Publications by authors named "Juan I Rojas"

26 Publications

  • Page 1 of 1

Multiple sclerosis and neuromyelitis optica spectrum disorder testing and treatment availability in Latin America.

Neurol Res 2021 Jul 9:1-6. Epub 2021 Jul 9.

Department of Neurology, Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina.

Background: The objective of our study was to describe the availability of diagnostic tests and treatment for MS and NMOSD in Latin America (LATAM).

Methods: A survey instrument was used in a sample of physicians from LATAM countries. The goal of the survey was to understand availability of: 1) imaging tests for diagnosing MS and NMOSD and its barriers; 2) diagnostic laboratory tests for diagnosing MS and NMOSD and its barriers; and 3) treatments for MS and NMOSD in the acute and chronic phases of the disease.

Results: Responses were received from 80 physicians. AQP4-ab test was available in 54% of the countries and MOG-ab test in 42%. All of countries had available use of high doses of intravenous methylprednisolone, oral steroids, plasmapheresis, and intravenous immunoglobulins for relapses. For NMOSD, 93% of the countries were able to use azathioprine and mycophenolate mofetil, and 87% rituximab. In MS, 93% of countries had available to them IFN beta, 69% glatiramer acetate, 75% teriflunomide, 93% fingolimod, 69% dimethyl-fumarate, 75% cladribine, 69% natalizumab, 93% ocrelizumab and 81% alemtuzumab. The most common challenge and barrier identified was the cost of medications.

Conclusion: The present study allows an understanding of the delivery of care for MS and NMOSD in the region.
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http://dx.doi.org/10.1080/01616412.2021.1949686DOI Listing
July 2021

Family planning in Argentinian women with multiple sclerosis: An important yet seldom approached issue.

Mult Scler J Exp Transl Clin 2021 Apr-Jun;7(2):20552173211025312. Epub 2021 Jun 16.

Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina.

Background: The purpose of this study was to assess family planning (FP) among women with multiple sclerosis (WwMS).

Methods: We invited 604 WwMS to answer a survey focused on FP: a) Temporal relationship between pregnancy and the diagnosis of multiple sclerosis; b) History of FP; c) Childbearing desire; d) Information on family planning. Comparisons between pregnancy and not pregnancy after MS, as well as, planned and unplanned pregnancy were analyzed. Multivariate and univariate analyses were used to assess the impact of independent variables and FP.

Result: 428 (71.7%) WwMS completed the survey. A 19.1% got pregnant after MS diagnosis and we evaluated FP in the last pregnancy, 56.1% patients had a planned pregnancy. Professional addressing FP (OR = 0.27, 95%-CI 0.08-0.92, p = 0.03) and non-injection drug treatment before pregnancy (OR = 2.88, 95%-CI 1.01-8.21, p = 0.047) were independent predictors of unplanned pregnancy in our multivariate model. Among WwMS ≤ 40 years, 48.7% had future childbearing desire. Young age (p < 0.001), PDDS <3 (p = 0.018), disease duration <5 years (p = 0.02), not childbearing before MS diagnosis (p < 0.001) and neurologist addressing family planning (p = 0.01) were significantly associated with childbearing desire.

Conclusions: This research highlights that pregnancy remains an important concern among WwMS.
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http://dx.doi.org/10.1177/20552173211025312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216353PMC
June 2021

COVID-19 in Argentine teriflunomide-treated multiple sclerosis patients: First national case series.

Mult Scler Relat Disord 2021 May 30;53:103049. Epub 2021 May 30.

Centro de Esclerosis Múltiple de Buenos Aires, CABA; Argentina; Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina.

We report COVID-19 presentation, course and outcomes in teriflunomide-treated MS patients in Argentina.

Methods: descriptive, retrospective, multicentre, study that included MS patients receiving teriflunomide who developed COVID-19, with clinical follow-up at reference MS centres, also listed in a nationwide registry.

Results: Eighteen MS patients on teriflunomide treatment, from eight MS centres developed COVID-19. The mean age was 41,2 years and 72% of them were female; 94% had diagnosis of relapsing-remitting MS and 6% presented a radiologically isolated syndrome. Median EDSS was 2 (range 0-5.5). The average time on teriflunomide therapy was 3 years. COVID-19 diagnosis was confirmed with nasal swab in 61%. None required hospitalization and they completely recovered from the acute-phase within 7-14 days. All the patients continued their teriflunomide therapy during COVID-19 course. No MS relapses occurred during or after COVID-19 course.

