Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina

Introduction/aims: Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID-19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID-19-associated lockdown. Methods: Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019. Results: An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome. Discussion: In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID-19-associated lockdown, which may be prevented with changing positions during sedentary activities.Fil: Brand, Patricio. Fleni. Departamento de Neurología; Argentina.Fil: Cejas, Claudia Patricia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Rivero, Alberto Daniel. Fleni. Departamento de Neurología. Servicio de Neurofisiología Clínica; Argentina

Evolución de la RM en el estudio del laberinto membranoso

Fil: Cejas, Claudia Patricia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina

Single cell transfection of human-induced pluripotent stem cells using a droplet-based microfluidic system

Microfluidic tools have recently made possible many advances in biological and biomedical research. Research in fields such as physics, engineering, chemistry and biology have combined to produce innovation in microfluidics which has positively impacted diverse areas such as nucleotide sequencing, functional genomics, single-cell studies, single molecules assays and biomedical diagnostics. Among these areas, regenerative medicine and stem cells have benefited from microfluidics since these tools have had a profound impact on their applications. In this study, we present a high-performance droplet-based system for transfecting individual human-induced pluripotent stem cells. We will demonstrate that this system has great efficiency in single cells and captured droplets, like other microfluidic methods but with lower cost. Moreover, this microfluidic approach can be associated with the PiggyBac transposase-based system to increase its transfection efficiency. Our results provide a starting point for subsequent applications in more complex transfection systems, single-cell differentiation interactions, cell subpopulations and cell therapy, among other potential applications.Fil: Pérez-Sosa, Camilo. Universidad Tecnológica Nacional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina.Fil: Sanluis-Verdes, Anahí. Universidad Tecnológica Nacional; Argentina.Fil: Waisman, Ariel. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Lombardi, Antonella. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Rosero, Gustavo. Universidad Tecnológica Nacional; Argentina.Fil: La Greca, Alejandro. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Bhansali, Shekhar. Florida International University. Department of Electrical and Computer Engineering; Estados Unidos.Fil: Bourguignon, Natalia. Universidad Tecnológica Nacional; Argentina. Florida International University. Department of Electrical and Computer Engineering; Estados Unidos.Fil: Luzzani, Carlos. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Pérez, Maximiliano S. Florida International University. Department of Electrical and Computer Engineering; Estados Unidos. Universidad de Buenos Aires. Institute of Biomedical Engineering; Argentina.Fil: Miriuka, Santiago Gabriel. Fleni. Laboratorio de Investigación Aplicada a las Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Lerner, Betiana. Universidad Tecnológica Nacional; Argentina. Florida International University. Department of Electrical and Computer Engineering; Estados Unidos

Monoclonal antibodies against CGRP pathway in patients with migraine. Experience in a Headache

Fil: Nagel, Vanesa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Cavanagh, Sol. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Grandinetti, Mariela. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Calvo, Daniela. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Gutierrez, Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Larripa, Natalia. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Bravo, Yasmín. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Tajan, Emilia. 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.Fil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina

La necesidad de la detección temprana de la hipertensión arterial pulmonar

Pulmonary arterial hypertension (PAH), Group 1 of the pulmonary hypertension classification, is a rare, highly complex and progressive disorder that ultimately leads to premature death. PAH causes significant physical, social, occupational, and emotional inconveniences among affected patients and their caregivers. Early diagnosis and initiation of the most optimal treatment possible are required in order to achieve the best results, trying to stop vascular remodeling and right heart failure; however, the clinical presentation of PAH is nonspecific and is often associated with other comorbidities, leading to delayed diagnosis or misdiagnosis. In recent decades, a greater understanding of the pathophysiology of PAH has led to changes in its definition, diagnosis, and treatment. In addition, contemporary PAH registries have shown higher survival rates among PAH patients and have allowed the development of risk calculation tools that are now used to drive therapeutic targets. To date, multiple PAH-specific treatments have been developed that target all 3 pathways that contribute to the pathogenesis of PAH endothelial dysfunction (prostacyclin, endothelin, and nitric oxide pathways). Because PAH is subdivided into 7 subgroups, it is essential that individuals be properly grouped to optimize treatment efficacy and complication prevention and improve outcome. Since the impairment of health-related quality of life in PAH is multifactorial, it is important for patients to be educated in the pathology, participate in the clinical decision-making process, and have access to multidisciplinary care, which will improve compliance with medical indications. There is convincing evidence that screening for PAH in high-risk populations will enable earlier diagnosis and intervention, offering a promising opportunity to improve patient outcomes. However, detection methods commonly used in clinical practice have limitations and a combination of tools or parameters may be required to improve the sensitivity and selectivity of current programs. The creation of detection algorithms for patients at risk of PAH with systemic sclerosis has increased the speed and specificity of diagnosis, potentially improving survival, and although the costs of detection remain significant, they are irrelevant given the high cost of treatment of this disease in advanced stages. The development and validation of detection algorithms for PAH of other aetiologies is required. Screening for PAH in asymptomatic patients at risk and developing screening-based approaches in symptomatic patients, where diagnosis is rarely considered, are needed to improve detection rates and reduce time to diagnosis. There is a clear and unmet need for improvements in the diagnosis, characterization and management of patients with PAH. PAH is a rapidly progressing disease, even in patients with mild symptoms, and timely therapeutic intervention is essential to influence the long-term prognosis of patients with PAH.Fil: Bevacqua, Raúl J. Hospital General de Agudos Dr. J. M. Ramos Mejía. División Cardiología; Argentina.Fil: Perrone, Sergio Victor. Fleni. Departamento de Neurología. Servicio de Cardiología; Argentina

