Factors associated with migraine aura mimicking stroke in code stroke.

INTRODUCTION: Migraine with aura (MA) is a frequent stroke simulator that can lead to erroneous diagnosis and subsequent unnecessary acute or secondary prevention treatments. We analyzed clinical and laboratory data of migraine with aura and ischemic stroke patients to detect differences that could help in the diagnosis. METHODS: Retrospective analysis of a consecutive register of code strokes between January 2005 and June 2020. Diagnosis of ischemic stroke or MA was collected. Multivariable logistic regression analyses were performed to test associations between clinical and blood data with ischemic stroke. RESULTS: Of 3140 code strokes, 2424 (77.2%) were ischemic strokes and 34 (1.1%) were MA. Migraine cases were younger, more frequently females and with lower prevalence of vascular risk factors. Initial NIHSS was lower in MA cases, but no differences were seen in fibrinolysis rate (30%). Blood test showed lower levels of glucose, D-dimer, and fibrinogen in MA cases. Multivariable model showed and independent association for ischemic stroke with age [OR, (95%CI): 1.09, (1.07-1.12, p < 0.001], male sex [OR, (95%CI): 4.47, (3.80-5.13), p < 0.001], initial NIHSS [OR, (95%CI): 1.21, (1.07-1.34), p < 0.01], and fibrinogen levels [OR, (95%CI): 1.01, (1.00-1.01), p < 0.05]. A model including sex male OR: 3.55 [2.882; 4.598], p < 0.001, and cutoff points (age > 65, OR: 7.953 [7.256; 8.649], p < 0.001, NIHSS > 6, OR: 3.740 [2.882; 4.598], p < 0.01, and fibrinogen > 400 mg/dL, OR: 2.988 [2.290; 3.686], p < 0.01) showed a good global discrimination capability AUC = 0.89 (95%CI: 0.88-0.94). CONCLUSIONS: In code stroke, a model including age, sex, NIHSS, and fibrinogen showed a good discrimination capability to differentiate between MA and Ischemic stroke. Whether these variables can be implemented in a diagnostic rule should be tested in future studies.

Epigenetic Clock Explains White Matter Hyperintensity Burden Irrespective of Chronological Age.

In this manuscript we studied the relationship between WMH and biological age (B-age) in patients with acute stroke. We included in this study 247 patients with acute stroke recruited at Hospital del Mar having both epigenetic (DNA methylation) and magnetic resonance imaging data. WMH were measured using a semi-automated method. B-age was calculated using two widely used methods: the Hannum and Horvath formulas. We used multiple linear regression models to interrogate the role of B-age on WMH volume after adjusting for chronological age (C-age) and other covariables. Average C-age of the sample was 68.4 (±11.8) and we observed a relatively high median WMH volume (median = 8.8 cm3, Q1-Q3 = 4.05-18.8). After adjusting for potential confounders, we observed a significant effect of B-ageHannum on WMH volume (ßHannum = 0.023, p-value = 0.029) independently of C-age, which remained significant (ßC-age = 0.021, p-value = 0.036). Finally, we performed a mediation analysis, which allowed us to discover that 42.7% of the effect of C-age on WMH is mediated by B-ageHannum. On the other hand, B-ageHoarvath showed no significant associations with WMH after being adjusted for C-age. In conclusion, we show for the first time that biological age, measured through DNA methylation, contributes substantially to explain WMH volumetric burden irrespective of chronological age.

