Introduction. Executive functions (EF) are a set of mental skills that allow to regulate the behavior, metacognition and emotions; executing a conscious control of the own thought. The development is progressive along the vital cycle of the human being, therefore, they meet involved in the social, emotional and academic development of the persons. There exist studies that affirm that the academic performance meets influenced by the level of development of the EF (inhibitory control, working memory, cognitive flexibility, monitoring and self-regulation) which relation has been progressively studied in diverse ages ranges and educational levels. Method. This article, has the aim to define and explain principal EF that they influence in the academic performance in university students. For it, there was realized a method of systematic review that allows to compile the investigations that affirm the above mentioned relation. Results and Conclusions. The scopes of the studies affirm that the principal EF involved in the academic performance of the university students is the working memory and in minor measure, the skills of planning, inhibitory control and cognitive flexibility. Finally, there are discussed the limitations and projections that this study allows to approach; considering the EF to be a key factor for the academic university success and the implementation of instances of pedagogic supports that should favor the professional development of the students.
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Neurocisticercosis, Epilepsia y Uso de Drogas Antiparasitarias. Neurocysticercosis, Epilepsy And The Use Of Antiparasitic Drugs.
Cysticidal drugs have been used for more than three decades. However, its efficacy has been questioned on the assumption that cysts would die spontaneously, and thus, inflammatory reactions related to therapy are unnecessary. In addition, isolated reports have also questioned whether neurocysticercosis (NCC) causes epilepsy. A large body of evidence is currently available and little – if any – doubt exists on NCC as a cause of unprovoked seizures. NCC is consistently associated with seizures when suitable groups are compared, and in a sizable subset of patients, the semiology of seizures correlates with the anatomical location of parasites. Cyst degeneration and the subsequent inflammatory reaction related to therapy may transiently increase seizure expression, and this can be anticipated and managed with the additional use of corticosteroids. Several controlled trial support the concept that cysticidal drug efficacy, safety, and the impact of cyst destruction in decreasing seizures largely overcome the potential risks of therapy, and have provided evidence of the role of NCC as a cause of r ecurrent unprovoked seizures (epilepsy).
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Complejo Esclerosis Tuberosa Atípico Con Espasmos Epilépticos de Inicio Tardío: Diagnóstico Complejo Por Telemedicina En Una Comunidad Rural de Honduras. Atypical Tuberous Sclerosis Complex With Late Onset Epileptic Spasms: Complex Diagnosis by Telemedicine in a Rural Community of Honduras.
Tuberous sclerosis complex (TSC) is an uncommon neurocutaneous disease often underdiagnosed in remote areas where specialists in neurology are usually not available. A 22 month-old girl was taken to a clinic in a rural village presenting refractory epilepsy of undetermined cause that started at 18 months of age with upward eye deviation episodes and epileptic extensor spasms. She also presented perinasal angiofibromas and hypomelanotic skin lesions in trunk. The interictal encephalogram done in the community showed multifocal and generalized epileptic activity. The girl had been taken to the city for a brain magnetic resonance, which revealed multifocal subcortical hyperintensities and subependymal nodules. By teleconsult between community doctors and national and international specialists, atypical TSC with late onset epileptic spasms was diagnosed. The recommended treatment resulted in controlled seizures, and a follow-up plan was established. This case illustrates that telemedicine units in rural areas are a technological option to provi de access to specialized epilepsy care.
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Demencia por Cuerpos de Lewy, un Reto Diagnóstico. Dementia With Lewy Bodies, A Diagnostic Challenge.
