Predictores de respuesta favorable a la colocación de derivación ventriculoperitoneal en pacientes con hidrocefalia normotensiva idiopática

Introduction: The indication of a ventriculoperitoneal shunt (VPS) is discussed in patients with idiopathic normal pressure hydrocephalus (iNPH), due to the heterogeneity of the response to treatment and the risks involved in neurosurgery. Objective: To search for clinical factors and complementary studies in order to determine predictors of a favorable response to the VPS placement in patients with iNPH. Methodology: A retrospective study of patients with probable iNPH (according to international guidelines) treated with VPS assisted in a neurological clinic from January 2014 to January 2017 was conducted. A univariate statisticalanalysis of the variables considered as possible prognostic factors was performed. Results: 58 patients were included. Women presented 3.68 times more chances of improvement after the VPS (p=0.019). Good response to the gait test was associated with better response to the VPS (p=0.024). Conclusions: Female sex and good response to the gait test could be considered as predictors of a favorable response to the VPS placement in patients with iNPH. A prospective study is necessary to achieve a homogeneous diagnostic evaluation and a more extensive longitudinal follow-up to evaluate the clinical evolution in this group of patients.Introducción: La indicación de la derivación ventriculoperitoneal (DVP) se discute en pacientes con hidrocefalia normotensiva idiopática (HNTi), debido a la heterogeneidad de la respuesta al tratamiento y los riesgos que conlleva la neurocirugía. Objetivo: Búsqueda de factores clínicos y estudios complementarios, para determinar predictores de respuesta favorable a la colocación de DVP en pacientes con HNTi. Metodología: Estudio retrospectivo de pacientes con probable HNTi (según guías internacionales) tratados con DVP asistidos en una clnica neurológica desde enero de 2014 hasta enero de 2017. Se realizó un análisis estadístico univariado de las variables consideradas como posibles factores pronósticos. Resultados: seincluyeron 58 pacientes. Las mujeres presentaron 3,68 veces más posibilidades de mejora tras la DVP (p=0,019). La buena respuesta a la prueba de la marcha se asoció con una mejor respuesta a la DVP (p=0,024). Conclusiones: el sexo femenino y la buena respuesta a la prueba de la marcha podrían  considerarse predictores de una respuesta favorable a la colocación de la DVP en pacientes con HNTi. Es necesario un estudio prospectivo para lograr una evaluación diagnóstica homogénea y un seguimiento longitudinal más extenso para evaluar la evolución clínica en este grupo de pacientes

Realidad de las estructuras organizacionales en el sector público Ecuatoriano 2007-2016

The objective is to evaluate the methodological application of the Organization and Administration by Processes and its incidence in the planning of human talent in the Ecuadorian public sector, based on the current normative framework during the analysis period. From six coordinating ministries existing until April 2017, the Coordinating Ministry of Social Development was selected for the study, with its ministries attached, analyzing the information published on the web page of each institution, which is required by the Organic Law of Transparency and access to Public information. It was evidenced that these institutions have partially observed both the Process Administration Technical Standard and the Human Resources Planning Subsystem, leaving open the possibility of creating new products or services, which implies formulating new processes that "justify" the demand number of servers, especially in adjective macroprocesses that manage administrative processes, to the detriment of value-adding macroprocesses, related to the institutional mission, causing an imbalance in the allocation of servers, with an excess of personnel in adjective macroprocesses and / or insufficient staff in the value aggregators and governors, with the consequent budgetary impact.El objetivo de este trabajo es evaluar la aplicación metodológica de la Organización y Administración por Procesos y su incidencia en la planificación del talento humano en el sector público ecuatoriano, en base al marco normativo vigente en el período de análisis. De los seis ministerios coordinadores existentes hasta abril del 2017, se seleccionó para el estudio el Ministerio Coordinador de Desarrollo Social, con sus ministerios adscritos, y se analizó la información publicada en la página web de cada institución, de obligado cumplimiento por la Ley Orgánica de Transparencia y Acceso a la Información Pública. Se evidenció que estas instituciones han observado parcialmente tanto la Norma Técnica de Administración de Procesos, como la del Subsistema de Planificación de Recursos Humanos, dejando abierta la posibilidad de crear nuevos productos o servicios, lo que implica formular nuevos procesos que “justifiquen” la demanda del número de servidores, especialmente en los macroprocesos adjetivos que gestionan procesos administrativos, en detrimento de los macroprocesos agregadores de valor, relacionados con la misión institucional. De esta manera, se provoca un desequilibrio en la asignación de servidores, con un exceso de personal en los macroprocesos adjetivos y/o insuficiente personal en los agregadores de valor y gobernantes, con el consiguiente impacto presupuestario

