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.
Palabras clave: editorial,
enfermedad cerebrovascular,
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.
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Evaluación Neuropsicológica de la Atención: Test de Símbolos y Dígitos. Neuropsychological Assessment of Attention: Symbols And Digits Test.
Introduction: The symbol digit modality test is a reactive which provides great support in neuropsychological evaluation. Its execution permits to evaluate brain functions such as visual perception, stimuli recognition, attention (focal, selective and sustained), task supervision, interference control among others. Object: The purpose of the current research study was to analyze the normative percentiles of the execution of the test, to identify the performance activity of the reactive according to age group and gender; applying the test in a sample of college students. Method: The sample included 250 university students,142 (56.8%) males and 108 (43.2%) females. The age range of the participants was between 18 and 34 years old (M=21.53, DE=2.25). A transversal, non-experimental, quantitative research model with a correlational scope was used. Results: The correct answer average for the test was 52.83 (DE=13,60) and for percentile P5 31,55 right answers were found; for percentile P75 60,00 right answers, P25 had 46,00 right answers, and for P95 74,45 right answers were found. No significant differences were found for the mean of errors in the test in terms of age group f(3, 246)=0,67, p=0,57 and gender t(248)=0,68, p=0,49 of the participants as comparison factor. Conclusions: Results were discussed based on prior research pointing out the importance of counting with a first statistical parameter of the test as ground for neuropsychological clinical practice in Ecuador.
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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,
Deterioro Cognitivo en Pacientes Diabéticos De 55 a 65 Años de Edad. Reporte Final de Estudio Observacional, Transversal en la Ciudad de Guayaquil. Cognitive Impairment In Diabetic Patients Between 55 And 65 Years Old. Final Report Of A Cross-Sectional, Observational Study In Guayaquil City.
Introduction: Diabetes mellitus is a frequent and systemic illness. Deleterious effects on cognition are one of its lesser known consequences. Diabetic individuals are at an increased risk for development of dementia in the future. Objective: To compare cognitive function in middle aged diabetic population with non-diabetic control group, in order to determine high risk population for developing cognitive decline or dementia in the future. Methodology: This is a cross-sectional, observational study conducted in Guayaquil. We studied 309 individuals between the ages of 55 and 65 years, of which 142 were diabetics and 167 were non-diabetic controls. A neuropsychological evaluation was performed to assess memory, attention, executive functioning and processing speed. Results: Group comparisons revealed significant differences between diabetics and non-diabetics in systolic blood pressure (p<.001), hyperlipidemia (p<.001) and cardiovascular risk (p < .001). Cognitive performance, after considering differences in scholarship, was lower in diabetic people (memory p values between .000 and .002; attention p values between .000 and .019; executive function p values between .000 and .001). Correlation between years of disease and cognitive decline was not significant (memory -.055; attention -.040; executive function .0169). Correlation between glycated hemoglobin and cognitive performance was significant for all evaluated functions (memory -.219; attention -.186; executive function -.269). Conclusion: Middle aged diabetic population has lower cognitive performance compared with non diabetics. The identification of individuals at risk for cognitive decline will contribute to the development and implementation of intervention strategies that will allow the slowing of cognitive decline in vulnerable individuals.
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Palabras clave: Alzheimer,
Cognición,
demencia,
deterioro cognitivo,
Diabetes mellitus,
pruebas neuropsicológicas,
salud cerebral,
Retardo en la Llegada de Pacientes con Ictus Isquémico a un Hospital Terciario de Ecuador. Delay In The Arrival Of Ischemic Stroke Patients At A Tertiary Hospital In Ecuador.
Introduction. In an Stroke unit, the ischemic stroke treatment with a pharmacological thrombolysis is associated with a better recovery. The aim of this study is to identify the variables having a significant impact in the delay of the arrival of patients at a tertiary hospital. Methods. A prospective and longitudinal study was undertaken in patients with an ischemic stroke diagnosis, who were admitted to the Stroke Unit of Eugenio Espejo Hospital of Quito city in Ecuador in the time period from November 2016 to July 2017. Patients treated with r-Tpa were compared to those who arrived 4,5 hours later. Results. A total of 61 patients were analyzed: of those, 51 arrived 4,5 hours after first symptoms at the hospital, and 10 (16,4%) were thrombolysed in the period of therapeutic window. None of the social, demographic and clinical variables were related to the early arrival, except the history of an atrial fibrillation. In the group of patients who received r-Tpa, a significantly higher percent sought for medical care as a first option compared with those arriving after the 4,5 hours (90 vs 49%, p 0,0170). The greatest impact of the early referral and the thrombolysis concerned the difference of score between the initial medical evaluation and the hospital discharge in the NIHSS scale. Conclusions. The results of this study point out to the unawareness of the stroke and the behavior to follow. The r-Tpa treatment shows clear benefits to the patients in our environment.
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Utilidad del Video EEG en un Hospital Pediátrico de Nivel Terciario Durante el Año 2015. Utility Of Video EEG In A Pediatric Tertiary Hospital During 2015.
The aim was to evaluate the V-EEG usefulness in the differential diagnosis of epilepsy in a Third Level Children’s Hospital during 2015. Materials and Methods: A descriptive study was performed over 90 patients in this unit during 2015. The data was obtained from variables related to indications and results of V-EEG, which were analyzed using descriptive statistics. Results: Fifty three percent of the patients were male. The mean age was 7.7 years (SD ± 4.7 years). The time measured between the first seizure and the V-EEG recording was 4,3 years. Seventy two patients (80%) had epileptic seizures, 12 patients (13,3%) had nonepileptic seizures, while six children (6.7%) had no seizures during the V-EEG monitoring. Ninety three percent of all recordings were successful. Conclusions: It was demonstrated the usefulness of V-EEG monitoring for the differential diagnosis of epilepsy.
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Factores Pronósticos de la Esclerosis Múltiple Prognostic Factors In Multiple Sclerosis.
Multiple sclerosis is an inflammatory and degenerative disease of the central nervous system which affects young adults. The prevalence of multiple sclerosis in the world is heterogeneous and is low in Ecuador. The diagnosis is based on the McDonald 2017 criteria. Once the diagnosis has been made, it is necessary that any negative factors which will impact the type of treatment used be identified. At this time, factors such as epidemiological, clinical, biomolecular, and magnetic resonance images, which will allow us to identify if the case is aggressive or benign, are studied. The number of lesions shown in a brain MRI, the presence of lesions in the brain stem and spinal cord are factors which have been demonstrated to have an impact on the progression of disability. The presence of oligoclonal bands in the cerebrospinal fluid has a fundamental role in the conversion of an isolated clinical syndrome to multiple sclerosis. Low levels of vitamin D have been associated with a negative prognosis, however how important vitamin D is in the prognosis of MS in countries such as Ecuador is still an area to be studied.
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La Musicoterapia Neurológica Como Modelo de Neurorrehabilitación. Neurologic Music Therapy As A Neurorehabilitation Model.
Neurologic music therapy (NMT) is being implemented in hospitals and neurorehabilitation facilities around the world, thanks to the abundant neuroscience research and to the growing interest in the effects of music on the brain. Recognized and endorsed by the World Federation for Neurorehabilitation, neurologic music therapy is utilized as a non-pharmacological, non-invasive intervention to treat patients with neurologic disease that present cognitive, motor, and/or language impairments. This article aspires to introduce this discipline as an effective, evidence-based method of treatment for neurologic disease.
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Oxigenación y Flujo Sanguíneo Cerebral, Revisión Comprensiva de la Literatura. Brain Oxygenation And Cerebral Blood Flow, A Comprehensive Literature Review.
Background: The brain is an organ that has a broad blood perfusion. Many factors such as hypoxia, anaesthesia, stress or the presence of CO2 as well as hydrogen ions within arterial blood, modify cerebral blood flow and tisular perfusion. Objectives: The objective of this review is to analyse the available literature about cerebral blood flow and tisular oxygenation. Methods: A targeted literature review and specific search was carried out aimed at the identification, recovery and bibliographic review of several independent studies that are key in brain physiology and that allow us to better understand cerebral perfusion and oxygenation. Conclusions: Cerebral blood flow is highly dependent on both, internal and external factors. Maintaining adequate cerebral oxygenation is essential to ensure the proper functioning of the brain and maintain neuronal homeostasis. The cerebral blood flow of the brain is on average 45-50 ml/100g/min and the partial pressure of cerebral oxygen (PtO2) ranges between 20 to 30 mmHg under normal conditions.
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Apnea Obstructiva del Sueño y Neumatización Aberrante de Huesos del Cráneo. Obstructive Sleep Apnea And Aberrant Pneumatization Of Skull Bones.
Objective: We aimed to assess the association between obstructive sleep apnea (OSA) and aberrant pneumatization of skull bones in Amerindians living in rural Ecuador.
