Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

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Factores asociados al tiempo libre de discapacidad en pacientes con Esclerosis Múltiple de un instituto de neurología en Medellín, Colombia. Factors associated with disability-free time in patients with Multiple Sclerosis of a neurology institution in Medellin, Colombia

Introduction: Multiple Sclerosis is the leading neurological cause of disability in young adults. The objective of this study was to describe the time free from disability since diagnosis and to analyze associated factors.

Method: Retrospective follow-up study of a cohort based on records of patients who consulted the Neurological Institute of Colombia between 2013 and 2021. Progression to disability was defined as the time to obtain a value greater than 3.5 on the EDSS scale. Parametric survival model for interval censored data with Weibull distribution was used to estimate survival function and Hazard Ratios.

Results: 216 patients were analyzed. The median disability-free time was 12 years (95% CI 7.56-17.66). Cerebellar complications (aHR = 8.18; 95% CI 4.09-16.35), vision (aHR = 2.25; 95% CI 1.25-4.05) and age at diagnosis over 40 (aHR = 1 .28; 95% CI 0.68-2.4) were associated with shorter time to progression, other initial symptoms (aHR = 0.35; 95% CI 0.18-0.68), stem lesions (aHR = 0.6; 95% CI 0.33-1.1), MSRR (aHR = 0.17; 95% CI 0.08-0.33) and women were associated with a longer time to progression.

Conclusion: Clinical and imaging factors allow identifying patients at high risk of rapid progression to disability.

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Palabras clave: Análisis de Supervivencia, Discapacidad, esclerosis múltiple, Supervivencia sin Progresión,

Keywords: Disability, Disability-Free Survival, multiple sclerosis, Survival Analysis,

Correlación entre variables clínicas sugestivas de hipertensión intracraneal y alteraciones en la neuroimagen en trauma craneoencefálico. Correlation between clinical variables suggestive of intracranial hypertension and alterations in neuroimaging in traumatic brain injury

Methods: Retrospective observational cohort study where patients admitted for TBI to the ICU area of the HLV were included. 

Results: We included a total of 297 subjects. The most common neuroimaging lesion was multiple lesions (35.4%). We found that there is a significant correlation between the presence of lesion in neuroimaging and the presence of fixed pupils at admission (p = <0.001), score ≤ 8 on the Glasgow scale (p = <0.001) and need for orotracheal intubation (p = <0.001). Similarly, the same 3 variables were significant when related to the score ≥ III on the Marshall scale. In the logistic regression model, pupil fixation was the only one that was shown to increase the risk of a score ≥ III on the Marshall scale (OR: 3.50, 95% CI 1.53-7.99). 

Conclusion: The clinical variables: pupil fixation, need for endotracheal intubation and Glasgow ≤ 8 are related to the development and severity of lesion on neuroimaging in patients with TBI.

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Palabras clave: escala de Marshall, hipertensión intracraneal, injuria cerebral aguda, injuria cerebral traumática, neuroimagen, tomografía, traumatismo craneoencefálico,

Keywords: acute brain injury, Cranioencephalic traumatism, Intracranial hypertension, Marshall scale, neuroimaging, tomography, traumatic brain injury,

Entrenamiento sensoriomotor en casa en personas mayores con Enfermedad Parkinson durante el periodo de confinamiento por COVID-19: Estudio piloto. Sensorimotor training at home in elderly people with Parkinson’s Disease during the period of confinement due to COVID-19: A pilot study

The pandemic caused those therapeutic activities associated with people with Parkinson’s disease to be suspended (PD) with the aim of preventing COVID-19 infections by increasing motor and non-motor symptoms, due to social isolation and stress. Therefore, there was a rise of care based on telemedicine to continue the treatment in the context of a health emergency, promoting training at home. The objective of this experimental research was to document the effects of a sensorimotor training program (NM-FITT®) in people with PD through weekly telematic follow-up during the COVID-19 pandemic. A quasi-experimental study was carried out with pre, inter and post test evaluations that characterized the physical, functional condition and quality of life, in an intervention group (n=5) and a control group (n=5) of elderly people (69.5 ±4.5 years) with PD in Hoehn & Yahr stages 1 to 3, for 18 weeks, through an exercise manual, video calls and telephone follow-up. Favorable and significant effects were demonstrated on all the parameters studied after the application of the intervention in detriment of the health condition of the persons who did not participate in the home training program.

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Palabras clave: calidad de vida, COVID, ejercicio, enfermedad de Parkinson, entrenamiento en casa, entrenamiento sensoriomotor, monitorización remota de pacientes (RPM), Rehabilitación, Telemedicina,

Keywords: COVID, exercise therapy, home training, Parkinson’s disease, quality of life, Rehabilitation, remote patient monitoring (RPM), sensorimotor training, telemedicine,

Caracterización histológica de las dendritas de la amígdala por alto consumo de fructosa en un modelo experimental de isquemia cerebral. Histological features of dendrites in the amygdala due to high fructose consumption in an experimental model of cerebral ischemia

Introduction. High fructose consumption has been shown to magnify cerebral ischemic injury in the ischemic focus and penumbra region. However, ischemia also produces changes in exofocal areas such as the amygdala, an important structure in emotional processing. Therefore, the objective of the investigation was to characterize the histological changes of the amygdala dendrites caused by high fructose consumption in an experimental model of cerebral ischemia.

