of Medicine. Department of Pathology & Immunology. Division of Neuropathology; Estados Unidos.Fil: Buckles, Virginia. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos.Fil: Berman, Sarah B. University of Pittsburgh. Department of Neurology; Estados Unidos.Fil: Chhatwal, Jasmeer P. Massachusetts General Hospital, Harvard Medical School. Department of Neurology; Estados Unidos.Fil: Fagan, Anne M. Washington University School of Medicine. Department of Neurology. Charles F. and Joanne Knight Alzheimer's Disease Research Center; Estados Unidos.Fil: Farlow, Martin R. Indiana University School of Medicine. Department of Neurology; Estados Unidos.Fil: O’Connor, Antoinette. Queen Square Institute of Neurology. Dementia Research Centre; Inglaterra.Fil: Ghetti, Bernardino. Indiana University School of Medicine. Department of Pathology and Laboratory Medicine; Estados Unidos.Fil: Graff-Radford, Neill R. Mayo Clinic. Department of Neurology; Estados Unidos.Fil: Goldman, Jill. Columbia University. Department of Neurology; Estados Unidos
Impacto psicosocial de la pandemia por COVID-19 en adultos de Buenos Aires
No full textIntroducción: En marzo de 2020, la Organización Mundial de la Salud (OMS) declaró a la enfermedad SARS-CoV-2, coronavirus, una pandemia. Desde ese momento, se lleva a cabo un experimento psicológico notablemente grande en el mundo: el
aislamiento social.
Objetivos: Analizar la repercusión del aislamiento social sobre los hábitos saludables y algunos aspectos psicosociales y conductuales durante el confinamiento y las restricciones impuestas por la pandemia en el área metropolitana de Buenos Aires
(AMBA).
Material y métodos: Se confeccionó una encuesta y se convocó por redes sociales (WhatsApp, Instagram, Facebook, e-mail) a
que la respondieran en forma anónima todos excepto el personal médico.
Resultados: Tras 7 días de enviado el correspondiente enlace, habían contestado la encuesta 2912 personas; el 48,2% de ellas
tenía entre 40 y 60 años y en su mayoría eran mujeres. El 43,53% percibieron modificaciones en sus hábitos de vida, como
el aumento en las horas frente a dispositivos electrónicos, que se duplicó en la cuarentena. Esto se acompañó de mayor
sedentarismo: el 83,5% hacía ejercicio antes de la pandemia, pero solo el 6,4% mantuvo la cantidad de horas semanales de
ejercicio que hacía antes del aislamiento. El 43,52% presentó alteración en sus hábitos alimenticios y el 41% refirió síntomas
compatibles con depresión, ansiedad, tristeza, falta de voluntad o desesperanza.
Conclusiones: Nuestro estudio sugiere que el bienestar psicológico y los hábitos saludables son amenazados por el confinamiento establecido para contener la traFil: Herrera Paz, Juan José. Fleni. Servicio de Cardiología; Argentina.Fil: Bobadilla-Jacob, Pamela. Instituto Cardiovascular Lezica. Servicio de Cardiología; Argentina.Fil: Igolnikof, Darío Ben. Sanatorio de la Trinidad. Servicio de Cardiología; Argentina.Fil: García-Zamora, Sebastian. Investigaciones Médicas. Servicio de Cardiodiagnóstico; Argentina.Fil: Sandoval, Carla. Fleni. Servicio de Cardiología; Argentina.Fil: Cancer, Marcelo. Instituto Argentino de Riñón y Trasplante. Servicio de Cardiología; Argentina.Fil: González Dávila, Emanuel. Instituto de Cardiología y Medicina del Deporte Wolff; Argentina.Fil: Wolff, Sebastian. Instituto de Cardiología y Medicina del Deporte Wolff; Argentina.Fil: Wolff, David. Instituto de Cardiología y Medicina del Deporte Wolff; Argentina.Fil: Picco, José Miguel. Instituto de Cardiología y Medicina del Deporte Wolff; Argentina