Conclusion: Our report adds to the evidence that COVID-19 is mild in patients receiving teriflunomide therapy and that continuing with teriflunomide therapy during Sars-CoV-2 infection is safe and advisable for MS patients.
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http://dx.doi.org/10.1016/j.msard.2021.103049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164731PMC
May 2021

Research priorities in multiple sclerosis in Latin America: A multi-stakeholder call to action to improve patients care: Research priorities in MS in LATAM.

Mult Scler Relat Disord 2021 May 24;53:103038. Epub 2021 May 24.

nstituto Nacional de Neurología y Neurocirugía "MVS", Ciudad de México, México.

As human and economic resources are limited, especially in Latin America (LATAM), it is important to identify research priorities to improve multiple sclerosis (MS) patients care in the region. The objective was to generate a multidisciplinary consensus on research priorities in MS for patients care in LATAM by involving healthcare professionals and MS patient associations. METHODS: consensus was reached through a four-step modified Delphi method designed to identify and rate research priorities in MS in LATAM. The process consisted of two qualitative assessments, a general ranking phase and a consensus meeting followed by a more detailed ranking phase RESULTS: a total of 62 participants (35 neurologists, 4 nurses, 12 kinesiologists, 7 neuropsychologists and 4 patient association members) developed the process. At the final ranking stage following the consensus meeting, each participant provided their final rankings, and the top priority research questions were outlined. 11 research priorities were identified focusing on healthcare access, costs of the disease, physical and cognitive evaluation and rehabilitation, quality of life, symptoms management, prognostic factors, the need of MS care units and patient's management in emergencies like COVID-19. CONCLUSION: this work establishes MS research priorities in LATAM from multiple perspectives. To pursue the actions suggested could launch the drive to obtain information that will help us to better understand the disease in our region and, especially, to better care for affected patients.
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http://dx.doi.org/10.1016/j.msard.2021.103038DOI Listing
May 2021

Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM.

J Clin Neurosci 2021 Jul 1;89:360-364. Epub 2021 Jun 1.

Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina.

The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177).

Methods: The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset.

Results: A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively).

Conclusion: 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.
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http://dx.doi.org/10.1016/j.jocn.2021.05.047DOI Listing
July 2021

Improvement over previous decades in time of diagnosis but not in time of initiating DMD in MS patients in Argentina.

Mult Scler Relat Disord 2021 Jul 7;52:103007. Epub 2021 May 7.

Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Argentina.

Background: The objective of the study was to compare the interval from first symptom of MS to diagnosis, and the interval between date of diagnosis and DMD initiation with the introduction of upgraded MS diagnosis criteria.

Methods: retrospective cohort study. To be included, data concerning date of disease onset (first relapse), date of diagnosis (confirmed disease) and date of DMD initiation had to be available. Kaplan-Meier estimator and plots were applied. Survival probabilities were evaluated for the 2 diagnosis epoch groups according to the diagnostic criteria advised at the time: group 1, for diagnosis performed between 2005-2009 (2005 revised McDonald criteria) and group 2, for diagnosis performed between 2010-2017 (2010 revised McDonald criteria).

Results: 654 patients were included (278 in group 1 and 308 in group 2). The mean time from disease onset to diagnosis in group 1 was 11 ± 4 vs. 7 ± 3 months (p = 0.001). Mean time from disease diagnosis to first DMD was 2.9 ± 1.1 months in group 1 vs. 6.8 ± 1.5 months in group 2 (p = 0.002).

Conclusion: although a shortening in time of diagnosis was described, a trend to increase the time to initiate a DMD was noted in group 2.
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http://dx.doi.org/10.1016/j.msard.2021.103007DOI Listing
July 2021

Use of cannabis in patients with multiple sclerosis from Argentina.

Mult Scler Relat Disord 2021 Jun 6;51:102932. Epub 2021 Apr 6.

Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.

Background: The use of cannabis to treat some symptoms of neurological diseases, including multiple sclerosis (MS), has increased worldwide. We aimed to assess the use of cannabis in patients with MS (PwMS) from Argentina, its reasons and patients' perceptions on the management of MS symptoms. Additionally, we assessed their association with socio-demographic and clinical aspects.

