Catholic University of Santiago de Guayaquil
Guayaquil, Ecuador
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OBJECTIVE:: To evaluate associations between anxiety and severe impairment of quality of life (QoL) in Latin American postmenopausal women. METHODS:: This was a secondary analysis of a multicenter cross-sectional study among postmenopausal women aged 40 to 59 from 11 Latin American countries. We evaluated anxiety (The Goldberg Depression and Anxiety Scale), and QoL (Menopause Rating Scale [MRS]), and included sociodemographic, clinical, lifestyle, and anthropometric variables in the analysis. Poisson family generalized linear models with robust standard errors were used to estimate prevalence ratios (PRs) and 95% CIs. There were two adjusted models: a statistical model that included variables associated with the outcomes in bivariate analyses, and an epidemiologic model that included potentially confounding variables from literature review. RESULTS:: Data from 3,503 women were included; 61.9% had anxiety (Goldberg). Severe QoL impairment (total MRS score ≥17) was present in 13.7% of women, as well as severe symptoms (MRS subscales): urogenital (25.5%), psychological (18.5%), and somatic (4.5%). Anxiety was independently associated with severe QoL impairment and severe symptoms in the epidemiological (MRS total score: PR 3.6, 95% CI, 2.6-5.0; somatic: 5.1, 95% CI, 2.6-10.1; psychological: 2.8, 95% CI, 2.2-3.6; and urogenital: 1.4, 95% CI, 1.2-1.6) and the statistical model (MRS total score: PR 3.5, 95% CI, 2.6-4.9; somatic: 5.0, 95% CI, 2.5-9.9; psychological: 2.9, 95% CI, 2.2-3.7; and urogenital: 1.4; 95% CI, 1.2-1.6). CONCLUSIONS:: In this postmenopausal Latin American sample, anxiety was independently associated with severe QoL impairment. Hence, screening for anxiety in this population is important. © 2017 by The North American Menopause Society.

La Tegola A.,Catholic University of Santiago de Guayaquil | Mera W.,Catholic University of Santiago de Guayaquil
Key Engineering Materials | Year: 2017

After the inspections to the damage caused by the last earthquake in Ecuador, and considering the construction typologies of reinforced concrete buildings in Guayaquil and Manta (Ecuador), in order to rebuild or repair the masonry walls we must resort to composite materials with inorganic matrix (cementitious). The use of composite materials made of organic matrix (FRP, fiber reinforced polymers) are not appropriate because, with an increase of strength they have a brittle behavior, therefore without possibility of energy dissipation not having the ductility provided by a metallic mesh or cobalt-metallic mesh, which have the advantage of using it with a cementitious matrix of frequent use in the current technology. Since the photographic records and the design of those masonry structures allow determining in detail the dynamics of the damage, it is possible to add to the theoretical analysis an experimental verification on the behavior of masonry walls with reinforced plastering with FRP or with metallic mesh with inorganic matrix under seismic actions. © 2017 Trans Tech Publications.

Perez-Lopez F.R.,University of Zaragoza | Chedraui P.,Catholic University of Santiago de Guayaquil | Fernandez-Alonso A.M.,Hospital Torrecardenas
Maturitas | Year: 2011

Background: Low serum 25-hydroxyvitamin D (25[OH]D) levels are common and may be associated with morbidity and mortality (and indeed with frailty more generally). This association is not restricted to the links between vitamin D and calcium and bone metabolism. Objective: To review the influences of vitamin D on the aging process other than those related to bone and calcium. Its effect on mortality is also assessed. Methods: The PubMed database was searched for English-language articles relating to vitamin D, using the following MeSH terms: vitamin D, mortality, cardiovascular diseases, and frailty. In addition, searches were carried out with Google. Results: Although some of the reported results have proved controversial, overall the evidence seems to support an association between low serum 25[OH]D levels and mortality rates (all-cause and cardiovascular). Frailty is a condition frequently associated with low serum 25[OH]D levels. Conclusion: The aging process and mortality are associated with low vitamin D levels. Prospective controlled trials are warranted to determine whether vitamin D supplements can increase longevity and reduce the incidence of certain conditions. © 2011 Elsevier Ireland Ltd. All rights reserved.