European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs

Disease-modifying therapy; Infections; VaccinationTeràpia modificadora de la malaltia; Infeccions; VacunacióTerapia modificadora de la enfermedad; Infecciones; VacunaciónBackground and purpose With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy. We aimed to develop a European evidence-based consensus for the vaccination strategy of pwMS who are candidates for disease-modifying therapies (DMTs). Methods This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk–benefit balance. Results Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in subpopulations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus. Conclusion This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS

Adaptive Autoimmunity and Foxp3-Based Immunoregulation in Zebrafish

Background: Jawed vertebrates generate their immune-receptor repertoire by a recombinatorial mechanism that has the potential to produce harmful autoreactive lymphocytes. In mammals, peripheral tolerance to self-antigens is enforced by Foxp3+ regulatory T cells. Recombinatorial mechanisms also operate in teleosts, but active immunoregulation is thought to be a late incorporation to the vertebrate lineage. Methods/Principal Findings: Here we report the characterization of adaptive autoimmunity and Foxp3-based immunoregulation in the zebrafish. We found that zebrafish immunization with an homogenate of zebrafish central nervous system (zCNS) triggered CNS inflammation and specific antibodies. We cloned the zebrafish ortholog for mammalian Foxp3 (zFoxp3) which induced a regulatory phenotype on mouse T cells and controlled IL-17 production in zebrafish embryos. Conclusions/Significance: Our findings demonstrate the acquisition of active mechanisms of self-tolerance early in vertebrate evolution, suggesting that active regulatory mechanisms accompany the development of the molecular potential for adaptive autoimmunity. Moreover, they identify the zebrafish as a tool to study the molecular pathways controlling adaptive immunity

Effects of systolic blood pressure on brain integrity in multiple sclerosis

Background: In MS patients, hypertension is associated with a delayed diagnosis and an increased risk of progression. Understanding the mechanisms of this association could potentially lead to improved prevention of disease progression. We aimed to establish whether high blood pressure contributes to white-matter injury and brain atrophy in MS. Methods: Cross-sectional study of 95 patients with RRMS. Estimates of fractional anisotropy, gray-matter volume and lesion load were obtained from 3T MRI. We used fractional anisotropy voxel-based statistics to establish the effect of blood pressure on white matter tracts. Additionally, we used voxel-based morphometry (VBM) to study the effect on gray matter integrity. Results: Only 29.5% had normal blood pressure levels, with 52.6% suffering from prehypertension and 17.9% with hypertension. Increasing systolic blood pressure was associated with damage to posterior white-matter tracts as well as greater levels of gray matter atrophy, in particular in the frontal cortex. Age-adjusted linear regression indicated that neither lesion volume (β = 0.002, 95%CI: 0.02-0.02; p = 0.85) or lesion number (β = -0.004, 95%CI: 0.03-0.02; p = 0.74) were associated with systolic blood pressure. Conclusions: Prehypertension and hypertension are frequent in MS. Increased blood pressure is related to white- and gray-matter integrity, both related to MS disability outcomes. These findings suggest attention to the control of blood pressure in MS patients.Fil: Dossi, Daiana. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Chaves, Hernán. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Heck, Evelyn Sabrina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Rodriguez Murua, Sofia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ventrice, Fernando. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Bakshi, Rohit. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Quintana, Francisco Javier. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Correale, Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Farez, Mauricio Franco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentin

Brain volumes quantification from MRI in healthy controls: Assessing correlation, agreement and robustness of a convolutional neural network-based software against FreeSurfer, CAT12 and FSL

