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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Prescription Patterns Of Antimigraine Drugs. Patrones de Utilización de Antimigrañosos.

Introduction: The objective was to determine the prescription patterns of antimigraine drugs in a Colombian population.

Methods: A cross-sectional study of a population database that recorded all patients diagnosed with migraine and the drugs used for crisis and prophylaxis treatment for at least three months during 2018. Multivariate analysis was performed to identify variables associated with the use of prophylaxis.

Results: A total of 5973 patients diagnosed with migraine were identified, with a mean age of 37.7±14.5 years and female predominance (81.3%). The most common diagnosis was migraine without aura (36.9%), followed by migraine with aura (28.4%). Overall, 7.3% of patients were treated by neurologists and 92.8% by general practitioners, and 85.4% (n=5101) received treatment for acute episodes. Nonsteroidal anti-inflammatory drugs (52.1%) were the most prescribed drugs, followed by ergotamine (42.1%). The 46.3% of patients were receiving prophylactic therapy. Women older than 35 years and patients treated by neurologists were more likely to receive prophylactic therapy.

Conclusions: The use of medications for acute migraine management prevailed, with a very low proportion of triptans. Despite the significant undesirable effects, ergotamine continues to be used frequently. Physicians should evaluate the need for prophylaxis, focusing on finding an effective therapy that reduces disabilities.

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Palabras clave: acetaminofen, antiinflamatorios no esteroideos, ergotamina, Farmacoepidemiología, migraña con aura, migraña sin aura, Trastornos migrañosos,

Keywords: acetaminophen, anti-inflammatory agents, ergotamine, Migraine Disorders, migraine with aura, migraine without aura, non-steroidal, Pharmacoepidemiology,

Prevalence Of Major Depressive Disorder In Portoviejo, Ecuador. Prevalencia del Trastorno Depresivo Mayor en Portoviejo, Ecuador.

Major depressive disorder (MDD) is a debilitating neuropsychiatric disorder that affects more than 300 million people, causing enormous socioeconomic burden. Little data has been known about prevalence of MDD in Ecuador. Thus, the aim of this study was to describe the prevalence of MDD in the population in a highly populated city in Ecuadorian Coast. This population-based study was accomplished in Portoviejo, Manabí. Here, we analyzed 114.239 records about MDD using Structured Clinical Interview for the Diagnosis of DSM-IV Disorders in younger, adults, and older peoples. We observed that the MDD score of 8.6% of the studied population. There was a suitable agreement between mild MDD and residence location scores (urban or rural zone). Both models had a good standard of fit (R2 = 0.91 and 0.95) and a mean p-value of 0.04 for both locations. A significant positive correlation between marital status and MDD scores, particularly for single (p = 0.001361, r = 0.94), and education levels (p = 0.00102, r = 0.95) was also demonstrated. Moreover, both age (p = 0.001067, r = -0.94) and widowed (p = 0.009662, r = -0.87) were negatively correlated with MDD scores. Collectively, our results revealed a high prevalence of MDD in the Portoviejo population, an effect more prominent in man, living alone, young and resident of the urban zone.

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Palabras clave: depresión, Ecuador, Prevalencia, salud mental, trastorno depresivo mayor,

Keywords: depression, Ecuador, major depressive disorder, mental health, Prevalence,

Adaptación Lingüística de la Batería de Evaluación Neuropsicológica “BREV” en Una Población de Escolares Ecuatorianos. Linguistic Adaptation Of The Neuropsychological Evaluation Battery “BREV” In A Population Of Ecuadorian Schoolchildren.

This article reports the process followed for the linguistic adaptation of the Neuropsychological Assessment Battery “BREV” in a population of Ecuadorian school children. The translation-back-translation method was used. The final version of the test was applied to a pilot sample of 100 schoolchildren from the city of Cuenca – Ecuador. The piloting revealed results similar to the original version in most of the subtests, however, there are still certain adaptation errors at the level of some terms and stimuli of the test that must be corrected. The statistical results demonstrated a significance of 5% (p <0.05) in the correlations between the performance of each subtest and the age of the Ecuadorian children. It was concluded that the final version of the linguistic adaptation of the Battery “BREV” obtained in this first part of the investigation similar results to the original version; but a statistical analysis by retest is necessary to ensure the equivalence and reliability of the adapted instrument with respect to the original French test.

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Palabras clave: Adaptación de la Batería Brev, desarrollo infantil, evaluación., neuropsicología, pruebas neuropsicológicas,

Keywords: Brev Battery Adaptation, child development, evaluation, neuropsychological tests, neuropsychology,

Correlación Entre Calidad de Sueño y Calidad de Vida en Estudiantes de Medicina. Correlation Between Quality Of Sleep And Quality Of Life In Medical Students.

Introduction: Sleep is important for the proper performance of the individual since it participates in many biological processes. Medical students often do not get the recommended amount of sleep per day, this affects their quality of sleep, with repercussions on their quality of life.

Objective: To identify the association between sleep quality according to the Pittsburgh Sleep Quality Index (PSQI) questionnaire and quality of life according to the World Health Organization Quality of Life (WHOQOL–BREF) questionnaire of the World Health Organization (WHO) and describe the most prevalent risk factors for sleep disorders in medical students from the Catholic University Santiago de Guayaquil (UCSG).

Methods: Cross-sectional observational study in UCSG medical students.

