Factores de riesgo

Factores de riesgo cardiovascular y etiología del ictus en adultos jóvenes. Cardiovascular risk factors and stroke etiology in young adults.

Objectives: To describe the etiology of stroke and the frequency of cardiovascular risk factors in a group of patients under 50 years of age, hospitalized in the stroke unit of a public tertiary hospital in Ecuador.

Patients and methods: Descriptive and retrospective cross-sectional study of patients aged 50 and under, admitted between November 2016 and August 2019. Demographic data, cardiovascular risk factors, type of stroke, etiology door symptom time and the length of stay in the neurology department were analyzed. The results were compared between sexes.

Results: 45 patients were included. The mean age was 38 ± 10 years and there were no differences between the sexes. The 77.8% had some cardiovascular risk factors. Alcohol consumption predominated (33.3%), followed by smoking and dyslipidemia (22.2%). In general, and by sex, ischemic stroke (75.5%) was the most frequent. Intracerebral hemorrhage represented 24.4%. In the etiology of the ischemic stroke, an unusual cause predominated (35.3%), followed by cardioembolic stroke (26.8%) and that of undetermined etiology. For intracerebral hemorrhage, the most frequent etiology was hypertension (63.3%).

Conclusions: The high frequency of at least one modifiable cardiovascular risk factor, added to the delay in arrival at the hospital, constitute an alert to consider the need to insist on primary prevention and carry out information campaigns aimed to improve knowledge of the disease.

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Palabras clave: Adultos jóvenes, Ecuador, Etiología, Factores de riesgo, Ictus,

Keywords: Ecuador, Etiology, Risk factors, stroke, Young adults,

White matter hyperintensities severity and progression are not related to earlobe crease presence. A cross-sectional and longitudinal prospective study in community-dwelling older adults. La severidad y progresión de hiperintensidades de la sustancia blanca no están relacionados con la presencia del pliegue del lóbulo de la oreja. Un estudio transversal y longitudinal prospectivo en una población de adultos mayores

Background: Earlobe crease (ELC) has been associated with coronary atherosclerosis. Recently, ELC has been associated with white matter hyperintensities (WMH) of presumed vascular origin. However, the results are heterogeneous among studies. We aimed to assess whether ELC is associated with WMH severity and progression in community-dwelling older adults.

Methods: Atahualpa Project Cohort participants received earlobe photographs and brain MRIs to assess the association between ELC and WMH severity, as well as the relationship between ELC and WMH progression using ordinal logistic and Poisson regression models, respectively.

Results: The cross-sectional component of the study included 359 individuals aged ≥60 years. ELC was present in 175 subjects. On MRI, 107 participants did not have WMH, 174 had mild, 56 had moderate, and 22 had severe WMH. A multivariate ordinal logistic regression model did not show a significant association between the main variables investigated (OR: 0.72; 95% C.I.: 0.48 – 1.06). The longitudinal component included 252 individuals, 126 of whom had ELC and 103 had WMH progression. A Poisson regression model showed no association between ELC and WMH progression (IRR: 1.02; 95% C.I.: 0.69 – 1.51).

Conclusions: ELC is not related to WMH severity and progression in the study population.

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Palabras clave: el signo de Frank, Estudio de cohorte prospectivo, Factores de riesgo, hiperintensidades de sustancia blanca, Pliegue del lóbulo de la oreja, Progresión,

Keywords: Earlobe crease, Frank’s sign, Progression, Prospective cohort study, Risk factors, White matter hyperintensities,

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

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

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

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

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

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

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

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

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.

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Palabras clave: Conocimiento, Factores de riesgo, Ictus, infarto cerebral, Población.,

Keywords: ischemic stroke, Knowledge, Population., Risk factors, stroke,

Factores de Riesgo Asociados a Parálisis Cerebral en una Poblacion de Niños y Jóvenes Mexicanos. Risk Factors Associated With Cerebral Palsy In A Population Of Mexican Children.

Objectives: To establish the risk factors associated with Cerebral Palsy in a population of Mexican children and compare the results with studies from other countries.Methods: Analytical, retrospective, randomized, observational study, through review of the file and a survey, comparison of proportions. Participants: 230 patients with Cerebral Palsy between 0 and 29 years of age and their biological mothers from a specialized institution in Mexico. Results: We studied 29 risk factors , range 0 to 9 in each patient. Prenatal 244 factors; Perinatal 378, Postnatal 319. Most frequent prenatal risk factors: urinary infection, 99 (43%), and transvaginal bleeding, 61 (27%). Perinatal: perinatal hypoxia, 131 (57%); and prematurity, 116, (50%). Postnatal: convulsive syndrome <2 Years old, 92 (42%); and jaundice, 84 (37%). Conclusions: The most common cerebral palsy associated risk factors were perinatal, which differs from that reported in countries such as Spain, USA and England, where the prenatal ones are. Sweden results are similar to Mexico. It is suggested to carry out prospective studies in this field.

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Palabras clave: Atención Primaria, Espasticidad Muscular, Factores de riesgo, parálisis cerebral, Prematuro,

Keywords: cerebral palsy, Muscle Spasticity, Premature, Primary Care, Risk factors,

Conversión de Deterioro Cognitivo Leve a Demencia.

Great social efforts and sanitary conditions have decreased child mortality rates, decreased birth rates and increased life expectancy. Consequently, the proportion of adults has increased. The increased incidence of neurodegenerative disease such as dementia occurs in parallel to this demographic transition. Dementia may be associated with several risk factors. However, few studies have examined the rate of cognitive and functional decline.

Objective: To determine the prevalence of cognitive decline and dementia, risk factors and report results of cognitive and functional decline in patients in the National Institute of Neurology and Neurosurgery.

Methods: We included all outpatients aged ≥ 50 years attending between 1999 and 2000. We sought to asses the Petersen criteria for the mild cognitive impairment (MCI). Patients were assessed using the Consortium to Establish a Registry for Alzheimer’s Disease, Diagnostic and Statistical Manual of Mental Disorders (4th edition), and the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association criteria. We followed for up to 8 years.

Results: A total of 239 individuals were included. The conversion of MCI was of 25.6% per year and 56.4% at the eight years. The consumption of alcohol were associated with dementias (p<0.01).