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.
Artículos Originales
Validación de un paradigma de razonamiento abstracto para Resonancia Magnética funcional (RMf). Validation of an abstract reasoning paradigm for functional magnetic resonance (fMR).
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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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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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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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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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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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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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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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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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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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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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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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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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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Influencia del Estrés Crónico y de la Masticación Sobre el Dolor. Influence Of Chronic Stress And Chewing Over Pain.
Introduction: Chronic stress and mastication affect the response to pain; however, there is little knowledge about the relationship between these variables.
Objective: Determine the influence of chronic stress and mastication on the response to pain.
Methods: thirty-two 8-week-old male Balb/c mice were used. The sample was divided into 4 equal groups: Group N: normal mastication without stress; Group NE: Normal chewing + stress, Group D: deficient chewing without stress and Group DE: Poor chewing + stress. The response to the painful stimulus was evaluated through the tail withdrawal assay due to a thermal stimulus.
Results: By comparing the 4 experimental groups to the fourth and the eighth week through the ANOVA test yielded a value of p = 0.982 and p = 0.176; respectively. By applying the ‘t’ student, within each group, in comparison of the variation of the pain response between the fourth and eighth week, the values of p = 0.52; p = 0.17; p = 0.84 and p = 0.069 were obtained for the group N, NE, D and DE respectively.
Conclusion: Chronic stress and mastication do not modify the response to pain in albino Balb/c mice.
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Arterial Stiffness Is Not Independently Associated With Nighttime Sleep Duration In Community-Dwelling Older Adults. Results From The Atahualpa Project. La Rigidez Arterial no se Encuentra Asociada con la Duración del Sueño Nocturno en Adultos Añosos Que Viven en la Comunidad. Resultados del Proyecto Atahualpa.
Objectives: We aimed to assess the association between arterial stiffness and nighttime sleep duration in community-dwelling older adults living in rural Ecuador.
Methods: Aortic pulse wave velocity (PWV) determinations were used to assess arterial stiffness. Nighttime sleep duration was assessed by a single question. A generalized linear model—adjusted for demographics, cardiovascular risk factors and psychological distress—was fitted to assess the independent association between the aortic PWV and nighttime sleep duration (dependent variable).
Results: A total of 303 individuals were enrolled. Univariate analysis showed a significant association between the aortic PWV and long sleep duration (p=0.034), which vanished in a multivariate linear model (p=0.524). The single covariable remaining significant was anxiety (p=0.013).
Conclusion: Lack of independent association between arterial stiffness and nighttime sleep duration might be more likely related to lack of reliability of evaluation of sleep duration by means of a single question.
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Escala Reducida Para Valorar el Sentido de Coherencia: SOC 15 Scale Reduced To Value The Sense Of Coherence: SOC 15
Introduction: The sense of coherence is a construct of health that allows the individual to face difficult situations of life. It is configured by three factors: meaning, understanding and management. As a method of assessment of this construct, has been proposed the SOC scale with 29 items in its original version.
Objective: The objective of this study is to propose a reduced SOC scale.
Methods: We worked with a sample of 445 healthy participants from Quito-Ecuador, 145 men (32.5%) and 300 women (67.4%).
Results: It was obtained that the reduced scale of 15 items presents an adequate internal consistency in its three factors: understanding α= .74, management α= .82 and meaning α= .82. In the confirmatory factor analysis, an acceptable adjustment of the reduced model was found (SOC-15) x2= 317.90, DF= 87, p= <. 001, CFI= .92, RMSEA= .07 (.06-.08) and SRMR= .04.
Conclusions: The data is discussed in relation to the benefits of counting with a reduced scale for its future application in the clinical and health scientific context.
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Meningitis Criptocócica. Diferentes Contextos Clínicos y Complicaciones. Serie de 7 Casos. Cryptococal Meningitis. Different Clinical Context And Complications. Seven Cases.
Introduction. Cryptococcal meningitis (CM) is a serious infection of the Central Nervous System. The diagnosis and treatment of these patients is often complex, due to the severity of the clinical manifestations and their complications. The aim of this study is to describe the different clinical contexts, the neuroradiological characteristics and the complications of patients with CM.
Patients. We performed a retrospective review of clinical and radiological factors of 7 patient’s diagnosis and treated with CM during the period October 2016 and September 2017, at the Eugenio Espejo Hospital.