Methods: A cross-sectional online survey that included 281 PwMS from Argentina was conducted. Screening instruments: Demographics and clinical data, health-related QoL (MS Impact Scale-29), Fatigue Severity Scale, The Hospital Anxiety and Depression Scale, sleep disorders, physical disability (self-administrated Expanded Disability Status Scale) and medical or recreational cannabis use were evaluated. A logistic regression model was carried out.

Results: Current users (cannabis was used within the past year) was reported in 34.2% and former users (had tried cannabis but not used it within the past year) in 22.7%. Daily cannabis use was reported in 31.3% (current + former users) of the studied cohort, 41.9% started their use after MS diagnosis and 54.3% of them had never discussed about cannabis use with their neurologist. Recreational use was reported in 47.5%. Younger (age below 30 years) PwMS (OR = 2.39, p = 0.03), presence of chronic pain (OR = 2.42, p = 0.002) and current alcohol intake (OR = 3.33, p = 0.001) were predictors of current cannabis use in our multivariate model.

Conclusion: A high prevalence of use of cannabis in PwMS from Argentina was observed. Demographic, symptoms and lifestyle factors predict cannabis use. Identifying the presence and severity of these conditions would contribute to a better MS management and treatment.
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http://dx.doi.org/10.1016/j.msard.2021.102932DOI Listing
June 2021

COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM.

Mult Scler Relat Disord 2021 Jun 7;51:102886. Epub 2021 Mar 7.

Centro de esclerosis múltiple de Buenos Aires, Argentina.

Background: There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America.

Objective: The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19.

Methods: RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19-typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission.

Results: 145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 - 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU.

Conclusion: we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
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http://dx.doi.org/10.1016/j.msard.2021.102886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937038PMC
June 2021

What percentage of AQP4-ab-negative NMOSD patients are MOG-ab positive? A study from the Argentinean multiple sclerosis registry (RelevarEM).

Mult Scler Relat Disord 2021 Apr 7;49:102742. Epub 2021 Jan 7.

Hospital Central de Mendoza, Mendoza.

Background: Myelin oligodendrocyte glycoprotein antibodies (MOG-ab) have been described in aquaporin-4-antibodies(AQP4-ab)-negative neuromyelitis optica spectrum disorder (NMOSD) patients. We aimed to evaluate the percentage of AQP4-ab-negative NMOSD patients who are positive for MOG-ab in a cohort of Argentinean patients included in RelevarEM (Clinical Trials registry number NCT03375177).

Methods: RelevarEM is a longitudinal, strictly observational multiple sclerosis (MS) and NMOSD registry in Argentina. Of 3031 consecutive patients (until March 2020), 165 patients with phenotype of suspected NMOSD, whose relevant data for the purpose of this study were available, were included. Data on demographic, clinical, paraclinical and treatment in AQP4-ab (positive, negative and unknown) and MOG-ab (positive and negative) patients were evaluated.

Results: A total of 165 patients (79 AQP4-Ab positive, 67 AQP4-Ab negative and 19 unknown) were included. Of these, 155 patients fulfilled the 2015 NMOSD diagnostic criteria. Of 67 AQP4-Ab-negative patients, 36 (53.7%) were tested for MOG-Ab and 10 of them (27.7%) tested positive. Serum AQP4-ab levels were tested by means of cell-based assay (CBA) in 48 (35.2%), based on tissue-based indirect immunofluorescence assays in 58 (42.6%) and enzyme-linked immunosorbent assay in 4 (2.9%). All MOG-ab were tested by CBA. Optic neuritis (90%) was the most frequent symptom at presentation and optic nerve lesions the most frequent finding (80%) in neuroimaging of MOG-ab-associated disease. Of these, six (60%) patients were under immunosuppressant treatments at latest follow-up.

Conclusion: We observed that 27.7% (10/36) of the AQP4-ab-negative patients tested for MOG-ab were positive for this antibody, in line with results from other world regions.
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http://dx.doi.org/10.1016/j.msard.2021.102742DOI Listing
April 2021

Time interval between disease onset and MS diagnosis during the last decades in Latin America.

Mult Scler Relat Disord 2021 Feb 10;48:102672. Epub 2020 Dec 10.

Department of Neurology, Fleni, Buenos Aires, Argentina.

The objective was to evaluate the interval from first symptom of multiple sclerosis (MS) to diagnosis with the introduction of MS diagnostic criteria in a Latin American (LATAM) population.

