Kidney Limited Complement-Mediated Thrombotic Microangiopathy- a Challenging Case

Introduction: Complement-mediated thrombotic microangiopathy (CM-TMA) is a rare disease characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and organ injury. The absence of hemolysis and thrombocytopenia is rare. We present a case of kidney limited CM-TMA successfully treated with eculizumab. Method(s): A 36 year-old man with poorly controlled hypertension, obesity, CKD (baseline creatinine (sCr) 2,6mg/dL, albuminuria 150mg/g), hyperlipidemia, obstructive sleep apnea, hyperuricemia, SARS-CoV-2 infection 3 months earlier, and family history of CKD of unknown etiology (father started kidney replacement therapy (KRT) at young age) presented to the ER with high blood pressure and right hemiplegy. Head CT scan showed left thalamo-capsular hemorrhage. Oftalmologic exam was normal. Laboratory findings were: hemoglobin (Hb) 12.5g/dL, elevated white cell count (17.900/uL), platelet count 214.000/uL, sCr 4.3mg/dL, lactate dehydrogenase (LDH) 303U/L. Urine dipstick revealed protein+ and Hb++. Chest X-ray showed signs of pneumonia. The patient was admitted in ICU and mechanically ventilated. After 3 weeks, renal function recovered to its baseline (sCr 1.5mg/dL, no proteinuria) without KRT, and the patient was transferred to the medical ward. Several infectious complications prolonged hospital stay. After 3 months, a new mild SARS-CoV-2 infection was detected. At this time: Hb 9.9g/dL, platelets 220.000/uL, sCr 2.2mg/dL. Six days later the patient showed Hb 9.5 g/dL, without reticulocytosis, platelets 195.000/uL, sCr 6.3mg/dL, LDH 348U/L, normal haptoglobin, no schizocytes on blood smear. After 3 days, the patient was anuric and sCr increased to 10mg/dL, prompting KRT. Kidney ultrasound showed no abnormalities. Autoimmunity study was negative, normal C3/C4, no monoclonal gammopathy, and negative viral serologies. Kidney biopsy (KB) was performed as the etiology of AKI remained unclear. Light microscopy revealed thickned glomerular capillary walls with subendothelial expansion forming double contouring, arteriolar intimal expansion and fibrin thrombi occluding the vascular lumina. Scarse C3 deposition was observed in capillary walls. Since the morphological features were consistent with TMA, secondary causes were excluded and primary causes also investigated: ADAMTS13 activity, complement factor B and I were within normal range, slight decrease of factor H with normal anti factor H antibody. The molecular studies of complement genes were performed by NGS-based gene panel revealing a rare heterozygous missense mutation on gene CFB, c.1189G>A (p.Asp397Asn), described as a genetic risk factor of CM-TMA in the presence of a trigger. Result(s): Treatment with eculizumab was started and the patient showed signs of kidney recovery allowing KRT suspension 1 month later (sCr 5.53mg/dL). Of note, the patient never presented MAHA or thrombocytopenia. After 5 months, renal function improved to sCr 3.9mg/dL. Conclusion(s): We report a case of CM-TMA with isolated kidney injury without laboratory hallmarks of TMA. Patients usually require a secondary trigger for the disease to manifest, and in this case SARS-CoV-2 infection may have been the causative agent. A mutation in gene CFB may have predisposed the patient to the outcome. KB was crucial for diagnosis and prompted the treatment with eculizumab with partial recovery without the need for chronic KRT. No conflict of interestCopyright © 2023

Enhanced recovery after radical cystectomy: Outcomes of implementation after 80 cases

