Botulinum Toxin Type A (BoNT-A) Use for Post-Stroke Spasticity: A Multicenter Study Using Natural Language Processing and Machine Learning.

We conducted a multicenter and retrospective study to describe the use of botulinum toxin type A (BoNT-A) to treat post-stroke spasticity (PSS). Data were extracted from free-text in electronic health records (EHRs) in five Spanish hospitals. We included adults diagnosed with PSS between January 2015 and December 2019, stratified into BoNT-A-treated and untreated groups. We used EHRead® technology, which incorporates natural language processing and machine learning, as well as SNOMED CT terminology. We analyzed demographic data, stroke characteristics, BoNT-A use patterns, and other treatments. We reviewed the EHRs of 1,233,929 patients and identified 2190 people with PSS with a median age of 69 years; in total, 52.1% were men, 70.7% had cardiovascular risk factors, and 63.2% had suffered an ischemic stroke. Among the PSS patients, 25.5% received BoNT-A at least once. The median time from stroke to spasticity onset was 205 days, and the time from stroke to the first BoNT-A injection was 364 days. The primary goal of BoNT-A treatment was pain control. Among the study cohort, rehabilitation was the most common non-pharmacological treatment (95.5%). Only 3.3% had recorded monitoring scales. In conclusion, a quarter of patients with PSS received BoNT-A mainly for pain relief, typically one year after the stroke. Early treatment, disease monitoring, and better data documentation in EHRs are crucial to improve PSS patients' care.

Influencia de la edad de los veronicélidos en la infección con Angiostrongylus costaricensis / Influence of the age of Veronicellid slugs in Angiostrongylus costaricensis infection

In Costa Rica, Veronicellid slugs are the most important hosts for Angiostrongylus costaricencis. Apparently, these molluscs develop a resistant mechanism after being exposed to the infection. In naturally infected slugs, the higher infection rates were found in larger slugs, but they usually bear few larvae. larger number of larvae were found in medium sized molluscs. Experimental infection in laboratory breed slugs produced an amebocytic reaction around developing larvae; later, the formation of a fobrotic capsule is observed. When there is a second infection, cell reaction is stronger and the larvae show degenerativesigns. This cell-mediated resistant mechanism seems to explain why the biggest moluscs, although more probably exposed to infection, bear fewer larvae.