Dementia with Lewy bodies is a neurodegenerative disease of unknown etiology, it is the second cause of dementia of the sixth decade of life; Its diagnosis is a challenge, because certain signs and symptoms that it presents are typical of Parkinson’s Disease and Alzheimer’s Disease. The following case report is one of the few documented patients with Dementia with Lewy bodies in Ecuador. We report this in order to state the diagnostic difficulty that this pathology generates and describe the main characteristics that differentiate it from other dementia syndromes, highlighted in the recently updated criteria by the Consortium of Dementia with Lewy bodies. A meticulous neurological examination and neuropsychological assessment were essential in the study and prognosis of the patient. Dementia with Lewy bodies requires a thorough diagnosis, due to the challenge that originates its early recognition; the criteria described accelerated their recognition due the update of the recommendations on the clinical diagnosis of Dementia with Lewy bodies.
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Síndrome de Kinsbourne: Papel de Rituximab. Kinsbourne Syndrome: Role of Rituximab.
Kinsbourne syndrome, also known as “Opsoclonus-myoclonus syndrome” or “Dancing eyes syndrome” is a rare condition characterized by rapid, irregular, multi-directional eye movements (opsoclonus), myoclonic movements in the trunk, face and/or limbs and ataxia. It occurs in children aged between 6 and 36 months. Its etiology may be paraneoplasic (neuroblastoma), nonparaneoplasic (infectious processes) or idiopathic. Regardless of its etiology, immunosuppressive drugs have been used in order to reduce the formation of antibodies possibly involved in the pathophysiology. We report the case of a four years-old boy with this syndrome secondary to an infectious urinary illness. He had ataxia, opsoclonus, upper limbs myoclonus, irritability and altered sleep pattern. Neuroblastoma was ruled out. Initial management was done with methylprednisolone pulses, followed by oral prednisolone and intravenous gammaglobulin. He started with rituximab with a good response. He had progressive clinical improvement, and is currently asymptomatic with no sequelae. In these patients a paraneoplasic syndrome should always be ruled out.
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Leucoencefalopatía Post-Radioterapia: Reporte de Caso y Revisión de Literatura. Radiation-Induced Leukoencephalopathy: Case Report And Literature Review.
Radiation-induced leukoencephalopathy presents clinically as a cognitive disorder chronologically associated with radiotherapy. The characteristic findings are: acute reversible edema, demyelination and vascular necrosis associated with thrombosis. The diagnostic test of choice is magnetic resonance imaging (MRI) and the treatment is with corticosteroids. We present a case of a patient with brain metastases who developed a post-radiotherapy leukoencephalopathy.
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Publicar Desde América Latina. ¿Hay un Grado de Dificultad Mayor? Experiencia del Proyecto Atahualpa. Publishing From Latin America. Is There A Greater Degree Of Difficulty? The Atahualpa Project Experience.
Globesidad y Enfermedad Cerebrovascular: Una Pandemia Originada en la Globalizacion. Globesity And Cerebrovascular Disease: A Globalization Pandemic.
Heterogeneidad Sintomatológica. Perfiles de Pacientes Diagnosticados con Demencia Tipo Alzheimer en Antioquia (Colombia) Symptomatology Heterogeneity. Profiles Of Patients Diagnosed With Alzheimer’s Type Dementia In Antioquia (Colombia).
Objective: To describe and contrast the symptomatic variability of cases with sporadic or non-sporadic Alzheimer’s dementia (DTA + E) with the data obtained from the cases with early familial Alzheimer’s dementia caused by the E280A of the Neurobank of the Neurosciences Group of Antioquia (GNA). Materials and Method: This study was of exploratory – descriptive and correlacional type, 83 donors’ cases were taken with DTA stored in the Neurobank. These cases were divided in two groups, i) a group defined genetically like E280A; and ii) another not carrying group of the mutation (DTA+E); the scoreboards and / or characteristics neuropsychiatric, neuropsychological, neurological and neuropathological of both groups were confirmed. Results: The symptom that showed higher differences between both groups was iteration iteration (DTAF E280A with 1.2% and 18.4% for the DTA+E group). Other symptoms as depression or the time of appearance of progressive loss of memory did not show big differences among groups (DTAF E2080A=55.9%; DTA+E =53.1%) and (DTAF E2080A=55.9%; DTA+E =53.1%). The language disorders that were observed with major frequency among the donors were the loss of the language, mutism, anomia and aphasia. The sign with higher frequency in both groups was lost of sphincter control. The atrophy was with more intensity in the temporary lobes of the brains of the donors with DTA+E (83.3%). The weight of the brain and of the posterior fosse content, they have a moderate, directly proportional and highly significant relation from the statistical point of view. Conclusions: DTA +E has neuropathological differences with DTAF E280A that can be associated with the physiology hereditary from of DTAF E280A.
