Guillain-Barré Syndrome and COVID-19 Vaccine: A Multicenter Retrospective Study of 46 Cases.

ABSTRACT: In the context of the global vaccination campaign against COVID-19, several cases of postvaccinal Guillain-Barré syndrome (GBS) were reported. Whether a causal relationship exists between these events has yet to be established. We investigated the clinical and electromyographic characteristics of patients who developed GBS after COVID-19 vaccination and compare these with findings in patients with GBS, without a history of recent vaccination. We included 91 cases between March 2020 and March 2022, treated at 10 referral hospitals of Buenos Aires, Argentina. Of these, 46 had received vaccination against COVID-19 within the previous month. Although Medical Research Council sum-scores were similar in both groups (median 52 vs. 50; P = 0.4), cranial nerve involvement was significantly more frequent in the postvaccination group (59% vs. 38%; P = 0.02), as was bilateral facial paralysis (57% vs. 24%; P = 0.002). No differences were found in clinical or neurophysiological phenotypes, although 17 subjects presented the variant of bilateral facial palsy with paresthesias (11 vs. 6; P = 0.1); nor were significant differences observed in length of hospital stay or mortality rates. Future vaccine safety monitoring and epidemiology studies are essential to demonstrate any potential causal relationship between these events.

Brain magnetic resonance imaging features in multiple sclerosis and neuromyelitis optica spectrum disorders patients with or without aquaporin-4 antibody in a Latin American population.

INTRODUCTION: There is scarce evidence comparing the behavior in magnetic resonance (MRI) between positive and negative aquaporin-4 antibody neuromyelitis optica spectrum disorders (P-NMOSD and NNMOSD, respectively). The aim of this study was to describe and compare MRI features through a quantitative and qualitative analysis between P-NMOSD and NNMOSD patients in a cohort from Latin American (LATAM) patients. METHODS: We retrospectively reviewed the MRI and medical records of NMOSD patients as defined by the 2015 validated diagnostic criteria, and with at least 3 years of follow-up from disease onset (first symptom). We included patients from Argentina, Brazil and Venezuela. To be included, NMOSD patients must have had AQP4-ab status measured by a cell-based assay. Brain MRIs were obtained for each participant at disease onset and every 12 months for 3 years. Demographics, clinical and MRI variables (T2 lesion volume [T2LV], lesion distribution, cortical thickness [CT] and percentage of brain volume loss [PBVL]) were analyzed and compared between groups (P-NMOSD; NNMOSD) at disease onset and follow-up. A multiple sclerosis (MS) control group of patients was also included. RESULTS: We included 24 P-NMOSD, 15 NNMOSD and 35 MS patients. No differences in age, gender and follow-up time were observed between groups. Nor were differences found in lesion distribution at disease onset or in brain volumes during follow-up between P-NMOSD and NNMOSD patients (T2LV = 0.43, CT = 0.12, PBVL p = 0.45). Significant differences were observed in lesion distribution at disease onset, as well as in brain volumes during follow-up between NMOSD and MS (T2LV = p<0.001, CT = p<0.001, PBVL p = 0.01). CONCLUSION: Different MRI features were observed between MS and NMOSD. However, no quantitative nor qualitative differences were observed between P-NMOSD and NNMOSD, not allowing us to differentiate NMOSD conditions by MRI.

Multiple sclerosis and neuromyelitis optica spectrum disorders in Argentina: comparing baseline data from the Argentinean MS Registry (RelevarEM).

The objective of this study was to describe and compare the baseline epidemiological data of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients included in RelevarEM (Clinical Trials registry number NCT03375177). METHODS: RelevarEM is a longitudinal, strictly observational MS and NMOSD registry in Argentina. Epidemiological and comorbidity data from MS and NMOSD patients were described and compared. For comorbidities, the Charlson comorbidity index (CCI) was used to calculate the burden at entry. CCI was stratified in 0 and ≥ 1 and described for the entire cohort. RESULTS: A total of 1588 and 75 MS and NMOSD patients (respectively) were included. For MS patients, the mean age was 42 ± 7 years, female sex 65.3%, mean EDSS 2, and mean disease duration 8 ± 6 years. In NMOSD, the mean age was 40 ± 7 years, female sex 78.7%, mean disease duration 5 ± 3.5 years, and mean EDSS 2.5. The most frequent MS phenotype was RRMS in 82.4%. In MS, the CCI was 0 in 85.8.2% while ≥ 1 was in 14.2% of patients. Regarding phenotype stratification, CCI ≥ 1 was 3.9% in CIS, 13.5% in RRMS, 28.7% in SPMS, and 17.4% in PPMS (p < 0.001 between groups). In NMOSD, the CCI was 0 in 64% while ≥ 1 was in 36%. The MS/NMOSD ratio found was 21/1. CONCLUSIONS: This is the first analysis of the longitudinal Argentinean registry of MS and NMOSD describing and comparing conditions that contributes to provide reliable real-world data in the country.

New MRI lesions and topography at 6 months of treatment initiation and disease activity during follow up in relapsing remitting multiple sclerosis patients.

Objective: The objective of this study was to assess if the presence of new lesions and their topography on the reference MRI have a prognostic value regarding disease activity during the follow up in relapsing remitting multiple sclerosis (RRMS) patients.Methods: Retrospective cohort study that included patients with RRMS who had a reference MRI (performed at 6 months from the onset of a DMT) and radiological and clinical follow up for at least two years. We identified the number of new MRI lesions and their topography at reference MRI and during the follow up. Cox proportional hazards model analysis was used to evaluate the association between new lesions on reference MRI and the appearance of new lesions and/or clinical relapses at 24-month follow-up.Results: 56 patients were included, 13 (23.2%) showed new lesions in the reference MRI. The presence of new lesions at reference MRI predicted the occurrence of new lesions at month 24 (HR 3.1, CI 95% 2.5-5.8). The number of lesions and the infratentorial topography at reference MRI were associated with an increased risk of new radiological activity during follow up (HR 3.5, IC95% 3.1-6.1 and HR 2.4, IC95% 1.9-2.7 respectively).Conclusion: New lesions at the reference MRI in terms of number and topography increase the risk of radiological disease activity during the follow up.

The Argentinean multiple sclerosis registry (RelevarEM): Methodological aspects and directions.

Despite that different registries already exist in various countries in Europe and North America, no ongoing nationwide registry exists in Latin America (LATAM), a region where the disease behaves differently than in other regions. The objective of this document is to describe the methodology behind RelevarEM, the first nationwide MS registry in Argentina and LATAM. METHODS: In this article, we described the creation, implementation and data management of the nationwide MS registry in Argentina. The registry contains information on the structure, ethical aspects, implementation and variables of the registry (Clinical Trials registry number NCT NCT03375177). CONCLUSION: RelevarEM is the first MS nationwide registry in Argentina, as well as in LATAM, with the objective of providing reliable real-world data of MS in the country.

Bilateral Optic Perineuritis as Initial Presentation of Giant Cell Arteritis.

Giant cell arteritis is a large vessel vasculitis with neurological manifestations that range from visual disturbances to ischemic stroke. Among the former, visual acuity and visual field defects are prevalent, with anterior ischemic optic neuropathy being their most frequent cause. We present a clinical case in which the presenting ocular feature of the disease was a peripheral monocular visual field defect secondary to optic perineuritis.

Intimidación entre pares (bullying) en el ámbito escolar. Comparación de la percepción de los docentes con la de sus alumnos. / Bullying at school. A comparison of the perception of teachers and students

Introducción: La intimidación entre pares es un problema frecuente en el ámbito escolar, con consecuencias a corto y largo plazo. Objetivos: Analizar las percepciones sobre este problema que poseen docentes de escuelas públicas de la ciudad de Bahía Blanca (2012) y la medida en la que estas percepciones coinciden con las de los alumnos. Métodos: Estudio cuali-cuantitativo en docentes y alumnos de cuarto a sexto grado que combino una encuesta (muestreo por conveniencia) por medio de cuestionario validado PRECONCIMEI (versiones alumnos y docentes) y grupos de discusión con docentes. Resultados: Encuestas: 407 niños/as y 37 docentes. Seis grupos de discusión en los que participaron 19 docentes en total. Percepción de niños/as: 36% manifiesta haber estado involucrado en situaciones de intimidación; 14% y 36% opino que las familias y docentes, respectivamente, "deberían hacer algo" para que se solucione el problema. Percepción de docentes: 38% opina que la intimidación es un problema grave, aunque predomina una conceptualización mas acotada (casos puntuales de agresión física por alumnos varones). Reconocen que tanto la familia como los docentes tienen un rol esencial en la prevención de este problema, aunque señalan que el rol docente estaría muy condicionado por factores externos. Conclusiones: Docentes y alumnos perciben a la intimidación como un hecho frecuente, aunque en los primeros predomina una conceptualización mas acotada. Si bien ambos reconocen que la familia posee un rol clave, los alumnos le otorgan menor relevancia. En contraste, el rol docente es jerarquizado tanto por los niños/ as como por sus docentes.

Introduction: Intimidation among peers is a frequent issue in school environments with short and long term consequences. Objetive: To analyze the perceptions of Bahía Blanca city public school teachers (2012) on this problem and the extent to which these perceptions are in agreement with those of the students. Methods: Quali-quantitative study of teachers and students from fourth to sixth grade combining a survey (convenience survey) using the PRECONCIMEI validated questionnaire (student and teacher versions) and discussion groups with teachers. Results: Surveys: 407 children and 37 teachers. Six discussion groups in which 19 teachers participated in total. Perception of Children: 36% expressed to have been involved in bullying situations; 14% and 36% said that families and teachers, respectively, "should do something" to solve the problem. Perception of Teachers: 38% considered that bullying is a serious problem although the concept is more circumscribed -special cases of physical aggression by male students. They recognized that both the family and the teachers have a key role in preventing this problem, although they pointed out that the role of teachers would be largely conditioned by external factors. Conclusions: Teachers and students perceive bullying as a frequent event, although in the former a more circumscribed conceptualization prevails. Although both recognize that the family has a key role, students consider this less relevant. In contrast, the role of teachers is prioritized both by the children and their teachers.