Internal Medicine Research Unit

Medicine, Argentina

Internal Medicine Research Unit

Medicine, Argentina
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Serra M.M.,Hospital Italiano Of Buenos Aires Argentina Hiba | Serra M.M.,Hospital Italiano Of Buenos Aires | Serra M.M.,ARG Argentine Rendu Study Group | Besada C.H.,HIBA | And 12 more authors.
Orphanet Journal of Rare Diseases | Year: 2017

Background: Around 47-74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. Results: Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23-26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32-17.20; p < 0.001). Conclusions: Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. Trial registration: NCT01761981 . Registered January 3rd 2013. © 2017 The Author(s).


Bettini M.,Italian Hospital of Buenos Aires | Vicens J.,Internal Medicine Research Unit | Vicens J.,Hospital Italiano Of Buenos Aires | Giunta D.H.,Internal Medicine Research Unit | And 2 more authors.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration | Year: 2013

The incidence of amyotrophic lateral sclerosis (ALS) ranges from 1.7 to 2.3 per 100,000 persons worldwide. Few epidemiological studies have been published in Latin America. The aim of this study was to estimate the incidence and prevalence of ALS in an HMO (Health Maintenance Organization) of Buenos Aires, capital city of Argentina. The population studied was affiliates of the Italian Hospital Medical Care Program, whose distribution across age and gender strata is similar to the population of Buenos Aires. Cases were detected from 1 January 2003 to 31 December 2010. Incidence density (ID) and prevalence for ALS were estimated for the whole period and at 31 December 2010, respectively. During the seven-year study period, the crude ID estimated was 3.17 per 100,000 person-years (95% CI 2.24-4.48) and the age-adjusted ID for the Buenos Aires population was 2.23 per 100,000 person-years (95% CI 1.45-3.01). Point prevalence at 31 December 2010 was 8.86 per 100,000 persons (95% CI 4.05-13.68). Mean age at diagnosis was 72.29 years (SD 8.5). In conclusion, estimated age-adjusted ID and prevalence of ALS were similar to the incidence and prevalence rates found in other geographical areas. © 2013 Informa Healthcare.

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