Person: Munoz Venturelli, Paula
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Munoz Venturelli
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Paula
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Publication Post-COVID-19 condition: a sex-based analysis of clinical and laboratory trends(2024) Delfino, Carlos; Poli Harlowe, María Cecilia; Vial Cox, María Cecilia; Vial, Pablo; Martínez, Gonzalo; Riviotta, Amy; Arbat, Catalina; Mac-Guire, Nicole; Hoppe, Josefina; Carvajal, Cristóbal; Munoz Venturelli, PaulaBackground and aim: Post-COVID-19 condition (PCC) encompasses long-lasting symptoms in individuals with COVID-19 and is estimated to affect between 31-67% of patients, with women being more commonly affected. No definitive biomarkers have emerged in the acute stage that can help predict the onset of PCC, therefore we aimed at describing sex-disaggregated data of PCC patients from a local cohort and explore potential acute predictors of PCC and neurologic PCC. Methods: A local cohort of consecutive patients admitted with COVID-19 diagnosis between June 2020 and July 2021 were registered, and clinical and laboratory data were recorded. Only those <65 years, discharged alive and followed up at 6 and 12 months after admission were considered in these analyses. Multivariable logistic regression analysis was performed to explore variables associated with PCC (STATA v 18.0). Results: From 130 patients in the cohort, 104 were contacted: 30% were women, median age of 42 years. At 6 months, 71 (68%) reported PCC symptoms. Women exhibited a higher prevalence of any PCC symptom (87 vs. 60%, p = 0.007), lower ferritin (p = 0.001) and procalcitonin (p = 0.021) and higher TNF levels (p = 0.042) in the acute phase compared to men. Being women was independently associated to 7.60 (95% CI 1.27-45.18, p = 0.026) higher risk for PCC. Moreover, women had lower return to normal activities 6 and 12 months. Conclusion: Our findings highlight the lasting impact of COVID-19, particularly in young women, emphasising the need for tailored post-COVID care. The lower ferritin levels in women are an intriguing observation, warranting further research. The study argues for comprehensive strategies that address sex-specific challenges in recovery from COVID-19.Publication Disparities in Stroke Incidence Over Time by Sex and Age in Latin America and the Caribbean Region 1997 to 2021: A Systematic Review and Meta-Analysis(2023) Nuñez, Marilaura; Delfino, Carlos; Asenjo, Claudia; Schilling, Andrea; Lavados, Pablo; Anderson, Craig; Munoz Venturelli, PaulaBackground High-income country studies show unfavorable trends in stroke incidence (SI) in younger populations. We aimed to estimate temporal change in SI disaggregated by age and sex in Latin America and the Caribbean region. Methods and Results A search strategy was used in MEDLINE, WOS, and LILACS databases from 1997 to 2021, including prospective population-based observational studies with first-ever stroke incidence in Latin America. Reports without data broken down by age and sex were excluded. Risk of bias was assessed with The Joanna Briggs Institute's guide. The main outcomes were incidence rate ratio and relative temporal trend ratio of SI, comparing time periods before 2010 with after 2010. Pooled relative temporal trend ratios considering only studies with 2 periods in the same population were calculated by random-effects meta-analysis. Meta-regression analysis was used to evaluate incidence rate determinants. From 9242 records identified, 6 studies were selected including 4483 first-ever stroke in 4 101 084 individuals. Crude incidence rate ratio in younger subjects (<55 years) comparing before 2010:after 2010 periods showed an increase in SI in the past decade (incidence rate ratio, 1.37 [95% CI, 1.23-1.50]), in contrast to a decrease in older people during the same period (incidence rate ratio, 0.83 [95% CI, 0.76-0.89]). Overall relative temporal trend ratio (<55:≥55 years) was 1.65 (95 CI%, 1.50-1.80), with higher increase in young women (pooled relative temporal trend ratio, 3.08 [95% CI, 1.18-4.97]; P for heterogeneity <0.001). Conclusions An unfavorable change in SI in young people, especially in women, was detected in population-based studies in the past decade in Latin America and the Caribbean. Further investigation of the explanatory variables is required to ameliorate stroke prevention and inform local decision-makers. Registration URL: https://www.crd.york.ac.uk/prospero/ Identifier: CRD42022332563.Publication STatin TReatment for COVID- 19 to Optimise NeuroloGical recovERy (STRONGER): study protocol for a randomised, open label clinical trial in patients with persistent neurological symptoms after COVID- 19 infection(2025) Delfino, Carlos; Carcel, Cheryl; Lin, Xiaolei; Munoz Venturelli, Paula; Naismith, Sharon; Woodward, Mark; Peters, Ruth; Wijesuriya, Nirupama; Law, Meng; Harding, Ian; Wang, Xia; Elliott, Julian; Leder, Karin; Hutchings, Owen; Stecher, Ximena; Zoungas, Sophia; Anderson, CraigIntroduction Increasing awareness of the high frequency, wide spectrum and disabling nature of symptoms that can persist following COVID-19 infection has prompted the investigation of management strategies. Our study aims to determine the effectiveness of atorvastatin on cognitive function, physical