Method. Wistar rats fed with standard food were used; the control group was given water and the fructose (HDF) group was given add libitum 20% fructose in water for 11 weeks. Some rats were subjected to cerebral ischemia. Therefore, there were four experimental groups: Sham control, Sham HDF, Ischemia control, Ischemia HDF. 50 um coronal sections of the brains were made and microtubule-associated protein 2 (MAP2) immunohistochemistry was performed. Images were captured and processed in Image J software.

Results. Loss of dendrite immunoreactivity was found in ischemic groups, and also cluster-type MAP2 immunoreactivity in HDF groups.

Conclusion. According to the above, both ischemia and high fructose consumption generate dendritic alterations in the amygdala.

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Palabras clave: amígdala, dendritas, fructosa, isquemia,

Keywords: amygdala, dendrites, fructose, ischemia,

Relación entre factores de riesgo y la distribución topográfica en niños con parálisis cerebral. Relationship between etiological factors and topographic distribution in children with cerebral palsy

 Introduction: Cerebral palsy is a health condition that seriously impacts the life condition of children and their family. Different risk factors are becoming increasingly important in its etiology.

Objective: The aim of this study was to analyze the most frequent risk factors for cerebral palsy and their association with topographic distribution in children aged 0 to 15 years in the city of Barranquilla.

Methods: An analytical observational cross-sectional survey type study was conducted with a sample of 78 children diagnosed with cerebral palsy in the city of Barranquilla, where the association of the most frequent risk factors of this condition with the topographic distribution was analyzed.

Results: The risk factors associated with cerebral palsy in order of importance were: perinatal hypoxia, gestational history of maternal infections, maternal trauma and congenital malformations. There was statistically significant association between gestational weeks at birth and GMFCS level (p<0.05) and between gestational weeks and topographic distribution.

Conclusions: Subjects with higher gestational age presented greater involvement at the level of motor function and a more extensive topographic distribution.

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Palabras clave: adolescentes, Etiología, Infantes, parálisis cerebral,

Keywords: adolescents, cerebral palsy, Etiology, Infants,

Hipernatremia como factor pronóstico de mortalidad en trauma encefalocraneano severo. Hypernatremia as a prognostic factor of mortality in patients with severe traumatic brain injury

Background: A severe traumatic brain injury is a frequent pathology, it implies a non-negligible morbidity and mortality. Hypernatremia could be considered a factor associated with poor prognosis in order to optimize treatment in the group of high-risk patients. We aim to determine if hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury in a public hospital which is a local reference center in trauma.

Material and Methods: We performed a non-probabilistic sampling of adult patients of both sexes with severe traumatic brain injury from the Intensive Care Unit of the Hospital Regional Docente de Trujillo, Perú during the 2015–2018 period.

Results: Mortality in the group with and without hypernatremia was 38% and 6% respectively (p=0.001). The difference in natremia mean values between the group with and without mortality was 21,86 (95% CI 18.2-25.5) (p=0.000). In the multivariate analysis, we found hypernatremia with adjusted OR of 16.73 (95% CI 1.96-142.82) (p=0.01). The ROC curve showed adequate performance to predict mortality, with an AUC 0.878 (95% CI 0.77-0.97) (p=0.00).

Conclusion: Hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury.

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Palabras clave: Hipernatremia, Mortalidad, trauma encefalocraneano severo,

Keywords: Hypernatremia, Mortality, severe traumatic brain injury,

Psychiatrists available in the Ecuadorian public health system and psychiatry residency programs in Ecuador – A cross-sectional analysis. Psiquiatras disponibles en el sistema de salud público y programas de residencia en psiquiatría del Ecuador – Un análisis transversal

Introduction: In 2008, Ecuador’s mental health profile displayed deficiencies due to the lack of psychiatrists and psychiatry residency programs. The same year, access to universal health care, was instituted as a right in the Constitution. There are no studies on the Public Health System’s capacity to provide mental health services, hence an updated analysis of the number of psychiatrists and psychiatry training programs available is required.

Objective: To determine the number of psychiatrists available through the Public Health System and to calculate the ratio of psychiatrist per 10,000 population; to establish the number of residency programs available.

Methods: Cross-sectional analysis of the data available from the Ecuadorian Public Health System and the Higher Education Council of Ecuador. Ratios were calculated using data from the National Institute of Statistics and Censuses.

Results: Ecuador’s psychiatrists ratio is 0.08:10,000 and the adjusted ratio (psychiatrists and psychologists) is 0.65:10,000. The Public Health System has 138 psychiatrists, concentrated in Pichincha (n=51) and Guayas (n=27). Three provinces had no psychiatrists available. There are two psychiatry training programs in Quito.

Conclusion: Ecuadorian Public Healthcare holds a shortage of psychiatrists which inhibit the minimum ideal ratio fulfillment, along with a noticeable lack of psychiatric training programs availability.

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Palabras clave: Ecuador, Psiquiatría, salud mental, salud pública,

Keywords: Ecuador, mental health, Psychiatry, public health,

Limited value of blood pressure levels in predicting white matter hyperintensities progression among community dwelling older adults living in a rural setting. Utilidad limitada de los niveles de presión arterial como predictor de progresión de hiperintensidades de sustancia blanca en adultos mayores que viven en un entorno rural

Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador.

Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Multilevel logistic regression models, which accounted for WMH severity at baseline, were fitted to assess the risk of WMH progression according to BP levels and other covariates.

Results: Analysis included 263 participants. WMH progression increased 3.45 times (95% C.I.: 1.94 – 4.96) among non-hypertensive individuals but 6.15 times (95% C.I.: 3.18 – 9.12) among those with arterial hypertension. However, overlapping of confidence intervals make such difference non-significant. Likewise, no differences in WMH progression were noticed when steady and pulsatile components of BP were used as independent variables.

Conclusions: High BP is not an independent predictor of WMH progression in the study population. 

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Palabras clave: enfermedad cerebral de pequeño vaso, estudio poblacional, hiperintensidades de sustancia blanca, Hipertensión arterial, presión arterial, Pronóstico,

Keywords: Arterial hypertension, blood pressure, cerebral small vessel disease, population study, Prognosis, White matter hyperintensities,

Conducta adaptativa en estudiantes chilenos sin discapacidad intelectual: Diferencias por género y edad. Adaptative behavior in chilean students with intellectual disability: Differences by gender and age

Adaptive Behavior (CA) is a set of skills learned and performed by people in their daily lives, which are categorized in the conceptual, social and practical domains. The objective of the research was to compare the CA skills according to sex and age range (under 10, between 10 and 16 and over 16) of the participants. A comparative-correlational design was used, which evaluated 457 students (between 5 and 18 years old) with the ABAS-II questionnaire. The results report that CA does not have significant differences when compared by sex, but in age ranges. Downward associations were observed as age increases when relating conceptual skills to social and practical domains. It is concluded that there are no differences in skills according to sex, but there are differences by age ranges and high positive correlations in the younger group, which tend to decrease in the other groups as they advance in age. It is believed necessary to continue deepening the evaluation of CA in children of typical development using the four dimensions of the instrument (conceptual, social, practical, work) in order to obtain results that allow generating comprehensive support for the better development of boys and girls.

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Palabras clave: autodeterminación, Chile, Conducta Adaptativa, educación,

Keywords: Adaptive behavior, Chile, education, self-determination,

Rehabilitación neuropsicológica en memoria declarativa y la funcionalidad en un adulto con epilepsia y lobectomía temporal izquierda. Neuropsychological rehabilitation program on declarative memory and functionality in an adult with epilepsy and left temporary lobectomy

Introduction: Surgical intervention is a treatment option for refractory epilepsy, and after this procedure cognitive alterations may occur. Software-based intervention approaches represent an alternative to traditional approaches.

Objective: To identify the effect of a neuropsychological rehabilitation plan for declarative memory in an adult with left temporal lobectomy, on their functional abilities.

Methodology: A single-case quasi-experimental design was used; the participant was a 45-year-old woman with memory problems and difficulties in performing daily activities. The intervention was carried out using the CogniFit rehabilitation software, and the Functioning Classification Scale and the Quality of Life Questionnaire in Epilepsy were used for the measurement. 

Results: A large effect (NAP; 95%) was found in both indices.

Conclusions: The implementation of a software-based program allows a comprehensive rehabilitation.

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Palabras clave: Epilepsia, lobectomía temporal, Memoria, rehabilitación neuropsicológica,

Keywords: Epilepsy, Memory, neuropsychological rehabilitation, temporal lobectomy,

Propiedades psicométricas del test de evaluación neuropsicológica – Neuropsi en población peruana. Psychometric properties of the neuropsychological evaluation test – Neuropsi in peruvian population

This research aims to estimate the psychometric properties of the neuropsychological assessment instrument – Neuropsi in patients treated in the Neurology area of a public hospital in Peru. The study is of a technological, psychometric type, of a non-experimental and cross-sectional design and is oriented through a quantitative approach. We worked with a non-probabilistic sample of 432 medical records of elderly patients who were diagnosed with or without cognitive disorders or dementia, to whom the brief neuropsychological assessment instrument in Spanish – Neuropsi was applied. A factor analysis was found that reports a good fit in a 6-factor model with X2 = 2.825, CFI = 0.990, GFI = 0.986, PNFI = 0.460, AIC = 47.774, SRMR = 0.0196, RMSEA = 0.065 and the Cognitive performance differs according to the age range of the patient. In addition, it has a Cronbach’s alpha reliability of .863. These findings suggest that the instrument is valid, short, accurate, and adequate for measuring cognitive performance.

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Palabras clave: neuropsicología, psicometría, rendimiento cognitivo,

Keywords: cognitive performance, neuropsychology, psychometry,

Práctica de la neuropsicología en Ecuador. Practice of neuropsychology in Ecuador

Objectives: To explore the current state of neuropsychology practice in Ecuador through the administration of an online survey.

Methods: A total of 48 professionals working in the field of neuropsychology completed an online survey between August 2018 and December 2019. 

Results: The majority of the participants were female (62.5%), with a mean age of 37.23. 87.5% report having received postgraduate neuropsychology training. Most are employed in private practice, universities and/or clinics, and report being satisfied with their work. The most commonly treated diagnoses are Attention Deficit with Hyperactivity Disorder (ADHD), learning disabilities and language disorders. The three main barriers identified for the development of neuropsychology are the lack of academic training programs, the lack of clinical training programs and the lack of willingness to collaborate among professionals.

Conclusions: The practice of neuropsychology in Ecuador is on par with that of Latin America. However, certain changes are needed, such as increasing academic and clinical training programs in the area, formalizing regulations that guarantee quality and standards in practice, and continuing to standardize and validate neuropsychological tests in the country.

