Repositorio Institucional Fleni
Not a member yet
602 research outputs found
Sort by
Parvovirus-Related Arthritis
No full textResumen no disponibleFil: Brom, Martin. Fundación Favaloro; Argentina. Hospital Italiano de Buenos Aires; Argentina.Fil: Perandones, Carlos Edgardo. Fundación Favaloro; Argentina. Fleni. Departamento de Medicina Interna; Argentina
IMITA Score: distinguishing between ischemic stroke and stroke mimics (P3.3-065)
No full textObjective: We developed a score to distinguish ischemic strokes (IS) from stroke mimics (SM) and identify patients that could benefit from undergoing brain MRI to confirm or reject the diagnosis of IS.
Background: Stroke mimics represent 25–30% of probable ischemic strokes. Fibrinolysis in these patients seems to be safe but carries high economical cost.
Design/Methods: There were 1314 patients with diagnosis of probable IS between january 2012 and july 2018. Univariate analysis of demographic and clinical variables was performed. Variables with a p<0.25 were entered into a multiple logistic regression model, obtaining adjusted odds ratios (OR) and their beta coefficients. The model was fitted comparing patients that had events of interest and the corresponding model prediction. Precision was tested by Hosmer-Lemeshow Χ2 and the goodness of fit with C-statistic. Finally, the IMITA score was developed, assigning points for each variable based on the regression coefficient. The total score was calculated with the sum of all scores. Internal validity was tested with bootstrapping. Fisher’s exact test and chi square was used for categorical variables and t-test/Mann-Whitney for continuous variables according to distribution assumptions. A p-value of <0.05 was considered statistically significant.
Results: The IMITA score is composed of 4 variables (1 point for each one): male gender (OR 3.6), age > 50 years (OR 6.7), pure motor symptoms (OR 4.4) and absence of pure sensory symptoms (OR 3.3). The ROC curve analysis showed that a IMITA score ≥ 2 has sensitivity of 96%, specificity of 57%, being that the best performance of the score.
Conclusions: A IMITA score ≥ 2 predicts with acceptable sensitivity and specificity patients with IS. A process of external validation will be performed.Fil: Rosales, Julieta S. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Ricciardi, Mario Emiliano. Fleni. Departamento de Neurología; Argentina.Fil: Acosta, Julián Nicolás. Fleni. Departamento de Neurología; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina
Protocolo y técnica de estudio de la neurografía por RM: bases e interpretación
No full textCapítulo relativo a la interpretación básica de las imágenes neurográficas, evaluación del músculo en la imagen de RM y futuras perspectivas de la neurografía por RM.Fil: Serra, María Mercedes. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Calvar, Jorge Andrés. Fleni. Departamento de Diagnóstico por Imágenes; Argentina
Multiple Sclerosis Misdiagnosis: A Persistent Problem to Solve
Get PDFFil: Gaitán, María Inés. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina
P3713. Positive troponin levels and electrocardiographic findings in acute ischemic stroke
No full textBackground: Troponin elevation and ECG changes are frequent findings
in patients with acute ischemic stroke (AIS). The pathophysiology of these
findings is still debated.
Purpose: To assesss the prevalence of electrocardiographic (ECG)
changes and troponin elevation in AIS and to determine if these findings
correlate with stroke severity.
Methods: Observational, retrospective study among AIS patients admitted
to our stroke unit between October 2016 and December 2018. ECG was
performed at admission and 24 hours later. Troponin levels were obtained
after 6 hours of stroke symptoms onset. The NIH Stroke Scale (NIHSS)
was performed by stroke neurologists.
Results: We included 744 consecutive patients (58% male), aged 66.8
years ±16.6 SD. Main vascular risk factors were hypertension (62%), dyslipidemia
(49%), type 2 diabetes (18%), smoking (16%) and coronary
artery disease (CAD) (17%). Twelve patients (1.6%) died during the hospitalization.
Almost a half of patients (48.7%) had abnormal ECG. The most
frequent ECG findings were: long QTc (26%), pathologic Q wave (18%),
atrial fibrillation (AF) (9.4%), T wave inversion (5%), left-bundle bunch block
(LBBB) (4%) and ST segment depression (2%). Patients who had a history
of CAD had abnormal ECG findings more frequently than those who had
not. (71% vs 44%, p<0.001).