Background and purpose: There are instances in which an estimate of the brain volume should be obtained from MRI in clinical practice. Our objective is to calculate cross-sectional robustness of a convolutional neural network (CNN) based software (Entelai Pic) for brain volume estimation and compare it to traditional software such as FreeSurfer, CAT12 and FSL in healthy controls (HC). Materials and Methods: Sixteen HC were scanned four times, two different days on two different MRI scanners (1.5 T and 3 T). Volumetric T1-weighted images were acquired and post-processed with FreeSurfer v6.0.0, Entelai Pic v2, CAT12 v12.5 and FSL v5.0.9. Whole-brain, grey matter (GM), white matter (WM) and cerebrospinal fluid (CSF) volumes were calculated. Correlation and agreement between methods was assessed using intraclass correlation coefficient (ICC) and Bland Altman plots. Robustness was assessed using the coefficient of variation (CV). Results: Whole-brain volume estimation had better correlation between FreeSurfer and Entelai Pic (ICC (95% CI) 0.96 (0.94−0.97)) than FreeSurfer and CAT12 (0.92 (0.88−0.96)) and FSL (0.87 (0.79−0.91)). WM, GM and CSF showed a similar trend. Compared to FreeSurfer, Entelai Pic provided similarly robust segmentations of brain volumes both on same-scanner (mean CV 1.07, range 0.20–3.13% vs. mean CV 1.05, range 0.21–3.20%, p = 0.86) and on different-scanner variables (mean CV 3.84, range 2.49–5.91% vs. mean CV 3.84, range 2.62–5.13%, p = 0.96). Mean post-processing times were 480, 5, 40 and 5 min for FreeSurfer, Entelai Pic, CAT12 and FSL respectively. Conclusion: Based on robustness and processing times, our CNN-based model is suitable for cross-sectional volumetry on clinical practice.Fil: Chaves, Hernan. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Dorr, Francisco. Entelai; ArgentinaFil: Costa, Martín Elías. Entelai; ArgentinaFil: Serra, María Mercedes. Entelai; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Fernandez Slezak, Diego. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Entelai; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Investigación en Ciencias de la Computación. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Investigación en Ciencias de la Computación; ArgentinaFil: Farez, Mauricio Franco. Entelai; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Sevlever, Gustavo. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Entelai; ArgentinaFil: Yañez, Paulina Celia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Universidad de Buenos Aires; ArgentinaFil: Cejas, Claudia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin

COVID-19 pneumonia accurately detected on chest radiographs with artificial intelligence

PurposeTo investigate the diagnostic performance of an Artificial Intelligence (AI) system for detection of COVID-19 in chest radiographs (CXR), and compare results to those of physicians working alone, or with AI support.Materials and methodsAn AI system was fine-tuned to discriminate confirmed COVID-19 pneumonia, from other viral and bacterial pneumonia and non-pneumonia patients and used to review 302 CXR images from adult patients retrospectively sourced from nine different databases. Fifty-four physicians blind to diagnosis, were invited to interpret images under identical conditions in a test set, and randomly assigned either to receive or not receive support from the AI system. Comparisons were then made between diagnostic performance of physicians working with and without AI support. AI system performance was evaluated using the area under the receiver operating characteristic (AUROC), and sensitivity and specificity of physician performance compared to that of the AI system.ResultsDiscrimination by the AI system of COVID-19 pneumonia showed an AUROC curve of 0.96 in the validation and 0.83 in the external test set, respectively. The AI system outperformed physicians in the AUROC overall (70% increase in sensitivity and 1% increase in specificity, p < 0.0001). When working with AI support, physicians increased their diagnostic sensitivity from 47% to 61% (p < 0.001), although specificity decreased from 79% to 75% (p = 0.007).ConclusionsOur results suggest interpreting chest radiographs (CXR) supported by AI, increases physician diagnostic sensitivity for COVID-19 detection. This approach involving a human-machine partnership may help expedite triaging efforts and improve resource allocation in the current crisis.Fil: Dorr, Francisco. Entelai; ArgentinaFil: Chaves, Hernán. Entelai; Argentina. Fundación P/la Lucha C/enferm. neurológicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Serra, María Mercedes. Entelai; Argentina. Fundación P/la Lucha C/enferm. neurológicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Ramirez, Andres. Entelai; ArgentinaFil: Costa, Martín Elías. Entelai; ArgentinaFil: Seia, Joaquín Oscar. Entelai; ArgentinaFil: Cejas, Claudia. Fundación P/la Lucha C/enferm. neurológicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Castro, Marcelo. Departamento de Diagnóstico por Imágenes, Clínica Indisa ; ChileFil: Eyheremendy, Eduardo. Hospital Alemán; ArgentinaFil: Fernández Slezak, Diego. Entelai; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Investigación en Ciencias de la Computación. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Investigación en Ciencias de la Computación; ArgentinaFil: Farez, Mauricio Franco. Entelai; Argentina. Fundación P/la Lucha C/enferm. neurológicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Lesiones medulares catastróficas en el rugby argentino. Impacto de las medidas implementadas y su reducción relativa en el tiempo