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Palabras clave: Ecuador, neuropsicología, práctica,

Keywords: Ecuador, neuropsychology, practice,

Cerebro, hormonas y genes: conocimientos biológicos de la homosexualidad y transexualidad en una muestra chilena. Brain, hormones, and genes: biological knowledge of homosexuality and transsexuality in a Chilean sample

Introduction: Sexual orientation and gender identity have some biological bases based on genes, perinatal hormones and brain dimorphisms that have been studied in recent decades. The objectives of this study are to know the psychometric properties of a questionnaire to evaluate biological knowledge of homosexuality and transsexuality and to investigate such knowledge in a Chilean sample.

Methodology: 144 people from three regions of Chile were surveyed. A sociodemographic survey and the Biological Knowledge of Homosexuality and Transsexuality Questionnaire (BKHT) were applied. The results show that the instrument is valid and reliable for the sample used. It is also noted that 75,7% of the respondents obtained between 1 and 6 correct answers out of a maximum of 18. Of the sociodemographic variables, only religious beliefs and having dealt with homosexuality and transsexuality in their sex education classes are predictors of the BKHT scores.

Conclusions and Recommendations: BKTH is valid and reliable to be applied in Chilean population samples. The sample evaluated has low levels of knowledge about the biological basis of homosexuality and transsexuality. It is recommended to replicate this research in larger samples, in other regions of Chile and in other Latin American countries.

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Palabras clave: cerebro, genes, homosexualidad, hormonas, transexualidad,

Keywords: brain, genes, homosexuality, hormones, transsexuality,

Test de Lectura de la Mente a través de la Mirada: Primera aproximación a las propiedades psicométricas en población peruana. Reading the Mind in the Eyes Test: A first approximation to the psychometric properties in the Peruvian Population

Theory of mind (ToM) is a central cognitive process of social cognition, with great importance in neuroscience and neuropsychiatric disorders. One method used to evaluate advanced ToM in adults is the Reading the Mind in the Eyes Test (RMET), which despite being widely known in Peru, still lacks standardized and adequately validated measures for its application in the clinical area and not clinical. Objectives: 1. Explore the psychometric properties of RMET in Peruvians, as well as the percentage of precision for each item among the different versions of the RMET; 2. Evaluate the test-retest reliability after one year of follow-up. Two hundred eighty-eight participants between 17 and 55 years old, of both sexes, were recruited. Results: The RMET shows a medium validity and consistency according to the KR-20, Cronbach’s Alpha, and Omega tests (0.645 – 0.666). Women perform better than men (p <0.041*), and scores remain stable after one year of follow-up. Conclusions: The RMET shows good psychometric properties, similar to other versions and different countries, with women showing better mental capacity.

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Palabras clave: cognición social, estudio normativo, población joven y adulta, psicometría, teoría de la mente ToM, Test de la Mirada,

Keywords: normative study, psychometrics, reading the mind on the eyes test, social cognition, ToM theory of mind, young and adult population,

Drip and ship: Una práctica usual en el tratamiento de ictus isquémico por oclusión de arterias proximales en países de altos ingresos pero anecdótica en Colombia. Drip and ship: a prevalent practice in acute stroke with large vessel occlusion in high-income countries but anecdotal in Colombia

The Drip and Ship consists of giving intravenous thrombolysis in the primary center and referral for mechanical thrombectomy.

Objective: To describe the experience of Drip and Ship in acute ischemic stroke in two regions of Colombia.

Methods: We conducted a retrospective case series study of patients undergoing Drip and Ship from 2019 to first quartile of 2021. We compared times: door-to-image, door-to-needle, door-to-groin and clinical outcomes. Measures of central tendency and descriptive statistics were calculated. 

Results: Six patients with ischemic stroke and large vessel occlusion were registered. Median of 60 minutes of the onset of symptoms, 75 minutes for door-to-needle, 167.5 minutes for door-in door-out time, and 91.5 minutes for travel time referred from another city. Five patients received mechanical thrombectomy with TICI 2c-3. 50% of patients with favorable modified Rankin scale at discharge and 84% at three months. 

Conclusions: According to the RES-Q registry, between 2019 and the first quartile of 2021, there were 5954 cases of ischemic stroke cases in Colombia, and 20 patients received Drip and Ship strategy (0.33%). In agreement to international guidelines, door-to-needle and remission times were longer than recommended, especially in patients from other cities. It is necessary to structure care networks to improve treatment times and the number of patients treated.

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Palabras clave: Ictus isquémico, país de medianos ingresos, trombectomía, Trombolisis,

Keywords: ischemic stroke, middle income countries, thrombectomy, Thrombolysis,

The association between pineal gland calcification and intracranial atherosclerotic disease in older adults. Asociación entre calcificaciones de la glándula pineal y enfermedad aterosclerótica intracraneal en adultos mayores

Background: This study assesses whether pineal gland calcification (PGC) – a surrogate for reduced endogenous melatonin production – is associated with significant stenosis of large intracranial arteries – a biomarker of intracranial atherosclerotic disease (ICAD). 

Methods: Individuals aged ≥60 years enrolled in the Three Villages Study received head CT to assess PGC and MRA to estimate stenosis of large intracranial arteries. Multivariate logistic regression models were fitted to assess the association between PGC and ICAD, after adjusting for relevant confounders. Inverse probability of exposure weighting was used to estimate the effect of PGC on ICAD. 

Results: A total of 581 individuals were enrolled. PGC and ICAD were associated in a fully-adjusted logistic regression model (p=0.032). Inverse probability of exposure weighting showed an estimate for the proportion of ICAD among those without PGC of 3.7% and the adjusted-effect coefficient was 5.7% higher among those with PGC (p=0.031). 

Conclusions: PGC is associated with ICAD. Study results provide grounds for evaluating the role of melatonin deficiency in ICAD progression. 

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Palabras clave: Adultos Mayores, aterosclerosis intracraneal, calcificación de la glándula pineal, estenosis de arterias cerebrales de mediano calibre, estudio poblacional,

Keywords: intracranial atherosclerosis, melatonin, older adults, pineal gland calcification, population study, stenosis of large intracranial arteries,

Niveles altos de hemoglobina glicosilada se asocian a hemorragia intracerebral espontánea: Estudio de casos y controles. High levels of glycated hemoglobin are associated with spontaneous intracerebral hemorrhage: A case control study

Introduction: Evidence shows that glycosylated hemoglobin (HbA1C) is associated with spontaneous intracerebral hemorrhage (ICH). However, reports in Latin-American patients are scarce.

Objective: To determine if HbA1C is a risk factor for ICH.

Methods: A case-control study was carried out. Cases were hospitalized patients with ICH, whereas the controls were diabetic patients within the same age range. Logistics regression was calculated to identify risk factors associated with ICH.

Results: A total of 45 cases and 45 controls were included. HbA1C values were higher in the ICH group (median 6.8%, IQR=5.8– 7.5) compared to the control group (median 5.8%, IQR=5.5–6.2%; P<0.001). High HbA1C values were identified as a risk factor for ICH (OR=2.75, 95% CI=1.41-5.41). Among the ICH patients, barely 29% had a confirmed previous diagnosis of diabetes. The hospital mortality rate in the ICH patients was 37.8%, while mortality was 15% in the patients with diabetes and 46% in those without a previous diabetes diagnosis. 

Conclusions: High HbA1C levels were associated with the development of ICH. It is paramount to improve public policies for early detection of diabetes due to the potential to reduce the impact of spontaneous intracerebral hemorrhage in the general population.

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Palabras clave: diabetes, evento cerebrovascular, Factores de riesgo, hemoglobina glicosilada, Hemorragia intracerebral, hiperglicemia,

Keywords: cerebrovascular event, diabetes, glycosylated hemoglobin, hyperglycemia, Intracerebral hemorrhage, Risk factors,

Uso de la Escala de Inteligencia de Adultos de Wechsler-IV para la evaluación neuropsicológicas en Ecuador. The Wechsler Adult Intelligence Scale-IV for use in Neuropsychological Assessments in Ecuador

An important part of cognitive status evaluation is the determination of general cognitive ability. However, the most common tests are not standardized for use in Ecuador. This has limited the extent and accuracy of clinical neuropsychological assessments within the country. We used the 7-subtest Wechsler Adult Intelligence Scale-IV (WAIS-IV) with 155 mainly city-living Ecuadorian adults, recruited from a range of socioeconomic backgrounds around 4 different sites in Ecuador. The sample was matched to the Ecuadorian urban population for gender, education, and ethnicity. We show that this version of the WAIS-IV is a reliable and valid assessment for this context. In addition, we provide a method to adjust standard scores derived from the Spanish population, and used in the WAIS-IV manual, so that they are more appropriate for use in Ecuador. These can potentially be used to calculate full IQ scores. We also describe methods of comparing the Ecuador-adjusted standard scores so that they can be used in clinical neuropsychological evaluations of Ecuadorian adults.

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Palabras clave: CI, evaluación cognitiva, evaluación neuropsicológica, inteligencia, neuropsicología,

Keywords: cognitive assessment, intelligence, IQ, Neuropsychological assessment, neuropsychology,

Cognición, afectividad y resiliencia en el perdón de una transgresión en la pareja. Cognition, affectivity and resilience in the forgiveness of a transgression in the couple

The transgression of the agreements between the couple is a current problem that generates discomfort on a personal, family and social level. In this article, an investigation is reported that analyzes a model that proposes the interaction between the variables positive cognition, positive affect and resilience as predictive factors that contribute to the understanding of the process of forgiveness of a transgression in the couple. 203 adults (103 women 60%, 88 men 40%) between 18 and 26 years of age participated in the research (Mage = 20.4, SD = 1.68). The hypothesized model was tested through the process of structural equations, finding adequate levels of goodness of fit x2 = 113.87, GL = 84, p = .02, SRMR = .05, RMSEA = .04 (.03 – .06), CFI = .97. The results found contribute to two essential levels in the line of investigation of the interaction between couples, firstly, at a theoretical level, it is provided with an innovative theory that allows us to understand the process of forgiveness in the couple and, secondly, to clinical level, for psychotherapeutic intervention in variables such as cognition and positive affect that would benefit a couple to overcome a conflict and reach a forgiveness.

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Palabras clave: afecto positivo, cognición positiva, perdón, relación de pareja, resiliencia,

Keywords: couple relationship, forgiveness, positive affect, positive cognition, resilience,

Estudio piloto sobre el funcionamiento sexual en mujeres con Esclerosis Múltiple en México. Pilot Study on Sexual Functioning in Women with Multiple Sclerosis in Mexico

Introduction: Sexual dysfunction in women with Multiple Sclerosis (MS) is frequent. The way it is approached by physicians and communication with patients has not been widely explored.

Objective: Describe the sexuality of women with MS, their satisfaction with their relationship and communication with doctors.

Material and Methods: Descriptive cross-sectional study, carried out in the MS Clinic in the main concentration center in Mexico, with self-administered questionnaires through an online survey, on mental health, couple relationships, doctor-patient interaction on the subject of health sexual and reproductive, female sexual functioning, intimacy and sexuality.

Results: 37 women participated, average age 35.0 ± 8.25 years. They have been with the disease for 4.3 ± 3.8 years and the main course is relapsing remitting MS (79.2%). 89.1% report sexual intercourse and 43.8% used contraceptives in their first relationship. Out of self-interest, 40% spoke to a doctor about sexuality. Women who are not in a relationship and have not spoken to a doctor about sexuality score low in the domains of sexual functioning.

Discussion and Conclusions: Communication about sexual health is fundamental and for this the doctor-patient relationship is central.

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Palabras clave: comunicación médico-paciente, disfunción sexual, enfermedad degenerativa, esclerosis múltiple, Mujeres, satisfacción con la relación de pareja,

Keywords: degenerative illness, doctor-patient communication, multiple sclerosis, satisfaction with the couple relationship, sexual dysfunction, Women,

Índice leucoglucémico alto como predictor de mortalidad intrahospitalaria en pacientes con ictus isquémico agudo. High leuko-glycemic index as an in-hospital mortality predictor in patients with acute ischemical ictus

Objective: To demonstrate that the high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.

Material and method: Observational, analytical, cohort and retrospective research, conducted at Belen of Trujillo Hospital, with a census sample of patients hospitalized in the Neurology department with diagnosis of acute ischemic stroke in the period from January 2014 to December 2018 , who met the selection criteria.

Results: 281 medical records were analyzed, where 18 were of deceased patients, of which 56% died with a leuko-glycemic index greater than 1600, the association being statistically significant (RRa: 6.33, CI: 95% [1.35 – 29.64]; p = 0.019). In addition, in the multivariate analysis, age greater than or equal to 80 years, admission moderate awareness disorder and in-hospital pneumonia were also relevant.

Conclusion: The high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.

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Palabras clave: ictus isquémico agudo, índice leucoglucémico, mortalidad intrahospitalaria,

Keywords: acute ischemic stroke, in-hospital mortality, leuko-glycemic index,

Prevalencia de neuromitos en académicos universitarios de Chile. Neuromyth prevalence in university academics in Chile

Introduction: A neuromyth is an interpretation error derived from a misunderstanding or mistaken belief about scientific findings, being frequent in educational contexts, but also in the area of neurology and other neurosciences. This research aimed to determine the prevalence of neuromyths among Chilean university scholars.

Methodology: Quantitative, non-experimental, cross-sectional study. The instrument used was the Neuromyth Prevalence Questionnaire, Spanish version. The sample considered 64 scholars from six Chilean universities.

Results: Among university teachers of education careers, four neuromyths had a prevalence higher than 70% in the items related to the relevance of the stimuli in the preschool stage and that individuals learn better when they receive information according to a learning style (visual, auditory or kinesthetic, VAK).

Conclusions and Recommendations: In conclusion, there is a high prevalence of neuromyths among the Chilean university scholars studied. As a challenge of scholar performance, they should adequately disseminate neuroscience research, as this impacts student training and their professional future. Furthermore, the awareness about neuromyths that prevail among them will allow us to address the dismissal of misconceptions that have lasted for a long time in the complex scenario of the interaction between educational sciences and neurosciences.

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Palabras clave: académicos, educación, neurociencia, neuromitos,

Keywords: academics, education, neuromyths, neuroscience,

Función cognitiva en adultos mayores con y sin dedos de Dawson relacionados con enfermedad de pequeño vaso cerebral. Cognitive performance in older adults with and without Dawson’s fingers-related cerebral small vessel disease

Background/objective: Dawson’s fingers have been traditionally associated with multiple sclerosis. However, this imaging biomarker has also been linked to white matter hyperintensities related to cerebral small vessel disease. In the latter, Dawson’s fingers could represent damage of small venules in subjects with severe small vessel disease and could theoretically be associated with cognitive decline. In this study, we aimed to assess the association between Dawson’s fingers and cognitive performance in a population of older adults. 

Methods: Population-based study conducted in individuals aged 60 years or older, residing in three rural villages of coastal Ecuador (Atahualpa, El Tambo and Prosperidad). Of 712 older adults identified by means of a door-to-door survey, 590 underwent a brain MRI. Of them, 575 also had the Montreal Cognitive Assessment (MoCA). We selected the 157 individuals with moderate-to-severe white matter hyperintensities to assess the presence of Dawson’s fingers. The independent association between Dawson’s fingers and cognitive performance (as the dependent variable) was assessed by means of a linear regression model, after adjusting for demographics, cardiovascular risk factors, and the other biomarkers of cerebral small vessel disease. 

Results: Of 157 individuals with moderate-to-severe White matter hyperintensities, 17 (11%) had Dawson’s fingers on MRI. The mean MoCA score in subjects with Dawson’s fingers was 14.5±6.4 points and that of those without this neuroimaging biomarker was 17.3±6.2 points. The association between Dawson’s fingers and the MoCA score was marginal in univariate models (p=0.082), but it completely vanished in a multivariate linear regression model adjusted for relevant covariates (β:-0.31; 95% C.I.: -3.23 – 2.60; p=0.833). A mediation model disclosed that 83.5% of the effect of Dawson’s finger on cognitive performance was mediated by age. 

Conclusion: Dawson’s fingers are not independently associated with cognitive performance in individuals with cerebral small vessel disease. Most of the effect of this association is mediated by age. 

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Palabras clave: Adultos Mayores, dedos de Dawson, enfermedad de pequeño vaso cerebral, hiperintensidades de sustancia blanca, prueba cognitiva de Montreal,

Keywords: cerebral small vessel disease, Dawson’s fingers, Montreal Cognitive Assessment, older adults, White matter hyperintensities,

Síntomas de depresión, ansiedad y estrés en la población general ecuatoriana durante la pandemia por COVID-19. Depression, anxiety and stress symptoms experienced by the ecuadorian general population during the pandemic for COVID-19

Objective: To describe the mental health state of Ecuadorian adults during the COVID-19 pandemic from March to August 2020. Data from a larger study involving several Spanish-speaking countries were analyzed. This research was non-experimental, quantitative, and cross-sectional, conducted through an anonymous online survey used as the collection tool.

Results: A total of 766 people participated, 64.23% were women and the mean age was 32.35 (SD = 12.54). Around 8% of the participants declared having presented a diagnosis of COVID-19, and 12.9% having experienced associated symptoms. Most participants (77.4%) indicated not having had mental health problems in the past, and 87.6% did not have these problems during the pandemic. However, 41% acknowledged having experienced greater psychological distress. Participants presented low levels of symptoms of depression, anxiety, and stress. Women and young adults were the most affected groups by the assessed symptoms.

Conclusions: In pandemic and confinement situations, providing mental health care services for the general population is essential, especially for women and young adults.

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Palabras clave: confinamiento, malestar psicológico, salud mental, síntomas COVID-19,

Keywords: COVID-19 symptoms, lockdown, mental health, psychological distress,

Music therapy intervention for memory, attention, and language in children with dyslalia. Intervención musicoterapéutica para mejorar la memoria, atención y lenguaje in niños con dislalia

Dyslalia is a language disorder that is present in a wide percentage of children. This work proposes an intervention protocol in music therapy to improve attention, memory, and language for children with the dyslalia disorder. A confirmatory mixed-method design composed of two studies was conducted: the first included a quantitative and pre-experimental design with a sample of 20 children aged between 5 and 8 years (Mage=6.45, SD=1.23) diagnosed with dyslalia. The second study used a qualitative confirmatory methodology, where participants’ parents and therapists participated. Wepman’s and the initial Luria pre- and post-tests measurements were applied. The results of the pre-experiment found statistically significant improvements in verbal regulation t(19)=-5.03, p=<.001, d=.76, attention t(19)=-5.05, p=<.001, d=.76, and memory t(19)=-2.88, p=.009, d=.55. In the qualitative phase, narratives were found that affirmed the positive results of the pre-experiment. Moreover, data surrounding the benefits of the music therapy intervention protocol in the improvement of cognitive processes and the relationship with previous literature that found positive results with this type of intervention are discussed.

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Palabras clave: Atención, dislalia, intervención, Lenguaje, Memoria, musicoterapia, Tratamiento,

Keywords: Attention, dyslalia, intervention, Language, Memory, music therapy, Treatment,

Ronquido, Eventos Respiratorios y Cardíacos Después de la Colocación de un Dispositivo de Avance Mandibular. Snoring, Respiratory And Cardiac Events After The Placement Of A Mandibular Advancement Device.

Objective: To compare snoring levels, respiratory and cardiac events before and after the placement of a new mandibular advancement device (MAD) designed for snoring control, placed as an option for the control of pathological mechanisms respiratory disorders that have been associated with cognitive dysfunction, excessive daytime sleepiness and as an aggravator of the development of Alzheimer’s and Parkinson’s.

Methodology: Study of a case series that considered 12 snoring adults initially identified with the Roncolab® App. A clinical history of sleep and initial (A) and final (D) polysomnography (PSG) was performed. A new design of intra-oral mandibular advancement device for snoring control was placed, which was reviewed every 20 days for two months. Neurophysiological, cardio-pulmonary and sleep parameters were analyzed. The statistical differences between the variables were established according to the distribution of the data with tests of t-student or Mann-Whitney U.

Results: The average snoring events according to PSG were (A: 198; D: 260) with p> 0.05; according to Roncolab® (A: 73.6; D: 22.6) with a p <0.05. There were no differences between the oximetry averages (A: 0.84; D: 0.83) or heart rate (A: 65; D: 66.9).

Conclusions: There was no statistically significant difference in respiratory, cardiac events, oximetry nor apnea episodes according to PSG, after the placement of the manufactured DAM. Roncolab® registered a significant decrease in snoring events.

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Palabras clave: Apnea Obstructiva del Sueño, Disfunciones cognitivas, Férulas oclusales, Ronquido,

Keywords: Cognitive Dysfunction, Obstructive apnea, Occlusal splints, Sleep apnea syndrome, Snoring,

Evaluación de la Utilidad de las Escalas Pronósticas del Status Epiléptico Convulsivo en el Status Epiléptico no Convulsivo. Usefulness Of Status Convulsive Score In Prognosis Of Non-Convulsive Status Epilepticus

Introduction: The Non-Convulsive Status Epilepticus (NCSE) is a rare clinical entity. As of today, a predictive mortality scale has not been developed. Moreover, the risk factors that contribute to the prognosis have not been clearly defined. The aim of this study was to evaluate the usefulness of the prognostic scores for status epilepticus (SE): the epileptic status severity score (STESS), the modified RANKIN scale STESS (mRSTESS) and the epileptic status mortality score based on epidemiology (EMSE-EACEG) applied in patients diagnosed with NCSE.

Results: The sample analyzed for this study consisted of 66 patients with an average age of 59 years (SD 18.5).

The STESS and mRSTESS were significantly associated with higher odds for poor prognosis at the time of discharge in patients with NCSE (p<0.05 and p<0.05, respectively). However, none of the three was associated with mortality.

Conclusion: Considering that the scores used to predict prognosis in patients with SE have not shown equal diagnostic accuracy in the NCSE, we believe that a validated predictive scale of morbidity and mortality would be of great help for these patients.

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Palabras clave: Mortalidad, Pronóstico, Status epiléptico no convulsivo,

Keywords: Mortality, Non convulsive status epilepticus, Prognosis,

Estructura Factorial del Funcionamiento Neuropsicológico en la Discapacidad Intelectual Leve en Niños. Factorial Structure Of Neuropsychological Functioning In Mild Intellectual Disability In Children.

An exploratory factor analysis was performed to establish the factor structure of neuropsychological functioning in mild intellectual disability in children. It was a quantitative, descriptive and cross-sectional study. Eighty children with a diagnosis of mild intellectual disability were included. An extensive battery of neuropsychological tests was applied. An Exploratory Factor Analysis was performed to identify the main factors. The results showed that mild intellectual disability in children has a structure in which the neuropsychological functions associated with executive functioning explain 56% of the variance and have a factor priority over 13%, which explains the variables associated with two traditional tests for assess intelligence. Each factor is analyzed and discussed from clinical and experimental neuropsychology. The study findings have theoretical and clinical implications for differential diagnosis.

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Palabras clave: discapacidad intelectual leve, Funciones Ejecutivas, inteligencia, neuropsicología, Niños,

Keywords: Children, Executive functions, intelligence, mild intellectual disability, neuropsychology,

Epilepsia Como Factor Pronóstico de Refractariedad y Funcionalidad en Estado Epiléptico en Pacientes Mexicanos. Epilepsy As Prognostic Factor Of Refractoriness And Functionality In Status Epilepticus In Mexican Patients.

Introduction: Status epilepticus is a medical condition which could lead to a great disability and be mortal. Background of epilepsy could prevent a progression to a refractory status epilepticus and predict a good functional prognosis. Nevertheless, in Mexican population there are no studies about that.

Materials and methods: An observational, analytic, retrospective, cohort study was performed with patients with status epilepticus in Specialities Hospital of “Siglo XXI” National Medical Center, in Mexico. It was evaluated the probability of presenting refractory status epilepticus and a good functional outcome in patients with a background of epilepsy, performing Pearson Chi-square.

Results: 40 patients with status epilepticus were included, 32 with refractory status epilepticus and 14 with a background of epilepsy. The probability of presenting a refractory status epilepticus with a background of epilepsy was OR 1.29 (p 0.53), and for a good functional outcome was OR 3.63 (p 0.10).

Conclusions: Background of epilepsy is not a protective factor for preventing the progression to a refractory status epilepticus, neither a factor for predicting a good functional outcome in our study with Mexican population. Nevertheless, further studies with a bigger sample are needed in order to prove these results.

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Palabras clave: Epilepsia, estado epiléptico, factor de riesgo, funcionalidad, Pronóstico, refractariedad,

Keywords: Epilepsy, functionality, Prognosis, refractoriness, risk factor, Status Epilepticus,

Magnetic Resonance Poor Prognostic Factors In Mexican Multiple Sclerosis Patients. Factores de Mal Pronóstico Por Resonancia Magnética en Pacientes Mexicanos Con Esclerosis Múltiple.

Introduction: Multiple sclerosis is one of the main causes of disability in young people. It has characteristic lesions in magnetic resonance images which are part of diagnosis criteria, and some of them could predict a long-term disability. In mexican population there is no description about multiple sclerosis imaging characteristics.

Materials and methods: We performed an observational, descriptive, cross-sectional, and retrolective study at the Neurology Service of Specialties Hospital of Siglo XXI National Medical Center of Mexican Social Security Institute, in Mexico, evaluating magnetic resonance images characteristics of patients with multiple sclerosis diagnosis between January 2017 and January 2020.

Results: 75 patients were included, 8% had 1-3 T2-weighted lesions, 18.6% had 4-9 T2-weighted lesions, and 73.3% had 10 or more T2-weighted lesions. 50.6% had infratentorial lesions and 61.3% had spinal cord lesions. Gadolinium enhancing lesions were found in 48%, with a median of lesions 2 (IQR 1,3).

Conclusions: Mexican patients with multiple sclerosis have a great incidence of magnetic resonance image poor prognosis factors, which should lead to a closer follow-up and influence treatment options.

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Palabras clave: Discapacidad, epidemiología, esclerosis múltiple, pacientes mexicanos, Pronóstico,

Keywords: Disability, epidemiology, magnetic resonance, mexican patients, multiple sclerosis, Prognosis,
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