Thirteen percent of patients had positive troponin levels and 6% presented
severe strokes (defined as a NIHSS >15). In the univariate analysis, positive
troponin was associated with ST segment depression (p=0.01), T wave
inversion (p<0.01), LBBB (p<0.01) and AF (p<0.01). Patients with severe
strokes had more frequent ECG abnormalities (p=0.002) and positive troponin
levels (p<0.001). LBBB and AF were also associated with severe
stroke (p=0.002 and p<0.0001 respectively).
Conclusions: ECG changes are prevalent in acute stroke. T wave inversion,
ST segment depression, AF and LBBB are associated with high troponin
levels, potentially suggesting underlying CAD. High troponin levels,
LBBB and AF are associated with severe stroke. Patients with acute stroke
may have underlying cardiovascular disease and may benefit from cardiologic
evaluation.Fil: Zareba, Natalia Del Carmen. Fleni. Servicio de Cardiología; Argentina.Fil: Urdapilleta, Marcela. Fleni. Servicio de Cardiología; Argentina.Fil: Sandoval, Carla Elizabeth. Fleni. Servicio de Cardiología; Argentina.Fil: Garcia-Zamora, Sebastián. Fleni. Servicio de Cardiología; Argentina.Fil: Ameriso, Sebastián Francisco. Fleni. Centro Integral de Neurología Vascular; Argentina.Fil: Herrera Paz, Juan José. Fleni. Servicio de Cardiología; Argentina
Prediction of Gait without Physical Assistance after Inpatient Rehabilitation in Severe Subacute Stroke Subjects
No full textBACKGROUND:
Gait recovery is one of the main therapeutic goals of the rehabilitation for patients after a stroke.
OBJECTIVE:
This study is aimed at describing the frequency of achievement of gait without physical assistance in poststroke subacute patients by the time of discharge from a rehabilitation hospitalized program. Secondarily, our goal is to identify gait without physical assistance predictors in this same population based on the admission's clinical and demographic conditions.
METHODS:
Data from 185 first unilateral hemispheric stroke patients that need physical assistance to walk at admission were analyzed. The sample was dichotomized into gait with physical assistance and gait without physical assistance to calculate the frequency of achievement of gait without assistance at discharge. Multivariate logistic modeling was applied to identify prognostic factors for regaining gait without physical assistance.
RESULTS:
Gait without assistance was achieved in 50.27% of the subjects. Five variables were identified for the prediction model: age (Odds ratio [OR] = .87, 95% confidence interval [CI] = .83-.92), gender (OR = .37, 95% CI = .14-.94), time between stroke and hospitalization (OR = .96, 95% CI = .94-.99), initial Berg Balance (OR = 1.52, 95% CI = 1.23-1.88), and initial lower limb Fugl Meyer (OR = 1.17, 95% CI = 1.07-1.27).
CONCLUSIONS:
Although discharge planning is complex, achievement of gait without physical assistance is undoubtedly a landmark to decide on hospitalization discharge. Half of this sample was able to walk without physical assistance at hospitalization discharge. Five clinical and demographic conditions at admission were found predictors of gait without physical assistance at inpatient discharge.https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104367Fil: Gianella, Matías Gabriel. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Kinesiología; Argentina.Fil: Gath, Christian Federico. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Kinesiología; Argentina.Fil: Bonamico, Lucas. Fleni. Centro de Rehabilitación Adultos CR. Servicio de Neurorehabilitación; Argentina.Fil: Olmos, Lisandro Emilio. Fleni. Centro de Rehabilitación Adultos CR; Argentina.Fil: Russo, María Julieta. Fleni. Centro de Rehabilitación Adultos CR; Argentina
Acute Headache Diagnosis in the Emergency Department: Accuracy and Safety of an Artificial Intelligence System (P5.10-002)
Get PDFObjective: Evaluate the accuracy and safety of an artificial intelligent (AI) system for acute headache diagnosis in the emergency department.
Background: Headache is the main cause of neurologic consultation in emergency departments, entailing high costs in healthcare systems. Moreover, the access to qualified specialists and appropriate detection of potentially dangerous causes is not ensured, especially in areas with low number of neurologist per capita. We hypothesize that and AI-system could assist in the diagnosis of headaches with high accuracy and safety.
Design/Methods: We retrieved 16,000 clinical records from patients consulting for headache at the emergency department. 7,972 patients were finally included after removing non-headache consults, incomplete, empty and duplicate entries. Clinical records were processed with Latent Semantic Analysis (LSA) and a Support Vector Machine (SVM) model was trained. We analyzed the performance of different models at classifying the headache as primary versus secondary. All the development and analysis was done using Python.