Objectives: To evaluate the effect of implementing Enhanced Recovery After Surgery (ERAS) and compliance to protocol in patients undergoing radical cystectomy (RC) and urinary diversion during the COVID-19 pandemic. Method(s): Since February 2020, a 14-point multimodal ERAS protocol has been implemented for patients undergoing elective CR and urinary diversion at our institution. We retrospectively evaluated 80 patients who underwent CR between February 2020 and February 2022. The effects of ERAS implantation for CR during the COVID-19 pandemic were validated. Result(s): With a mean age of 68.5 years [CI: 66.4-70.7], 80 patients who underwent RC were included in the analysis, 69 men (86%) and 11 women (14%). Main indication for surgery was muscle-invasive bladder cancer and laparoscopic or robot-assisted RC was performed in most cases (86%). Regarding urinary diversion, in 66 patients (82.5%) an ileal conduit was done and an orthotopic neobladder in 14 cases (17.5%). The attached table shows the percentage of compliance with each parameter of the 14-point ERAS protocol. Most of the compliance rates are above 80%, except for early mobilization. Efficiency item assesses whether the expected days of hospital admission are met. In this way, the median length of hospital stay (LOS) was 5 days [IQR 2.5]. In terms of follow-up, the hospital readmission rate one month after surgery was 6%. Before the application of the ERAS program this rate was 9.1%, thus it represents a significant reduction (p<0.05). [Formula presented] Conclusion(s): Our initial experience with the implementation of a 14-point enhanced recovery protocol after RC has been satisfactory achieving a 85% compliance rate and promising results regarding reduction of LOS and hospital readmission. Further cases and analysis are required to draw definitive conclusions. Disclosure of Interest: None declared Copyright © 2022

Rates and predictors of serious infections in MS and NMOSD patients treated with anti-CD20 therapy

Introduction: Chronic immunosuppression with anti-CD20 therapy can increase the risk of serious infections including complicated COVID19. Objectives and Aims: To evaluate the rates and predictors of serious infections in MS and NMOSD patients treated with anti- CD20 agents. Method(s): MS and NMOSD patients treated with ocrelizumab or rituximab at University Hospitals Cleveland Medical Center were evaluated. Patients hospitalized for any infection during their anti- CD20 therapy were identified and compared to those without infection-related hospitalizations. Significant differences were evaluated in a multivariate logistic regression model to identify predictors of serious infection. Result(s): There were 184 patients treated with anti-CD20 therapy (average age 48+/-13 years, 67% females, 84% MS). Of those, 21 (11%) patients had one or more serious infection during therapy including 16 MS patients treated with ocrelizumab and 5 NMOSD patients treated with rituximab. The most common serious infections were complicated COVID19 (9), bacterial skin infections (5), bacterial pneumonia (3), urosepsis (3), ocular infection (1), and disseminated shingles (1). Compared to those without serious infections, patients with serious infections had a higher average time on anti-CD20 therapy (1087.57+/-5 days vs 796.28+/-35 t= -2.61, P=0.005) and were more likely to have total lymphopenia (80% vs 40%;P=.004). There was a trend towards higher rates of hypogammaglobulinemia in patients with serious infections (24% vs 10%;P=.07). Logistic regression identified total lymphopenia (<1.0 x109/L) as an independent predictor of serious infection in patients treated with anti-CD20 therapy. Conclusion(s): Serious infections are rare in MS and NMOSD patients treated with anti-CD20 therapies. Those with serious infections were exposed to treatment longer and more frequently had lymphopenia and hypogammaglobulinemia. Total lymphopenia during therapy is an independent risk factor for serious infections.

Post-vaccination Central Nervous System Inflammation at a Tertiary Neuroimmunology Clinic: Impact of Influenza, SARS-CoV-2, and Other Vaccines

Objective: We aim to determine the prevalence and clinical characteristics of iatrogenic CNS inflammation associated with vaccinations at a tertiary neuroimmunology clinic and compare the frequency of these events before and after the COVID-19 pandemic. Background: Various vaccines are implicated in rare demyelinating events. Although influenza is the most commonly-implicated vaccine, an increasing number of CNS inflammatory events are linked to SARS-CoV-2 vaccines. Design/Methods: We analyzed consecutive patients seen over 4 years (2017-2021) at a tertiary neuroimmunology clinic who were screened for iatrogenic CNS inflammation secondary to vaccinations. In patients with suspected iatrogenic events, the Naranjo Adverse Drug Reaction Probability Scale was used to score the probability of vaccine-related events as doubtful, possible, probable, or definite. Results: In total, 419 patients were seen over 4 years and were screened. Eleven cases were identified, and the total prevalence was 2.6% (82% female, average age 56+/- 18 years). Most events (10, 91%) were scored as probable. The following disease phenotypes were identified: multiple sclerosis relapse (6, 55%), optic neuritis (1, 9%), monophasic MOGAD (1, 9%), transverse myelitis relapse (1, 9%), seropositive NMOSD (1, 9%), and autoimmune encephalitis (1, 9%). The vaccines included influenza (n=4), SARS-CoV-2 mRNA (n=3), swine flu (n=1), and HPV (n=1). Two patients were exposed simultaneously to multiple vaccines (tetanus, MMR, and VZV;tetanus, hepatitis A, and meningococcal vaccines). Spontaneous resolution occurred in 36% of events, complete response to corticosteroids/immunotherapy in 46%, partial response in 9%, and unresponsiveness in 9%. Finally, 8 patients (73%) had relapsing disease and 3 patients (27%) had monophasic disease. Conclusions: Post-vaccination iatrogenic CNS inflammation is a rare but distinct neuroimmunological disease spectrum mostly involving spontaneous recovery or responsiveness to corticosteroids. We did not identify an excess of SARS-CoV-2 vaccine-related events. The rare occurrence and predominantly favorable prognosis suggest the benefit of vaccination outweighs the neurological risks, especially during the COVID-19 pandemic.