Methods: Patients with relapsing-remitting MS (RRMS) completed a survey in 12 LATAM countries. Date of disease onset (first relapse) and date of diagnosis (confirmed disease) were required. Survival probabilities were evaluated for 5 diagnosis epoch groups: group 1: 1983-2000 Poser; group 2: 2001-2004 McDonald's first version; group 3: 2005-2009 revisions of 2005; group 4: 2010-2016 revisions of 2010; and group 5: 2017-2019 revisions of 2017.

Results: 1188 (75.6% females) patients were included. Mean time from disease onset to diagnosis in group 1 was 21 ± 8 months; in group 2, 19 ± 7 months; in group 3, 16 ± 10 months; in group 4, 9.6 ± 8.5 months; and in group 5, 8.2 ± 10 months. Significant differences were observed between groups 1, 2, 3 vs. 4 and 5 (p<0.001), while no differences were observed between groups 4 and 5 (p=0.08).

Conclusion: We observed a significant shortening of time from MS onset to diagnosis with the adoption of new diagnostic criteria in LATAM.
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http://dx.doi.org/10.1016/j.msard.2020.102672DOI Listing
February 2021

Absence of latitudinal gradient in oligoclonal bands prevalence in Argentina.

Mult Scler Relat Disord 2020 Nov 13;46:102582. Epub 2020 Oct 13.

Servicio de Neurología - Hospital San Bernardo, Salta, Argentina.

Background: Like MS prevalence, oligoclonal bands (OCB) frequency seems to follow a latitudinal gradient. Argentina is extensive, latitude-wise, and previous studies have not found an MS prevalence latitudinal gradient. Our aim is to describe OCB prevalence in MS, clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) patients included in the Argentinean MS and NMOSD registry (RelevarEM) and to investigate if it follows a latitudinal gradient.

Methods: For each province, an average latitude was calculated, and OCB frequency was investigated. Multivariate logistical regression analysis and linear correlation were performed. Statistical analysis was repeated after excluding patients from centers using isoelectric focusing (IEF) in less than 95% of patients (CwIEF<95).

Results: We included 2866 patients. OCB where positive in 73.9% of patients. No association or correlation were found between OCB and latitude of residence, even after excluding patients from (CwIEF<95).

Conclusion: OCB positivity does not follow a latitudinal gradient in Argentina. Also, OCB positivity is lower than described in other world regions.
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http://dx.doi.org/10.1016/j.msard.2020.102582DOI Listing
November 2020

Usage trend of oral drugs for multiple sclerosis patients in Argentina.

Mult Scler Relat Disord 2021 Jan 2;47:102664. Epub 2020 Dec 2.

Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía. Electronic address:

Introduction: Over the past decade, numerous disease modifying drugs (DMDs) for relapsing- remitting multiple sclerosis (RRMS) have been approved in Argentina. The use of oral DMDs (oDMDs) has increased in recent years, although real-life data in our region is limited. We aimed to describe the tendency in the use of oDMDs (as first treatment option or after switch) in relationship with their approval in Argentina.

Methods: A retrospective study in a cohort of MS patients from five Argentinian MS centers was conducted. Regarding the availability of different oDMDs in Argentina, we define three periods (P1-3): P1: 2012 - 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency for oDMDs use over time.

Result: The most frequently prescribed treatment as first DMD was: interferon beta 1a (40%) in P1, fingolimod (37.3%) in P2 and also fingolimod (35%) in P3. We found an increase in the use of oDMTs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; Chi-square = 41.9 p <0.01). We also found a tendency to increase the use of oDMTs after a first switch (P1: 45.5%, P2: 60.1% and P3 78.3%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of treatment initiation (OR=1.01 p<0.01) were independently associated with choice of oDMTs.

Conclusion: This study identified an increasing tendency for the use of oDMDs as initial treatment of RMS in relationship with their approval in Argentina.
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http://dx.doi.org/10.1016/j.msard.2020.102664DOI Listing
January 2021

[Clinical and demographic aspects of secondary progressive multiple sclerosis in Argentina].

Medicina (B Aires) 2020 ;80(6):606-610

Centro de Esclerosis Múltiple de Buenos Aires, Argentina.

