Changes in the Care of Neurological Diseases During the First Wave of the COVID-19 Pandemic: A Single Private Center Study in Argentina

Introduction: Healthcare systems are struggling to cope with the rapid evolution of the COVID-19 pandemic. In Argentina, the pandemic is advancing despite prolonged lockdown measures. We aim to analyze the impact of the easing of lockdown measures in the number of visits to the emergency department (ED), and outpatient consultations (OC) to a tertiary neurological center. Methods: We compared the number of ED visits with the social mobility overtime. We also compared the number of OC, and the geographic distribution of patients' addresses between 2019 and 2020. Results: ED visits decreased 48.33% (n = 14,697 in 2019 vs. n = 7,595 in 2020). At the beginning of the lockdown, the social mobility decreased in pharmacies/groceries, and workplaces, along with a reduction in the number of ED visits. With the easing of lockdown restrictions, the social mobility decreased in residential places, slightly increased in workplaces and almost return to normal in pharmacies/groceries. Variations in ED visits correlate better with social mobility in workplaces (coef. =0.75, p < 0.001) than in groceries/pharmacies (coef. =0.68, p < 0.001). OC decreased 43%. Fourteen percent of OC were tele consults. This was associated with an increase of the geographical area of influence of our center (standard distance of 109 km in 2019 and 127 km in 2020). Conclusions: Despite an increase in social mobility, the number of ED visits and OC to an Argentinian tertiary neurological center remain worrisomely low. The pandemic catalyzed the introduction of telemedicine in our country. This has also allowed patients from distant zones to gain access to specialized neurological care.Fil: Calandri, Ismael L.. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Hawkes, Maximiliano Alberto. University of Nebraska; Estados UnidosFil: Marrodan, Mariano. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Ameriso, Sebastian Francisco. 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: Allegri, Ricardo Francisco. 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

Clinically relevant increases in serum neurofilament light chain and glial fibrillary acidic protein in patients with Susac syndrome

Background and purpose: Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are promising neuro-axonal damage and astrocytic activation biomarkers. Susac syndrome (SS) is an increasingly recognized neurological condition and biomarkers that can help assess and monitor disease evolution are highly needed for the adequate management of these patients. sNfL and sGFAP levels were evaluated in patients with SS and their clinical relevance in the relapse and remission phase of the disease was assessed. Methods: As part of a multicentre study that enrolled patients diagnosed with SS from six international centres, sNfL and sGFAP levels were assessed in 22 SS patients (nine during a relapse and 13 in remission) and 59 age- and sex-matched healthy controls using SimoaTM assay Neurology 2-Plex B Kit. Results: Serum NfL levels were higher than those of healthy controls (p &lt; 0.001) in SS patients and in both subgroups of patients in relapse and in remission (p &lt; 0.001 for both), with significantly higher levels in relapse than in remission (p = 0.008). sNfL levels showed a negative correlation with time from the last relapse (r = -0.663; p = 0.001). sGFAP levels were slightly higher in the whole group of patients than in healthy controls (p = 0.046) and were more pronounced in relapse than in remission (p = 0.013). Conclusion: In SS patients, both sNFL and sGFAP levels increased compared with healthy controls. Both biomarkers had higher levels during clinical relapse and much lower levels in remission. sNFL was shown to be time sensitive to clinical changes and can be useful to monitor neuro-axonal damage in SS

Mechanisms of Neurodegeneration and Axonal Dysfunction in Progressive Multiple Sclerosis

Multiple Sclerosis (MS) is a major cause of neurological disability, which increases predominantly during disease progression as a result of cortical and grey matter structures involvement. The gradual accumulation of disability characteristic of the disease seems to also result from a different set of mechanisms, including in particular immune reactions confined to the Central Nervous System such as: (a) B-cell dysregulation, (b) CD8+ T cells causing demyelination or axonal/neuronal damage, and (c) microglial cell activation associated with neuritic transection found in cortical demyelinating lesions. Other potential drivers of neurodegeneration are generation of oxygen and nitrogen reactive species, and mitochondrial damage, inducing impaired energy production, and intra-axonal accumulation of Ca2+, which in turn activates a variety of catabolic enzymes ultimately leading to progressive proteolytic degradation of cytoskeleton proteins. Loss of axon energy provided by oligodendrocytes determines further axonal degeneration and neuronal loss. Clearly, these different mechanisms are not mutually exclusive and could act in combination. Given the multifactorial pathophysiology of progressive MS, many potential therapeutic targets could be investigated in the future. This remains however, an objective that has yet to be undertaken

Spinal Cord Involvement in MS and Other Demyelinating Diseases

Diagnostic accuracy is poor in demyelinating myelopathies, and therefore a challenge for neurologists in daily practice, mainly because of the multiple underlying pathophysiologic mechanisms involved in each subtype. A systematic diagnostic approach combining data from the clinical setting and presentation with magnetic resonance imaging (MRI) lesion patterns, cerebrospinal fluid (CSF) findings, and autoantibody markers can help to better distinguish between subtypes. In this review, we describe spinal cord involvement, and summarize clinical findings, MRI and diagnostic characteristics, as well as treatment options and prognostic implications in different demyelinating disorders including: multiple sclerosis (MS), neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, anti-myelin oligodendrocyte glycoprotein antibody-associated disease, and glial fibrillary acidic protein IgG-associated disease. Thorough understanding of individual case etiology is crucial, not only to provide valuable prognostic information on whether the disorder is likely to relapse, but also to make therapeutic decision-making easier and reduce treatment failures which may lead to new relapses and long-term disability. Identifying patients with monophasic disease who may only require acute management, symptomatic treatment, and subsequent rehabilitation, rather than immunosuppression, is also important

2-Chlorodeoxyadenosine (Cladribine) preferentially inhibits the biological activity of microglial cells

Cladribine (2CdA) is a synthetic chlorinated purine nucleoside analogue which acts as a pro-drug requiring intracellular phosphorylation to be activated. It is biologically active in selected cell types, which results in a reduction of circulating T and B lymphocytes implicated in multiple sclerosis (MS) pathogenesis. In addition, 2CdA shows good central nervous system (CNS) penetration and can therefore exert its action on microglia and astrocytes. Therefore, we studied the effects of 2CdA on microglial cells and astrocytes, both emerging as potential targets for MS therapy. Other than its effects on the peripheral immune system, 2CdA induced the apoptosis of microglial cells, inhibited their proliferation and reduced the production of cytokines, particularly pro-inflammatory cytokines IL-1β, IL-6 and TNF-α. These represent additional mechanisms of 2CdA that may contribute to limiting inflammatory pathways. By contrast, astrocytes showed resistance to the action of 2CdA, which may be explained by differences in its intracellular phosphorylation. Insights into the mechanism of action of and resistance to 2CdA in CNS-resident cells may prove crucial for its optimal use.Fil: Aybar, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Julia Perez, María. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Silvina Marcora, María. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Samman, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Marrodan, Mariano. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: María Pasquini, Juana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Correale, Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin

sj-docx-2-msj-10.1177_13524585231219138 – Supplemental material for Clinical impact of gender and age at onset on disease trajectory in primary progressive multiple sclerosis patients

Supplemental material, sj-docx-2-msj-10.1177_13524585231219138 for Clinical impact of gender and age at onset on disease trajectory in primary progressive multiple sclerosis patients by Sebastian Camerlingo, Fernando Rubinstein, Maria Celia Ysrraelit, Jorge Correale, Edgar Carnero Contentti, Juan I Rojas, Liliana Patrucco, Felisa del Valle Leguizamon, Veronica Tkachuk, Nora Fernandez Liguori, Edgardo Cristiano, Carolina Mainella, Gisela Zanga, Adriana Carra, Mariano Marrodan, Alejandra Diana Martinez, Berenice Anabel Silva and Ricardo Alonso in Multiple Sclerosis Journal</p

sj-docx-1-msj-10.1177_13524585231219138 – Supplemental material for Clinical impact of gender and age at onset on disease trajectory in primary progressive multiple sclerosis patients