The humoralresponse to SARS-COV-2 vaccines in MS patients: Impact of DMT, lymphocyte count, immunoglobulins, and vaccine type

Objective: to compare different variables in MS patients with positive versus negative spike protein antibody following SARS-COV-2 vaccination Background: Many MS-related clinical, demographic, and immunological variables can potentially impact vaccine response and those variables have not been fully explored. Design/Methods: patients with MS and related neuroimmunological disorders who requested verification of the immune response to the SARS-COV-2 vaccine were tested for the spike protein antibody between January and September of 2021. We compared patients with positive versus negative spike protein antibody. Results: Forty patients (mean age 53+/-11, 77% females) were included. Twenty-two patients had positive post-vaccination spike protein antibody (55%) and 18 were negative (45%). Negative patients were more likely to have been on B-cell therapy (83% vs 32%, P=.001) while positive patients were more likely to have been on a fumarate (36% vs 5.5%, P=.02). There was no difference between the two groups in the utilization of S1P1 modulators or non-selective immunosuppressants, gender, age, race, disease phenotype, vaccine brand, and lymphocyte counts. Half the positive patients on fumarates had lymphopenia at the time of vaccination but none below 0.8×109 /L. Among patients on B-cell therapy, 32% had a positive humoral response and were more likely to have detectable CD19 cells at the time of vaccination compared to negative patients (P=0.04). There was no difference between the two subgroups in terms of vaccine timing relative to B-cell therapy dose or the presence of hypogammaglobinemia. None of the patients with or without humoral response had post-vaccination COVID19 infection. Conclusions: B-cell therapy is associated with negative humoral responses to SARS-COV-2 vaccines but patients with detectable CD19 counts are more likely to have a positive antibody. The fumarates are associated with positive humoral response even in the presence of mild lymphopenia. Both positive and negative humoral responses were equally seen in S1P1 modulator patients.

Development of a prioritisation protocol for the use of immunoglobulins in view of the global supply problem

Background and importanceHighly purified immunoglobulins (95%) are obtained from the purification of human plasma extracted from healthy donors. The mechanism of action consists of an antigen-specific activity, exerting immunomodulatory functions in addition to those of the natural immunoglobulins. The increase in demand, the dependence exclusively on plasma donations, and the pandemic situation have reduced the supply of immunoglobulins worldwide.Aim and objectivesTo elaborate a protocol at regional level (seven hospitals) to prioritise, rationalise and reduce the use of immunoglobulins in view of the worldwide supply problem.Material and methodsA multidisciplinary work team was created comprising professionals involved in the use of these therapies (immunologists, haematologists, internists, neurologists, paediatricians and pharmacists). The main pathologies involved were specified.Subsequently, the indications depicted in the technical data sheet and the available scientific evidence were reviewed, to define three priority groups:Priority 1: Necessary treatment, there is no other therapeutic alternative.Priority 2: Pathologies or clinical situations where the use of immunoglobulins is recommended.Priority 3: Clinical situations without sufficient scientific evidence.Finally, the indications and dose regimen of all patients under active treatment were reviewed.ResultsThe work team defined Priority 1 as follows:Chronic treatments: primary and secondary immunodeficiencies, CAR–T hypogammaglobulinaemia in paediatrics, pure motor chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy.Acute treatments: Kawasaki disease, primary immune thrombocytopenia (PIT) before undergoing urgent surgery or PIT with severe thrombopenia/large bleeding diathesis.Priority 2 included: Guillain-Barré syndrome, myasthenia gravis, PIT with high risk of bleeding, CIDP (excluding pure motor), severe neonatal sepsis, alloimmune haemolytic disease in neonates, alloimmune neonatal thrombocytopenia, haemophagocytic syndrome and paediatric multisystem inflammatory syndrome due to SARS-CoV-2.Pathologies not mentioned above were considered Priority 3, being evaluated by a multidisciplinary Experts Committee.After reviewing the active treatments, 21% of them were temporarily suspended. Since the protocol approval, eight new cases have been assessed as Priority 3, with only one of them being denied.Conclusion and relevanceThe creation of the protocol has made it possible to rationalise the use of immunoglobulins, reducing their consumption and promoting the use of therapeutic alternatives. Thus, completely necessary treatments are guaranteed through equitable and equal access throughout the region.References and/or acknowledgementsConflict of interestNo conflict of interest