Results: 7,098 patients had a primary headache diagnosis and 874 a secondary headache diagnosis. We divided the database into a training (70%) and a testing (30%) set. A SVM model was trained with the former one, and we evaluated the performance of the model in the detection of probable secondary headaches in the test set. The sensitivity of the model for probable secondary headaches was 89% with a specificity of 73%, and a negative predictive value of 98.2%.
Conclusions: AI has a great potential for its application in acute headache diagnosis. Advancements in this field would both improve the accessibility to quality healthcare and optimize the time spent by health professionals at emergency departments.Fil: Acosta, Julián Nicolás. Fleni. Departamento de Neurología; Argentina.Fil: Dorr, Francisco. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Computación; Argentina.Fil: Goicochea, Maria Teresa. Fleni. Departamento de Neurología. Clínica del Color. Clínica de Cefaleas; Argentina.Fil: Fernández Slezak, Diego. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Computación; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina
Evaluation of Cerebrospinal Fluid Neurofilament Light Chain as a Routine Biomarker in a Memory Clinic
No full textSystematic evaluation of biomarkers in representative populations is needed to validate their clinical utility. In this work, we assessed the diagnostic performance of cerebrospinal fluid (CSF) neurofilament light chain (NfL) in a neurocognitive clinical setting. A total of 51 patients with different cognitive clinical syndromes and 11 cognitively normal individuals were evaluated in a memory clinic in Argentina. Clinical conditions included mild cognitive impairment (MCI, n = 12), dementia of Alzheimer's type (DAT, n = 14), behavioral variant frontotemporal dementia (bvFTD, n = 13), and primary progressive aphasia (logopenic [n = 6], semantic [n = 2], and nonfluent [n = 4]). We quantified CSF NfL and core Alzheimer's disease biomarkers using commercially available ELISA kits. Cortical thickness was analyzed on brain magnetic resonance imaging scans from 10 controls and 10 patients. CSF NfL was significantly increased in MCI, FTD, and DAT patients compared with controls (Kruskal-Wallis, p < .0001). Interestingly, receiver operating characteristic curve analysis showed the highest area under the curve (AUC) value when analyzing control versus bvFTD patients (AUC = 0.9441). Also, we observed a marginally significant correlation between NfL levels and left orbitofrontal cortex thickness in a small group of patients with FTD. Overall, our results further support CSF NfL as a promising biomarker in the diagnostic workup of bvFTD.Fil: Niikado, Matías. Fleni. Departamento de Neuropatología y Biología Molecular.Laboratorio de Biología Molecular; Argentina.Fil: Chrem Méndez, Patricio Alexis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Itzcovich, Tatiana. Fleni. Departamento de Neuropatología y Biología Molecular.Laboratorio de Biología Molecular; Argentina.Fil: Barbieri-Kennedy, Micaela. Fleni. Departamento de Neuropatología y Biología Molecular.Laboratorio de Biología Molecular; Argentina.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Martinetto, Horacio. Fleni. Departamento de Neuropatología y Biología Molecular.Laboratorio de Biología Molecular; Argentina.Fil: Serra, Mercedes. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Calvar, Jorge Andrés. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Campos, Jorge. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Russo, María Julieta. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Pertierra, Lucía. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría. Centro de Memoria y Envejecimiento; Argentina.Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular.Laboratorio de Biología Molecular; Argentina.Fil: Surace, Ezequiel Ignacio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Biología Molecular; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Video Head Impulse Test Contributes to Susac Syndrome Diagnosis
No full textResumen no disponibleFil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; ArgentinaFil: Laffue, Alfredo Hernan. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina.Fil: Fiol, Marcela Paula. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Gualtieri, Francisco José. Fleni. Departamento de Neurología. Sección de Neurootología; Argentina
Amnesia global transitoria: características clínicas y factores pronósticos sugestivos de recurrencia
Get PDFObjective: The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Our objective was to search for recurrence predictors in TGA patients.
Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model.
Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence.
Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología; Argentina.Fil: Fernández Suarez, Marcos. Fleni. Departamento de Neurología; Argentina.Fil: Heredia, María Liliana. Fleni. Centro de Rehabilitación Adultos CR. Rehabilitación Cognitiva y Lenguaje; Argentina.Fil: Chaves, Hernán. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina