Prevalence and factors related to orthostatic syndromes in recently diagnosed, drug-naïve patients with Parkinson disease.

PURPOSE: The aim of this study was to explore the prevalence of and factors related to orthostatic syndromes in recently diagnosed drug-naïve patients with Parkinson disease (PD). METHODS: This was a cross-sectional study that included 217 drug-naïve patients with PD and 108 sex- and age-matched non-parkinsonian controls from the Parkinson's Progression Markers Initiative (PPMI) prospective cohort study who were devoid of diabetes, alcoholism, polyneuropathy, amyloidosis, and hypotension-inducing drugs. Orthostatic symptoms were evaluated using the Scales for Outcomes in PD-Autonomic Dysfunction (SCOPA-AUT). Ioflupane-I123 single-photon emission computerized tomography was used to evaluate striatal dopamine active transporter (DaT) levels. Blood pressure was assessed both in the supine position and 1-3 min after the switch to a standing position. Orthostatic hypotension (OH) was defined by international consensus, and orthostatic intolerance (OI) was defined as the presence of orthostatic symptoms in the absence of OH. RESULTS: Compared with non-parkinsonian controls, patients with PD experienced a mild fall in systolic blood pressure upon standing (p = 0.082). The prevalence of OH was 11.1% in PD patients and 5.6% in controls (p = 0.109). The prevalence of OI was higher in patients with PD than in controls (31.3 vs. 13.3%; p = 0.003). Logistic regression revealed that OH and OI were related to a lower striatal DaT level and higher SCOPA-AUT gastrointestinal score. CONCLUSIONS: Orthostatic syndromes were common in the recently diagnosed drug-naïve patients with PD enrolled in the study, but only the prevalence of OI was higher in PD patients than in the non-parkinsonian controls. Unlike motor or functional disability indicators, markers of dopaminergic striatal deficit and gastrointestinal dysfunction were associated with OH and OI.

Clinical and demographic characteristics of primary progressive multiple sclerosis in Argentina: Argentinean registry cohort study (RelevarEM).

BACKGROUND: Primary progressive multiple sclerosis (PPMS) is an infrequent clinical form of multiple sclerosis (MS). Scarce information is available about PPMS in Latin America. The aim of this work is to describe the clinical and demographic characteristics of PPMS patients in Argentina. MATERIAL AND METHODS: RelevarEM is a longitudinal, strictly observational registry in Argentina. Clinical and epidemiological data from PPMS patients were described. RESULTS: There were 144 cases of PPMS. They represented 7% of MS patients. The mean age was 44.1 years. The female:male ratio was 1.08. The mean Expanded Disability Status Scale (EDSS) score was 5.5 and the mean disease evolution time was 10.6 years. Oligoclonal bands were found in 72.9%. At the time of diagnosis, magnetic resonance imaging showed spinal cord lesions in 82.6% and contrast-enhancing brain lesions in 18.1% of patients. Almost one third of patients were treated with a disease-modifying drug, and ocrelizumab was the most frequently used (55.8%). CONCLUSIONS: PPMS is an infrequent subtype of MS and its recognition is of the highest importance as it has its own evolution, treatment, and prognosis. The importance of our research resides in providing local data and contributing to a better understanding of PPMS and its treatment in Latin America.

Role of Astrocytic Dysfunction in the Pathogenesis of Parkinson's Disease Animal Models from a Molecular Signaling Perspective.

Despite the fact that astrocytes are the most abundant glial cells, critical for brain function, few studies have dealt with their possible role in neurodegenerative diseases like Parkinson's disease (PD). This article explores relevant evidence on the involvement of astrocytes in experimental PD neurodegeneration from a molecular signaling perspective. For a long time, astrocytic proliferation was merely considered a byproduct of neuroinflammation, but by the time being, it is clear that astrocytic dysfunction plays a far more important role in PD pathophysiology. Indeed, ongoing experimental evidence suggests the importance of astrocytes and dopaminergic neurons' cross-linking signaling pathways. The Wnt-1 (wingless-type MMTV integration site family, member 1) pathway regulates several processes including neuron survival, synapse plasticity, and neurogenesis. In PD animal models, Frizzled (Fzd) neuronal receptors' activation by the Wnt-1 normally released by astrocytes following injuries leads to ß-catenin-dependent gene expression, favoring neuron survival and viability. The transient receptor potential vanilloid 1 (TRPV1) capsaicin receptor also participates in experimental PD genesis. Activation of astrocyte TRPV1 receptors by noxious stimuli results in reduced inflammatory response and increased ciliary neurotrophic factor (CNTF) synthesis, which enhances neuronal survival and differentiation. Another major pathway involves IκB kinase (IKK) downregulation by ARL6ip5 (ADP-ribosylation-like factor 6 interacting protein 5, encoded by the cell differentiation-associated, JWA, gene). Typically, IKK releases the proinflammatory NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) molecule from its inhibitor. Therefore, by downregulating NF-κB inhibitor, ARL6ip5 promotes an anti-inflammatory response. The evidence provided by neurotoxin-induced PD animal models guarantees further research on the neuroprotective potential of normalizing astrocyte function in PD.

Upper Limb Dexterity in Patients with Multiple Sclerosis: An Important and Underrated Morbidity.

BACKGROUND: Scales to assess disability in multiple sclerosis (MS) rarely provide reliable data on actual global impairment. Upper limb dysfunction is usually overlooked, which has a negative effect on patient well-being. We sought to analyze associations among upper limb dexterity, lower limb speed, and Expanded Disability Status Scale (EDSS) score; the difference in upper limb dexterity between patients with EDSS scores less than 5 and 5 or greater; and the associations that upper limb dexterity, lower limb speed, and EDSS score have with health-related quality of life measurements and depression. METHODS: A total of 140 adults with MS were evaluated using the Nine-Hole Peg Test, Timed 25-Foot Walk test, EDSS, Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire, and Beck Depression Inventory. Thorough descriptive-analytical research was conducted using the Spearman correlation, multiple linear regression, and structural equation modeling. RESULTS: Upper limb dexterity was more closely related to EDSS score than lower limb speed (r = 0.43 vs 0.29, R 2 = 0.38) and was greatest in patients with EDSS scores less than 5 (P < .01). Moreover, upper limb dexterity was negatively associated with EDSS score and the MusiQoL questionnaire (rS = -0.557 to -0.321, P < .05). The correlation that depression has with upper limb dexterity loss was higher than the one it has with lower limb speed (0.098 vs 0.066, t > 1.96). CONCLUSIONS: Upper limb dexterity is associated with global disability, depression, and health-related quality of life. We advocate for the assessment of upper limb dexterity in patients with MS to adopt a better approach to their functional impairment.

[Age difference in the choice of the sexual partner as a risk factor for sexually transmitted infections]. / Diferencia de edad entre parejas sexuales como riesgo de infecciones de trasmisión sexual.

An age difference > 5 years in the choice of sexual partner may constitute a risk factor for sexually transmitted infections (STIs), including HIV infection. A sexual and reproductive health survey was carried out on people who consulted for STIs or HIV serology in two health centers in Buenos Aires suburbs, with the aim of providing information for the design of prevention measures and to know if in this area there is an association between the maximum age difference (MAD) in the choice of sexual partner and the acquisition of HIV and/or STIs. A total of 120 patients consulted, 90% (108) performed serology, resulting 15 of them (13.9%) infected with HIV and 46 (42.6%) with syphilis. The MAD with the partner was = 5 years in 65 (54.6%) and > 5 years in 54 (45.4%) of 119 who answered the survey. Men who have sex with men reported a MAD > 5 years more frequently (p = 0.022 OR: 3.59). The risk for HIV increased 9% for each year of age difference with the sexual partner (OR: 1.093). The percentage of urethritis cases was significantly lower in the age group = 25 years. None of the people with urethritis had HIV infection. In conclusion: Men who have sex with men tended to choose their sexual partners with a higher MAD, and a higher MAD was a risk factors for HIV infection.

Una diferencia de edad > 5 años en la elección de la pareja sexual puede constituir un factor de riesgo de infecciones de trasmisión sexual (ITS), incluida la infección por HIV. Se realizó una encuesta de salud sexual y reproductiva a personas que consultaron por ITS o serología para HIV en dos centros de salud del conurbano bonaerense, con el objetivo de brindar información para el diseño de medidas de prevención y conocer si en nuestra área existe asociación entre la máxima diferencia de edad (MDE) en la elección de la pareja sexual y la adquisición de HIV y/o ITS. Se incluyeron 120 consultantes. En 108 (90%) se investigó serología, resultando 15 (13.9%) positivos para HIV y 46 (42.6%) para sífilis. La MDE con la pareja fue = 5 años en 65 (54.6%) y > 5 años en 54 (45.4%) de 119 que respondieron la encuesta. Los hombres que tenían sexo con hombres refirieron una MDE > 5 años con mayor frecuencia (p = 0.022, OR: 3.59). El riesgo de HIV aumentó 9% por cada año de diferencia de edad con la pareja sexual (OR: 1.093). El porcentaje de casos de uretritis fue significativamente menor en el grupo de edad = 25 años. Ninguna de las personas con uretritis tenía infección HIV. En conclusión: en esta población los hombres que tenían sexo con hombres tendieron a elegir sus parejas sexuales con una MDE mayor, y una MDE mayor fue un factor de riesgo de infección HIV.

Effects of angiotensin type 1 receptor antagonists on Parkinson's disease progression: An exploratory study in the PPMI database.

INTRODUCTION: We explored the potential clinical effects of angiotensin-II AT1 receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) in patients from the Parkinson's Progress Marker Initiative (PPMI) study database. METHODS: We included 423 newly diagnosed PD patients, free from antiparkinsonian treatment, from the PPMI. We compared the proportion of patients starting on l-DOPA during the first year of follow-up, and the changes in MDS-UPDRS total score and sub-scores during the first five follow-up years for patients exposed or not to ARBs or ACEIs. RESULTS: Treatment with ARBs did not affect the proportion of patients on l-DOPA during the first year (adjusted OR, 95% CI = 0.26, 0.03-2.18, N.S.) while reduced MDS-UPDRS total score (0.85, 0.76-0.95, p < 0.01). Patients treated with ACEIs experienced no changes in either measure. CONCLUSIONS: These results show potential signals for a beneficial effect with ARBs. Further clinical trials are warranted.

[Knowledge, attitudes, and practices about COVID-19 in Argentina. A cross-sectional study]. / Conocimientos, actitudes y prácticas sobre COVID-19 en Argentina. Estudio tranversal.

Our objective was to assess levels of knowledge, attitudes, and practices against COVID-19. A total of 3774 persons were surveyed between September 18 and October 16, 2020. Eighty% resided in Buenos Aires City or Buenos Aires Province: 58% had completed tertiary education; 72% worked either independently or as employees in the public or the private sector; 51% used a prepaid health care plan, 34% were covered by a trade union-based health system, and near 10% used the public health services. According to the socio-demographic variables analyzed, the population studied was representative of the middle class. A total of 7% had been diagnosed with COVID-19. There was a high level of knowledge about the disease, judging by the high proportion of correct answers (80-90%). Regarding the measures taken by the government, the answers varied widely ("correct", "inadequate", "harmful", "unnecessary", etc.). The medical staff was the preferred source of information; 44% of respondents felt protected by their health system; 28% would only seek healthcare when feeling very sick. There was a high degree of compliance with most protection measures, except for attendance to social events in poorly ventilated spaces (50%). The results of these studies contribute to establishing communication strategies for the prevention and control of COVID-19 and thus deal more efficiently with eventual outbreaks of the disease.

Nuestro objetivo fue evidenciar el nivel de conocimientos, actitudes y prácticas frente al COVID-19. Fueron encuestados 3774 individuos mayores de 16 años entre el 18/09/20 y el 16/10/20. El 80% residía en la ciudad de Buenos Aires o la Provincia de Buenos Aires. El 58% había completado estudio terciario. El 72% tenía actividad laboral independiente o en relación de dependencia pública o privada. Utilizaban el sistema de salud prepago el 51%, obra social laboral el 34%, y sistema público de salud cerca del 10%. De acuerdo a las variables socio-demográficas analizadas, la mayoría de la población fue representativa de la clase media. Del total de encuestados, el 7% tuvo diagnóstico de COVID-19. Observamos un alto nivel de conocimiento de la enfermedad, con 80 a 90% de respuestas correctas. En relación a las medidas adoptadas por las autoridades, los juicios emitidos variaron entre "correctas", "insuficientes", "perjudiciales", "innecesarias", etc. El 44% se sentía protegido por el sistema de salud. En cuanto a los referentes válidos para transmitir información, la respuesta preponderante fue el personal médico. En cuanto al momento deconsultar por síntomas, un porcentaje importante (28%) lo haría en forma tardía. Observamos un alto grado de cumplimiento de las medidas de protección, a excepción del ítem "Asistencia a reuniones" (50%). Los resultados de estos estudios contribuyen a establecer estrategias comunicacionales para la prevención y el control de la enfermedad y de ese modo enfrentar de forma más eficiente eventuales rebrotes de la enfermedad.

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

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.

State-of-the-art pharmacotherapy for autonomic dysfunction in Parkinson's disease.

Introduction: Autonomic dysfunction is one of the most frequent and disabling non-motor symptoms of Parkinson's disease (PD). It includes, among others, orthostatic hypotension (OH), sialorrhea, constipation, erectile dysfunction (ED), urinary dysfunction, and diaphoresis. They are usually under-recognized and suboptimally managed.Areas covered: Recommended treatments for dysautonomias are summarized with a description of the mechanism of action and observed results. The pathophysiology of each disorder is reviewed to pinpoint possible therapeutic targets. Drugs approved for treating dysautonomia in the general population along with those under development for PD-related dysautonomia are also reviewed. Finally, the key elements of each symptom that should be addressed in clinical trials' design are considered.Expert opinion: Midodrine, droxidopa, fludrocortisone, and domperidone may be used for OH treatment. Sialorrhea can be managed with botulin toxin injections and oral glycopyrrolate. Erectile dysfunction can benefit from sildenafil treatment, as urinary dysfunction can from solifenacin. Macrogol, lubiprostone, and probiotics might be effective in treating constipation. Further research is needed to determine adequate treatment for diaphoresis in PD patients. Multidisciplinary management of motor and non-motor symptoms in PD is the best approach for dysautonomias in PD.

Acute and Chronic Anti-ganglioside Neuropathies: From Theory to Practice in Buenos Aires, Argentina.

BACKGROUND AND AIMS: During the last two decades important advances have been made regarding the knowledge of immunomediated neuropathies, which entitled them to evolve from a theoretical existence to subtype differentiation. Nevertheless, questions regarding antigen topography or antibody's pathogenicity still need to be answer. Moreover, antibody typification is not necessarily available during clinical practice and usually diagnostic decisions or follow-up are done without it. The aim of this study is to raise awareness of the importance of divergent clinical findings in patients with immunomediated neuropathies. METHODS: We present an acute and a chronic case of anti-ganglioside neuropathy immunologically studied with the best anti-ganglioside antibody panel available nowadays in our country along with an update of the current knowledge of these entities. RESULTS: Although there is no consensus regarding the pathogenicity of these antibodies, diverging clinical features (mainly ataxia and ophthalmoparesis) and disease prognosis (as markers of axonal damage) are known to be associated with different antibodies. CONCLUSIONS: Antibody characterization in anti-ganglioside neuropathies is an evolving field, which we believe should periodically updated and minded for patient's diagnosis and follow-up, even if laboratory confirmation is not immediate, if available at all.

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

Predictors of amyotrophic lateral sclerosis mimic syndrome.

The term amyotrophic lateral sclerosis mimic syndrome (ALSms) includes pathologies that present signs or symptoms similar to those caused by amyotrophic lateral sclerosis (ALS), which can lead to misdiagnosis. In general, any kind of misdiagnosis can result in negative clinical, psychological and economic consequences as well diagnostic and treatment delay. The objectives were to determine the frequency and to compare the demographic and clinical characteristics of patients with ALS and ALSms in our ALS clinic. We retrospectively studied all patients evaluated from 2007 to 2017 including only patients with a definite final diagnosis. Out of 368 patients with motor neuron disease symptomatology, 43 (11.7%) had an ALSms. The most frequent etiology was compressive myelopathy (32.6%). Multivariate analysis considering positive associations was statistically significant for patients having only upper or lower motor neuron signs in the physical examination, a non-compatible electromyogram (EMG), as well as atypical first symptoms. ALS misdiagnosis is an ongoing and not infrequent problem. From our series of patients, atypical symptoms, absence of EMG pathological findings or isolated upper or lower motor neuron disease should prompt suspicion of a differential diagnosis.

Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases.

INTRODUCTION: L-threo-3,4-dihydroxyphenylserine (droxidopa), a pro-drug metabolized to norepinephrine in nerve endings and other tissues, has been commercially available in Japan since 1989 for treating orthostatic hypotension symptoms in Parkinson's disease (PD) patients with a Hoehn & Yahr stage III rating, as well as patients with Multiple System Atrophy (MSA), familial amyloid polyneuropathy, and hemodialysis. Recently, the FDA has approved its use in symptomatic neurogenic orthostatic hypotension (NOH). Areas covered: The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF). Expert opinion: A few small and short placebo-controlled clinical trials in NOH showed significant reductions in the manometric drop in blood pressure (BP) after posture changes or meals. Larger Phase III studies showed conflicting results, with two out of four trials meeting their primary outcome and thus suggesting a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks. Results appear essentially similar in PD, MSA, and PAF. The FDA granted droxidopa approval in the frame of an 'accelerated approval program' provided further studies are conducted to assess its long-term effects on OH symptoms.

Everything you always wanted to know about sex and Neurology: neurological disability and sexuality.

OBJECTIVE: Chronic neurological disorders generate disabilities affecting multiple aspects of life, including sexuality. OBJECTIVE: To describe the presence of sexual dysfunction and comorbidities in a population with chronic neurological disorders. To analyze the relationship between disability and sexual dysfunction. METHODS: A cross-sectional case-control study was carried out. Patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson's disease (PD), and stroke of at least one year since the onset of symptoms were included, and compared with controls with no neurological disease, matched by age and sex. RESULTS: We included 71 participants: 29 controls, with a mean age of 49.4 years, and 42 patients with a mean age of 53.8 years. Sexual dysfunction was present in 22.5% of the controls and 77.5% of the patients. A statistically significant relationship between sexual dysfunction and disability was found in the logistic regression analysis (OR = 20.38, 95%CI: 2.5 -165.86). CONCLUSIONS: Disability proved to be the main variable related to the presence of sexual dysfunction. Patients with ALS had the worst rates of sexual dysfunction. Patients with MS were similar to the control group. As for the PD group, no patient had normal sexuality. Finally, in stroke patients, the presence of comorbidities and their treatment may have negatively influenced sexuality. These findings showed that patients with chronic neurological diseases have sexual dysfunction and underscore the need for neurologists to know and address this problem.

Are astrocytes executive cells within the central nervous system?

Experimental evidence suggests that astrocytes play a crucial role in the physiology of the central nervous system (CNS) by modulating synaptic activity and plasticity. Based on what is currently known we postulate that astrocytes are fundamental, along with neurons, for the information processing that takes place within the CNS. On the other hand, experimental findings and human observations signal that some of the primary degenerative diseases of the CNS, like frontotemporal dementia, Parkinson's disease, Alzheimer's dementia, Huntington's dementia, primary cerebellar ataxias and amyotrophic lateral sclerosis, all of which affect the human species exclusively, may be due to astroglial dysfunction. This hypothesis is supported by observations that demonstrated that the killing of neurons by non-neural cells plays a major role in the pathogenesis of those diseases, at both their onset and their progression. Furthermore, recent findings suggest that astrocytes might be involved in the pathogenesis of some psychiatric disorders as well.

Astrocytes As the Main Players in Primary Degenerative Disorders of the Human Central Nervous System.

Along the last years it has been demonstrated that non-neural cells play a major role in the pathogenesis of the primary degenerative disorders (PDDs) of the human central nervous system. Among them, astrocytes coordinate and participate in many different and complex metabolic processes, in close interaction with neurons. Moreover, increasing experimental evidence hints an early astrocytic dysfunction in these diseases. In this mini review we summarize the astrocytic behavior in PDDs, with special consideration to the experimental observations where astrocytic pathology precedes the development of neuronal dysfunction. We also suggest a different approach that could be consider in human investigations in Alzheimer's and Parkinson's disease. We believe that the study of PDDs with human brain samples may hold the key of a paradigmatic physiopathological process in which astrocytes might be the main players.

Conocimientos, actitudes y prácticas sobre covid-19 en argentina. estudio tranversal / Knowledge, attitudes, and practices about COVID-19 in Argentina. A cross-sectional study

Resumen Nuestro objetivo fue evidenciar el nivel de conocimientos, actitudes y prácticas frente al COVID-19. Fueron encuestados 3774 individuos mayores de 16 años entre el 18/09/20 y el 16/10/20. El 80% residía en la ciudad de Buenos Aires o la Provincia de Buenos Aires. El 58% había completado estudio terciario. El 72% tenía actividad laboral independiente o en relación de dependencia pública o privada. Utilizaban el sistema de salud prepago el 51%, obra social laboral el 34%, y sistema público de salud cerca del 10%. De acuerdo a las variables socio-demográficas analizadas, la mayoría de la población fue representativa de la clase media. Del total de encuestados, el 7% tuvo diagnóstico de COVID-19. Observamos un alto nivel de conocimiento de la enfermedad, con 80 a 90% de respuestas correctas. En relación a las medidas adoptadas por las autoridades, los juicios emitidos variaron entre "correctas", "insuficientes", "perjudiciales", "innecesarias", etc. El 44% se sentía protegido por el sistema de salud. En cuanto a los referentes válidos para transmitir información, la respuesta preponderante fue el personal médico. En cuanto al momento deconsultar por síntomas, un porcentaje impor tante (28%) lo haría en forma tardía. Observamos un alto grado de cumplimiento de las medidas de protección, a excepción del ítem "Asistencia a reuniones" (50%). Los resultados de estos estudios contribuyen a establecer estrategias comunicacionales para la prevención y el control de la enfermedad y de ese modo enfrentar de forma más eficiente eventuales rebrotes de la enfermedad.

Abstract Our objective was to assess levels of knowledge, attitudes, and practices against COVID-19. A total of 3774 persons were surveyed between September 18 and October 16, 2020. Eighty% resided in Buenos Aires City or Buenos Aires Province: 58% had completed tertiary education; 72% worked either independently or as employees in the public or the private sector; 51% used a prepaid health care plan, 34% were covered by a trade union-based health system, and near 10% used the public health services. According to the socio-demographic variables analyzed, the population studied was representative of the middle class. A total of 7% had been diag nosed with COVID-19. There was a high level of knowledge about the disease, judging by the high proportion of correct answers (80-90%). Regarding the measures taken by the government, the answers varied widely ("correct", "inadequate", "harmful", "unnecessary", etc.). The medical staff was the preferred source of information; 44% of respondents felt protected by their health system; 28% would only seek healthcare when feeling very sick. There was a high degree of compliance with most protection measures, except for attendance to social events in poorly ventilated spaces (50%). The results of these studies contribute to establishing communication strategies for the prevention and control of COVID-19 and thus deal more efficiently with eventual outbreaks of the disease.

Diferencia de edad entre parejas sexuales como riesgo de infecciones de trasmisión sexual / Age difference in the choice of the sexual partner as a risk factor for sexually transmitted infections

Resumen Una diferencia de edad > 5 años en la elección de la pareja sexual puede constituir un factor de riesgo de infecciones de trasmisión sexual (ITS), incluida la infección por HIV. Se realizó una encuesta de salud sexual y reproductiva a personas que consultaron por ITS o serología para HIV en dos centros de salud del conurbano bonaerense, con el objetivo de brindar información para el diseño de medidas de prevención y conocer si en nuestra área existe asociación entre la máxima diferencia de edad (MDE) en la elección de la pareja sexual y la adquisición de HIV y/o ITS. Se incluyeron 120 consultantes. En 108 (90%) se investigó sero logía, resultando 15 (13.9%) positivos para HIV y 46 (42.6%) para sífilis. La MDE con la pareja fue ≤ 5 años en 65 (54.6%) y > 5 años en 54 (45.4%) de 119 que respondieron la encuesta. Los hombres que tenían sexo con hombres refirieron una MDE > 5 años con mayor frecuencia (p = 0.022, OR: 3.59). El riesgo de HIV aumentó 9% por cada año de diferencia de edad con la pareja sexual (OR: 1.093). El porcentaje de casos de uretritis fue significativamente menor en el grupo de edad ≥ 25 años. Ninguna de las personas con uretritis tenía infección HIV. En conclusión: en esta población los hombres que tenían sexo con hombres tendieron a elegir sus parejas sexuales con una MDE mayor, y una MDE mayor fue un factor de riesgo de infección HIV.

Abstract An age difference > 5 years in the choice of sexual partner may constitute a risk factor for sexually transmitted infections (STIs), including HIV infection. A sexual and reproductive health survey was carried out on people who consulted for STIs or HIV serology in two health centers in Buenos Aires suburbs, with the aim of providing information for the design of prevention measures and to know if in this area there is an association between the maximum age difference (MAD) in the choice of sexual partner and the acquisition of HIV and/or STIs. A total of 120 patients consulted, 90% (108) performed serology, resulting 15 of them (13.9%) infected with HIV and 46 (42.6%) with syphilis. The MAD with the partner was ≤ 5 years in 65 (54.6%) and > 5 years in 54 (45.4%) of 119 who answered the survey. Men who have sex with men reported a MAD > 5 years more frequently (p = 0.022 OR: 3.59). The risk for HIV increased 9% for each year of age difference with the sexual partner (OR: 1.093). The percentage of urethritis cases was significantly lower in the age group ≥ 25 years. None of the people with urethritis had HIV infection. In conclusion: Men who have sex with men tended to choose their sexual partners with a higher MAD, and a higher MAD was a risk factors for HIV infection.

Severe Spinal Injury in Hirayama Disease.

Hirayama disease is a rare neurological disorder characterized by an insidious progressive subacute unilateral or bilateral weakness of the hands and forearm muscles leading to a painless amyotrophy. The disease primarily affects young men in the second to third decades of life. It has always been described as a second motor neuron disease, thus sparing the pyramidal and sensitive pathways. It usually has a slow progression course of 3 to 5 years followed by stabilization. Since its initial description by Keyzo Hirayama in 1959, most cases have been reported in Asia, particularly Japan and India, although the disease reportedly has worldwide distribution.