Browsing by Author "Soler León, Bernardita María"

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    Frequency of diminished ovarian reserve in women with multiple sclerosis in Chile: An exploratory study
    (2023) Pelayo Carolina; Ciampi Díaz, Ethel Leslie; Soler León, Bernardita María; Uribe San Martín, Reinaldo Moises; Reyes Delgado, Ana Cecilia; García, Lorena; Del Canto, Adolfo; Gutiérrez Carquin, Leticia; Barrerra Hormazabal, Antonia; Jurgensen Heinrich, Lukas; Guzman Cárcamo, Ignacio; Carvajal, Andrés; Troncoso, Carlos; Carvajal, Rodrigo; Cárcamo Rodríguez, Claudia Andrea
    Introduction: Multiple Sclerosis (MS) is a chronic disease affecting around 2.8 million people worldwide. Two-thirds are women, and the mean age at diagnosis is about 30 years old. Social trends are moving towards older age at first pregnancy, both in women with and without MS. Objectives: To determine the frequency of diminished ovarian reserve (DOR) through anti-Mullerian Hormone (AMH) measurement in women with MS at fertile age and Healthy Females (HF) in Chile. Methods: Case-control, multicentric, cross-sectional study including relapsing-remitting people with MS (pwMS) between 18 and 40 years and sex and age-matched HF. We obtained a blood sample to determine AMH levels. We defined DOR as AMH <1.5 ng/mL and very-low AMH levels as <0.5 ng/mL. Also, we performed questions regarding reproductive decision-making. Results: We included 79 sex and age-matched HF and 92 pwMS, median age 32(19–40) years, median disease duration 6 (1–17)years, median EDSS 1.0 (0–6), 95% were receiving disease-modifying therapy (DMT), 70% high-efficacy DMT and 37% with a treatment that contraindicates pregnancy. DOR was observed in 24% (n = 22) of the pwMS, compared to 14% (n = 11) of the HF (p = 0.09), while very-low AMH levels were observed in 7.6% (n = 7) of pwMS and none of the HF (p = 0.0166). We observed an inverse correlation between age and AMH levels. Age was the only significant risk factor for low AMH levels in pwMS (OR 1.14 95%CI(1.00–1–31), p = 0.04), including smoking, body mass index (BMI), hormonal contraception, autoimmune comorbidity, high/low-moderate efficacy DMT, and active disease as covariables. We did not find statistically significant differences in age at diagnosis, BMI, disease duration, EDSS, autoimmune comorbidity, use of hormonal contraception, or percentage of active disease between MS women with normal vs DOR. Over 70% of pwMS desired to become pregnant in the future, while 60% considered that the diagnosis of MS was a limitation for pregnancy planning. Conclusions: No differences in DOR, measured by levels of AMH, were observed between pwMS MS and HF in Chile. As expected, AMH levels were correlated only with ageing. This information may be evaluated early during the disease course to help patients and neurologists with fertility counselling and family planning considerations regarding DMT use.
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    Multiple sclerosis and related disorders: Short report peripheral vascular events in a real-world cohort of multiple sclerosis patients using Fingolimod
    (2020) Pelayo, Carolina; Ciampi Díaz, Ethel Leslie; Uribe San Martín, Reinaldo; Soler León, Bernardita María; Reyes, Ana; Vergara, Elizabeth; Cárcamo Rodríguez, Claudia Andrea
    Background: Fingolimod is a high-efficacy disease-modifying therapy for multiple sclerosis (MS) and was the first oral treatment approved for the disease. Adverse events include bradyarrhythmia, hypertension, macular oedema and increased risk of infections, mainly due to its main mechanism of action, the non-selective modulation of sphingosine-1-phosphate receptor.", "Methods and Results: We report the baseline characteristics, effectiveness outcomes and adverse events of a prospective cohort of 177 patients with a median treatment duration of 24 months, in which four patients (2.3%) presented with otherwise non-provoked peripheral vascular events (PVE).", "Conclusions: Further studies are still needed to evaluate the frequency and severity of PVE in fingolimod patients.
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    Pregnancy outcomes in women with Multiple Sclerosis
    (2021) Soler León, Bernardita María; Ciampi, Ethel; Uribe San Martín, Reinaldo; Keller K.; Astudillo M.; Charaf V.; Reyes A.; Vergara E.; Cárcamo Rodríguez, Claudia Andrea
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    Prevalence of comorbidities in Multiple Sclerosis and impact on physical disability according to disease phenotypes
    (2020) Ciampi, Ethel; Uribe San Martín, Reinaldo; Soler León, Bernardita María; Molnar, Karolyn; Reyes Placencia, Diego Armando; Keller Matamala, Karina Pascale; Cárcamo Rodríguez, Claudia Andrea
    Background: Comorbidities are prevalent among Multiple Sclerosis (MS) patients. Few studies have characterized their prevalence and impact in Latin American populations.Objective: We aim to assess the prevalence of comorbidities and their impact on the risk of physical disability across different MS phenotypes.Methods: Cross-sectional multicenter study of patients under regular clinical care at the Programa de Esclerosis Múltiple UC and Hospital Dr. Sótero del Río in Chile. Prevalence of comorbidities was estimated from the retrospective assessment of electronic medical charts. Disease phenotypes were categorized into two groups: clinically isolated syndrome/relapsing-remitting (inflammatory group) and primary/secondary progressive MS patients (progressive group). A multivariable analysis using binary logistic regression for assessing the risk of EDSS ≥ 6.0 in each group was performed.Results: A total of 453 patients was included, 71% female, mean age at onset 31 years, mean disease duration 10 years, and median EDSS 2.0 (range 0–10). In the whole sample, most prevalent comorbidities were ever-smoking (42.2%), depression/anxiety (34.9%), thyroid disease (15.7%), hypertension (11.3%) and insulin resistance/type 2 diabetes mellitus (11.0%). When assessing the risk of EDSS ≥ 6, in the inflammatory group (N = 366), age at onset (OR 1.06, 95%CI(1.02–1.11), p = 0.008), disease duration (OR 1.06, 95%CI(1.00–1.12), p = 0.039) and epilepsy comorbidity (OR 5.36, 95%CI(1.33–21.5), p = 0.018) were associated with a higher risk of disability. In the progressive group (N = 87), disease duration was a risk factor (OR 1.08 95%CI(1.02–1.16), p = 0.014), while shorter diagnostic delay (OR 0.91 95%CI(0.85–0.99), p = 0.025) and insulin resistance/type 2 diabetes mellitus comorbidity were protective factors (OR 0.18 95%CI(0.04–0.83), p = 0.028), 72% of these patients were receiving metformin.Conclusions: Comorbidities are common across different MS disease phenotypes. Epilepsy seems particularly related with a higher risk of physical disability in relapsing-remitting patients, while the role of insulin resistance/type 2 diabetes mellitus or the impact of metformin use as a protective factor should be further studied. Prospective and larger studies are still needed in order to assess the real impact of comorbidities and their management in MS outcomes.
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    Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile
    (2023) Ciampi Díaz, Ethel Leslie; Soler León, Bernardita María; Uribe San Martín, Reinaldo; Jurgensen Heinrich, Lukas; Guzmán, I.; Keller Matamala, Karina Pascale; Reyes C., Ana Belén; Bravo Grau, Sebastián Eduardo; Cruz, Juan Pablo; Cárcamo Rodríguez, Claudia Andrea
    Background: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. Objective: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. Methods: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. Results: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0–34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0–10), and median PI 0.17 (0–4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). Conclusion: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.