Use of blood products and hemostatic agents during massive transfusions: Review of our practice

Background : Massive bleeding(MB) is associated with coagulopathy and high mortality. Currently, there are diverse approaches to the management of MB. The main difference is the number of blood products in the transfusion packages, which include red blood cells(RBC), fresh frozen plasma(FFP) and platelet concentrates(PC). The use of hemostatic agents like fibrinogen concentrate(FC), tranexamic acid and prothrombin complex concentrate (PCC) has been shown to reduce mortality.Our MB protocol utilizes a ratio of 4RBC:4FFP:1PC in the initial transfusion package. Our hospital administrates approx. 12000 blood products/year. The anesthetics team is experienced with the use of Rotational thrombelastometry (ROTEM) in the management of MB. Aims : This study aimed to determine the use of blood components and hemostatic agents during MB in our hospital. Methods : We performed a retrospective review of MB cases from January 2018 to December 2020. Patient demographics, indications and laboratory records were analyzed. ROTEM guided transfusion was performed by the team of anesthesiologists managing the patient. Results : During this period, a total of 108 MB were detected, with an average of 36/year. The medium age for these events was 57.18 y (range of 18-88 y) and included 49 females and 59 males. MB were associated with surgery(57), cirrhotic complications(27), trauma(20), obstetric bleeding(4).The blood products used were 850 RBC(average 7.87/patient) and 169 PC(average 1.56/patient). Of the 510 FFP units(average 4.72/patient) that were thawed, 411(average 3.84/patient) were used. The remaining units were discarded. Tranexamic acid was used in 70 patients and CCP in 13.There was a favorable outcome in 83 cases and 25 patients died from the major bleeding event.A decrease in MB events was recorded during the COVID pandemic. Conclusions : The optimal way to resuscitate patients with MB remains unclear, and clinical trials are difficult to perform in this setting. We believe that uniform approach for the management of MB is deleterious to the best use of blood products.

REGISTRI: Regorafenib in first-line of KIT/PDGFR wild type advanced GIST: Capatalize the A Spanish (GEIS), Italian (ISG) and French Sarcoma Group (FSG) phase II trial