The objective of the study was to describe the clinical and demographic aspects of patients with secondary progressive multiple sclerosis (SPMS) included in the Argentine MS Registry (RelevarEM, Clinical Trials registry number 03375177). RelevarEM is a longitudinal, strictly observational registry of patients with MS and neuromyelitis optica spectrum disorders. Clinical and demographic aspects were described in patients with SPMS and compared with relapsing remitting MS patients (RRMS). A total of 1723 patients with MS were included (1605, 93.2% RRMS and 118, 6.8%, SPMS). In SPMS, the median age was 53 (inter quartile range [IQR] 47-62) years, 67% were women, median disease duration of 19.5 (IQR 14-26) years, median EDSS (expanded disability status scale) 6.5 and 48.3% were under treatment for their MS. Only 23.7% of patients with SPMS were actively working and 86% had a disability certificate; 35.6% of patients with SPMS presented new lesions in MRI and 5% had clinical relapses during the past 12 months of the registry entry showing a significantly lower disease activity compared with RRMS (p < 0.01).
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December 2020

High birth weight and risk of multiple sclerosis: A multicentre study in Argentina.

Mult Scler Relat Disord 2021 Jan 12;47:102628. Epub 2020 Nov 12.

Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina.

Background: Multiple sclerosis (MS) is now recognized as a multifactorial disease in which genetic and environmental factors intervene. Considerable efforts have been made to identify external risk factors present in childhood, adolescence and youth, though only a few perinatal risk factors have been positively associated with MS. Previously, we found an association between high birth weight and MS in male patients in a small study in Argentina. The present research was designed to further assess the association between high birth weight and MS in a larger sample of patients, using an extensive and validated general population database as control.

Methods: We present an analytical observational, multicentre, population-based, and case-control study. A total of 637 patients (cases) with confirmed MS diagnosis attending five MS specialized centres in Argentina were included. Birth weight (BW) data was recalled by the patient's mother, which is a validated approach. A two-way comparison was performed. First, we used the standard categories of high, adequate and low BW in grams. Then, we applied the weight percentile distribution to provide reproducible results for further research. For a proper assessment and comparison of variables, we adopted the guidelines of the American Academy of Pediatrics for neonate classification according to gestational weeks and to BW in grams. The neonate's BW distribution of the general population was used as control. For the purposes of the study, we adapted Urquía's et al. curves, which are based on an extensive database of all the live births registered in the country from 2003 to 2007. To measure the magnitude of the proportional differences between low, adequate and high BW, the odds ratio (OR) and their 95% confidence interval (CI) were estimated. The mean BW and percentile values for each sex were compared using a z-Normal test. The respective MS patients and general population BW distribution curves by sex were compared between each other.

Results: Cases and controls were comparable in their demographic, geographic and environmental characteristics. Males showed higher BW than females both in the MS patients and the general population groups. When we applied the sex stratified analysis separately, we found that males in the MS group showed an almost seven times higher risk of high birth weight than males from the general population (OR 6.58 [95% CI 4.81-8.99]). Female patients showed an almost five times higher risk of high BW than their respective controls (OR 4.5 [95% CI 3.06-6.58]). The comparison based on the BW percentile distribution confirmed that MS patients showed higher BW than the general population. This result reached statistical significance from the 75 percentile onwards for both sexes.

Conclusion: In summary, our findings suggested that high BW could be one of the earliest risk factors for MS in life. If this results were reproduced in other centres, high birth weight would emerge as a novel and very early risk factor, potentially modifiable in utero or immediately postpartum, representing a unique opportunity to prevent the disease in future generations.
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http://dx.doi.org/10.1016/j.msard.2020.102628DOI Listing
January 2021

COVID-19 in people with multiple sclerosis: A global data sharing initiative.

Mult Scler 2020 09 14;26(10):1157-1162. Epub 2020 Jul 14.

MSBase Registry, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.

Background: We need high-quality data to assess the determinants for COVID-19 severity in people with MS (PwMS). Several studies have recently emerged but there is great benefit in aligning data collection efforts at a global scale.

Objectives: Our mission is to scale-up COVID-19 data collection efforts and provide the MS community with data-driven insights as soon as possible.

Methods: Numerous stakeholders were brought together. Small dedicated interdisciplinary task forces were created to speed-up the formulation of the study design and work plan. First step was to agree upon a COVID-19 MS core data set. Second, we worked on providing a user-friendly and rapid pipeline to share COVID-19 data at a global scale.