Methods: A random sample of community-dwelling individuals aged ≥60 years enrolled in the Atahualpa Project, were invited to undergo a single diagnostic night polysomnography (PSG) at the sleep unit of the Atahualpa Project Community Center. Exams were performed with an Embletta® X100™ Comprehensive Portable PSG System. A board-certified sleep neurologist carried out analyses of sleep efficiency, architecture, arousal indexes, apnea/hypopnea index, oxygen saturation, heart rate and motor activity. CT readings were focused on the presence and distribution of pneumatization of intracranial bones, as assessed by CT with bone window settings.
Results: Thirty-eight participants were included. Mean age was 74.5 ± 6.8 years and 25 (66%) were women. The apnea/hypopnea index ranged from 0.2 to 56 (mean 15.7 ± 14.6) episodes per hour. Fifteen persons (39%) had ≥10 episodes per hour and were considered to have OSA. Abnormal pneumatization of skull bones was noticed in six persons, included five out of 15 (33%) with OSA and one out of 23 (4%) without (p=0.027). Air was found in the temporal squamas in five (bilateral in four), the occipital bones in one, and in both the temporal squamas and the occipital bones in the remaining person.
Conclusion: This study shows a significant association between OSA and aberrant pneumatization of skull bones. These findings are of potential clinical relevance, since these individuals could be at increased risk of painless fractures from minor trauma or may be prone to develop spontaneous cerebrospinal fluid leaks.
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Índice de Pulsatilidad Cerebral en Adultos Mayores con Infarto Lacunar Silente (Proyecto Atahualpa). Cerebral Pulsatility Index In Older Adults With Silent Lacunar Strokes (The Atahualpa Project).
Background: Diagnosis of silent lacunar infarcts is complicated in remote rural areas where MRI is not available. Hospital series have suggested an association between the pulsatility index of intracranial arteries –as assessed by transcranial Doppler –and some neuroimaging signatures of cerebral small vessel disease. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of silent lacunar infarctions.
Methods: A random sample of stroke-free Atahualpa residents aged ≥60 years investigated with MRI underwent transcranial Doppler for calculating the pulsatility index (PI) of the middle cerebral artery (MCA). For each person, mean PI was obtained by averaging both MCAs. Using conditional logistic regression for matched pairs data, we evaluated whether the pulsatility index of both MCAs correlate with silent lacunar infarcts.
Results: Silent lacunar infarcts were noticed in 28 (12%) of 234 scanned persons. Six of them were excluded due to poor insonation through transtemporal windows. The remaining 22 participants were considered case-patients and were matched 1:1 with individuals free of infarcts (controls). Moderate-to-severe white matter hyperintensities were noticed in 12 (55%) case-patients and 7 (32%) controls (p=0.228). The mean MCA PI value in the 44 participants was 1.15 ± 0.21, with no difference found across case-patients and controls, after adjustment for white matter hyperintensities (β coefficient: 3.361, 95% C.I.: -0.693 to 7.417, p=0.104).
Conclusions: Cerebral PI should not be used to identify candidates for MRI screening in population-based studies assessing the burden of silent lacunar infarcts.
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Funciones Ejecutivas en Niños Preescolares con y sin Trastorno del Lenguaje. Executive Functions In Preschool Children With And Without Language Disorders.
The objectives of this study were to compare the executive functions (attention, flexibility, inhibitory control, planning and working memory) of preschool children with and without language disorder and to define a profile of executive functions. The design is non-experimental for descriptive/comparative purposes. The sample consisted of 105 children. The group with language disorder was composed of 31 children and 19 girls, average age 4.68 years, of Special Language Schools. The group without language disorder was composed of 15 children and 24 girls, average age 4.98 years, of Public Schools of the city of Concepcion in Chile.
The results show that there is statistically significant evidence to state that the scores obtained by children with language disorders are lower than their peers without language disorder in all the executive functions evaluated, which supports the current literature on the subject. Regarding the profile of executive functions, the function that could predict the presence of language disorder in a preschool is the executive planning function.
It is interesting to continue deepening the profile of executive functions in children with language disorder and their specific relationship with the linguistic problems that these children have.
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Autismo en Ecuador: un Grupo Social en Espera de Atención. Autism In Ecuador: A Social Group Waiting For Attention.
Although increasing historical progresses have been achieved in defining the characteristics on a unusual behavior among people who could be on the autism spectrum disorder, unattended issues remain. Accuray is necessary for a correct diagnosis and urgent attention.