Background: Around 15% of adult GIST are wild type for KIT/PDGFRA mutations (KPWT), usually have SDH deficiencies, and are resistant to imatinib (IM). The underlying mechanisms include overexpression of HIF1α in SDH deficient-GIST, high IGFR signaling through MAPK, BRAF mutation or STAT3 activation. Regorafenib (RE), targeting these pathways, could be more active as upfront therapy in KPWT GIST. Methods: Patients (pts) >18, with advanced non pretreated KPWT GIST were eligible after central confirmation by next-generation sequencing (NGS). Eligible pts received RE at 160mg/d for 21/28d cycles. Primary end-point was disease control rate (DCR) at 12 weeks (RECIST 1.1 ) by central radiological assessment (CRA). Secondary objectives were PFS, OS, ORR (RECIST,Choi), safety and QoL. An amendment allowed previous IM (adjuvant). Statistical assumptions [H0 73% and H1 90% (α 0.1 and β 0.2)], defined a sample size of 20 pts. Results: From May 2016 to October 2020, 30pts with KPWT GIST (by Sanger) underwent central molecular screening. Among the 15 non-eligible pts, 8 harbored KIT exon 11 mutations, 3 exon 9 and 3 PDGFRA exon 18 by NGS. The remaining 16 (53.3%) molecularly eligible pts were enrolled and started RE except one pt due to COVID-19 pandemic. The trial was prematurely closed due to low recruitment, especially after COVID outbreak. Demographics and treatment details in the table. Based on CRA, 12w-DCR was 86.7%. With a median (m) FU of 26 (5-44) months (mo), 10/15 pts progressed, with a mPFS of 10.8 mo (95% CI 6.9-14.8). 6 mo, 9 mo and 12 mo PFS rates were 65%, 48% and 29% respectively. 2 pts were PD-free at 25 and 43 mo from start of RE. 6/15 pts died, with a mOS of 33.5 mo (95% CI NR). [Formula presented] Conclusions: The study results approach the prespecified activity threshold. The low recruitment rate could have affected this attainment. Other analysis of secondary endpoints are ongoing. The high percentage of overlooked mutant GIST by Sanger raises the need of NGS in presumed KPWT GIST. Clinical trial identification: NCT02638766. Legal entity responsible for the study: Spanish Group for Research on Sarcoma (GEIS). Funding: Bayer. Disclosure: J. Martin Broto: Financial Interests, Personal, Expert Testimony, Honoraria: Lilly;Financial Interests, Personal, Expert Testimony, Honoraria: PharmaMar;Financial Interests, Personal, Expert Testimony, Honoraria: Eisai;Financial Interests, Personal, Expert Testimony, Honoraria: Bayer;Financial Interests, Personal, Invited Speaker: PharmaMar;Financial Interests, Institutional, Invited Speaker: PharmaMar;Financial Interests, Institutional, Invited Speaker: Eisai;Financial Interests, Institutional, Invited Speaker: Novartis;Financial Interests, Institutional, Invited Speaker: IMMIX Biopharma;Financial Interests, Institutional, Invited Speaker: Lixte;Financial Interests, Institutional, Invited Speaker: Karyopharm;Financial Interests, Institutional, Invited Speaker: Bayer;Financial Interests, Institutional, Invited Speaker: Celgene;Financial Interests, Institutional, Invited Speaker: Pfizer;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Invited Speaker: Blueprint;Financial Interests, Institutional, Invited Speaker: Deciphera;Financial Interests, Institutional, Invited Speaker: Nektar;Financial Interests, Institutional, Invited Speaker: FORMA;Financial Interests, Institutional, Invited Speaker: Amgen;Financial Interests, Institutional, Invited Speaker: Daiichi Sankyo;Financial Interests, Institutional, Invited Speaker: Lilly;Financial Interests, Institutional, Invited Speaker: AROG;Financial Interests, Institutional, Invited Speaker: Adaptimmune;Financial Interests, Institutional, Invited Speaker: GSK. N. Hindi: Financial Interests, Personal, Invited Speaker: PharmaMar;Financial Interests, Personal, Advisory Board: PharmaMar;Financial Interests, Institutional, Research Grant: PharmaMar;Financial Interests, Institutional, Sponsor/Funding: PharmaMar;Financial Interests, Institutional, Research Grant: Nova tis;Financial Interests, Institutional, Research Grant: Eisai;Financial Interests, Institutional, Research Grant: Immix Bio;Financial Interests, Institutional, Sponsor/Funding: Bayer;Financial Interests, Institutional, Sponsor/Funding: Deciphera;Financial Interests, Institutional, Sponsor/Funding: Daychii;Financial Interests, Institutional, Sponsor/Funding: Blueprint;Financial Interests, Institutional, Sponsor/Funding: Adaptimmune;Financial Interests, Institutional, Sponsor/Funding: GSK;Financial Interests, Institutional, Sponsor/Funding: Karyopharm;Financial Interests, Institutional, Sponsor/Funding: Celgene;Financial Interests, Institutional, Sponsor/Funding: AROG. J. Lavernia: Financial Interests, Personal, Invited Speaker: PharmaMar;Financial Interests, Personal, Invited Speaker: BMS. C. Serrano: Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Institutional, Research Grant: Bayer. D. Moura: Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Institutional, Research Grant: Eisai;Financial Interests, Institutional, Research Grant: PharmaMar;Financial Interests, Institutional, Research Grant: Immix Bio. J. Blay: Financial Interests, Institutional, Research Grant: Bayer;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Institutional, Research Grant: Roche;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Institutional, Research Grant: Deciphera;Financial Interests, Personal, Research Grant: Deciphera. E.R. Fumagalli: Financial Interests, Institutional, Research Grant: Bayer. All other authors have declared no conflicts of interest.