El-Masry M.,View Medical | Gilbert C.P.,Catholic University of Santiago de Guayaquil | Saab S.,University of California at Los Angeles
Liver International | Year: 2011

Liver transplant remains the ultimate treatment for decompensated liver disease. However, many diseases do recur after orthotopic liver transplant, which may affect recipients' quality of life and survival rate. We performed a systematic review of relevant epidemiological studies available on Medline that provided information on the recurrence of non-viral hepatitis after orthotopic liver transplantation in adult patients published until August 2010. All data were compiled from either review articles or retrospective studies. Primary sclerosing cholangitis, primary biliary cirrhosis, autoimmune hepatitis, non-alcoholic steatohepatitis, alcoholic steatohepatitis and haemochromatosis can recur after liver transplantation. The rates for disease recurrence varied according to the indication for transplantation, and ranged from 7 to 50%. Although the survival rate of patients with liver disease has increased with the advent of liver transplantation and novel immunosuppressive protocols, recurrence of the primary liver disease remains a concern. The recurrence rates differ not only according to the cause of underlying liver disease but also vary within the indication for transplant. Further studies are needed to elucidate the risk factors for varied disease recurrence. © 2011 John Wiley & Sons A/S.

Chedraui P.,Catholic University of Santiago de Guayaquil | Chedraui P.,Enrique C Sotomayor Obstetrics And Gynecology Hospital | Perez-Lopez F.R.,University of Zaragoza
Maturitas | Year: 2015

Assessment of sexual function is a complex process, especially in women, which requires in any individual case: time, appropriate training and experience. The prevalence of female sexual dysfunction is quite variable depending on the studied population, assessment methods, comorbid conditions and treatments, and age. A large number of screening methods have been developed over the last decades which range from tedious, exhaustive and boring tools to very simple standardized questionnaires. The 19-item female sexual function index (FSFI-19) is among the most used and useful- instrument designed to assess female sexual function in all types of circumstances, sexual orientation and perform the comparison of transcultural factors. A short 6-item- version of the FSFI-19 has been developed to provide a quick general approach to the six original domains (one item per domain). Nevertheless, further studies are needed to demonstrate its validity in different clinical situations as it has been extensively demonstrated with the original tool. © 2015 Elsevier Ireland Ltd.

Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto V.J.,Catholic University of Santiago de Guayaquil
Cephalalgia | Year: 2012

Background: Anecdotal reports and a single case-control epidemiological survey have suggested an association between the helminthic disease neurocysticercosis and primary headache. The present study was undertaken to determine whether neurocysticercosis is more common among patients with primary headaches than in other neurological disorders.Methods: We determined the prevalence of neurocysticercosis in a cohort of patients with primary headache who were seen at our institution over a 20-year period. We used as controls all people from the same cohort with four major different categories of neurological disorders, including cerebrovascular disease, degenerative disorders of the CNS, head trauma, and primary brain tumors. We evaluated differences in the prevalence of neurocysticercosis between patients and controls.Results: Forty-eight of 1017 patients with primary headache and 31 of 1687 controls had neurocysticercosis (4.7% vs 1.8%, p < 0.0001). Calcified parenchymal brain cysticerci were more frequent among patients with primary headache than in those with cerebrovascular disease (4.7% vs 1%, p < 0.001), degenerative disorders of the CNS (4.7% vs 2.4%, p < 0.05), and head trauma (4.7% vs 2.3%, p < 0.05). There were no significant differences, however, for the subset of controls with primary brain tumors (4.7% vs 3.5%), a condition that has also been associated with neurocysticercosis.Conclusions: There is a relationship between calcified neurocysticercosis and primary headache disorders. It is possible that periodic remodeling of cysticercotic calcifications, with liberation of antigens to the brain parenchyma, contributes to the occurrence of headache in these patients. © International Headache Society 2012.

Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto V.J.,Catholic University of Santiago de Guayaquil
Acta Neurologica Scandinavica | Year: 2012

Snake bite envenoming is a neglected tropical disease affecting millions of people living in the developing world. According to the offending snake species, the clinical picture may be dominated by swelling and soft tissue necrosis in the bitten limb, or by systemic or neurological manifestations. Serious neurological complications, including stroke and muscle paralysis, are related to the toxic effects of the venom, which contains a complex mixture of toxins affecting the coagulation cascade, the neuromuscular transmission, or both. Metalloproteinases, serine proteases, and C-type lentins (common in viper and colubrid venoms) have anticoagulant or procoagulant activity and may be either agonists or antagonists of platelet aggregation; as a result, ischemic or hemorrhagic strokes may occur. In contrast, the venom of elapids is rich in phospholipase A 2 and three-finger proteins, which are potent neurotoxins affecting the neuromuscular transmission at either presynaptic or post-synaptic levels. Presynaptic-acting neurotoxins (called β-neurotoxins) inhibit the release of acetylcholine, while post-synaptic-acting neurotoxins (called α-neurotoxins) cause a reversible blockage of acetylcholine receptors. Proper management of the envenomed patient, including prompt transport to the hospital, correction of the hemostatic disorder, ventilatory support, and administration of antivenom, significantly reduces the risk of neurological complications which, in turn, reduce the mortality and improve the functional outcome of survivors. © 2011 John Wiley & Sons A/S.

Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto V.J.,Catholic University of Santiago de Guayaquil
Journal of the Neurological Sciences | Year: 2012

Objective: To confirm recent evidence suggesting a change in the pattern of disease expression of neurocysticercosis, manifested by a decreasing number of severe and recent infections. Methods: Retrospective cohort of 246 neurocysticercosis patients residing in Guayaquil, evaluated over 20 years (1990 to 2009). Eighty-seven patients were seen from 1990 to 1994, 58 from 1995 to 1999, 57 from 2000 to 2004, and 44 from 2005 to 2009. Neurocysticercosis was classified as active or inactive according to neuroimaging findings. Patients with parenchymal, subarachnoid or ventricular cystic lesions were considered to have active disease, and those with calcifications and chronic arachnoiditis were classified as inactive. Results: Mean age was 36.6 ± 20 years, and 61% were women. The relative prevalence of active and inactive cases varied according to the year of evaluation. Active neurocysticercosis was found in 63% of patients seen between 1990 and 1994, in 48% between 1995 and 1999, in 47% between 2000 and 2004, and in only 18% between 2005 and 2009 (p < 0.0001). Together with reduction of active cases, there was an increased prevalence of asymptomatic infections over the years (from 17.2% between 1990 and 1994 to 54.5% between 2005 and 2009; p < 0.0001). Conclusion: In this single-center cohort, the relative prevalence of active cases of neurocysticercosis reduced over the past years, suggesting a decreased incidence of new infections. Improved sanitation together with widespread use of cysticidal drugs were the most likely causes of these findings. © 2011 Elsevier B.V. All rights reserved.

Chedraui P.,Catholic University of Santiago de Guayaquil | Perez-Lopez F.R.,Hospital Clinico Lozano Blesa
Climacteric | Year: 2013

Interactions between genetic (genome) and environmental factors (epigenome) operate during a person's entire lifespan. The aging process is associated with several cellular and organic functional alterations that, at the end, cause multi-organic cell failure. Epigenetic mechanisms of aging are modifiable by appropriate preventive actions mediated by sirtuins, caloric input, diet components, adipose tissue-related inflammatory reactions, and physical activity. The Mediterranean lifestyle has been for many millennia a daily habit for people in Western civilizations living around the Mediterranean sea who worked intensively and survived with very few seasonal foods. A high adherence to the traditional Mediterranean diet is associated with low mortality (higher longevity) and reduced risk of developing chronic diseases, including cancer, the metabolic syndrome, depression and cardiovascular and neurodegenerative diseases. Reports indicate that some dietary components, such as olive oil, antioxidants, omega-3 and -6 polyunsaturated acids, polyphenols and flavonoids, mediate beneficial anti-aging effects (anti-chronic diseases and increased longevity). Equally, physical activity displays a positive effect, producing caloric consumption and regulation of adipose and pancreatic function. The predictive strength of some food patterns may be a way of developing recommendations for food and health policies. This paper will discuss several ways of improving health during mid-life, focusing on certain groups of functional foods and healthy habits which may reduce or prevent age-related chronic diseases. © 2013 International Menopause Society.

Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto V.J.,Catholic University of Santiago de Guayaquil
Clinical Neurology and Neurosurgery | Year: 2012

Objective: To determine if the number of neurocysticercosis cases among patients with late-onset epilepsy has decreased over the past two decades. Design: Retrospective cohort study of 431 consecutive patients with recurrent seizures starting after the age of 20 years evaluated at our Institution from 1990 to 2009. Methods: Patients were classified according to the year in which they were first seen. Group I included 129 patients evaluated between 1990 and 1994, Group II included 108 patients evaluated between 1995 and 1999, Group III included 106 patients evaluated between 2000 and 2004, and Group IV included 88 patients evaluated between 2005 and 2009. We correlated the percentage of persons with cryptogenic and symptomatic epilepsy between the groups to determine if there was any change in the causes of late-onset epilepsy. Results: One hundred seventy-one patients had cryptogenic and 260 had symptomatic epilepsy. Common causes of symptomatic epilepsy were neurocysticercosis in 120 cases, cerebrovascular disease in 68, and brain tumors in 40. We found a reduction in the number of patients with symptomatic epilepsy (p = 0.0007) as well as a reduction in the number of neurocysticercosis cases (p = 0.0004) over the study years. There was a reduction in the weight of neurocysticercosis as an etiological factor for symptomatic late-onset epilepsy related to a drop in the number of patients with this condition evaluated between 2005 and 2009 (p = 0.0045). Conclusion: The number of neurocysticercosis cases among patients with late-onset epilepsy has changed over the years. This parasitic disease is no longer the most common cause of symptomatic late-onset epilepsy in our population. © 2012 Elsevier B.V. All rights reserved.

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