Publications by authors named "M Marrodan"

57 Publications

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

Front Neurol 2021 3;12:613838. Epub 2021 Sep 3.

Departamento de Neurología, Fleni, Buenos Aires, Argentina.

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. 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. ED visits decreased 48.33% ( = 14,697 in 2019 vs. = 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, < 0.001) than in groceries/pharmacies (coef. =0.68, < 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). 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.613838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446505PMC
September 2021

Hand grip strength in boys and girls from summer school camps in Spain, 1900-1925. A comparison with 21st century data.

Am J Hum Biol 2021 Sep 17:e23681. Epub 2021 Sep 17.

Grupo de Investigación Epinut, Universidad Complutense de Madrid, Madrid, Spain.

Objectives: The Spanish National Pedagogic Museum (Museo Pedagógico Nacional, MPN), founded by La Institución Libre de Enseñanza, organized the first summer school camps in Spain and their initiative was followed by other institutions in this country. MPN prepared anthropological forms for those sojourns, which included information about both metric and physiological measurements of the schoolchildren. The aim of the current work is to analyze hand grip strength data and to compare them with recent values.

Methods: The initial sample included 2418 schoolchildren from 6 to 16 years old (1467 males, 951 females) attending the camps, but after preliminary analyses, the study was restricted to 1073 boys and 818 girls in the 1900-1925 interval. Three time periods were established and 13 categories of height at camp entry, every 5 cm. Normality tests were run as well as contrasts of means, and both average values and percentiles were calculated for hand grip strength in both hands, as a function of age and height categories.

Results: The 1900-1925 interval was chosen since there were no significant differences among hand grip data within that period. Results show that children attending the camps had dynamometry values in both hands well below the current ones, both with reference to their height and to their age.

Conclusions: Camp attendees displayed very low values of height and hand grip strength in both hands. Both are significantly lower than contemporary values, manifesting a secular effect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ajhb.23681DOI Listing
September 2021

Accumulative risk of clinical event in high-risk radiologically isolated syndrome in Argentina: data from the nationwide registry RelevarEM.

J Neurol 2021 Sep 7. Epub 2021 Sep 7.

Sanatorio Güemes, Buenos Aires, Argentina.

Introduction: We aimed to analyze the accumulative risk of MRI and OB factors for evolution from RIS to MS in subjects included in the Argentinean MS registry (NCT03375177).

Methods: RIS subjects were identified according to RIS diagnosis criteria. Subjects were longitudinally followed with clinical and MRI at intervals of 6 months. Time from RIS identification to the first clinical event was estimated using Kaplan-Meier. Multivariable Cox regression models were created to assess the independent predictive value of demographic characteristics, as well as clinical, OB and MRI data on time to the first clinical event. The single and increased risk factor of evolution of RIS was quantified.

Results: A total of 88 RIS subjects, mean follow-up time 42 ± 4 months were included. 39 (44.3%) and 23 (26.1%) had a new MRI lesion or a clinical event, respectively, during the follow-up. OB (HR 5.9, 95% CI 1.29-10.1, p = 0.004), infratentorial lesions (HR 3.7, 95% CI 1.09-7.5) and spinal cord lesions (HR 5.3, 95% CI 1.4-8.2, p = 0.01) at RIS identification were independent predictors associated with a subsequent clinical event. The accumulative risk showed that when two of the three factors (OB, infratentorial or spinal cord lesions) were present the HR was 10.4, 95% CI 4.4-22, p < 0.001, and when three factors were present, it was HR 15.6, 95% CI 5.7-28, p < 0.001 for a relapse.

Conclusion: The presence of three factors significantly increased the risk of clinical event; high-risk subjects should probably be managed by a different approach than those used for individuals without high-risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00415-021-10791-4DOI Listing
September 2021

Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina.

Mult Scler J Exp Transl Clin 2021 Jul-Sep;7(3):20552173211032334. Epub 2021 Aug 20.

Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Buenos Aires, Argentina.

We aimed to examine treatment interventions implemented in patients experiencing neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and response).

Methods: Retrospective study. Data on patient demographic, clinical and radiological findings, and administered treatments were collected. Remission status (complete [CR], partial [PR], no remission [NR]), based on changes in the EDSS score was evaluated before treatment, during attack, and at 6 months. CR was analyzed with a generalized estimating equations (GEEs) model.

Results: A total of 131 patients (120 NMOSD and 11 myelin oligodendrocyte glycoprotein-antibody-associated diseases [MOGAD]), experiencing 262 NMOSD-related attacks and receiving 270 treatments were included. High-dose steroids (81.4%) was the most frequent treatment followed by plasmapheresis (15.5%). CR from attacks was observed in 47% (105/223) of all treated patients. During the first attack, we observed CR:71.2%, PR:16.3% and NR:12.5% after the first course of treatment. For second, third, fourth, and fifth attacks, CR was observed in 31.1%, 10.7%, 27.3%, and 33.3%, respectively. Remission rates were higher for optic neuritis vs. myelitis (p < 0.001). Predictor of CR in multivariate GEE analysis was age in both NMOSD (OR = 2.27, p = 0.002) and MOGAD (OR = 1.53, p = 0.03).

Conclusions: This study suggests individualization of treatment according to age and attack manifestation. The outcome of attacks was generally poor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/20552173211032334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381444PMC
August 2021

Therapeutic plasma exchange in MS refractory relapses: Long-term outcome.

Mult Scler Relat Disord 2021 Jul 25;55:103168. Epub 2021 Jul 25.

Department of Neurology. Fleni. Buenos Aires, Argentina. Electronic address:

Introduction: Therapeutic plasma exchange (TPE) is considered a treatment option for steroid-refractory multiple sclerosis (MS) relapses. Our objective was to assess long-term clinical response to TPE in MS steroid-refractory exacerbations.

Methods: Retrospective study of relapsing remitting MS (RRMS) patients presenting intravenous methylprednisolone (IVMPS)-refractory relapses, who underwent TPE. Response to TPE was assessed at 1, 3, 6, 12 and 24-months post-treatment, and compared to a second group of RRMS patients with similar demographic and clinical characteristics presenting, IVMPS-refractory relapses but not treated with TPE. Multivariate regression analysis was used to assess potential predictors of significant clinical response.

Results: Between 2011 to 2020, a total of 23 RRMS patients were treated with TPE. Twenty-one patients not receiving the treatment served as controls. No differences in demographic or clinical characteristics, or predictors of clinical improvement after TPE were detected between groups. Seventy-eight percent of patients treated with TPE presented clinical improvement at 24 months. TPE-treated patients presented lower EDSS scores at 6 and at 24 months. Younger age, presence of gadolinium-enhancing lesions and TPE treatment were associated with better clinical outcomes. No life-threatening side effects were reported.

Conclusions: TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msard.2021.103168DOI Listing
July 2021
-->