Recommendations for the teams that manage school canteens in the public health emergency of COVID-19 in Argentina

The impact of the pandemic caused by COVID-19 may deepen the situations of malnutrition, where it will be necessary to adapt food programs to this new context. The objective of this work was to present the methodology and the main results of the process of formulating a federal guide based on scientific evidence and adapted to the reality of the child and adolescent population that attend school canteens in the 24 jurisdictions of Argentina. It was observed that the modalities for the implementation of SC during the pandemic were: food modules (the most frequent);food modules delivered at school with regular SC support and, food and/or snacks delivered daily. There was little evidence at the global and regional level on specific recommendations applied to the implementation of SC, although recommendations on hygiene and food handling were found. Based on a participatory process among key actors, specific recommendations were obtained according to the dimensions of food and nutrition security (FNS). It is concluded that it is necessary to increase participatory experiences in the design of recommendations based on evidence, adapted to the territory and that assume a comprehensive approach from the dimensions of FNS. Arch Latinoam Nutr 2020;70(3): 215-234. © 2020 Archivos Latinoamericanos Nutricion. All rights reserved.

COVID-19 and the forgotten pandemic: Follow-up of neurocognitive disorders during lockdown in Argentina

Introduction Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected;Argentina’s lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. Methods We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. Results Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P < .001) and diagnosis of Alzheimer disease (P = .017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P < .001), but no significant differences were found between groups for Zarit Burden Interview scores. Conclusion We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients. Resumen Introducción Varios países del mundo padecen una grave carga en sus sistemas de salud como consecuencia de la pandemia por COVID-19. Esta realidad pone en riesgo el seguimiento de patologías crónicas como las demencias. Asimismo, la atención de las posibles complicaciones neuropsiquiátricas relacionadas al aislamiento preventivo de la población (cuarentena), que en el caso de Argentina, se considera la más prolongada la Latinoamérica. El objetivo del presente trabajo es determinar la frecuencia de las distintas modalidades de consulta médica en relación a la patología neurocognitiva del paciente y las variables predictoras de consulta desde el inicio de la cuarentena. Métodos Estudio descriptivo observacional, transversal basado en la recolección de datos a través de una encuesta. Resultados Hubo 324 participantes, 165 (50,9%) de los cuales realizaron al menos una consulta médica. Frecuencia de modalidades de consulta: teléfono, 109 (33,6%);correo electrónico, 62 (19,1%);videoconsulta, 30 (9,3%);servicio de emergencias, 23 (7,1%). Predictores de consulta: Clinical Dementia Rating ≥1 (p < 0,001);diagnóstico: Alzheimer (p = 0,017). Se encon-traron puntajes más altos del Inventario Neuropsiquiátrico (NPI) en el grupo que ha realizado consultas médicas (p < 0,001). Dicha diferencia no fue observada en el puntaje de la escala decarga del cuidador (Zarit). Conclusión Evidenciamos alta prevalencia de trastornos conductuales en pacientes y de sobrecarga en cuidadores durante la cuarentena. Solamente el 50% accedió a una consulta médica (52,7% por modalidad Telefónica y correo electrónico). Es necesario extremar los cuidados en personas con demencia, garantizando el seguimiento de su patología.

COVID-19 and the forgotten pandemic: follow-up of neurocognitive disorders during lockdown in Argentina. / COVID-19 y la pandemia olvidada: el seguimiento de las enfermedades neurocognitivas durante la cuarentena en Argentina.

INTRODUCTION: Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected; Argentina's lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. METHODS: We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. RESULTS: Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P<.001) and diagnosis of Alzheimer disease (P=.017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P<.001), but no significant differences were found between groups for Zarit Burden Interview scores. CONCLUSION: We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients.