comorbilidades

Características Clínicas de Pacientes Hipertensos hospitalizados con y sin Enfermedad Cerebrovascular de 60 a 90 años en Quito, Ecuador: Estudio de Casos y Controles. Clinical Characteristics of hospitalized Hypertensive Patients with and without Stroke aged 60 to 90 years in Quito, Ecuador: A Case-Control Study.

Background: Stroke is the world’s second leading cause of death from disease, and disability-adjusted life years. The investment in management of a hospitalized stroke patient generates a high healthcare cost. In Ecuador it is the third leading cause of death. Hypertension is one of the most important factors in the stroke development. Patients with high blood pressure and stroke have a higher risk of complications, mortality and poor prognosis.

Objective: The present study aimed to identify which variables differ between hypertensive patients with stroke versus hypertensive patients without stroke, hospitalized, during 2017- 2020.

Methods: In a population of 96 cases and 57 controls, a retrospective analytical cohort study between two groups of patients was conducted.

Results: The variable education (primary education) was the most affected among cases (χ²=13.298; p=0.039). Patients with atrial fibrillation were significantly higher in the case group (χ²=7.31 p=0.007). Other variables like: sex, age, provenance, years lived with hypertension, smoking, type 2 diabetes mellitus, heart failure, hypercholesterolemia and anticoagulant therapy, showed no significant difference between the two groups.

Conclusions: Patients with complete primary education and atrial fibrillation had significant presence in hypertensive patients with stroke.

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Palabras clave: comorbilidades, enfermedad cerebrovascular, enfermedades cardiovasculares, Factores de riesgo, Hipertensión arterial, síndrome metabólico,

Keywords: Arterial hypertension, cardiovascular diseases, Comorbidity, metabolic syndrome, Risk factors, stroke,

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.