Results: The COVID-19 MS core data set was agreed within 48 hours. To date, 23 data collection partners are involved and the first data imports have been performed successfully. Data processing and analysis is an on-going process.

Conclusions: We reached a consensus on a core data set and established data sharing processes with multiple partners to address an urgent need for information to guide clinical practice. First results show that partners are motivated to share data to attain the ultimate joint goal: better understand the effect of COVID-19 in PwMS.
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http://dx.doi.org/10.1177/1352458520941485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361123PMC
September 2020

Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina.

Mult Scler Relat Disord 2020 Aug 4;43:102147. Epub 2020 May 4.

Instituto Lennox/Clínica Reina Fabiola, Córdoba, Argentina.

Background: Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients.

Methods: A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used.

Results: Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues.

Conclusion: The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.
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http://dx.doi.org/10.1016/j.msard.2020.102147DOI Listing
August 2020

[Clinical and radiological outcomes measures in progressive multiple sclerosis].

Medicina (B Aires) 2019 ;79(1):37-43

Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.

During recent years, the development of measures to assess the accumulation of disability and inflammatory activity in the progressive forms of multiple sclerosis (MS) has been a central point of research in various groups. Several instruments have been developed and implemented in order to accurately and early identify the activity and progression in this MS phenotype. Many of these tools, with greater or lesser sensitivity, have been used in clinical trials, although their use in healthcare practice is not entirely familiar to professionals involved in the care of patients with MS. The objective of this review is to describe the clinical and imaging evaluation measures implemented during the last years to identify the activity and the evolution of the disease in its progressive forms.
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March 2020

Thalamus volume change and cognitive impairment in early relapsing-remitting multiple sclerosis patients.

Neuroradiol J 2018 Aug 5;31(4):350-355. Epub 2018 Jun 5.

1 Multiple Sclerosis Center of Buenos Aires, Italian Hospital of Buenos Aires, Argentina.

Aims The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods A prospective study included patients with relapsing-remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment ( P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume ( P < 0.001) was observed compared with the group without cognitive impairment. Conclusion We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.
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http://dx.doi.org/10.1177/1971400918781977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111418PMC
August 2018

Heart Transplantation in Patients >60 Years: Importance of Relative Pulmonary Hypertension and Right Ventricular Failure on Midterm Survival.

J Cardiothorac Vasc Anesth 2018 02 18;32(1):32-40. Epub 2017 Sep 18.

Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Objectives: To determine the impact of recipient age and perioperative risk factors on midterm survival after orthotopic heart transplantation (OHT). The authors hypothesized that perioperative variables are more important as predictors of mortality than is a recipient's age.

Design: Retrospective study.

Setting: Tertiary care university hospital.

Participants: The study comprised 126 consecutive adults who underwent OHT.

Interventions: After Institutional Review Board approval, the authors analyzed 126 consecutive adult patients who underwent OHT between January 2009 and December 2015 and followed-up with them up until June 2016. Patients were divided into the following 2 groups according to the recipient's age at the time of transplantation: older group (≥60 y old) and younger group (18 to 59 y).

Measurements And Main Results: Actuarial survival rates for all patients were 88.1%, 78.6%, and 72.2% at 30 days, 1 year, and after a median follow-up of 18.9 months (midterm survival) (1st quartile: 8.1; 3rd quartile: 37.4), respectively. In the unadjusted analysis, the older group demonstrated a significant increase in 1-year mortality (p = 0.005) and a trend toward worse midterm mortality (p = 0.087). Multivariable analysis was performed using Cox proportional hazards regression analysis. Independent risk factors related to midterm mortality after OHT were as follows: preoperative relative pulmonary hypertension using the mean arterial-to-mean pulmonary artery pressure ratio ≤3 (hazard ratio [HR] 5.39, 95% confidence interval [CI] 1.64-17.74, p = 0.006); cardiopulmonary bypass duration (per each 10-min increment) (HR 1.14, 95% CI 1.08-1.22, p < 0.001); and postoperative right ventricular dysfunction (HR 3.50, 95% CI 1.52-8.05, p = 0.003). Neither recipients ≥60 years old (HR 2.15, 95% CI 0.98-4.67, p = 0.054) nor donor/recipient body surface area ratio (HR 1.01, 95% CI 0.98-1.04, p = 0.463) was an independent risk factor for midterm mortality.

Conclusions: In patients undergoing heart transplantation, survival was related more to preoperative relative pulmonary hypertension, cardiopulmonary bypass duration, and postoperative right ventricular failure than to recipient age. Older patients should be selected for OHT carefully, taking into consideration preoperative factors other than age.
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http://dx.doi.org/10.1053/j.jvca.2017.09.017DOI Listing
February 2018

[Treatment with vitamin D and slowing of progression to severe stage of Alzheimer's disease].

Vertex 2014 Mar-Apr;25(114):85-91

Servicio de Neurología, Hospital Italiano de Buenos Aires.

The aim of the study was to analyze the impact of treatment with vitamin D in the progression of Alzheimer's disease. We performed a retrospective study including patients with mild stage of Alzheimer's disease with more than four years of follow-up. The presence of cardiovascular risk factors, osteoporosis, treatment with memantine, acetylcholinesterase inhibitors drugs and vitamin D were analyzed as independent variables. Time of progression to moderate and severe Alzheimer's disease was analyzed as dependent variable. The analysis was done using multivariate linear regression model, Kaplan Meier analysis, Chi-square and T test. Two hundred and two patients met the inclusion criteria. 11% of the patients (n = 23) remained in the mild stage of the disease, 54% (n = 110) developed the moderate form in a mean time of 3 ± 1.4 years while 35% (n = 69) developed the severe form in a mean time of 4.6 ± 1.4 years. Time of progression to severe stage of Alzheimer's disease was slower in patients under treatment with vitamin D compared with those without treatment (5.4 ± 0.4 years vs. 4.4 ± 0.16 years respectively, p=0.003). Treatment with vitamin D may be an independent protecting factor in the progression of Alzheimer's disease.
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December 2014

Cardiovascular risk factors and frontotemporal dementia: a case-control study.

Transl Neurodegener 2014 21;3:13. Epub 2014 Jun 21.

Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Cardiovascular risk factors (CRF) were widely described as related to dementia. There are very few studies regarding this association in FTD. The objective of the study was to compare the frequency of CRF in our population with FTD and controls. 100 consecutive subjects with FTD diagnosis according to Lund-Manchester clinical criteria and 200 controls matched by age and sex were included between January 2003 to February 2007 at the Cognitive and Behavior Unit of Hospital Italiano de Buenos Aires. Clinical evaluation, laboratory tests, brain images (CT/MRI), neuropsychological and neuropsychiatric assessment were performed. Multiple regression analysis was performed to analyze the association in CRF between FTD patients vs. controls. The mean age in FTD was 69.7 ± 0.9 vs. 70.1 ± 0.8 in controls (p 0.12). No difference in gender was observed between cases and controls. No differences were identified between patients and controls regarding hypertension (HTA) (65% vs. 67,3% p 0.44); dyslipidemia (57% vs. 54.7% p 0.74); obesity (39% vs. 27.6% p 0.14) and hypothyroidism (26% vs. 17.1% p 0.1). A significant difference was observed for Diabetes Mellitus (39% vs. 22.6% p 0.001). In our population, Diabetes Mellitus was associated as an independent risk factor for FTD. To our knowledge this is the first report in which CRF were evaluated prospectively in FTD patients. More studies are needed to confirm this finding in larger populations.
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http://dx.doi.org/10.1186/2047-9158-3-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080770PMC
July 2014

Current and emerging treatments for relapsing multiple sclerosis in Argentinian patients: a review.

Degener Neurol Neuromuscul Dis 2014 20;4:103-109. Epub 2014 Jun 20.

Multiple Sclerosis Center of Buenos Aires, Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Recent developments have led to newer therapeutic options for disease treatment. A few studies have reported MS prevalence rates between 12 and 20 per 100,000 inhabitants nationwide in Argentina, and an incidence of 1.76 cases per 100,000 inhabitants per year. Considering the epidemiology of MS in Argentina, the total number of patients affected is estimated at 5,000-8,000 patients, with nearly 55%-65% of patients having a relapsing-remitting MS subtype of the disease. The aim of this review is to provide an overview of current and emerging treatments available in Argentina for patients with MS.
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http://dx.doi.org/10.2147/DNND.S46557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337150PMC
June 2014

ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis.

Arq Neuropsiquiatr 2014 May;72(5):337-43

Novartis, Argentina.

Unlabelled: The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective.

Method: Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and <7; group 3 with EDSS ≥7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars.

Results: 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) for patients with an EDSS between 0-3; USD 40,705 (95%CI 37,199-46,300) for patients with EDSS >3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7.

Conclusions: This is the first Argentine study evaluating the costs of MS considering disease severity.
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http://dx.doi.org/10.1590/0004-282x20140016DOI Listing
May 2014

[Acute ischemic stroke in patients aged 80 or older].

Medicina (B Aires) 2007 ;67(6 Pt 2):701-4

Servicio de Neurología, Hospital Italiano, Buenos Aires, Argentina.

Young and old age stroke groups have different vascular risk profiles for cerebral ischemic events. The objective of the study was to describe the risk factor profile and stroke subtype in this population of very elderly people. We included patients over 80 years old with diagnosis of ischemic stroke and transient ischemic attack registered between June 2003 and June 2006. We described the demographic data and subtype of ischemic stroke. Of 535 patients with cerebrovascular ischemic events, the final diagnosis was stroke in 366 cases and transient ischemic attack in 169. Of these patients 33.5% were over 80 years old (179). The mean age was 84.4 +/- 4.4 years. The most frequent risk factors were: hypertension 82.7%, dyslipemia 40.2% and atrial fibrillation 24.6%. Stroke subtype was: large artery disease 6%, cardioembolic stroke 19.7%, small artery disease 41.7%, and other causes 0.8%. Among traditional risk factors for stroke in our very elderly patients, the most significant were hypertension and dyslipemia. This agrees with previous epidemiological studies. The high incidence of small artery disease in our patients may be explained by the risk factor profile.
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January 2009

[Spinocerebellar ataxia 7. Clinical and genetic investigation in an Argentine family].

Medicina (B Aires) 2007 ;67(2):147-50

Servicio de Neurología, Hospital Italiano.

Spino cerebellar ataxia (SCA) are a complex group of hereditary neurodegenerative disturbances of autosomal dominant pattern. They are largely characterized by the clinical presence of cerebellar ataxia related to ophtalmoplegia, dysarthria, pyramidal and extra-pyramidal signs and loss of deep sensitivity. SCA 7 belongs to the SCA group in which the disturbance is a result of the expansion of CAG triplet repetition located in the 3p12-p21 chromosome. The characteristic clinical feature of SCA7 is the loss of visual acuity and blindness. We present here three cases of ataxia, from the same family, with loss of visual acuity and other neurological disorders. The diagnosis was confirmed by a genetic analysis of the index case in whom the characteristic genetic abnormality of SCA7 was discovered. To our knowledge, this is the first case of SCA7 confirmed by genetic study in Argentina. Only two other reports on family cases were found in a review of the literature of Latin America up to January 2006. The purpose of our report is to draw attention to the diagnosis of this degenerative disease in patients with progressive cerebellar ataxia associated with loss of visual acuity symptoms, where a positive family history is found.
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July 2008

[Ischemic stroke registry].

Medicina (B Aires) 2006 ;66(6):547-51

Servicio de Neurologia, Hospital Italiano, Gascón 450, 1181 Buenos Aires, Argentina.

Current knowledge of stroke risk factors and epidemiology is based mostly on USA or European studies; scarce data have been published from developing countries. Because epidemiological and clinical characteristics in stroke vary according to regional factors, we need to know the peculiarities of stroke on this subcontinent. The purpose is to describe the clinical subtypes and risk factors in patients with ischemic stroke. We analyzed all consecutive ischemic stroke in patients admitted at Hospital Italiano of Buenos Aires, between June 1, 2003 and June 1, 2005. Among 395 ischemic stroke patients, the mean age was 71.36 years (+/- 13.82) and 55% were male. Ischemic stroke subtypes were as follows: 40% patients had lacunar, 20% atherosclerotic stroke, 10% cardioembolic infarction, and 5% other causes of stroke. Hypertension (76%), hyperlipemia (50%) and prior stroke (34%) were the most frequent risk factors. Most patients with cortical symptoms had significant large-artery atherosclerosis (> 70%). Stroke informations in developing countries is difficult to obtain. This could be the reason for the very few stroke registries in South America. Hypertension was the most frequent risk factor in our registry. The pattern of stroke subtypes seems to be different from that reported in other regions of the world, with a higher frequency of small-vessel disease.
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August 2007
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