Infecciones en enfermedades autoinmunes sistémicas / Infections in systemic autoimmune diseases

Introducción: Las infecciones son una importante causa de morbimortalidad en los pacientes con enfermedades autoinmunes sistémicas. El objetivo del presente estudio es describir la frecuencia de infecciones en una cohorte histórica de la policlínica de EAS del Hospital Maciel, según tipo de enfermedad y tratamiento recibido. Material y métodos: Se realizó un estudio analítico, retrospectivo y observacional de 339 pacientes con EAS asistidos en la consulta ambulatoria en el período comprendido entre el 1 de enero de 2012 y el 28 de febrero del 2019. Se analizaron las complicaciones infecciosas, según tratamiento y enfermedad. Resultados: Se encontraron 339 casos, mediana de edad de 56, mayoría sexo femenino. La mayoría de los casos presentaron LES (30,1%) y AR (23,6%), seguidos de síndrome antifosfolipídico (20,4%) y síndrome de Sjögren (12,1%). La hidroxicloroquina (66%), seguida de los corticoides (55,5%) fueron los tratamientos más frecuentemente utilizados. El 13,3% recibieron terapias biológicas. 46,9% de los casos presentaron alguna complicación infecciosa, 95% fueron no oportunistas. Las infecciones respiratorias fueron las más frecuentes (48,6%), seguidas de las urinarias (31,7%) y de piel y partes blandas (17,6%). Al comparar los grupos de infectados y no infectados se hallaron diferencias significativas en las siguientes variables: metotrexate, micofenolato, corticoides, terapias biológicas, combinación de fármacos, enfermedad activa, AR y casos con solapamiento. El uso de hidroxicloroquina y sulfasalazina se asoció con menor riesgo de infecciones en pacientes con AR. Conclusiones: Las infecciones son una complicación frecuente en los pacientes con EAS, por las alteraciones inmunitarias de la propia enfermedad y por los tratamientos indicados, fundamentalmente corticoides y biológicos. Se destaca la importancia del cribado y profilaxis de infecciones antes del inicio del tratamiento.(AU)

Introduction: Infections are a major cause of morbidity and mortality in patients with systemic autoimmune diseases. The aim of the present study is to describe the frequency of infections in a historical cohort of the SAD polyclinic of the Maciel Hospital, according to the type of disease and treatment received. Material and methods: An analytical, retrospective and observational study was conducted in 339 patients with SAD attended at the outpatient clinic in the period from January 1, 2012 to February 28, 2019. Infectious complications were analysed according to treatment and disease. Results: 339 cases, median age 56, mostly female. Most cases presented SLE (30.1%) and RA (23.6%), followed by antiphospholipid syndrome (20.4%) and Sjögren's syndrome (12.1%). Hydroxychloroquine (66%), followed by corticosteroids (55.5%) were the most frequently used treatments. Thirteen point three percent received biological therapies: 46.9% of the cases presented some infectious complication, 95% were non-opportunistic. Respiratory infections were the most frequent (48.6%) followed by urinary infections (31.7%) and skin and soft tissue infections (17.6%). On comparing the infected and non-infected groups, significant differences were found in the following variables: methotrexate, mycophenolate, corticoids, biological therapies, combination of drugs, active disease, RA and cases with overlap. The use of hydroxychloroquine and sulfasalazine was associated with a lower risk of infection in patients with RA. Conclusions: Infections are a frequent complication in patients with RA, due to the immune disturbances of the disease itself and prescribed treatments, mainly corticoids and biologicals. The importance of screening and infection prophylaxis before starting treatment is stressed.(AU)

Infections in systemic autoimmune diseases.

INTRODUCTION: Infections are a major cause of morbidity and mortality in patients with systemic autoimmune diseases. The aim of the present study is to describe the frequency of infections in a historical cohort of the SAD polyclinic of the Maciel Hospital, according to the type of disease and treatment received. MATERIAL AND METHODS: An analytical, retrospective and observational study was conducted in 339 patients with SAD attended at the outpatient clinic in the period from January 1, 2012 to February 28, 2019. Infectious complications were analysed according to treatment and disease. RESULTS: 339 cases, median age 56, mostly female. Most cases presented SLE (30.1%) and RA (23.6%), followed by antiphospholipid syndrome (20.4%) and Sjögren's syndrome (12.1%). Hydroxychloroquine (66%), followed by corticosteroids (55.5%) were the most frequently used treatments. Thirteen point three percent received biological therapies: 46.9% of the cases presented some infectious complication, 95% were non-opportunistic. Respiratory infections were the most frequent (48.6%) followed by urinary infections (31.7%) and skin and soft tissue infections (17.6%). On comparing the infected and non-infected groups, significant differences were found in the following variables: methotrexate, mycophenolate, corticoids, biological therapies, combination of drugs, active disease, RA and cases with overlap. The use of hydroxychloroquine and sulfasalazine was associated with a lower risk of infection in patients with RA. CONCLUSIONS: Infections are a frequent complication in patients with RA, due to the immune disturbances of the disease itself and prescribed treatments, mainly corticoids and biologicals. The importance of screening and infection prophylaxis before starting treatment is stressed.