Introducción: Se entiende por lesión catastrófica a cualquier trauma grave que comprometa la cabeza, el cerebro, la columna vertebral o la médula espinal, que pone en riesgo la vida o puede dejar una discapacidad permanente o semipermanente. En la Argentina, la incidencia de lesionados en el ámbito del rugby es alta comparada con la de otros países. En los últimos años, se han implementado múltiples medidas de prevención y se han modificado normas con el objetivo de evitar las lesiones catastróficas. Materiales y Métodos: Se analizaron datos obtenidos de una encuesta telefónica realizada en el marco de colaboración entre la Unión Argentina de Rugby y la Fundación para la Lucha de Enfermedades Neurológicas de la Infancia (Fleni). Se realizó un análisis descriptivo de los datos. Se recopilaron los cambios en las normativas del deporte, que pudieran tener impacto en las futuras lesiones. Resultados: Se observa que el número de lesiones se mantiene estable año tras año. Al asociar este dato con un aumento sostenido de la cantidad de jugadores por año, impresiona haber una disminución relativa del riesgo de lesionarse. Conclusiones: Las lesiones catastróficas generan un gran impacto en la calidad de vida del jugador y de su entorno. Deben considerarse inadmisibles y se deben incrementar los esfuerzos para lograr eliminar los riesgos de lesionarse. El esfuerzo de las entidades reguladoras impresiona tener un impacto positivo al haberse logrado una reducción relativa de las lesiones en relación con el aumento de jugadores año tras año

CONDUÇÃO E DOENÇA DE ALZHEIMER: UMA BATERIA DE TRIAGEM NEUROPSICOLÓGICA PARA IDOSOS

As life expectancy increases, there is a marked increase in the elderly population eager to continue driving. A large proportion of these elderly drive safely, however, patients with mild dementia are high-risk drivers. Objective: to identify the cognitive tests that best predict driving ability in subjects with mild dementia. Methods: 28 drivers with mild dementia and 28 healthy elderly subjects underwent an extensive cognitive assessment (NACC Uniform Data Set Neuropsychological Battery), completed an adapted On Road Driving Test (ORDT) and a Driving Simulator assessment. Results: drivers with mild dementia made more mistakes on the ORDT and had slower responses in the simulator tasks. Cognitive tests correlated strongly with on road and simulator driving performance. Age, the Digit Symbol Modalities Test and Boston Naming Test scores were the variables that best predicted performance on the ORDT and were included in a logistic regression model. Conclusion: the strong correlation between driving performance and performance on specific cognitive tests supports the importance of cognitive assessment as a useful tool for deciding whether patients with mild dementia can drive safely. The algorithm including these three variables could be used as a screening tool for the detection of unsafe driving in elderly subjects with cognitive decline

Effects of Systolic Blood Pressure on Brain Integrity in Multiple Sclerosis

Background: In MS patients, hypertension is associated with a delayed diagnosis and an increased risk of progression. Understanding the mechanisms of this association could potentially lead to improved prevention of disease progression. We aimed to establish whether high blood pressure contributes to white-matter injury and brain atrophy in MS.Methods: Cross-sectional study of 95 patients with RRMS. Estimates of fractional anisotropy, gray-matter volume and lesion load were obtained from 3T MRI. We used fractional anisotropy voxel-based statistics to establish the effect of blood pressure on white matter tracts. Additionally, we used voxel-based morphometry (VBM) to study the effect on gray matter integrity.Results: Only 29.5% had normal blood pressure levels, with 52.6% suffering from prehypertension and 17.9% with hypertension. Increasing systolic blood pressure was associated with damage to posterior white-matter tracts as well as greater levels of gray matter atrophy, in particular in the frontal cortex. Age-adjusted linear regression indicated that neither lesion volume (β = 0.002, 95%CI: 0.02–0.02; p = 0.85) or lesion number (β = −0.004, 95%CI: 0.03–0.02; p = 0.74) were associated with systolic blood pressure.Conclusions: Prehypertension and hypertension are frequent in MS. Increased blood pressure is related to white- and gray-matter integrity, both related to MS disability outcomes. These findings suggest attention to the control of blood pressure in MS patients