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Fístula Carótido Cavernosa. Utilidad del ultrasonido Doppler en el diagnóstico. Cavernous carotid fistula. Utility of Doppler ultrasound in diagnosis.
Introduction. Carotid cavernous fistulas are infrequent vascular malformations that generate a pathological arteriovenous shunt, which compromises ocular function. The definitive diagnosis is established by cerebral arteriography. However, its invasive nature limits its use in follow-up. The aim of this work is to illustrate the value of the study with transcranial doppler ultrasound for the diagnosis of cavernous carotid fistulas and to describe the flow parameters that could be modified. Patients. A retrospective review of the clinical histories of the patients treated with a diagnosis of cavernous carotid fistula was carried out in the stroke unit of the Hermanos Ameijeiras Hospital in Havana, between January 2005 and May 2014. Demographic and disease variables were collected, as well as the results of imaging and ultrasound studies. Results. We describe the clinical and imaging characteristics of three patients in whom carotid cavernous fistula was confirmed. In the two patients with direct communications, an increase of the mean flow velocity in the ophthalmic vein, arterialized, with decrease in pulsatility were registered; in addition to an increase in the diastolic peak velocity in the internal carotid artery ipsilateral to the fistula. In the patient with the indirect fistula the changes were less marked. Conclusion. The ultrasound study was useful in the diagnosis of carotid cavernous fistulas, showing differences in the flow parameters that can be used to classify the fistulas.
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Estatus Epiléptico. Factores Asociados a Una Evolución Desfavorable en un Centro Terciario. Status Epilepticus. Prognostic Variables For An Unfavorable Outcome In A Tertiary Center Of Care.
Introduction. Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective. To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods. A retrospective study was performed during the period of January 2016–June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated Results. Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions. The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.
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Neuronavegación en la Planificación Prequirúrgica y en la Cirugía de la Epilepsia Refractaria. Neuronavigation In Pre Surgical Planning And Surgery Of Refractory Epilepsy.
Epilepsy is one of the more frequent neurologic disorders, with an incidence of 50/100,000/year and prevalence between 0.5 and 2% worldwide. A third of these patients suffer focal epilepsy due to epileptogenic lesions evident by neuroimaging new techniques. Epilepsy surgery is the only treatment that can cure refractory epilepsy. Its goal is to remove the epileptogenic lesion with preservation of eloquent areas, and in this case both surgical experience and neuroimaging technology play a pivotal role. Objective. To demonstrate utility of neuronavigation in presurgical planning and surgery of refractory epilepsy. Method. Descriptive, cross sectional and analytic study of 47 performed surgeries (12 resective, 12 palliative and 3 diagnostic) in patients with refractory epilepsy with an average age of 9.93 years (SD 4.1). In 27 patients (57.44%) neuronavigation was used. In patients operated with assistance of neuronavigation, surgical time diminished in 47.17 minutes (p=0.022), hemorrhage in 111.41 ml (p=0.011) and days of hospitalization in 6.68 days (p=0.005) comparing with group without neuronavigation. Complications in the group with neuronavigation were 29.63% compared with 65% in the group without it. (P=0,034). Conclusions. In this study, using neuronavigation in planning and performing surgery in reducing the amount of blood loss, surgical time, days of hospitalization and post surgical complications.