Ecuador is also part of this reality. This study is the first research that has been performed in the country, with 160 school-aged boys and girls coming from the mountains and the coast of Ecuador, 80 diagnosed with autism, and 80 neuro-typical kids. The results reveal the necessity to attend this matter. Surveys and confirmation cases including an innovative way of social insertion analysis show that the diagnostic processes demands important economical resources, and these economical resources could vary according to social insertion, and socio-spatial location; 26% of the children that were part of this study, received between 1 to 5 previous different diagnosis, 13,75% were mistakenly diagnosed; 46,2% of them, that were from the city of Guayaquil, and 23,7% from the city of Quito, spent more than one thousand dollars trying to get the diagnosis. This case-control study with children between ages of 2 and 12 years old, from Quito and Guayaquil, allows us to know the real situation of autism in Ecuador. It reveals major problems regarding on how to obtain a diagnosis, a therapeutic process, most of them related to the socio economical situation of the parents that were part of this study.
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Regulación Emocional en Pacientes con Esquizofrenia: Un Estudio Piloto. Emotion Regulation In Schizophrenia Patients: A Pilot Study.
Background. It has been reported that schizophrenia patients display emotional processing impairments, specifically in the emotion perception domain. However, less is known about other domains of emotional processing, like emotion regulation. Objective. The aim of this study was to assess and compare emotion regulation abilities and neurocognition in schizophrenia patients and healthy controls, as well as to identify correlations between emotion regulation, neurocognition and demographic data. Methods. 9 patients (GE) and 9 controls (GC) were recruited. Demographic data was obtained. To assess emotion regulation, the Mayer-Salovey-Caruso Emotional Intelligence Test -Managing Emotions section- was administered. Finally, a brief neurocognitive assessment was conducted. Results. The GE showed significant poorer performance than the GC in the emotion regulation test as well as in the neurocognitive assessment (p < .05). No correlations were identified between emotion regulation, neurocognition, demographic and clinical data. Discussion and conclusion. Schizophrenia patients show emotion regulation impairment, as well as neurocognitive deficits. Our results are consistent with other studies.
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Tabaquismo y su Asociación con Mortalidad Intrahospitalaria en Pacientes con Ictus Hemorrágico. Cigarette Smoking And Its Association With In-Hospital Mortality In Hemorrhagic Stroke Patients.
Background: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker’s patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers. Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.
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Estimación de la Función Cognitiva Premórbida con el Test de Acentuación de Palabras. Estimation Of Premorbid Cognitive Function With The Word Accentuation Test.
Objectives: Premorbid estimation of cognitive function is essential for the interpretation of the presence and severity of actual cognitive impairment. The most reliable method in Spanish speaking countries is with the Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP). This is used to predict intelligence test scores by linear regression. Results: In an Ecuadorian sample the TAP was found to have good internal consistency and test-retest reliability. The correlation of the TAP with WAIS-IV full IQ scores was high (r= .827), allowing the development of a regression equation to estimate IQ scores from TAP performance. Furthermore, a sample of dementia patients was found to perform normally on the WAT compared to a matched control group. This suggests that WAT performance holds in the presence of neurological illness with associated cognitive impairment. Conclusions: The WAT has good psychometric properties and can be used to rapidly estimate actual intelligence test scores in healthy participants. It can also estimate premorbid intelligence scores in patients with neurological or psychiatric illnesses, allowing a clearer interpretation of the severity of impairment. This simple assessment could be used in various research and clinical contexts.
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Uso de Toxina Botulínica Tipo A en Pacientes con Espasmo Hemifacial en Cuba. Botulinum Toxin A In Hemifacial Spasm In Cuba.
Objective: To evaluate botulinum toxin A therapy in patients with hemifacial spasm attended in a Neurology Service in Cuba. Patients and methods: 35 patients with hemifacial spasm were treated with botulinum toxin A during 15 months. Some parameters of botulinum toxin were collected including doses, latency, maximum duration and total duration of improvement. Clinical data were determined, such as functional status, gravity, frequency and adverse events. Results: There was a high percentage of female with hemifacial spasm. Most patients showed a latency of 48 hs, maximum duration until 60 days and total duration of improvement of 3 months. Functional status decreased through time, independently of hemifacial spasm onset and its origin. Parameters related to functional status, as gravity and frequency also diminished significantly their categories. Botulinum toxin doses were statistically increased over this treatment, independently of any patient conditions. Only eight patients showed adverse events (facial muscle weakness and ptosis). Conclusions: Recovery of functional status, and low rate of adverse events observed during botulinum toxin treatment might suggest that this therapy seems to be effective and low-risk under our conditions.