Results. Male sex was predominant (6/7), with an average age of 31.6 years (Range 19-44). The average time for the diagnosis was 8.1 weeks. Immunosuppression causes were evidenced in 5 patients, two HIV positive, one case with Acute Lymphoblastic Leukemia, CD4 idiopathic lymphopenia and Primary Intestinal Linfagectasia respectively. Three patients developed complications as disseminated cryptococcosis, visual acuity and hearing loss, mortality rate reach 26.8% of patients. Hypoglycorrhachia was a relevant feature with average 12.7mmg / dl. In MRI, the most common lesion was dilatation of Virchow Robins spaces (5/7), followed by ischemic lesions.
Conclusions. CM is characterized for high morbidity and mortality, initial symptoms may be nonspecific and delays the diagnosis as well as initiation of antifungal agents. Several predisposing immunosuppressive conditions can be found and sometimes a diagnostic challenge.
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Factores Asociados a la Mortalidad de la Hemorragia Cerebral Intraparenquimatosa Espontánea en Pacientes Mayores de 50 Años de Edad que Acudieron al Hospital Teodoro Maldonado Carbo Durante el Año 2017. Factors Associated With Mortality Of Spontaneous Intraparenchymal Cerebral Hemorrhage In Patients Over 50 Years Old Who Attended The Teodoro Maldonado Carbo Hospital During 2017.
Objective. To determine the factors associated with the mortality of spontaneous intraparenchymal cerebral hemorrhage in patients over 50 years old who attended the Teodoro Maldonado Carbo Hospital during 2017.
Methods: A retrospective analytical observational study of 92 patients of diagnosis of spontaneous primary intraparenchymal hemorrhage, 30-day mortality was evaluated according to demographic characteristics, risk factors and poor prognostic factors. The Intracerebral Hemorrhage Grading Scale (ICH-GS) scale was applied in our population to evaluate the correlation of the scores obtained with the 30-day mortality.
Results: From 92 patients (mean age: 69 years, mean Glasgow Coma Scale [GCS] on admission: 10, mean supratentorial and infratentorial volume, respectively 36.63 and 13.92 ml, most common hematoma location: thalamus (21.74%). at 30 days it was [31.40%]). In a univariate analysis, GCS (odds ratio [OR] = 2.20, 95% confidence interval [CI] = 1.04- 4.65, p <0.04), infratentorial volume (OR) = 3.74 per ml, 95% CI = 1.25 to 11,120, p <0.02) and the ventricular extension was (OR = 5.43, 95% CI = 1.40-22.35, P = 0.02) were significant predictors for 30-day mortality The Pearson correlation showed correlations of 0.6556 between the IC-GS score and the 30-day mortality (P <0.001).
Conclusions: The GCS score at admission together with infratentorial volume and intraventricular extension are significant predictors of 30-day mortality in patients with primary spontaneous Intracerebral Hemorrhage (ICH) being useful for identifying high-risk patients in the short term.
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Ausencia de Asociación Entre la Posición de la Lengua Tipo IV de Friedman y Apnea Obstructiva de Sueño en Adultos Mayores con Ancestro Amerindio. Lack Of Association Between The Friedman’s Tongue Position Type IV And Obstructive Sleep Apnea In Older Adults Of Amerindian Ancestry.
Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman’s tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians.
Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador.
Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI.
Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 – 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 – 1.31; p=0.357).
Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).
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Adherencia al Tratamiento Antiepiléptico en Pacientes Pediátricos del Hospital Roberto Gilbert Elizalde en el Año 2014. Adherence To Antiepileptic Treatment In Pediatric Patients At Hospital Roberto Gilbert Elizalde During 2014.
Introduction: Epilepsy in the pediatric population is an entity that mostly affects underdeveloped countries. In Ecuador, hospital admissions due to poor control are increasing and the main cause is poor adherence to antiepileptic treatment.
Objective: To demonstrate the incidence of nonadherence to the antiepileptic regimen and determine the factors that contributes to it.
Materials and methods: A cross-sectional study was conducted in which 119 patients were included with ages between 6 months and 17 years. The parents or legal guardians were questioned regarding the degree of adherence to antiepileptic treatment using the Morisky questionnaire. A logistic regression model was used to measure the strength of association between variables.
Results: An incidence of non-adherence to antiepileptic treatment of 36.97% was found. The significantly associated variables were the mother’s schooling (x2=11.83, IC= 10.13 – 13.53, p=0.018), previous medical information (x2=9.35, IC= 7.95 – 10.75, p=0.02) and the failure to obtain medication due to lack of money (x2=5.98, IC= 5.29 – 6.67, p=0.01).
Conclusion: The incidence of nonadherence in this study was high; control over sociodemographic factors and related to treatment can have a great impact on these patients.
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Frecuencia de Casos Juveniles con Enfermedad de Huntington en Población Mexicana. Frequency Of Juvenile Huntington’s Disease In A Mexican Population.
Objective. The purpose of this study is to know the prevalence of juvenile cases in a sample of mexican subjects with confirmed Huntington Disease (HD).
Methods. Patients with clinical debut before 21 years of age were included who attended at movement disorders clinic of the National Institute of Neurology and Neurosurgery. The demographic and clinical information was obtained from the review of files.
Results. A total of 198 cases of patients diagnosed with HD were reviewed, of which 6.5% (n = .13) corresponded to juvenile forms. The mean age for the onset of symptoms was 17.8 ± 3.9 years. The mean score of the UHDRS-motor was 46.2 ± 17.4 points. The predominant motor symptom was chorea in (53.8%) of the cases. 84.6% of those affected presented at least one neuropsychiatric disorder.
Conclusion. It was detected that the dominant motor phenotype of these patients was chorea compared to the world reports until now, accordingly to that, our group of juvenile HD shows atypical motor clinical.
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Fibrinólisis Farmacológica en el Ictus Isquémico Agudo. Experiencia en un Hospital Terciario del Ecuador. Pharmacological Thrombolysis In Ischemic Stroke. Experience In A Tertiary Hospital From Ecuador.
Introduction. Pharmacological thrombolysis in ischemic stroke is associated with a better recovery.
Objective. Describe the thrombolysis results after using r-Tpa applying an intrahospital stroke code, during one year.
Methods. A prospective, longitudinal study was performed in patients with cerebral infarction admitted to the stroke unit, with clinical follow-up up to 3 months after hospital discharge. The variables evaluated were compared in two groups of patients (only one group received the treatment).
Results. 107 patients were studied: 16 (14.9%) were thrombolyzed, 29 (27.1%) arrived in the therapeutic window period and 76 (71%) arrived after 4.5 hours. The average age was 68, 8 years and women predominated. The greatest impact of thrombolysis was on the difference in score between the initial assessment and the discharge on the NIHSS scale. At three months of evolution, the percentage of patients with mild disability (Rankin 0-2) was almost equal in the two groups. Mortality increased in patients with more severe disability (Rankin 3-5).
Conclusions. Treatment with r-Tpa shows benefits at hospital discharge. Further analysis is required with a greater number of cases.
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Efectividad del Foto-Test Frente al MMSE, Para el Cribado del Deterioro Cognitivo en Población Peruana. Effectiveness Of The Photo-Test Front Of The MMSE, For The Screening Of Cognitive Deterioration In Peruvian Population.
The progressive increase of Alzheimer’s disease has generated interest in its early detection with cognitive screening tests being a useful tool, however, they need to be culturally adapted, objective and reliable. In Peru, this need is greater since the educational level of the elderly population is mostly low. The aim of the present study is to know the estimate sensitivity and specificity of FOTOTEST against MMSE for the screening/detection of cognitive impairment, analyzing the relationship of these cognitive tests with one of functional activity. 107 elderly people, aged 60-89 years, were evaluated. The Yesavage scale for geriatric depression was used, the functional activities questionnaire of Pfeffer, MMSE, and FOTOTEST. Pearson’s analysis showed a significant positive correlation between MMSE/FOTOTEST (Pearson 0.386, p <0.003), whereas only MMSE showed a significant negative correlation with PFAQ (Pearson -0.320, p <0.013). However, FOTOTEST did not show a significant correlation with PFAQ (Pearson -0.067, p <0.613). In addition, the percentage of effectiveness and specificity estimated for FOTOTEST was 100.00% and 92.68%, respectively, higher than the MMSE, with an estimated percentage of effectiveness being 83.33%, and specificity of 34.14%. We conclude that FOTOTEST would be a more useful test for the detection of cognitive impairment than MMSE.
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Salud Cardiovascular en Población Migrante Ecuatoriana en Madrid (España). ¿Debemos Preocuparnos?* Cardiovascular Health in an Ecuadorian Migrant Population to Madrid (Spain). Should we worry?
Background: The Ecuadorian community is the third largest foreign community in Spain. However, little is known about their cardiovascular (CV) health status and whether the effects of migration have caused a detriment in that state. Methods: With the aim of knowing the CV health in an Ecuadorian population of migrants in Madrid, a non-randomized, cross-sectional study was carried out, which included people of Ecuadorian nationality, older than 25 years, living in Madrid for a year or more. Surveys were conducted through the use of previously validated questionnaires, to determine the health status of the population, as well as the degree of neuro-physiological distress. Results: We included 165 participants (68.5% women), with an average age of 49 years. Of these, 86.1% presented poor cardiovascular health and 13.9% intermediate, without significant differences according to sex. There were no individuals that met the 7 variables consistent with and ideal CV status. Women had higher scores on the DASS-21 questionnaire compared to men (p <0.05). Conclusion: In the Ecuadorian migrant population living in Madrid, more than 85% had poor CV health, and none had an ideal CV health. Most prevalent risk factors in this population were poor physical activity, overweight/obesity and poor dietary habits. More studies are required to identify the real situation of CV risk in the Ecuadorian migrant population. Probably, in the medium-long term, it will be necessary to implement health policies especially addressed to migrants.
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Intracranial Atherosclerosis And The Earlobe Crease (Frank’s Sign). A Population Study. Aterosclerosis Intracraneal y Pliegue Auricular (Signo De Frank). Estudio Poblacional.
Background: The earlobe crease (ELC) has been linked to coronary artery disease and other vascular conditions, but there is no information on its association with intracranial atherosclerosis. Objective: This study aimed to assess the association between high calcium content in the carotid siphons (as a surrogate of intracranial atherosclerosis) and ELC in communitydwelling adults living in rural Ecuador. Methods: Atahualpa residents aged ≥40 years underwent head CT to estimate calcium content in the carotid siphons, and visual inspection of both earlobes to evaluate the presence of ELC. The association between both variables was assessed by logistic regression models, after adjusting for demographics and cardiovascular risk factors. Results: Of 651 enrolled individuals (mean age: 59.7±12.8 years; 54% women), 225 (35%) had ELC, and 143 (22%) had high calcium content in the carotid siphons. Univariate logistic regression showed a borderline (non-significant) association between high calcium content in the carotid siphons and ELC presence (OR: 1.44; 95% C.I.: 0.99 – 2.12; p=0.057), which disappeared when age (OR: 0.98; 95% C.I.: 0.65 – 1.48; p=0.923) and other covariables (OR: 0.97; 95% C.I.: 0.63 – 1.49; p=0.890) were added to the model. Conclusion: This population study shows no association between high calcium content in the carotid siphons and ELC presence.
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Rendimiento Diagnóstico de Minimental Frente Al DSM-5 en Trastorno Cognitivo: Experiencia de una Cohorte en Colombia. Diagnostic Performance Of Minimental Against DSM-5 In Cognitive Disorder. Experience Of A Cohort In Colombia.
Background: Cognitive screening tools are useful in the clinical and research setting. MiniMental (MMSE) is one of the most used instruments in Colombia, the objective of this work is to determine its performance against the new criteria for the diagnosis of cognitive disorder (DSM-5). Materials and methods: Diagnostic test study, assembled in a Colombian cohort, we evaluated a consecutive sample of 200 participants older than 50 years (66.5,+/-8.86) that represented the whole spectrum of the condition of interest, the index test (MMSE) was compared with the clinical reference standard (consensus diagnosis and classification by criteria DSM-5). Results: For mild cognitive impairment (MCI), the diagnostic performance of MMSE was: Sensitivity 45.3% (95% CI 33.7 to 57.4), specificity 96.9% (95% CI 91.4 to 99.0) and 76.9% accuracy (95% CI 69.5 to 82.4) at a cut-off point of 26 and, for major cognitive disorder (MCD) was: Sensitivity 76.32% (95% CI 60.8-87.0) and specificity 97.53% (95% CI 93.8-99.0) at the cut-off point of 24. Conclusions: MMSE is a valid alternative for the diagnosis of MCD, however it has limited validity for the detection of MCI, so new tools for the purpose of screening of MCI should be considered.
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Tasa de Hospitalización Según Comorbilidades en Pacientes con Alzheimer en el Hospital Teodoro Maldonado Carbo. Hospitalization Rate According To Comorbidities In Alzheimer’s Patients At Hospital Teodoro Maldonado Carbo.
Introduction: According to World Health Organization (WHO) 2017 report there are 50 millions of people with dementia worldwide and 60% to 70% of cases belong to Alzheimer’s Disease. The WHO admit that dementia is a public health priority. Aims: Descriptive analysis of patients Alzheimer’s Disease in Guayaquil, Ecuador, focused hospitalization and mortality predictors. Methods: Cross-sectional study. Multivariate and univariate logistic regression analysis to indicate predictors of hospitalization by pneumonia and mortality. Results: 42.57% of the sample was men and the average age was 80.02 years. In a multivariate logistic regression analysis, the most associated comorbidity to increase the risk of pneumonia were Diabetes Mellitus combined with Arterial Hypertension (OR 5.62, 95% CI (1.17 – 26.96) p 0.031), statistically significant. Antipsychotic medication increase the pneumonia risk with a statistically significant meaning (OR 3.03, 95% CI (1.23 – 7.44) p 0.016). Conclusion: Future studies should focus on report the effect of medications and comorbidities on admissions in patients with Alzheimer. Guidelines to focus prevent common causes of hospitalization in these patients should be adapted.
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Evaluación de las Habilidades de la Corteza Prefrontal: La Escala Efeco II-VC y II-VR. Evaluation Of The Skills Of The Prefrontal Cortex: The Efeco II-VC And II-VR.
The pre-frontal cortex is the basis of the most complex mental abilities of human development. In its evaluation process, the EFECO scale provides an important contribution to assess its status. In previous investigations this scale has been studied with its configuration of 67 items, narrative focused on the deficit and evaluation of 8 executive functions. This research presents a new version of the scale, centered on its narrative in executive ability, proposed items to assess executive verification function and a summarized version of 42 items. The study included 118 healthy adults between 18 and 25 years of age (Mage = 20.72, SD = 1.65). In the results it was found that the EFECO II-VC scale (modified and complete version) obtained as internal consistency α = .96 and its sub-scales internal consistency between α = .64 and .81. The EFECO II-VR scale (modified and summarized version) obtained α = .94 and its sub-scales between α = .68 and .79. The internal consistency of the factors in which the executive functions are included were adequate: the supervisory system of cognition II-VC α = .93 and II-VR α = .70, while the supervisor system of behavior II- VC α = .93 and II-VR α = .81. The correlations between the executive functions assessed with both scales were between medium and large r = .36 and .94. The work is closed discussing the clinical and scientific contribution of the modification of the EFECO scale.
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Conocimiento Acerca Del Ictus Isquémico En Ecuatorianos. Knowledge About Ischemic Stroke In Ecuadorian People.
Introduction. The arrival of patients with ischemic stroke to the hospital in the period of the therapeutic window, depends to a great extent on the identification of their clinical signs and the recognition that it is a medical emergency. Methods. A prospective, longitudinal, cross-sectional study was carried out, based on a structured interview with closed questions. The aim was to assess the degree of the population’s knowledge about the ischemic stroke. Results. A total of 135 subjects without a diagnosis of stroke were interviewed, randomly selected from the relatives of patients. The average age was 42.6 years, women predominated (92 / 68.1%), with an average level of education. 95.5% (129 subjects) admitted having little knowledge about stroke. Only 11.1% correctly indicated the clinical manifestations; The most recognized symptom was damping (59.3%) followed by speech disorders. 80.9% (109 respondents) identify stroke as a preventable condition. Less than half of the participants adequately named the risk factors (66 / 48.9%). 88.2% take a correct attitude to the symptoms. Conclusions. In the group of people interviewed there is a perception of risk regarding stroke, but knowledge about the manifestations and vascular risk factors is poor. It is necessary to carry out information campaigns aimed to improve knowledge of t he disease.