Revisión bibliográfica: alimentación vegetariana en la infancia y adolescencia / Vegetarian diet in childhood and adolescence

RESUMEN Introducción: la popularidad de las dietas vegetarianas y veganas está aumentando en países occidentales y son adoptadas por niños, niñas y adolescentes (NNyA). Las principales asociaciones de nutrición y dietética del mundo avalan este tipo de práctica alimentaria en estos grupos etáreos si son supervisados y acompañados por profesionales idóneos. Objetivo: tomar posicionamiento como Asociación Argentina de Dietistas y Nutricionistas Dietistas acerca de la implementación de dietas vegetarianas en edad pediátrica y adolescencia, considerando recomendaciones basadas en evidencias científicas. Materiales y método: revisión y actualización bibliográfica, no sistemática con búsquedas en Google Scholar, PudMed y Medline entre diciembre 2018 y marzo 2019. Resultados: la valoración nutricional, evaluando ingesta alimentaria utilizando recordatorio de 24 horas y frecuencia de consumo, orientará sobre cuáles son las potenciales deficiencias nutricionales que puede presentar para adecuar la dieta y/o suplementación de nutrientes específicos. La alimentación vegetariana tiene una densidad energética más baja que la no vegetariana, pero se logran alcanzar las recomendaciones. Las necesidades proteicas se satisfacen fácilmente cuando la dieta incluye variedad de alimentos y las calorías son adecuadas. Algunos autores sugieren aumentar un 10 a 15% la recomendación proteica. Además, considerar el aporte de ácidos grasos omega 3 (EPA y DHA) para lograr el equilibrio óptimo entre los ácidos grasos poliinsaturados omega3/omega6. Los requerimientos nutricionales de calcio no varían con respecto a los omnívoros. Es imprescindible suplementar vitamina B12 oral a todos los NNyA vegetarianos, incluso en ovolactovegetarianos o en NNyA que consuman habitualmente alimentos fortificados. La suplementación adecuada es la mejor forma de garantizar unos niveles óptimos de esta vitamina. Se recomienda evaluar el estado de la vitamina D suplementando según edad. Conclusiones: La Asociación Argentina de Dietistas y Nutricionistas Dietistas (AADYND) plantea que la alimentación vegetariana y/o vegana planificada, supervisada y suplementada por un profesional de la nutrición idóneo, son saludables en la niñez y adolescencia. Los profesionales de la alimentación y nutrición pueden desempeñar un papel clave en la educación y acompañamiento de las personas vegetarianas acerca de fuentes específicas de nutrientes, preparación de alimentos, y modificaciones dietéticas necesarias para satisfacer sus necesidades(AU)

ABSTRACT Introduction: the popularity of vegetarian and vegan diets is increasing in western countries and are adopted by children and adolescents (Ch&A). The main nutrition and dietetic associations in the world approve this type of dietary practice in these age groups if they are supervised and accompanied by qualified professionals. Objective: take a position as the Argentine Association of Dietitians and Dietitian Nutritionists about the implementation of vegetarian diets in pediatric and adolescent age, considering recommendations based on scientific evidence. Materials and Method: review and bibliographic update, non-systematic, with searches on Google Scholar, PudMed and Medline between December 2018 and March 2019. Results: The nutritional assessment, evaluating food intake using a 24-hour reminder and frequency of consumption, will provide guidance on what are the potential nutritional deficiencies that may come up, adapt the diet and/or supplementation of specific nutrients. The vegetarian diet has a lower energy density than the non-vegetarian diet but manages to meet the recommendations. Protein needs are easily met when the diet includes a variety of foods and calories are adequate. Some authors suggest increasing the protein recommendation by 10 to 15%. Considering the contribution of omega 3 fatty acids (EPA and DHA) to achieve the optimal balance between omega3/omega6 polyunsaturated fatty acids. The nutritional requirements of calcium do not vary with respect to omnivores. It is essential to supplement oral vitamin B12 to all vegetarian Ch&A, even in ovolactovegetarians or in Ch&A that habitually consume fortified foods. Proper supplementation is the best way to ensure optimal levels of this vitamin. It is recommended to evaluate the status of vitamin D by supplementing according to age. Conclusions: Argentine Association of Dietitians and Dietitian Nutritionists states that vegetarian and/or vegan food, planned, supervised and supplemented by a suitable nutrition professional, are healthy in childhood and adolescence. Food and nutrition professionals can play a key role in educating and mentoring vegetarians about specific sources of nutrients, food preparation, and dietary modifications necessary to meet their needs(AU)

Infections in systemic autoimmune diseases. / Infecciones en enfermedades autoinmunes sistémicas.

INTRODUCTION: Infections are a major cause of morbidity and mortality in patients with systemic autoimmune diseases. The aim of the present study is to describe the frequency of infections in a historical cohort of the SAD polyclinic of the Maciel Hospital, according to the type of disease and treatment received. MATERIAL AND METHODS: An analytical, retrospective and observational study was conducted in 339 patients with SAD attended at the outpatient clinic in the period from January 1, 2012 to February 28, 2019. Infectious complications were analysed according to treatment and disease. RESULTS: 339 cases, median age 56, mostly female. Most cases presented SLE (30.1%) and RA (23.6%), followed by antiphospholipid syndrome (20.4%) and Sjögren's syndrome (12.1%). Hydroxychloroquine (66%), followed by corticosteroids (55.5%) were the most frequently used treatments. Thirteen point three percent received biological therapies: 46.9% of the cases presented some infectious complication, 95% were non-opportunistic. Respiratory infections were the most frequent (48.6%) followed by urinary infections (31.7%) and skin and soft tissue infections (17.6%). On comparing the infected and non-infected groups, significant differences were found in the following variables: methotrexate, mycophenolate, corticoids, biological therapies, combination of drugs, active disease, RA and cases with overlap. The use of hydroxychloroquine and sulfasalazine was associated with a lower risk of infection in patients with RA. CONCLUSIONS: Infections are a frequent complication in patients with RA, due to the immune disturbances of the disease itself and prescribed treatments, mainly corticoids and biologicals. The importance of screening and infection prophylaxis before starting treatment is stressed.

Documento de postura y declaración de entidad libre de conflictos de intereses de la Asociación Argentina de Dietistas y Nutricionistas Dietistas: Protocolo por la total transparencia, la integridad y la equidad. 2018 / Position document and declaration of entity free of conflicts of interest of the Argentine Association of Dietitians and Nutritionists Dietitians: Protocol for total transparency, integrity and fairness. 2018

El conflicto de intereses (CDI) surge cuando el interés primario de un profesional de la salud, que es el bienestar de los pacientes, ya sea a través de su atención directa o de otras actividades que generen y difundan conocimiento para mejorar esa atención, está en riesgo de ser sesgado por un interés secundario que ocasionaría un daño. Sin embargo, no siempre la existencia de conflicto implica que se altere una conducta o una decisión, ni que ello resulte en un daño(AU).