Manejo de lesiones incidentales de la glándula pineal

Fil: Muggeri, Alejandro. Fleni. Departamento de Neurología. Servicio de Neurooncología; Argentina.Fil: Calabrese, Bernadette. Fleni. Departamento de Neurología. Servicio de Neurooncología; Argentina.Fil: Yorio, Florencia. Fleni. Departamento de Neurología. Servicio de Neurooncología; Argentina.Fil: Cerrato, Sebastián. Fleni. Departamento de Neurología. Servicio de Neurooncología; Argentina.Fil: Diez, Blanca. Fleni. Departamento de Neurología. Servicio de Neurooncología; Argentina

Predicting brain age from functional connectivity in symptomatic and preclinical Alzheimer disease

"Brain-predicted age" quantifies apparent brain age compared to normative neuroimaging trajectories. Advanced brain-predicted age has been well established in symptomatic Alzheimer disease (AD), but is underexplored in preclinical AD. Prior brain-predicted age studies have typically used structural MRI, but resting-state functional connectivity (FC) remains underexplored. Our model predicted age from FC in 391 cognitively normal, amyloid-negative controls (ages 18-89). We applied the trained model to 145 amyloid-negative, 151 preclinical AD, and 156 symptomatic AD participants to test group differences. The model accurately predicted age in the training set. FC-predicted brain age gaps (FC-BAG) were significantly older in symptomatic AD and significantly younger in preclinical AD compared to controls. There was minimal correspondence between networks predictive of age and AD. Elevated FC-BAG may reflect network disruption during symptomatic AD. Reduced FC-BAG in preclinical AD was opposite to the expected direction, and may reflect a biphasic response to preclinical AD pathology or may be driven by inconsistency between age-related vs. AD-related networks. Overall, FC-predicted brain age may be a sensitive AD biomarker.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Millar, Peter R. Washington University. Department of Neurology; Estados Unidos.Fil: Luckett, Patrick H. Washington University. Department of Neurology; Estados Unidos.Fil: Gordon, Brian A. Washington University. Department of Radiology; Estados Unidos.Fil: Benzinger, Tammie L.S. Washington University. Department of Radiology; Estados Unidos.Fil: Schindler, Suzanne E. Washington University. Department of Neurology; Estados Unidos.Fil: Fagan, Anne M. Washington University. Department of Neurology; Estados Unidos.Fil: Cruchaga, Carlos. Washington University. Department of Psychiatry; Estados Unidos.Fil: Bateman, Randall J. Washington University. Department of Neurology; Estados Unidos.Fil: Jucker, Mathias. German Center for Neurodegenerative Diseases (DZNE); Alemania. University of Tübingen. Hertie Institute for Clinical Brain Research; Alemania.Fil: Lee, Jae-Hong. University of Ulsan College of Medicine. Department of Neurology, Asan Medical Center; Corea.Fil: Mori, Hiroshi. Nagaoka Sutoku University; Japón. Osaka City University Medical School. Department of Clinical Neuroscience; Japón.Fil: Ances, Beau M. Washington University. Department of Neurology; Estados Unidos.Fil: Salloway, Stephen P. Brown University. Department of Neurology; Estados Unidos.Fil: Igor, Yakushev. Technical University of Munich. Department of Nuclear Medicine; Alemania.Fil: Morris, John C. Washington University. Department of Neurology; Estados Unidos

Is the binge-eating disorder a circadian disorder?

