Repositorio Institucional Fleni
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Pathological Basis for Classification (Cytomolecular Aspects)
No full textPeripheral nerve sheath tumors are neoplasms with clear morphological diagnostic features and, sometimes, nosological challenges. Their subtypes were described since the very beginning of the history of surgical pathology. Recently, they have been the subject of exciting diagnostic developments regarding their morphological and molecular characterization. Their molecular analysis has been fruitful in their classification and the understanding of the molecular pathway to malignant transformation due to their well-known relationship to genetic disorders. This approach has the added benefit of suggesting novel targeted therapeutic approaches. In this chapter, diagnostic criteria and differential diagnoses for the significant categories of nerve sheath tumors are reviewed, including neurofibroma, schwannoma, perineurioma, and malignant peripheral nerve sheath tumors (MPNSTs).
The growing current literature with hard to classify heterogeneously mixed “hybrid tumors” is discussed and illustrated.
MPNST represents a diagnostically controversial group; difficulties in grading and guidelines to separate “atypical neurofibroma” from MPNST are provided. Finally, we include differential diagnostic features between significant entities in the current WHO classification. The contemporary “omics” methodology may be useful in providing better, more biological, categorization systems. To sum up, although, for the skilled pathologists, the diagnosis and classification of the most common peripheral nerve sheath tumors are relatively reproducible, some uncertain and complex neoplasms continue to be tricky. In the current review, we intend to provide some conceptual approaches for surgeons and clinicians to safely navigate these issues.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina
Endocan, VEGF, FGF2 and PDGF Expression in Pituitary Tumors. A Precise Angiogenic Marker Relationship in the Context of Tumor Invasiveness
Full text linkBackground: Pituitary adenomas can become invasive and aggressive, and in turn produce tumor recurrence. Endocan or endothelial cell specific molecule-1 (ESM1) has been associated with angiogenesis and tumor growth in gliomas, and lung, kidney, liver among other cancers, but there is a scarcity of information regarding its role in pituitary adenomas. In the search for biomarkers of tumor behavior our objective was to determine the relationship between endocan (ESM1) mRNA expression and cavernous sinus invasion, and its association with gene expression of VEGF, FGF2 and PDGF angiogenic factors in human pituitary adenomas.
Methods: ESM1, VEGF, FGF2 and PDGF expression was determined by qRT-PCR in 28 pituitary tumor samples and tumor invasion was determined by the Knosp grade classification. Results were associated with clinical data.
Results: We found that ESM1 was expressed in 75% of the tumors. FGF2 expression was higher in ESM1-positive compared to ESM1-negative tumors, and a significant negative correlation in the expression of FGF2 and PDGF was found. Although ESM1 expression did not show any differences in invasive and non-invasive tumors, a positive correlation between ESM1 and Knosp grade was reached when grade 0-3 tumors were considered, suggesting its participation in the initial periods of tumor invasion. Finally, no difference in ESM1 expression was found between functioning and non-functioning adenomas, or patients age.
Conclusions: Our study points to a precise pattern of angiogenic factor expression in pituitary tumors, and its relation to invasive behavior, which should be considered in the tailoring of drug treatments for aggressive and resistant pituitary adenomas.Fil: Tao, Pengyou. Xuanwu Hospital; China.Fil: Perrone, Sofía. UNNOBA; Argentina.Fil: Demarchi, Gianina. UNNOBA; Argentina.Fil: Chimento, Agustina. UNNOBA; Argentina.Fil: Cervio, Andrés Eduardo. Fleni. Departamento de Neurocirugía; Argentina.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Berner, Silvia Inés. Clinica Santa Isabel. Servicio de Neurocirugia; Argentina.Fil: Becu-Villalobos, Damasia. Instituto de Biología y Medicina Experimental; Argentina.Fil: Basso, Armando. Fundación de Neurociencias Aplicadas; Argentina.Fil: Ge, Chen. Xuanwu Hospital; China.Fil: Ling, Feng. Xuanwu Hospital; China.Fil: Zhang, Qiuhang. Xuanwu Hospital; China.Fil: Cristina, Carolina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina
Rivaroxaban versus aspirin for prevention of covert brain infarcts in patients with embolic stroke of undetermined source: NAVIGATE ESUS MRI substudy
No full textBackground
Covert brain infarcts are associated with important neurological morbidity. Their incidence in patients with embolic stroke of undetermined source (ESUS) is unknown.