Creación del Código de Ética AADYND: historia, bases y fundamentos de un consenso profesional / Creation of AADYND´s code of ethics: history, bases and foundations of a professional consensus

La creación del Código de Ética de la Asociación Argentina de Dietistas y Nutricionistas Dietistas (AADYND) refleja el consenso de conductas éticas que los profesionales adherentes a nuestra asociación adoptamos conscientemente para nuestra práctica profesional. La doctrina del Dr. Escudero P. así como el estatuto de la Asociación, ya desde sus inicios, definen los valores profesionales o ideales que se pretendía y pretenden alcanzar. El Código de Ética que adoptan los miembros de la AADYND, es una demostración del ejercicio de su autonomía, de su capacidad de autorregularse, controlarse y autodirigirse hacia niveles de excelencia. El Código de Ética de AADYND es un medio y es un fin en sí mismo, se adecua a los principios de la bioética y fue consensuado oportunamente por sus miembros. Es una instancia abierta para ser revisada oportunamente.

The creation of the Code of Ethics of the Argentinean Association of Dietitians and Nutritionists Dietitians (AADYND) reflects the consensus of ethical behaviors that the professionals adhering to the Association consciously adopt for their professional practice. The doctrine by Dr. Escudero P, as well as the statute of the Association, since its start, has defined the professional values or ideals that were intended and are intended to be achieved. The Code of Ethics adopted by the members of the AADYND shows the exercise of their autonomy, of their ability to self-regulate, control themselves and self-direct towards levels of excellence. The AADYND's Code of Ethics is a means and an end in itself, it adapts to the principles of bioethics and was opportunely agreed by AADYND's members. It is an open instance to be reviewed in a timely manner.

Pénfigo familiar benigno (Enfermedad de Hailey-Hailey). A propósito de dos casos / Benign familial pemphigus (Hailey-Hailey disease). A report of two cases

El pénfigo familiar benigno (Enfermedad de Hailey-Hailey) es una rara genodermatosis localizada en pliegues, que cursa en brotes con ardor y prurito localizado predominantemente en verano. Presentamos dos pacientes con Enfermedad de Hailey-Hailey de diagnóstico tardío(AU)

Benign familial pemphigus (Hailey-Hailey disease) is a rare genodermatosis located in folds, which presents in outbreaks with burning and itching predominantly in summer. Two patients with Hailey-Hailey disease of late diagnosis are reported (AU)

Hereditary motor and sensory neuropathy (HMSN) type X1 in an Argentinean family reveals independent GJB1/Cx32 mutations at the identical nucleotide position.

X-linked Charcot-Marie-Tooth disease (CMT Type X1, OMIM: 302800) represents a frequent cause of hereditary peripheral motor and sensory neuropathies and is associated with mutations in GJB1 encoding the gap junction beta 1 protein connexin 32 (Cx32). Studying an Argentinean family of Italian origin with seven affected males in three generations exhibiting clinical signs of CMT, eight obligate female carriers were identified genealogically. DNA sequencing of exon 2 and adjacent regions of the GJB1 gene in two symptomatic males whose respective maternal grandfathers, both affected, were brothers, revealed mutations in GJB1/Cx32. Surprisingly, each of the two affected patients had a different mutation in hemizygous state at the same nucleotide position: c.383C>T (p.S128L) and c.383C>A (p.S128X). In both cases, the identified mutation was present in heterozygous state in the corresponding maternal genomic DNA. Furthermore, X-chromosomal microsatellite analysis showed identical marker alleles in both patients. Together with the genealogical information, these molecular data imply that a primarily mutated allele mutated for a second time. In conclusion, two different mutations at the same nucleotide position in this Argentinean family represent a finding with a very low probability of occurrence.

Xantoma diseminado / Disseminated xanthoma

Paciente de sexo femenino, de 22 años de edad, que consulta por poliuria, fiebre, desorientación témpo-espacial y pápulas pardo-rojizas en párpados, surco nasogenianos, pliegues y raíz de miembros. Se solicitan exámenes complementarios y biopsia confirmando el diagnóstico de xantoma diseminado. El interés del caso radica en una patología poco frecuente, generalmente de evolución benigna que en nuestra paciente tuvo desenlace fatal.