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Características Clínicas del Síndrome de Guillain-Barré en Relación a Chikungunya Y Zika: Revisión Sistemática. Clinical Manifestations Of Guillain-Barre Syndrome And Its Relation To Chikungunya And Zika.
In the last five years, there have been several cases of zika and chikungunya infections in the world, simultaneous with the increase in cases of Guillain-Barre syndrome, which have shown a potential causal relationship that is still not entirely clear. Objective: To describe the main clinical manifestations of Guillain-Barre syndrome in relation to chikungunya and zika, according to scientific literature. Methods: The databases PubMed and ScienceDirect were used to perform the search for the period 2014-2016 using with the keywords: zika, chikungunya and Guillain-Barre Syndrome; articles in English and Spanish were included. Results: 35 articles were found, one for the year 2014, two for 2015 and 32 for 2016. Conclusion: Variations in clinical characteristics and the increased incidence of GBS in the presence of zika and chikungunya, highlight the need to monitor these infections and perform analytic studies to determine the association between arboviruses and different neurological alterations.
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Anticoagulación en Pacientes con Injuria Traumática Cerebral: Revisión Narrativa. Anticoagulation In Patients With Traumatic Brain Injury: Narrative Review.
Patients receiving anticoagulation and those with traumatic cranial lesions are at increased risk of hemorrhagic phenomena at the intracranial level. Mortality in this class of patients is high, which makes them a population that deserves a careful approach and follow-up. Usually the patients we observe in emergency services are mild cranial traumas but the evolution of the anticoagulated patient in some cases is unpredictable. Currently, several studies have been published in relation to anticoagulation and traumatic brain injury. We present a concise review of the literature focused on neurologists and neurosurgeons.
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Batería Neuropsicológica Set de Datos Uniformes (UDS) Para la Evaluación de Enfermedad de Alzheimer y Deterioro Cognitivo Leve: Una Revisión Sistemática. Neuropsychological Battery Uniform Data Set (Uds) For The Evaluation Of Alzheimer’s Disease And Mild Cognitive Impairment: A Systematic Review.
The neuropsychological battery UDS (of the English Uniform Data Set), is used worldwide to homogenize the investigations of Alzheimer’s disease. Objective: Quantitatively synthesize the results of the subtests of the UDS for the cognitive profile of controls, patients with mild cognitive impairment and dementia of the Alzheimer type. Method: An advanced and manual systematic search was performed in databases (PubMed / MedLine, Web of Science, Scopus, Lilacs, Science Direct, Cochrane Library, PsycINFO) evaluating the diagnostic performance of the UDS. Results: The systematic review showed a narrative synthesis where 8 articles were included that included 9260 subjects, with an age range between 60 and 90 years. The quantitative synthesis used 13 articles with a total sample of 2,884 participants, with an average age of 74 years and an average of 15 years of education. Conclusion: We described a synthesis of the medial scores, which generate cut-off points for Alzheimer’s type dementia (DTA), mild cognitive impairment (MCI) and cognitively normal controls, evidencing an adequate diagnostic precession.
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El Pensamiento Moral Después del Daño Cerebral Adquirido. Moral Thought After Acquired Cerebral Damage.
Introduction. Moral thinking is a mental skill that allows respecting implicit and explicit social norms. One factor that can alter its functioning is acquired brain damage, as is the case of subjects who have suffered a brain injury at the frontal lobe. Aim. To analyze the relationship between the process of moral thinking and brain functioning, through the description of cases that have suffered acquired brain damage, with the purpose of explaining the situation that an individual lives after presenting brain damage and becoming unable to respect social norms. Development. The clinic of patients who have suffered brain damage at the frontal level, such as Phineas Gage, NN and Elliot, is shown, in which it was observed that its state after the traumatic event was characterized by going back to previous stages of thinking moral, unlike a subject who may present brain damage in later structures. Conclusions. We discuss the analysis performed on the role of the frontal lobe in the process of respecting social norms that allow human interaction and how it can be affected by brain damage.
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Encefalopatía Posterior Reversible en el Contexto de la Eclampsia. Reporte de Caso y Revisión de la Literatura. Reversible Posterior Encephalopathy In The Context Of Eclampsia. Case Report And Review Of Literature.
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder characterized by headaches, visual disturbances, altered level of consciousness, seizures, and a variety of neurological deficits that are caused by a severe increase in blood pressure. Hypertensive disorders of pregnancy, mainly preeclampsia and eclampsia, continue to be one of the main causes of morbidity and mortality during pregnancy worldwide, causing neurological complications ranging from singular seizures to the development of status epilepticus and the advent of potentially fatal cerebrovascular events. We describe the presentation of posterior reversible encephalopathy syndrome in a pregnant adolescent who developed a hypertensive disorder of pregnancy.
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Requisitos Para que Proceda la Responsabilidad Civil por Mala Práctica Médica. Requirements For Civil Liability To Proceed Due To Medical Malpractice.
A physician is subject to civil liability in his professional practice. Under Ecuadorian law, civil liability arises when three requirements are met: fraud or negligence, harm and causation between the fraud or negligence and the harm. Once these requirements have been met, an obligation to compensate is born. Compensating means paying a sum of money equivalent to the patient’s harm.
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Síndrome de Guillain Barré: Reporte de un Caso Causado por Enterovirus. Guillain Barre Syndrome: Report Of a Case Caused By Enterovirus.
Guillain Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy of autoimmune etiology that is usually preceded by a respiratory or gastrointestinal infection. It is characterized by a flaccid, symmetric, ascendent, arreflexic paralysis of rapid evolution. We describe a case of a 33 years old male patient, with a history of flu two weeks before admission, in addition to liquid stools that reverted spontaneously; his clinical picture consisted of a six days history of cuadriparesis aggravated by respiratory weakness, ending in mechanical ventilation. Examination of cerebrospinal fluid (CSF) revealed albumino-cytological disociation and PCR test resulted positive for Enterovirus. The patient received treatment with intravenous immunoglobulin with a favorable outcome. The purpose of this paper is to report a clinical case of GBS due to a new causal agent.
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Síndrome de Tourette Familiar: Reporte De Caso y Revisión de la Literatura. Familial Tourette Syndrome: Case Report And Review Of Literature.
Tourette syndrome is a childhood neuropsychiatric disorder characterized by multiple motor and vocal tics of at least one year. Its exact etiology is unknown, but fronto-subcortical neural pathways and complex interactions between social, environmental and genetic factors have been involved. Genetic studies have reported susceptibility loci in genes involved in synaptic connection, however, evidence is needed in larger samples. This case report describes a 14-year-old boy with a personal and family history of Tourette’s syndrome, suggesting an autosomal dominant mechanism of inheritance.
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Manifestaciones Neuropsiquiátricas de la Enfermedad de Whipple en una Adolescente: A Propósito de un Caso. Neuropsychiatric Manifestations Of Whipple Disease In An Adolescent: Case Report.
Whipple disease (WD) is a rare chronic systemic infection caused by the actinomycete Tropheryma Whipplei. The clinical manifestations are mainly intestinal, although occasionally may present extraintestinal locations (joints, heart, pulmonary, central nervous system…) , and even the last can be the only symptom.
We present a 15-year-old female patient referred to the psychiatry service, with a diagnosis of depression, with a 6-month evolution with worsening, admission due to autolytic attempt and, at the same time, atypical neurological symptomatology. She is referred to Neurology to rule out organic pathology, including autoimmune pathologies (antiNMDA encephalitis, …), finding in the study, PCR positive Tropheryma Whipplei, and being diagnosed of Whipple disease with neurological involvement. Antibiotic treatment was performed according to the established guidelines, repeated at the end of the treatment the lumbar puncture, resulting this negative and with clinical neurological improvement as well as psychiatric.
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Oclusión Endovascular de Arteria Carótida Interna Aberrante Como Causa de Tinnitus Pulsátil. Endovascular Occlusion Of Aberrant Internal Carotid Artery Causing Tinnitus.
We present a case of a 43-years old male patient with a history of chronic and intractable pulsatile tinnitus due to an aberrant course of the right internal carotid artery. In complementary studies, the angiography showed a preserved Willis’ arterial polygon and a balloon-occlusion test with adequate patency and no neurological symptoms. We performed the endovascular occlusion of the right internal carotid artery in the petrous and lacerum portions with the relief of symptoms.
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Presentación de Mieloma Múltiple en Sistema Nervioso Central. Multiple Myeloma Presentation In Central Nervous System.
Multiple myeloma is a monoclonal gammopathy with proliferation of plasma cells. Its form of presentation is hypercalcemia, osteolytic lesions, anemia and renal failure. The involvement of the central nervous system is rare. It occurs approximately in 1% of patients, whose diagnosis is made through the study of cerebrospinal fluid, with the presence of plasma cells. There is no specific treatment due to the low incidence. But there have been good results with intrathecal treatment.
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Dolor en Síndrome de Guillain Barré: Una Manifestación Subestimada. Pain In Guillain Barré Syndrome: An Underestimated Manifestation.
Guillain-Barré syndrome is an acute demyelinating polyneuropathy that presents clinically with muscular weakness and autonomic disorders in its typical form, while the sensory symptoms usually go unnoticed.
We describe the clinical history of a male patient with acute flaccid quadriparesis and sensory disorders such as paresthesia and allodynia that hinder diagnosis within the initial approach.
Complete diagnostic work up confirmed the presence of Guillain-Barré syndrome. Although the sensory symptoms confused the diagnosis during admission, it is important to highlight that pain is a frequent manifestation of this disorder, being underestimated in many patients.
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Fibrodisplasia Osificante Progresiva: Reporte de Casos. Progressive Ossifying Fibrodysplasia: Case Reports.
We report two cases with diagnosis of progressive ossifying fibrodysplasia (FOP) at the “Eugenio Espejo” Specialty Hospital. The FOP is a rare autosomal dominant disease. In most of the patients is due to a mutation in families not affected previously. It’s characterized by progressive ossification of connective tissue, aponeurosis, fascia, ligaments, tendons and skeletal muscle. The early diagnosis improves the prognosis and the quality of life.
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La Enfermedad Cerebrovascular en Ecuador. The cerebrovascular disease in Ecuador.
El Posicionamiento Elevado de Cabeza y Cuerpo Podrían Afectar la Autorregulación Cerebral Dinámica en Pacientes con Enfermedad Silente de Pequeño Vaso Cerebral. Protocolo y Definiciones Operacionales. Head-Up And Body Positioning Might Impair Dynamic Cerebral Autoregulation In Patients With Silent Cerebral Small Vessel Disease. Protocol And Operational Definitions.
Background: Cerebral autoregulation (CA) is the ability of intracranial vessels to maintain a constant cerebral blood flow (CBF) during changes of cerebral perfusion pressure (CPP) related to fluctuations in blood pressure, postural changes or increased metabolic demands. It has been suggested that individuals with silent cerebral small vessel disease (SVD) may have impaired CA, but information is inconclusive. We describe the protocol of a study aimed to assess the association between white matter hyperintensities (WMH) of presumed vascular origin and poor dynamic CA, and to determine the effects of head-up and body positioning in patients with this condition. Methods: Using a case-control study design, we will assess the relationship between severity of WMH and dynamic CA, measured by continuous transcranial Doppler assessment of CBF velocities in the middle cerebral arteries (MCAs) combined with beat-to-beat blood pressure monitoring. Dynamic CA will be analyzed by calculating the mean flow index as the ratio of median arterial pressure and mean flow velocities of the MCAs. Participants will be categorized as case-patients if the MRI shows moderate-to-severe WMH. For every case-patient, an age- and sex-matched healthy individual with no neuroimaging evidence of SVD will be selected as a control. Comment: This study will assess whether head-up and body positioning impairs dynamic CA in the setting of diffuse subcortical damage related to SVD, providing further evidence on the importance of CPP in maintaining the CBF. If positive, the study will provide evidence favoring the stop of aggressive hypertensive therapy or interventions promoting orthostatic hypotension to reduce the risk of further ischemic brain damage in these cases.