Aims
To assess the incidence of covert brain infarcts and cerebral microbleeds using MRI in a prospective substudy of the NAVIGATE ESUS randomized trial and to evaluate the effects of antithrombotic therapies.
Methods
At 87 sites in 15 countries, substudy participants were randomly assigned to receive rivaroxaban 15 mg daily or aspirin 100 mg daily and underwent brain MRI near randomization and after study termination. The primary outcome was incident brain infarct (clinical ischemic stroke or covert brain infarct). Brain infarcts and microbleeds were ascertained centrally by readers unaware of treatment. Treatment effects were estimated using logistic regression.
Results
Among the 718 substudy participants with interpretable, paired MRIs, the mean age was 67 years and 61% were men with a median of 52 days between the qualifying ischemic stroke and randomization and a median of seven days between randomization and baseline MRI. During the median (IQR) 11 (12) month interval between scans, clinical ischemic strokes occurred in 27 (4%) participants, while 60 (9%) of the remaining participants had an incident covert brain infarct detected by MRI. Assignment to rivaroxaban was not associated with reduction in the incidence of brain infarct (OR 0.77, 95% CI 0.49, 1.2) or of covert brain infarct among those without clinical stroke (OR 0.85, 95% CI 0.50, 1.4). New microbleeds were observed in 7% and did not differ among those assigned rivaroxaban vs. aspirin (HR 0.95, 95% CI 0.52–1.7).
Conclusions
Incident covert brain infarcts occurred in twice as many ESUS patients as a clinical ischemic stroke. Treatment with rivaroxaban compared with aspirin did not significantly reduce the incidence of covert brain infarcts or increase the incidence of microbleeds, but the confidence intervals for treatment effects were wide.Fil: Sharma, Mukul. McMaster University; Canadá.Fil: Smith, Eric E. University of Calgary; Canadá.Fil: Pearce, Lesly A. St. Catharines; Canadá.Fil: Perera, Kanjana S. McMaster University; Canadá.Fil: Kasner, Scott E. University of Pennsylvania; Estados Unidos.Fil: Yoon, Byung-Woo. Seoul National University Hospital; Corea del Sur.Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Puig, Josep. Hospital Dr. Josep Trueta; España.Fil: Damgaard, Dorte. Aarhus University Hospital; Dinamarca.Fil: Fiebach, Jochen B. Universitatsmedizin Berlin; Alemania.Fil: Muir, Keith W. University of Glasgow; Reino Unido.Fil: Veltkamp, Roland C. Imperial College London; Reino Unido.Fil: Toni, Danilo S. "Sapienza" University of Rome; Italia.Fil: Shamalov, Nikolay. Federal Medical Biological Agency; Rusia.Fil: Gagliardi, Rubens J. Irmandade da Santa Casa de Misericórdia de São Paulo; BrasilFil: Mikulik, Robert. Masaryk University; República Checa.Fil: Engelter, Stefan T. University of Basel; Suiza.Fil: Bereczki, Daniel. Semmelweis University; Hungría.Fil: O'Donnell, Martin J. National University Ireland; Irlanda.Fil: Saad, Feryal. University of Calgary; Canadá
Manejo clínico de la hipertensión arterial pulmonar. Relevancia del ventrículo derecho
No full textLa hipertensión arterial pulmonar (HAP) requiere procesos estructurados de diagnóstico y estratificación de riesgo, siendo la función del ventrículo derecho (VD) un marcador pronóstico central. Los
principales objetivos terapéuticos en la HAP son mejorar y/o intentar revertir la disfunción del VD y mantener
condición de bajo riesgo. Actualmente existen múltiples fármacos con diferentes mecanismos de acción cuya
combinación en doble o triple terapia ha mostrado mejores resultados que la monoterapia. Evidencia actual
demuestra la importancia de incorporar tempranamente prostanoides parenterales al esquema, mejorando la
funcionalidad del VD y la supervivencia. En esta revisión se refleja el papel de la función del VD en el diagnóstico, pronóstico y seguimiento de la HAP. Se recomienda la evaluación sistemática y estandarizada del VD, así
como el inicio temprano de tratamiento combinado en riesgo intermedio-alto para obtener las metas de alcanzar
y mantener un riesgo bajo y/o evitar la progresión de la HAP.Fil: Conde, Rafael E. Fundación Neumológica Colombiana; Colombia.Fil: Diez, Mirta. Instituto Cardiovascular de Buenos Aires; Argentina.Fil: Dueñas, Rubén. Clínica Shaio; Colombia.Fil: Giacomi, Guillermo. Hospital Interzonal de Agudos Oscar Alende; Argentina.Fil: Lema, Luis. Instituto Modelo de Cardiología; Argentina.Fil: Lescano, Adrián. Sanatorio Trinidad Quilmes; Argentina.Fil: Perna, Eduardo R. Instituto de Cardiología J. F. Cabral; Argentina.Fil: Zayas Hernández, Nayeli. Instituto Nacional de Cardiología Ignacio Chávez; México.Fil: Perrone, Sergio Víctor. Fleni. Servicio de Cardiología; Argentina. Hospital de Alta Complejidad en Red EL Cruce - Néstor Kirchner; Argentina. Instituto Argentino de Diagnóstico y Tratamiento; Argentina
Risk factors for respiratory failure among hospitalized patients with Guillain-Barré syndrome
No full textBackground: Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy that can lead to respiratory failure. In this study, we evaluate early clinical risk factors for respiratory failure at the time of hospital admission.