Results: The questionnaires were completed by 211 students; the mean age was 20,8 ± 2,6 years; 62,1% were women. The mean BMI was 23,1 ± 3,8, 20,4% of the students were overweight and 4,3% were obese. The mean score in the PSQI obtained in the study population was 7,2 ± 3,1 and in the WHOQOL – BREF was 60,9%. Pearson’s correlation coefficient, r2, between both variables was -0.33 (p: <0.01).

Conclusion: Poor quality of sleep is inversely correlated with quality of life. The quality-of-life domain most associated with poor sleep quality was the physical domain. The most frequent risk factor for poor quality sleep was snoring.

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Palabras clave: calidad, estudiantes, medicina, Pittsburgh Sleep Quality Index, Sueño, WHOQOL- BREF,

Keywords: medicine, Pittsburgh Sleep Quality Index, quality, sleep, students, WHOQOL-BREF,

Funcionamiento Ejecutivo en Adolescentes Embarazadas Del Departamento de Sucre-Colombia: Una Respuesta Desde la Cognición. Executive Functioning In Pregnant Adolescents In The Department Of Sucre-Colombia: A Response From Cognition.

Introduction: Teen pregnancy changes the way of life of girls and their families, sometimes they can be the product of poor decision-making when having sex.

Objective: To describe the executive functioning of adolescents in a state of pregnancy in the department of Sucre.

Method: Quantitative, observational, descriptive level and cross-sectional approach; a sample of 72 adolescents, 36 of them pregnant in the department of Sucre, Colombia. Sample: selection and rejection method, applying a simple analysis of variance, using the R-Studio program. Instruments: a test protocol was applied containing: Controlled word association test, Wisconsin classification test (WCST), Stroop test, Trail Making Test (TMT).

Results: Adolescent girls in pregnancy presented greater difficulty in making decisions, failures in problem solving, organization and planning of information, as well as poor self-monitoring, slow learning, and low speed of information processing.

Conclusion: The maturation of brain areas with changes occurred in adolescence is consistent with the difficulties found in this executive functioning and the appearance of risk behaviors resulting in possible pregnancies during adolescence.

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Palabras clave: adolescentes, conductas de riesgo, embarazo temprano, función ejecutiva,

Keywords: adolescents, early pregnancy, Executive function, risk behavior,

Puntaje Global de Potenciales Evocados Multimodales Sensoriales en el Estudio de Pacientes Con Esclerosis Múltiple. Global Score Of Sensory Multimodal Evoked Potentials In The Study Of Patients With Multiple Sclerosis.

Introduction: Multiple sclerosis (MS) is a demyelinating, inflammatory and degenerative disease of the central nervous system. Multimodal sensory evoked potentials (MSEP) have been used to evaluate the integrity of sensory pathways but have not been globally considered as a tool to MS diagnose.

Objective: to evaluate the relationship between the global score of MSEP with the degree of disability and the presence of structural lesions in MS patients.

Methods: Thirty-five patients with relapsing-remitting MS were studied in the International Center for Neurological Restoration. The score of the MSEP was correlated to the disability scale of Kurtzke and the degree of lesions evidenced in magnetic resonance images.

Results: A significant correlation was found between the global score and disability scale (R=0.33, p<0.05) and between the global score and the number of lesion levels detected in the resonance images (R=0.42, p< 0.05).

Conclusion: The relationship between the global score of the MSEP and the structural lesions and degree of disability confirms its utility to study MS patients, even though they aren’t part of the diagnostic criteria.

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Palabras clave: escala de discapacidad, esclerosis múltiple, imágenes de resonancia magnética, potenciales evocados, puntaje global,

Keywords: disability scale, evoked potentials, global score, magnetic resonance imaging, multiple sclerosis,

Exámenes no Costo-Efectivos En Pacientes Con Lumbalgia Inespecífica en un Hospital Referencial. Non-Cost-Effective Tests In Patients With Unspecified Lumbalgia In A Referential Hospital.

Introduction: Low back pain has become a serious health problem due to its high frequency and social, labor and economic impact. 90% of them correspond to non-specific low back pain, and in them routine examinations have proved to be non-cost-effective.

Objective: To identify the frequency of the use of non-cost-effective tests in patients with a diagnosis of non-specific low back pain treated at The Almanzor Aguinaga Asenjo National Hospital, in 2014-2015.

Material and methods: Cross-sectional descriptive study in patients aged 18 to 49 years with a diagnosis of non-specific low back pain (ICD-10 M54.5) attended by an outpatient clinic at The Almanzor Aguinaga Asenjo National Hospital in 2014-2015. Census sampling was used, including a clinical history of patients without a serious or specific underlying condition or who did not show any signs of alarm to suspect them. Excluded psychiatric comorbidities or fibromyalgia, obtaining 177 patients. A collection form validated by experts was used. The data was analyzed with SPSS v.22.

Results: A frequency of non-cost-effective exams of 53,11% was found. The occupations with the highest physical load (60,64%) and the clinical services (47,87%) were the most frequent. The radiodiagnosis exams represent approximately 75% of the exams requested. A total unnecessary expense of s / .32125,21 equivalent to USD 9 818.32 was obtained.

Conclusions: There is a high frequency of the use of non-cost-effective tests in patients with non-specific low back pain, with radiodiagnosis being the most prescribed.