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Mortalidad por enfermedades cerebrovasculares en Ecuador 2001- 2015: Estudio de tendencias, aplicación del modelo de regresión joinpoint. Mortality due to cerebrovascular diseases in Ecuador 2001- 2015: a trend study, application of the joinpoint regression model.
Objective. To analyze the mortality trend for cerebrovascular diseases in Ecuador and to identify the presence of changes in the temporal trend using the joinpoint regression model.
Materials and Methods. A mixed ecological study was carried out. Standardized mortality rates for the last 15 years (2001 to 2015) in Ecuador were calculated and stratified by age, sex, and provinces. A joinpoint regression analysis was used for analysis of trends.
Results. From 2001 to 2015, there were 48,621 deaths from cerebrovascular diseases in Ecuador. In the joinpoint regression analysis, age-adjusted rates in men declined from 71.4 to 59.5 deaths per 100,000 population, with an annual decline of 1.51% (p <0.05) in females from 61.2 to 55.5 deaths per 100,000 population, with an annual decrease of 1.11% (p <0.05). In the analysis by provinces, Sucumbíos presented a growing trend of 3.17% per year (p <0.05).
Conclusions. Mortality from cerebrovascular disease has declined in Ecuador in the last 15 years. The downward trend was observed in almost all age demographics.
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Riesgo Cardiovascular Entre Hispanos Residiendo en los Estados Unidos: El Sistema Conductual de Vigilancia de Factores de Riesgo 2013. Hispanic Ethnicity and the Risk of Cardiovascular Disease in the United States: The Behavioral Risk Factor Surveillance System 2013.
Background: Although the leading cause of death among Hispanics living in the United States (US) is cardiovascular disease (CVD), the association between Hispanic ethnicity and CVD has been scarcely explored. Objective: To examine whether being Hispanic is associated with an increased risk of CVD compared with the non-Hispanic US adult population in 2013. Methods: Secondary data analysis of a cross-sectional 2013 Behavioral Risk Factor Surveillance System survey in 2013 (n=486,905). The main exposure variable was Hispanic ethnicity (Mexican, Puerto Rican, Cuban or Spanish origin) and the main outcome variable was self-reported CVD (myocardial infarction/coronary artery disease/angina). The main covariates were sex, age, education, income, healthcare access, exercise, body mass index, current smoking, heavy drinking, diabetes, hypertension and hyperlipidemia. Unadjusted and adjusted logistic regressions were used to assess the effect between ethnicity and self-reported CVD. Odds ratios (OR) and 99% confidence intervals (CI) were calculated. Results: In total, 12% of the study participants were Hispanic (n=57,257). Approximately 24% of Hispanics were 25-34 y/o while (21%) of non-Hispanic were >65 y/o. After adjustment, Hispanics were 30% less likely to report CVD compared with non-Hispanics (OR=0.7; 99%; CI=0.6-0.8). Compared with men, women had a 40% decreased risk of having CVD (OR=0.60; 99% CI=0.5-0.6). Advanced age, lower educational attainment, income <$15,000/year, lack of exercise, smoking, non-heavy drinking, diabetes, hypertension and hyperlipidemia increased statistically significantly the likelihood of reporting CVD. Conclusion: The findings suggest that, in general, Hispanics residing in the US are significantly less likely to self-declare if they had a CVD compared with non-Hispanic Americans. These data suggest that although Hispanics are generally poorer and have less access to education and health services, their self-perceived health is better than in non-Hispanic residents of the US.