Methods: We studied a retrospective cohort of patients with GBS admitted to a tertiary care center. The potential risk factors studied were sociodemographic characteristics, GBS symptoms, overall and cervical muscle weakness (Medical Research Council [MRC] scores), electromyography findings, and cerebrospinal fluid analysis findings. Unadjusted odds ratios (OR) were calculated and exact logistic regression analysis (adjusted OR) performed to assess the association between baseline risk factors and respiratory failure.
Results: Overall, 13 of 113 (12%) patients included in the study developed respiratory failure. Unadjusted analyses showed that involvement of any cranial nerve (OR: 14.7; 95% CI, 1.8-117.1), facial palsy (OR: 17.3; 95% CI, 2.2-138.0), and bulbar weakness (OR: 10.7; 95% CI, 2.3-50.0) were associated with increased risk of respiratory failure. Lower MRC sum scores (for scores 3) were independently associated with respiratory failure.
Conclusions: Bulbar and neck muscle weakness at admission are clinical predictors of increased risk of respiratory failure in patients with GBS. These findings could guide the adequate management of high-risk patients.Fil: Maskin, Luis Patricio. Fleni. Departamento de Medicina Interna; Argentina.Fil: Wilken, Miguel. Fleni. Departamento de Neurología; Argentina.Fil: Rodríguez Lucci, Federico. Fleni. Departamento de Medicina Interna; Argentina.Fil: Wisnivesky, J. P. Icahn School of Medicine at Mount Sinai; Estados Unidos.Fil: Barroso, Fabio Adrián. Fleni. Departamento de Neurología. Sección de Enfermedades Neuromusculares; Argentina.Fil: Wainsztein, Néstor Adrián. Fleni. Departamento de Medicina Interna; Argentina
Personalized functional connectivity analysis in responders and nonresponders to ketamine and electroconvulsive therapy: A case series
No full textObjective
Major depressive disorder is a common medical problem, frequently resistant to antidepressant treatments. We sought to describe functional connectivity correlates of response and non-response to rapid-acting antidepressants in patients with treatment-resistant depression.
Methods
We performed an MRI-based, BOLD functional connectivity analysis on three patients with treatment-resistant depression, with varying degrees of response to electroconvulsive therapy (ECT) or intravenous subanesthetic ketamine.
Results
Response to treatment was associated with an increase of positive correlations and increased connectivity of bilateral frontal, subcortical, right temporal and right occipital regions. Treatment nonresponse was associated with an increase in negative correlations between frontal lobes and their respective contra- and ipsilateral parietal and occipital lobes.
Conclusion
Response to rapid-acting treatments was associated in this case series to increased functional connectivity, especially in homologous regions of both hemispheres. If replicated in a bigger sample, this correlate of response can provide insights into mechanisms of rapid-acting antidepressant treatment response.Fil: Fazzito, María Lucía. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Argentina. Universidad de Buenos Aires; Argentina.Fil: Gonzalez, Juan José. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina.Fil: Fiorentini, Leticia. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina.Fil: Leiman, Marina. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina.Fil: Pérez, Adriana. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina.Fil: Costanzo, Elsa. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina. Laureate Institute for Brain Research; Estados Unidos.Fil: Villarreal, Mirta F. Fleni. Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Argentina. Universidad de Buenos Aires; Argentina.Fil: Guinjoan, Salvador M. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina. Laureate Institute for Brain Research; Estados Unidos
Tratamiento preventivo en migraña: anticuerpos monoclonales contra la vía del péptido relacionado con el gen de la calcitonina
No full textLa migraña es un trastorno muy prevalente que afecta a alrededor del 15% de los sujetos adultos.
Es clasificada por la Organización Mundial de la Saludentre los primeros puestos como causa de
discapacidad. Los tratamientos preventivos habituales hasta ahora derivan de otras indicaciones y por serendipia
se utilizan en prevención de migraña: betabloqueantes, drogas antiepilépticas, antidepresivos tricíclicos, bloqueantes de canales de calcio, toxina botulínica. Todas ellas han mostrado eficacia similar al 50% en reducir el número
de episodios migrañosos pese a efectos secundarios indeseados. Durante los últimos años, se ha evaluado la
eficacia y seguridad de los anticuerpos monoclonales (AM) que actúan sobre la vía del péptido relacionado con
el gen de la calcitonina (CGRP) en migraña. Dicho péptido es relevante en la activación del dolor en territorio
meníngeoy es mediado por terminales nerviosas trigeminales una vez activado el proceso migrañoso. Su dosaje
en crisis migrañosas ha sido elevado en diversos estudios y su neutralización/bloqueo, redunda en alivio del
dolor. Los anticuerpos monoclonales erenumab, galcanezumab, fremanezumab, eptinezumab aprobados en el
mercado EE.UU./Europa desde 2018 y tras varios trabajos de Fase III y abiertos de extensión, mostraron clara
seguridad yeficacia y están presentes en nuestro medio desde mediados de 2019. Desarrollamos la racionalidad
e indicaciones de uso de los mismos.Fil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Bonamico, Lucas. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina
celldeath: A tool for detection of cell death in transmitted light microscopy images by deep learning-based visual recognition
No full textCell death experiments are routinely done in many labs around the world, these experiments are the backbone of many assays for drug development. Cell death detection is usually performed in many ways, and requires time and reagents. However, cell death is preceded by slight morphological changes in cell shape and texture. In this paper, we trained a neural network to classify cells undergoing cell death. We found that the network was able to highly predict cell death after one hour of exposure to camptothecin. Moreover, this prediction largely outperforms human ability. Finally, we provide a simple python tool that can broadly be used to detect cell death.Fil: La Greca, Alejandro Damián. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Pérez, Nelba. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Castañeda, Sheila. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Milone, Paula Melania. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Scarafía, María Agustina. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Möbbs, Alan Miqueas. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Waisman, Ariel. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Moro, Lucía Natalia. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Sevlever, Gustavo Emilio. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina.Fil: Luzzani, Carlos Daniel. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Miriuka, Santiago Gabriel. Fleni. Laboratorio de Investigación Aplicada a Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Biomarcadores radiológicos en RM para una aproximación al diagnóstico molecular en gliomas IDH-mutados (grado II y III)
No full textObjetivo:
Analizar características por resonancia magnética (RM) de gliomas IDH-mutados (grado II y III) en base a parámetros cualitativos, a fin de valorar el rendimiento del signo del mismatch T2-FLAIR y otras características morfológicas de los tumores, en predecir el estado del 1p/19q y su reproducibilidad interobservador. Métodos Estudio retrospectivo, descriptivo y analítico sobre una cohorte de 53 gliomas IDH-mutados (grado II y III) y molecularmente definidos respecto al 1p/19q, seleccionados a partir de la base de datos de la institución, durante el periodo 2014- 2019. Dos neuroradiólogos evaluaron características imagenológicas de forma independiente y enmascarada al diagnóstico: mismatch T2-FLAIR, localización tumoral, bordes, señal, infiltración cortical e inhomogeneidad en T2. Los casos discordantes fueron evaluados por un tercer neuroradiólogo de mayor experiencia.
Resultados:
Treinta de 53 (56,6%) gliomas fueron no codelecionados, y 23/53 (43,4%) codelecionados. El signo del mismatch T2-FLAIR fue positivo en 16/53 (30,18%) pacientes, 15/16 (93,75%) no codelecionados y 1/16 (6,25%) codelecionado (Exacto de Fisher p = <,0001). Los dos evaluadores demostraron una concordancia interobservador casi perfecta para ese signo, κ =,907 (95% CI, 0,781 a 1,0). La especificidad y el valor predictivo positivo del signo para predecir la ausencia de la codeleción fue de un 95,7% y un 93,8% respectivamente.