activity, mood, health-related quality of life and features of neurovascular impairment and neuroinflammation in adults with ongoing neurological symptoms after COVID-19 infection. Methods and analysis The STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy study is an ongoing international, investigator-initiated and conducted, multicentre, prospective, randomised, open label, blinded endpoint trial with fixed time points for outcome assessments. A total of 410 participants with long covid neurological symptoms were planned to be randomly assigned to either the intervention group to receive 40 mg atorvastatin for 12 months or to a control group of no treatment, on top of usual care. Ethics and dissemination This study protocol was designed, implemented and reported, in accordance with the International Conference on Harmonisation guidelines for Good Clinical Practice, the National Health and Medical Research Council of Australia, the National Statement on Ethical Conduct in Human Research and with the ethical principles laid down in the World Medical Association Declaration of Helsinki. Central ethics committee approval was obtained from Sydney Local Health District Royal Prince Alfred Hospital Ethics (No: X21-0113 and 2021/ETH00777 10) in Australia. Site-specific ethics committee approvals were obtained elsewhere before any local study activities. All participants provided written informed consent.Publication Multimorbidity in acute ischemic stroke and its impact on short-term mortality: A Chilean nationwide database analysis(2025) González, Francisca; Allende, María; Nuñez, Marilaura; Delgado, Iris; Jakszyn, Paula; Delfino, Carlos; Anderson, Craig; Munoz Venturelli, PaulaBackground: Multimorbidity predicts a worse prognosis for various diseases but its impact in people after an acute ischemic stroke (AIS) in developing societies is not well established. We aimed to characterize the pattern of multimorbidity and determine its association with in-hospital mortality after AIS in the nationwide Chilean database. Methods: A retrospective analysis of the Diagnosis-Related Groups database for hospitalized adult patients in Chile in 2019 was conducted. Association of multimorbidity, defined as the presence of ≥2 health conditions, in patients with AIS (ICD-10 code I63) on in-hospital mortality was determined in logistic regression models adjusted for confounding variables. Results: Of 1,048,575 recorded ICD-10 codes, there were 10,440 AIS episodes in whom 7,696 (73.7 %) patients had multimorbidity. Age, female sex, and low socioeconomic status were associated with a higher multimorbidity, and the combination of comorbidities differed across age groups. Cardiometabolic multimorbidity was associated with higher in-hospital mortality (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.16-1.66; p<0.001). Stage 5 chronic kidney disease combined with ischemic heart disease was the comorbidity with the highest risk of death (OR 4.20, 95 %CI 1.58-11.16; p = 0.004). Obesity, which exhibited a predominance in early to mid-life, had the highest association with mortality when combined with other conditions. Conclusions: Multimorbidity is common in patients with AIS and its components vary by age and sex. Cardiometabolic multimorbidity increases the likelihood of in-hospital mortality. Adopting a multimorbidity-focused approach to stroke care could improve outcomes.Publication Intracerebral haemorrhage management practices and adherence to the INTERACT3 care bundle in Latin America: Results from an international survey(2025) Rosales, Julieta; Carbonera, Leonardo; De Souza, Ana; Rocha, Eva; Cano, Vanessa; Orjuela, Karen; Guerrero, Rodrigo; Delfino, Carlos; Nuñez, Marilaura; Munoz Venturelli, Paula; Gonzalez, AlejandroObjective: To assess intracerebral hemorrhage (ICH) management practices and adherence to the INTERACT3 care bundle across Latin American countries. Methods: We conducted a multi-national survey among neurologists, neurosurgeons, intensive care specialists, and emergency physicians. From August to December 2024, the survey was distributed across 19 Latin American countries. It assessed hospital characteristics, availability of an ICH code, adherence to INTERACT3 measures, and resource availability. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. Results: Out of 580 respondents (mean age 40.25 years; 61.6% male), most worked in teaching (86%) and public hospitals (53.6%). Only 27.9% reported an ICH code at their institution. Adherence to INTERACT3 measures ranged from 57.2% (anticoagulation reversal) to 84.7% (blood pressure control), with just 44.5% reporting adherence to all four measures. Time-to-target was not measured by 65%, and only 53.9% maintained interventions for one week. Neuroimaging, neurosurgery, and hematology services were higher in private compared to public and mixed hospitals (p<0.001). ICH code availability was associated with private hospitals and emergency care specialists, while full adherence was more likely among intensive care specialists. Conclusions: ICH management in Latin America is evolving, with increasing adoption of evidence-based practices. However, variability in adherence underscores the need for regional initiatives to standardize ICH care and ensure equitable implementation of best practices.