Fil: Soneira, Sebastian. Fleni. Servicio de Psiquiatría. Sección de Trastornos Alimentarios y Psiquiatría Nutricional; Argentina.Fil: Plano, Santiago A. Institute for Biomedical Research; Argentina. Universidad Católica Argentina; Argentina. Universidad Nacional de Quilmes/CONICET; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Tortello, Camila. Institute for Biomedical Research; Argentina. Universidad Católica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Golombek, Diego A. Universidad Nacional de Quilmes/CONICET; Argentina. Universidad de San Andrés. Escuela de Educación; Argentina

Treatment-related fluctuations in Guillain-Barré syndrome​: clinical features and predictors of recurrence

Background: A treatment-related fluctuation (TRF) in a patient with Guillain-Barré syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. Objective: To investigate the clinical characteristics and factors that could increase the risk of relapse of GBS in patients with and without TRFs. Methods: Retrospective review of medical records of patients (>18 years) with GBS evaluated between January/2006 and July/2019. Demographic and clinical characteristics, ancillary studies, treatment received, and the clinical course of patients with and without TRFs were analyzed. Results: Overall, 124 cases of GBS were included; seven (5.6%) presented TRFs. GBS-TRF cases were triggered more frequently by infectious mononucleosis (28.57 vs. 8.55%; p=0.01). GBS-TRF were initially treated with plasmapheresis more frequently than those without TRF (14.29 vs. 1.70%; p=0.0349). Combined treatment (71.43 vs. 4.27%; p<0.001) and corticosteroids (42.86 vs. 1.71%; p<0.001) were more commonly used in the GBS-TRF group. GBS-TRF patients presented a higher median initial disability score (4 vs. 2; p=0.01). Conclusions: Patients with GBS triggered by infectious mononucleosis and a high degree of initial disability have higher chances of developing TRFs. Although patients with TRF were treated with plasmapheresis more often, the total number was too low to suggest a link between plasma exchange and TRF.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Castiglione, Juan Ignacio. Fleni. Departamento de Neurología; Argentina.Fil: Brand, Patricio. Fleni. Departamento de Neurología. Sección de Enfermedades Neuromusculares; Argentina.Fil: Bruno, Verónica. University of Calgary. Hotchkiss Brain Institute. Department of Clinical Neurosciences; Canadá.Fil: Barroso, Fabio Adrián. Fleni. Departamento de Neurología. Servicio de Neurofisiología; Argentina

Case Report: Progression of a Silent Corticotroph Tumor to an Aggressive Secreting Corticotroph Tumor, Treated by Temozolomide. Changes in the Clinic, the Pathology, and the β-Catenin and α-SMA Expression

Clinically silent corticotroph tumors are usually macroadenomas that comprise 20% of ACTH tumors. They frequently progress to aggressive tumors with high recurrence, invasiveness, and on rare occasions, they may become hormonally active causing Cushing's disease. Trustable biomarkers that can predict their aggressive course, as well as their response to traditional or new therapies, are paramount. Aberrant β-Catenin expression and localization have been proposed as responsible for several malignancies including pituitary tumors. Nevertheless, the role of β-Catenin in the aggressive transformation of silent corticotropinomas and their response to Temozolomide salvage treatment have not been explored yet. In this work, we present a case of a silent corticotroph tumor that invaded cavernous sinus and compressed optic chiasm and, after a first total resection and tumor remission it recurred six years later as an aggressive ACTH-secreting tumor. This lesion grew with carotid compromise and caused Cushing's signs. It required multiple medical treatments including Cabergoline, Ketoconazole, TMZ, and radiotherapy. Besides, other two surgeries were needed until it could be controlled. Interestingly, we found α-SMA vascular area reduction and differential β-Catenin cell localization in the more aggressive tumor stages characterized by high Ki-67 indexes and p53 expression. Our results may indicate a role of angiogenesis and β-Catenin trigged events in the pituitary tumor progression, which could in turn affect the response to TMZ and/or conventional treatments. These molecular findings in this unusual case could be useful for future management of aggressive pituitary tumors.Fil: Sevlever, Gustavo Emilio. Fleni. Departamento de Neuropatología y Biología Molecular. Laboratorio de Enfermedades Neurodegenerativas; Argentina.Fil: Demarchi, Gianin. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina.Fil: Perrone, Sofía. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina.Fil: Esper Romero, Gaela. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: De Bonis, Cristian. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Casasco, Juan Pablo. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Berner, Silvia Inés. Clínica Santa Isabel. Servicio de Neurocirugía; Argentina.Fil: Cristina, Carolina. Universidad Nacional del Noroeste de la Provincia de Buenos Aires. Centro de Investigaciones Básicas y Aplicadas; Argentina. Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires; Argentina