Supplemental material, sj-docx-1-msj-10.1177_13524585231219138 for Clinical impact of gender and age at onset on disease trajectory in primary progressive multiple sclerosis patients by Sebastian Camerlingo, Fernando Rubinstein, Maria Celia Ysrraelit, Jorge Correale, Edgar Carnero Contentti, Juan I Rojas, Liliana Patrucco, Felisa del Valle Leguizamon, Veronica Tkachuk, Nora Fernandez Liguori, Edgardo Cristiano, Carolina Mainella, Gisela Zanga, Adriana Carra, Mariano Marrodan, Alejandra Diana Martinez, Berenice Anabel Silva and Ricardo Alonso in Multiple Sclerosis Journal</p

Implementation of a University Guidance Service (SOU) in the Faculty of Biological Sciences: Comprehensive Student Support and Monitoring Program

El acompañamiento y el seguimiento académico de los estudiantes son tareas de gran importancia, necesarias para garantizar el éxito de su carrera profesional durante su vida universitaria, y después de ésta. Estos procesos no comienzan necesariamente con el ingreso de los estudiantes en la Universidad, sino que se extienden a los estudiantes de último curso de educación secundaria y bachillerato. Existe por tanto la necesidad de incluir dentro de las acciones que realizamos en la facultad (información, formación, inclusión) a los estudiantes de bachillerato, dándoles a conocer nuestro entorno de cara a su incorporación en la facultad. Por otro lado, la experiencia del equipo que trabajará en este proyecto, nos ha llevado a ser conscientes de los innumerables problemas que tienen los estudiantes de nuestra facultad para obtener información, formación, acompañamiento, seguimiento o inclusión en cuestiones que pueden afectar de una forma directa en sus actividades académica cotidianas y en su formación integral que reciben en nuestra facultad. La falta de una unidad o servicio centralizado para satisfacer estas necesidades ha sido aún más patente desde la pandemia. En la Facultad de Ciencias Biológicas se realizan multitud de actividades relacionadas con estas iniciativas y que son desconocidas por gran parte de la comunidad universitaria. Las acciones que se vienen realizando desde la facultad de Ciencias Biológicas estas dispersas entre distintos servicios y vicedecanatos (Vicedecanato de Calidad, Innovación y Sostenibilidad, Vicedecanato de Estudiantes, Practicas Externas y Movilidad, Vicedecanato de Estudios, Coordinadora de Grado, Oficina Erasmus, Vicedecanato de Investigación, Secretaría Académica, Delegación de Estudiantes, Oficina de Diversidad, etc.). En este sentido, con este proyecto pretendemos potenciar, sincronizar, coordinar y dar visibilidad a todas estas, mostrando la inmensa utilidad que suponen para nuestros estudiantes, cómo influyen en la mejora de sus actividades académicas curriculares y extracurriculares y su proyección hacia el mundo laboral. Analizaremos cómo cada una de estas actividades influyen positivamente generando una retroalimentación entre los distintos grupos de participantes del proyecto: Estudiantes, Profesores y Personal de Administración y Servicios. Todo ello, será evaluado cualitativa y cuantitativamente mediante la elaboración de encuestas a cada uno de los sectores y los comentarios y evaluaciones que el programa Docentia nos pueda aportar. La finalidad, por tanto, de este proyecto es crear de forma integrativa un Servicio de Orientación Universitario (SOU) para los estudiantes de nuestra facultad, donde se engloben todas las actividades de acompañamiento y seguimiento que venimos realizando, junto con otras que puedan surgir. Todo ello permitirá mejorar la integración y el desenvolvimiento de nuestros estudiantes en el centro mediante su participación en distintas acciones que, a su vez, redundarán en un mejor aprovechamiento de los recursos del centro, una mejora curricular y, en último término, facilitarán su proyección laboral. Este proyecto, también tiene por objetivo solventar la necesidad existente de dar visibilidad a las actividades de acompañamiento y seguimiento de estudiantes que los distintos colectivos de la facultad realizan, con la finalidad de mejorar su aprovechamiento y su optimización a través un análisis de fortalezas y debilidades, lo que nos permitirá generar futuras nuevas acciones que se integrarán en el SOU de la Facultad de Ciencias Biológicas.UCMDecanatoDepto. de Genética, Fisiología y MicrobiologíaFac. de Ciencias BiológicasFALSEsubmitte