Discusión:
La reciente actualización en la clasificación de los gliomas los clasifica acorde a su perfil molecular. En los últimos años, varios investigadores han estudiado características morfológicas por RM de los tumores con la intención de predecir las características moleculares de los mismos.
Conclusión:
En nuestra población, el signo del mismatch T2-FLAIR es el único biomarcador radiológico que muestra asociación estadísticamente significativa en predecir la ausencia de codeleción en los gliomas IDH-mutados (grado II y III), con una alta especificidad y un alto valor predictivo positivo.Fil: Darakdjian, Maximiliano. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Osa Sanz, Emilia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Hernández Pinzón, Jairo. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Carnevale, Martín. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Diebel, Alfonsina. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Arakaki, Naomi. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Martinetto, Horacio Enrique. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular; Argentina.Fil: Yáñez, Paulina. Fleni. Departamento de Diagnóstico por Imágenes; Argentina
Clinical and demographic characteristics of male MS patients included in the national registry-RelevarEM. Does sex or phenotype make the difference in the association with poor prognosis?
No full textBackground
In multiple sclerosis demographics there is a well-known female prevalence and male patients have been less specifically evaluated in clinical studies, though some clinical differences have been reported between sexes.
Objective
The objective of this study was to assess clinical and demographic differences between male and female patients included in the national Argentine MS Registry-RelevarEM.
Material and methods
This study was observational, retrospective, and was based on the data of 3099 MS patients included as of 04 April 2021. The statistical analysis plan included bivariate analyses with the crude data and also after adjustment for the MS phenotype, further categorized as progressive-onset MS or relapsing-onset MS. In the adjusted analysis, the Mantel-Haenszel odds ratio was compared to the crude odds ratio, to account for the phenotype as a confounder.
Results
The data from 1,074 (34.7%) men and 2,025 (65.3%) women with MS diagnosis were analysed. Males presented primary progressive disease two times more often than women (11% and 5%, respectively). In the crude analyses by sex, the presence of exclusively infratentorial lesions in the magnetic resonance imaging studies was more frequent in males than in females, but after adjustment by MS onset phenotype, such difference was only present in males with relapsing-onset MS (p = 0.00006). Similarly, worse Expanded Disability Status Scale scores were confirmed only in men with relapsing-onset disease after phenotype adjustment (p = 0.02).
Conclusion
We did not find any statistically significant clinical or demographic difference between sexes when the progressive MS phenotype was specifically considered. However, the differences we found between the clinical phenotypes are in line with the literature and highlight the importance of stratifying the analyses by sex and phenotype when designing MS studies.Fil: Luetic, Geraldine G. Instituto de Neurociencias de Rosario; Argentina.Fil: Menichini, María Laura. Instituto de Neurociencias de Rosario; Argentina.Fil: Vrech, Carlos. Sanatorio Allende; Argentina.Fil: Pappolla, Agustín. Hospital Italiano de Buenos Aires; Argentina.Fil: Patrucco, Liliana. Centro de esclerosis múltiple de Buenos Aires; Argentina.Fil: Cristiano, Edgardo. Centro de esclerosis múltiple de Buenos Aires; Argentina.Fil: Marrodán, Mariano. 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: Fiol, Marcela. 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: Cohen, Leila. Hospital Ramos Mejía; Argentina.Fil: Alonso, Ricardo. Hospital Ramos Mejía; Argentina.Fil: Silva, Berenice. Hospital Ramos Mejía; Argentina.Fil: Casas, Magdalena. Hospital Ramos Mejía; Argentina.Fil: Garcea, Orlando. Hospital Ramos Mejía; Argentina.Fil: Deri, Norma. Centro de Investigaciones Diabaid; Argentina.Fil: Burgos, Marcos. Hospital San Bernardo;Argentina.Fil: Liwacki, Susana. Clínica Universitaria Reina Fabiola; Argentina.Fil: Tkachuk, Verónica. Hospital de Clínicas José de San Martín; Argentina.Fil: Barboza, Andrés G. Hospital Central de Mendoza; Argentina