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Palabras clave: diagnóstico por imagen, Evaluación de costo-efectividad, Lumbalgia, Procedimientos Innecesarios, Uso Excesivo de los Servicios de Salud,

Keywords: cost-effectiveness Evaluation, diagnostic imaging, low back pain, Medical Overuse, Unnecessary Procedures,

Propiedades Psicométricas del Inventario CABI Para la Determinación del TDAH. Psychometric Properties Of The Cabi Inventory In The Determination Of ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequent mental health issues among children and adolescents

worldwide. Current literature shows that ADHD could affect both academic and work performances of those who present it. The aim of the present study was to analyze the psychometric properties of the Child and Adolescence Behavior Inventory (CABI) through an exploratory study, based on the report of 350 Chilean parents. Results indicated a three-dimensional model (sluggish cognitive tempo, inattention and hyperactivity) with adequate fit of the data (RMSEA=0.065; CFI= 0.954; TLI=0.941; PL=207) that explained 61.76% of the total variance with an Alpha of 0.961. Results show that the subscales analyzed have acceptable psychometric properties, an adequate internal consistency and that their indicators have a correct discriminatory power.

Therefore, according to these preliminary results, CABI can be considered a useful assessment tool for the diagnosis of ADHD. Implications for practice, policy and future research are discussed.

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Palabras clave: confiabilidad, evaluación., propiedades psicométricas, síntomas, trastorno por déficit de atención,

Keywords: assessment, Attention deficit disorder, Psychometric properties, reliability, symptoms,

Propuesta De Una Escala De Valoración De Las Funciones Ejecutivas En Universitarios. Proposal For An Evaluation Scale Of Executive Functions In University Students.

Introduction. The executive functions constitute a set of cognitive, affective and motivational processes, which allow the conscious control of thought, development of highly complex tasks, that is going to facilitate the adaptation to new situations, it is therefore necessary the contribution of new evaluation methodologies of executive functions centered on the university population, this is going to facilitate the access to check the cognitive processes of the pre-frontal cortex.

Objective. Evaluate executive functions in university students between 18 and 25 years of age using a self-report scale.

Subjects and method. 752 university students from Quito-Ecuador participated, aged between 18 and 25 years old, of whom 498 (66.2%) were female and 254 (33.8%) were male. As measuring reagent, the scale used to evaluate the executive functions in self-report was proposed in the project: Neuropsychological Systems for Supervision of Cognition and Behavior for the Benefit of Managing the Learning of Higher Education Students.

Results. Exploratory factor analysis reported an organization of 8 executive functions that explain 57% of the variance of the construct (p = <.001). An adequate level of reliability was obtained between α = .70 and .86, a factor was eliminated since its level of reliability was very low and did not improve under any statistical procedure. The correlation between the proposed factors was adequate at a median magnitude r = .67 and .39.

Conclusion. The results show that the proposed scale is based on situations in the student’s daily life, this scale design allows identifying both pathological situations and conditions that affect the quality of life and development in the university environment. Furthermore, psychometric indicators provide evidence in favor of their reliable use in the university context.

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Palabras clave: Escala de Auto reporte, estudiantes universitarios, Funciones Ejecutivas,

Keywords: Executive functions, Self-report Scale, university students,

Relación Entre Uricemia y El Estado Funcional Neurológico En El Ictus Isquémico Agudo – Estudio Multicéntrico. Relationship Between Uricemia And The Neurological Functional State In Acute Ischemic Stroke – Multicenter Study

INTRODUCTION: Various biomarkers are studied as a prognostic factor in ischemic stroke, the results obtained about uric acid are controversial.

OBJETIVE: To determine if there is a relationship between uricemia and the neurological functional state in acute ischemic stroke.

MATERIAL AND METHODS: A study was carried out that included 151 patients diagnosed with acute isquemic stroke from the neurology department of the Victor Lazarte Echegaray Hospital and Alta Complejidad Virgen de la Puerta Hospital that met the selection criteria, the relationship between uricemia and neurological functional prognosis using the modified Rankin Scale (mRS), using the Eta statics.

RESULTS: 55.6% of the patients had a poor neurological functional prognosis (mRS>2) reporting acid uric levels with a mean of 4.13 mg/dl. An Eta coefficient of 0.940 was obtained.

CONCLUSION: There is a direct relationship between uricemia and neurological functional state in patients with acute ischemic stroke, associating more extreme values with the worst functional prognosis at hospital discharge.

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Palabras clave: Accidente Cerebrovascular, Ácido úrico, pronóstico funcional,

Keywords: functional prognosis, stroke, Uric Acid,

Diseño y validación de un paradigma para evaluar la atención selectiva, utilizando el software de código abierto “PsychoPy”, aplicable a la Resonancia Magnética Funcional. Design and validation of a paradigm to evaluate selective attention, using the open source software “PsychoPy”, applicable to Functional Magnetic Resonance.

Introduction: Selective attention is a neuropsychological function involved in carrying out activities, from the simplest to the most complex, guiding us towards the search for relevant elements for the achievement of proposed tasks and inhibiting other responses.

Objective: Design and validation of the paradigm to evaluate selective attention.

Methodology: Quantitative study, exploratory-descriptive, experimental. The instrument was designed in three stages: 1) elaboration of the paradigm, 2) validation of the construct and content, 3) Field test and data analysis applied to 18 healthy adults, selected in a non-probabilistic way, between 18 and 30 years old. The paradigm was developed virtually in “PsychoPy”, based on the d2 test and adapted for the Magnetic Resonator.

Results: High scores were found in the evaluation of selective attention and the average time of correct answers is adequate in relation to the amount of work. When analyzing the influence of age and sex with the frequency of correct answers, no statistically significant differences were found.

Conclusions: The selective attention paradigm is a complementary prognostic tool, useful to assess this function, because it has construct and content validity; being a safe, free and easy-to-apply instrument.

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Palabras clave: Adultos, atención selectiva, Ecuador, neuropsicología, Paradigma, RMf,

Keywords: Adults, Ecuador, fMRI, neuropsychology, Paradigm, selective attention,

Efectos del Estrés Materno Intenso y Prolongado Durante el Embarazo y su Repercusión Sobre el Neurodesarrollo del Feto. Effects of Intense and Prolonged Maternal Stress During Pregnancy and its Impact on the Neurodevelopment of the Fetus.

Objective: To evaluate the possible repercussion of strong and prolonged maternal stress during pregnancy on the neurodevelopment of the fetus.

Method: Retrospective cross-sectional study with qualitative and quantitative analysis of seventy-three (73) cases of children -ages 1 through 6- who were seen in private practice between January and June 2017, in which reasons for consultation were analyzed through interviews, psychometric tests, and analysis of clinical history data. The variables were coded and entered into the statistical program SPSS version 22. Descriptive and inferential analysis tests were performed. For better understanding of the study sample, it was distributed in two groups according to the ‘type of pregnancy’ variable: group 1, non-stressed pregnancy, and group 2, stressed pregnancy.

Results: Significant differences were found between pregnancy types and reason for consultation  (t (62)=2.78; p=0.007) and language signs and types of pregnancy (t (62)=5.572; p=(0.001) confirming that high stress rates have a high incidence in neurodevelopmental processes.

Conclusion: Our study has confirmed the possible repercussion of strong and prolonged maternal stress during pregnancy on the neurodevelopment of the fetus with possible future repercussions.

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Palabras clave: estrés materno en embarazo, lentitud maduracional, neurodesarrollo,

Keywords: maternal stress in pregnancy, neurodevelopment, slowed maturation,

Propuesta de un paradigma computarizado para valorar memoria de trabajo. Proposal of a computerized paradigm for evaluation of working memory.

A paradigm for evaluating working memory was validated with the use of N-back tasks in a computer program to be applied within Functional Magnetic Resonance (RMF). The study hypothesis is based on the fact that a verbal 2-back difficulty level increases the success in the performance of the task in working memory, valid to be used in RMF. Through a quantitative cross-sectional study, the N-back paradigm was adapted to a PshicoPy computer program. The task consisted of responding to the stimulus or letter that is the same as the one that appeared two places behind (2 back). 4 blocks of 30 seconds each were presented, and 4 blocks of rest of 30 seconds; in total it lasts 4 minutes. To study the validity of the paradigm, an expert validation and a pilot test were carried out with the participation of 18 adult university subjects. The data was tabulated in a spreadsheet, using statistical contingency table tests; and of sensitivity and specificity. The results offered data greater than 80% sensitivity and specificity regarding the subject’s performance before the test, and the validity of the stimuli. It is concluded that the test can be used to assess working memory by means of a computer program, which can also be used in applications such as RMF.

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Palabras clave: Memoria de Trabajo, N-back, Paradigma, PsycoPy, RMf,

Keywords: fMRI, N-back, Paradigm, PsycoPy, working memory,

Intracranial atherosclerotic disease and severe tooth loss and in community-dwelling older adults. Enfermedad aterosclerótica intracraneal y pérdida dental severa en adultos mayores.

Background: Information on the association between tooth loss and intracranial atherosclerotic disease (ICAD) is limited. Here, we aimed to assess whether non-traumatic severe tooth loss – as a surrogate for chronic inflammatory periodontal disease – is associated with ICAD in a cohort of older adults (aged ≥60 years) living in rural Ecuador.

Methods: ICAD was identified by CT determinations of high calcium content in the carotid siphons or MRA findings of significant stenosis of intracranial arteries. An oral exam assessed the level of non-traumatic severe tooth loss (<10 remaining teeth). Logistic regression models were fitted to assess the independent association between severe tooth loss and ICAD, after adjusting for demographics, cardiovascular risk factors and MRI evidence of cerebrovascular damage.

Results: Of 581 individuals, 269 (46%) had severe tooth loss and 205 (35%) had ICAD. Univariate analysis found a significant association between the two variables (p=0.002). Significance persisted when age and sex were added to the model (p=0.047), although it became non-significant in a logistic regression model including all confounders. Covariates with a significance p<0.1 included age, poor body mass index, high fasting glucose, the presence of >10 enlarged basal ganglia perivascular spaces, and both lacunar and non-lacunar strokes. After factoring in age partitioned by the median and other significant covariates, severe tooth loss remained significantly associated with ICAD.

Conclusions: Severe tooth loss and age are both associated with ICAD in the study population. Some of the effect of severe tooth loss on ICAD is captured by age.

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Palabras clave: aterosclerosis intracraneal, calcificaciones de sifones carotideos, Edentulismo, estenosis de arterias intracraneales,

Keywords: carotid siphon calcifications, intracranial artery stenosis, intracranial atherosclerosis, Tooth loss,

Efectos del ajedrez en el funcionamiento neuropsicológico infantil de la memoria de trabajo y la planificación. 
Effects of chess on child neuropsychological functioning working memory and planning.

Introduction. Chess is a sport and game that benefits different cognitive capacities in the infant stage due to its actions of moving pieces, game rules, decision making and problem solving.

Objective. This article analyzes the benefit of chess in the working memory and planning of boys and girls between 7 and 11 years of age (Mage = 9.00, SD = 1.08).

Method. The design followed is of a comparative type with 30 chess players and 30 non-chess players.

Results. Statistically significant differences were found in the comparisons between the groups in: Labyrinth of Porteus t (58) = 2.38, p = .02, d = .30; ENFEN t (58) = 3.53, p = .001, d = .42, Color paths t (58) = 2.26, p = .03, d = .28 and Ring Test t (58) = 2.35, p = .02, d = .29. In the Parent Observation Questionnaire, no significant differences were found.

Conclusions. The results are discussed around previous research and underlining the positive impact that chess activity produces in the improvement of working memory and planning.

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Palabras clave: ajedrez, Funciones Ejecutivas, Memoria de Trabajo, planificación,

Keywords: chess, Executive functions, Planning, working memory,

Calidad de vida en pacientes con enfermedad cerebrovascular evaluados en un hospital venezolano. Quality of life in patients with stroke evaluated in a Venezuelan hospital.

Objective: Determine the health related quality of life (HRQL) in patients with cerebrovascular disease (CVD) evaluated in the Internal Medicine outpatient service from the Hospital General Hospital del Sur “Dr. Pedro Iturbe” en Maracaibo, Venezuela.

Materials and Methods: A descriptive and cross-sectional study was conducted, with a non-experimental design. The sample was represented by the first 80 patients with a new onset episode of CVD evaluated in the outpatient service from this hospital; to assess HRQL, the Quality of Life Scale for Stroke 38 was used.

Results: Of the subjects evaluated, 53.8% were women, the overall age was 60.7±9.4 years. Ischemic stroke was the most frequent, while 67.5% of the subjects evaluated showed some degree of involvement in their HRQL, specially moderate (36.3%) and mild (27.5%) degree.

Conclusion: no differences in HRQL were evidenced according to stroke type, although in general evaluation the majority reported a mild to moderate HRQL affectation, the analysis by domain shows a greater involvement in social functions, basic activities and physical problems.

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Palabras clave: calidad de vida, Déficit Motor, enfermedad cerebrovascular, salud, secuelas,

Keywords: Cerebrovascular disease, health, Motor Deficit, quality of life, sequelae,

Validación de un paradigma de razonamiento abstracto para Resonancia Magnética funcional (RMf). Validation of an abstract reasoning paradigm for functional magnetic resonance (fMR).

The paradigms are the experimental tasks that are used to map the brain through functional Magnetic Resonance Imaging. Its previous validation is essential to guarantee a successful record of the cognitive activity. A paradigm of abstract reasoning formed by a task of semantic and visual analogies was validated in young-adults between 18 and 30 years in the city of Cuenca-Ecuador. The paradigm was programmed in PsychoPy 3, a free software for neuroscience experiments. The results indicated that the experimental paradigm was understandable and easy to solve. It was also found that the average response time in the semantic reasoning task was significantly lower than the average resolution time of the visual reasoning task. Therefore, it was possible to establish the number of stimuli and their average exposure time needed for a functional Magnetic Resonance Imaging.

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Palabras clave: Paradigma, PsychoPy, razonamiento abstracto, resonancia magnética funcional, validación,

Keywords: abstract reasoning, Functional magnetic resonance imaging, Paradigm, PsychoPy, validation,

Profilaxis en la Migraña: Descripción de la Prescripción en un Primer Nivel de Colombia. Migraine Prophylaxis: Description Of The Prescription In A First Level Of Colombia

Introduction: Migraine is a prevalent disease, crisis can be prevented with medication for not less than 6 months.

Objective: To identify the drugs used for the prophylactic treatment of migraine, inappropriate prescriptions and associated variables.

Materials and methods. Cross-sectional study, in patients of legal age, diagnosed with migraine and prescribed with prophylactic medications. Sociodemographic, comedication, comorbidities and drugs variables were included. Univariate, bivariate and binary logistic regression analysis was performed. Inappropriate prescription was defined by the formulation of drugs without evidence of effectiveness for prophylaxis or by the use of drugs at doses or subtherapeutic times.

Results: 241 patients were included, 87.1% were women. 87.6% of patients received effective drugs, 10.8% probably effective, 2.5% possibly effective and 10.4% drugs without evidence. Propranolol was the most commonly used drug for prophylaxis, on average for 69.1±57.2 days, followed by valproic acid (53.2±55.3 days) and amitriptyline (45.7±39.6 days). 99.6% of patients presented an inappropriate prescription.

Conclusions: A high inadequate prescription of medications for the prophylactic treatment of migraine was identified due to not complying with the recommended dose and duration, as well as an important use of drugs without evidence.

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Palabras clave: Cefalea, Farmacoepidemiología, Prescripciones de Medicamentos, Propranolol, Trastornos migrañosos,

Keywords: headache, Migraine Disorders, Pharmacoepidemiology, Prescription Drugs, Propranololr,

The Effect Modification Of Gender On The Relationship Between Neck Circumference And Obstructive Sleep Apnea In Stroke-Free Older Adults. Efecto Modificador Del Género en la Relación Entre la Circunferencia Del Cuello y la Presencia de Apnea Obstructiva de Sueño en Individuos Añosos Libres de Ictus

Background: Objectives: Studies attempting to assess the association between the neck circumference (NC) and the apnea-hypopnea index (AHI) gave inconsistent results. We aimed to assess the effect modification of gender in the association between the NC and the AHI in stroke-free older adults living in Atahualpa (rural Ecuador).

Methods: The study included 190 stroke-free Atahualpa residents aged ≥60 years who underwent brain MRI, polysomnography, assessment of cardiovascular risk factors, the NC and nasal septum deflection.

Results: The mean age of the study population was 71.1±7.6 years, and 64% were women. The mean NC (37.4±2.6 versus 34±2.5 cm; p<0.001) as well as the mean AHI (14.4±14.5 versus 10.5±11.1 episodes per hour; p=0.039) were greater in men than in women. A fully-adjusted generalized linear model showed significant main effects for NC, gender, and a significant interaction between gender and NC over the AHI (dependent variable). Average AHI increased significantly as NC enlarged, but this change was different in men and women. Men started with lower AHI margins at the 10th percentile of the NC, and while both significantly increased, men had a much larger rate of change in the average AHI. Therefore, at the 90th percentile of NC, men had a larger average AHI than women.

Conclusions: This study shows a significant effect modification of gender in the association between NC and AHI. Differences in cervical fat tissue distribution between men and women probably accounted for such effect.

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Palabras clave: Circunferencia del cuello, género, Índice apnea-hipopnea, proyecto atahualpa,

Keywords: Apnea-hypopnea index, Gender, Neck circumference, The Atahualpa Project,

Asociación Entre Enfermedad Renal Crónica No Terminal y Deterioro Cognitivo en Adultos Entre 55 a 65 años de Edad. Association Between Chronic Non-Terminal Renal Disease And Cognitive Impairment In Adults Between 55 And 65 Years Old

Introduction: According to the Latin American Nephrology and Hypertension Society it is estimated that in Latin America exists around 300 patients with chronic renal failure per million inhabitants, while the American Academy of Neurology reports that patients with cognitive risk are investigated from 60 years old.

Objective: To demonstrate the existence of a relationship between levels of decreased glomerular filtration rate and the presence of cognitive impairment in patients with chronic kidney disease.

Methodology: A cross-sectional, observational, descriptive and analytical study was performed to relate glomerular filtration rate levels to the score obtained in the MoCA Test.

Results: The degree of association between the GFR and MoCA Test variables was evaluated. It was found that when the GFR decreases, the value of punctuation of the MoCA test also does, both variables are directly proportional with a p value of statistical significance of 0.000 (very significant) and a 76.55% strong force of association.

Conclusion: We propose that in medical consultations chronic renal ifailure patients must be evaluated integrally, especially their levels of cognition for avoiding the worsening of their quality of life and functional capacity. Our public health system should make more research about this topic

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Palabras clave: deterioro cognitivo, Enfermedad renal crónica, Nefrología, Tasa de Filtrado Glomerular,

Keywords: cognitive impairment, Glomerular Filtration Rate, Nephrology, Renal chronic disease,

Development And Validation Of A Brief Scale To Assess Attachment In Adults: Psychometric Analysis In Latin America. Desarrollo y Validación de Una Escala Breve Para Valorar el Apego en Adultos: Análisis Psicométrico en América Latina

Assessment of the adult attachment in the Latin American context as a research line is not yet solved. This study has the aim to present the results of the development and validation of a scale to assess the adult attachment. The sample was composed of 1563 participants aged between 17 and 33 years from Chile and Ecuador. This scale was formed by 14 items, which allowed the assessment of secure attachment, avoidant attachment, and ambivalent attachment. Results are as following: (a) the scale presented an adequate internal consistency for secure attachment α=.73 and ω=.82, avoidant α=.58 and ω=.70, and ambivalent α=.69 and ω=.73; (b) adequate convergent validity with sense of coherence (r=.34 and .43, p=< .001); (c) the exploratory factor analysis kept up the items’ organization developed KMO=.77, x2=4133.91, p=<.001; and, (d) the confirmatory factor analysis presented a good fit with three items for each attachment type x2(24)=136.28, p=<.001, CFI=.95, RMSEA=.05(.04–.06), SRMR=.03. Findings of psychometric properties are discussed, highlighting the contribution of this scale in the Latin American context and its relationship with previous research.

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Palabras clave: apego ambivalente, apego evitativo, apego seguro, propiedades psicométricas y escala de apego,

Keywords: ambivalent attachment, attachment scale, avoidant attachment, Psychometric properties, secure attachment,

The Role Of Inhibitory Control In The Ability To Solve Problems Of University Students. El Rol Del Control Inhibitorio en la Habilidad Para Resolver Problemas de Estudiantes Universitarios

The aim of the present study was to analyze the role of inhibitory control in the ability to solve problems of university students. The sample consisted of 90 young people with typical development (Mage= 20.58, SD= 1.27), 39 females (43.33%) and 51 males (56.7%). The Stroop and the Anillas’ Test tasks were applied as instruments. As results, it was found a directly proportional and predictive relationship between inhibitory control and problem-solving of university students (correlation between: r= .34 and .47, p= <.01; prediction: r2= .14, F(1,88)= 13.88, p= <.01). It concludes by reflecting on the contribution of conscious control to solve problems faced by the university student on a day-to-day basis in an efficient way and invites future research in order to train inhibitory control.

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Palabras clave: control inhibitorio, Funciones Ejecutivas, monitorización, planificación, resolución de problemas,

Keywords: Executive functions, inhibitory control, Monitoring, Planning, Problem-solving,

Niveles de Hemoglobina y Anemia en Niños: Implicancias Para el Desarrollo de Las Funciones Ejecutivas. Hemoglobin And Anemia Levels In Children: Implications For The Development Of Executive Functions

Introduction: Anemia is one of the most important health problems in the world. In developing countries; anemia coexists with malnutrition, lack of access to water, and sanitation. In Peru, more than 40% of children have anemia that affects their brain function and cognitive processes during their development, even to adult life.

Objective: This study sought (1) to know the levels of hemoglobin and the presence of anemia in children in rural and urban Arequipa, as well as other indicators of physical health, (2) compare the level of development of executive functions between both groups of children, and (3) analyzes of hemoglobin levels predict the cognitive profile.

Method: 49 subjects were evaluated (55% from rural area, 46% girls). Both groups begin regular basic education, different weight measurements were evaluated, including hemoglobin (HemoCuer®) and O2 saturation. The executive functions were assessed with the BANFE test.

Results: Disturbing levels of anemia have been found in the rural area of ​​Arequipa, as well as obesity in children in the urban area. Different processes of executive functions, especially from dorsolateral area have been reduced in rural children; despite having a similar educational and socioeconomic level. Finally, we found that hemoglobin levels explained the 27% of the variance; corresponding to the dorsolateral prefrontal score.

Conclusion: Anemia affects the development of executive functions in children, generating tombs consequences in their neurodevelopment.

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Palabras clave: Anemia, BANFE, Cognición, función ejecutiva, Perú, población infantil,

Keywords: anemia, BANFE, child-population, Cognition, Executive function, Peru,

Enfermedades Neuro-Psiquiátricas en Atención Primaria en una Zona Rural de la Sierra Ecuatoriana en el 2018. Neuro-Psychiatric Diseases In Primary Care In A Rural Area Of The Ecuadorian Highlands 2018

Aim: To provide epidemiological data of neuro-psychiatric diseases. Methods: The sample corresponds to a native population of the northern Ecuadorian highlands, the data was retrospectively collected obtained from daily records of the health center in 2018. Neurological and mental health pathologies codified in ICD-10 were considered. Results: Of the total registered medical consultations, 521 corresponded to neuro-psychiatric diagnoses (4.07%). The majority of patients were women 66.79%. The average age was 39.22 years old 95% CI 37.17-41.26. Ethnic self-identification was native in 90.79%. The most frequent neurological pathology observed was the spectrum of headaches including migraine, tension headache and headache with 240 cases; and the psychiatric mental and behavioral disorder with 18 cases. It was also found that older women are more predisposed to suffer from these diseases. Conclusions: The integration of neurological and psychiatric services in primary health care should be an important political objective in our country for the early diagnosis and treatment of these pathologies with great impact on health.

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Palabras clave: Atención Primaria, Ecuador, epidemiología, neurología, Psiquiatría,

Keywords: Ecuador, epidemiology, neurology, Primary Care, Psychiatry,

Midline Cava And Limbic System Dysfunction In Community-Dwelling Individuals Aged ≥20 Years Living In Rural Ecuador. A Case-Control Study Nested To A Population-Based Cohort. Cavum de Línea Media y Disfunción del Sistema Límbico en Individuos de 20 Años o Más Que Viven en Zonas Rurales Del Litoral Ecuatoriano. Estudio de Caso-Control Anidado en Una Cohorte Poblacional

Background: Persistence of cavum septum pellucidum (CSP) and cavum vergae (CV) into adulthood and their association with mood disorders is unknown. Objective: We aimed to assess persistence of these cava in Atahualpa cohort individuals, and their association with clinical depression (as a surrogate of limbic system dysfunction). Methods: Cases were defined as Atahualpa residents aged ≥20 years with CSP and/or CV and paired 1:1 to age- and sex-matched randomly-selected controls. A board-certified psychiatrist (blinded to case-control status) interviewed individuals with the aid of the Patient Health Questionnaire depression module (PHQ-9) to establish a diagnosis of clinical depression. The McNemar’s test and conditional logistic regression models were fitted to assess the independent association between persistence of CSP and/or CV and clinical depression (as the dependent variable). Results: Of 1,298 individuals undergoing a head CT, 51 (3.9%) had a CSP and/or CV. The selection process for the nested case-control study on the Atahualpa cohort (after excluding eight missing individuals with midline cava) generated 43 pairs. Nine of 43 case-patients (20.9%) and only two control subjects (4.7%) had moderate-to-severe scores on the PHQ-9 (cutoff ≥10 points). Clinical depression was significantly more frequent among case-patients than controls by the McNemar’s test (OR: 8; 95% C.I.: 1.1 – 354.9) and the conditional logistic regression model (OR: 8; 95% C.I.: 1.00 – 63.96). Conclusions: This study provides epidemiological evidence favoring the association between midline cava and clinical depression, supporting their relationship with limbic system dysfunction.

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Palabras clave: Cavum Septum Pellucidum, Cavum vergae, Depresión clínica, Módulo de depresión del cuestionario de salud del paciente,

Keywords: Cavum Septum Pellucidum, Cavum vergae, Clinical depression, Patient Health Questionnaire depression module,

Coeficiente de Difusión Aparente en Tejido Encefálico: Valores de Normalidad en Población Colombiana Clínicamente Sana. Apparent Diffusion Coefficient In Brain Tissue: Values Of Normality In Clinically Healthy Colombian Population

Introduction: The diffusion sequences in magnetic resonance, including the apparent diffusion coefficient (ADC), represent a fundamental tool for the radiologist in the clinical diagnosis. However, there is no standardization for measurements between normal limits or a range of normal ADC values. Objective: To determine normal ADC values ​​in the brain tissue for the clinical and radiologically healthy population. Methods: Cross-sectional study on retrospective data, ADC values ​​were measured for 21 encephalic regions (frontal gray, parietal and temporal substance, frontal and parietal white matter, caudate nucleus, putamen, thalamus, internal capsule, cerebellar hemispheres bilaterally and bridge of the brainstem) in 90 clinically and radiologically healthy subjects, in two private clinics in Bogotá. Results: Normal ADC values, in a clinical and radiologically healthy population, in 21 encephalic territories, comparative analysis of the results according to the sex and age of the patients, and correlation between the measurements made by two researchers. Conclusions: The findings serve as a reference for the Colombian and normal Latin American population, establish a point of comparison for the evaluation of intracranial pathologies, and open the possibility to develop new research projects that seek to determine ADC values ​​in sick population.

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Palabras clave: ADC, neuroimagen, resonancia magnética,

Keywords: magnetic resonance, neuroimaging,

Psychometric Properties Of ADHD Rating Scale In School Context. Propiedades Psicométricas de la Escala ADHD en el Contexto Escolar

Background: The ADHD Rating Scale IV (ADHD RS IV) is one of the most commonly used scales in attention deficit hyperactivity disorder (ADHD) assessment. Its psychometric properties have been studied in contexts including Europe and North America, however, in Latin America, there is shortage of empirical evidence about validity or reliability reported by teachers on a scholar context. The aim of the research was to analyze the psychometric properties of the ADHD RS IV based on the behavior of students reported by teachers. Material/methods: Three hundred and forty-five students voluntarily participated in this study (162 men and 183 women), aged between 5 and 15 years (Mage = 10.43, SD = 3.61). As instruments of measurement ADHD RS IV, Perception of Differences Test and Go / No-Go experiment were used. Cronbach’s alpha, Pearson correlation and confirmatory factor analysis were applied and analyzed. Results: In the results it was found that internal consistency coefficient of RS IV ADHD is between .93 and .97. There is a significant statistically correlation between the scale and the number of successes points in the Perception of Differences Test (r = -.55, p = < .001) and mistakes to stimuli no-go (r = .34, p = .002). The classic ADHD model of two factors had good indicators of goodness of fit x2(101) = 321.40, p < .001; CFI = .96; RMSEA = .08 (.07 to .09) and SRMR = .04. Conclusions: The article is finalized highlighting the ADHD RS IV has adequate psychometric properties in order to be applied in the school context.

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Palabras clave: ADHD RS IV, experimento Go / No-Go, propiedades psicométricas, prueba de percepción de diferencias, trastorno por déficit de atención con hiperactividad,

Keywords: ADHD RS IV, Attention deficit hyperactivity disorder, Go/No-Go experiment, Perception of differences Test, Psychometric properties,

Inhibitory Control And Symptomatology Of Attention Deficit Hyperactivity Disorder El Control Inhibitorio y la Sintomatología Del Trastorno Por Déficit de Atención Con Hiperactividad

Background. Inhibitory control has been described as a factor causing difficulties in the regulation present in the ADHD. Objective. The aim was to analyze the relationship between inhibitory control and symptoms of ADHD in a sample of 81 subjects diagnosed with ADHD (Mage=10.05, SD=2.53). Methods. A quantitative, cross-sectional and correlational scope research was carried out. The instruments used were the ADHD RS IV and SIMON experiment. Correlation inferential statistical regression and regression processes were applied. Results. Three regression models were tested, where inhibitory control presents a significant prediction with the (a) attention deficit F(1,79)=20.69, p=<.001, R2=.21, (b) hyperactivity and impulsivity F(1,79)=5.90, p=.01, R2=.07 and (c) the combination of both (a+b) F(1,79)=13.25, p=< .01, R2=.14. Conclusions. The findings suggest that inhibitory control is one of the main executive functions that determines the degree of affectation of the symptomatology of the child population with ADHD.

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Palabras clave: control inhibitorio, déficit de atención, funciones ejecutivas funciones, Hiperactividad, impulsividad,

Keywords: attention deficit, Executive functions, hyperactivity, impulsivity, inhibitory control,

Índice Ventricular De Levene y Mensuración del Tercer Ventrículo en Neonatos Ecuatorianos Mediante Ecografía Cerebral. Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound.

Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle’s diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks’ gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle’s mean diameter was 1.5 mm (range: 0.5 mm – 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.

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Palabras clave: Ecografía, Ecuador, Neonato, Ultrasonido dúplex transcraneal,

Keywords: duplex ultrasound, Ecography, Ecuador, neonate,

Percepción de Los Padres de Niños Con Déficit Ejecutivos Que Presentan Dificultades en el Aprendizaje de Matemáticas. Parental Perception In Children With Executive Deficits Who Have Learning Difficulties In Mathemathics

The main objective of this research is to describe the executive deficits of children with learning difficulties in ​​mathematics and their relationship with parental perceptions. A sample of 30 children with difficulties in ​​mathematics at ages between 9 and 12 years was studied, they underwent Tower of London test, and to the parents the Children’s Inventory of Executive Functions (CHEXI) was studied. According to the applied tests, the results showed difficulties in working memory, planning, regulation and inhibition. The results showed no correlation between the executive deficits evidenced in children and the perception of parents. However, there is a positive relationship between the perception of parents in the area of ​​working memory and poor academic performance. The results are discussed by the complexity of the evaluated construct and the multiple variables involved at the time of its clinical assessment.

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Palabras clave: déficit ejecutivo, neuropsicología, percepción de los padres, rendimiento académico,

Keywords: academic performance, executive disorders, neuropsychology, parental perception,
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