Espiritu Santo University, Guayaquil

www.uees.edu.ec
Samborondon, Ecuador
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Del Brutto O.H.,Espiritu Santo University, Guayaquil | Mera R.M.,Vanderbilt University
Atherosclerosis | Year: 2017

Background and aims The importance of the obesity paradox in the intracranial vasculature has not been explored. We assessed whether the body mass index (BMI) correlates with severity of carotid siphon calcifications (CSC) in community-dwelling adults. Methods Using a population-based study design, Atahualpa residents aged ≥40 years underwent head computed tomography (CT) for assessment of CSC. We evaluated the association between BMI and severity of CSC (dependent variable) using regression models adjusted for demographics and cardiovascular risk factors. Results Of 830 people enrolled in the Atahualpa Project, 651 (78%) were included. Mean BMI was 27.3 ± 5 kg/m2, with 39% being overweight and 27% obese. CT revealed high calcium content in the carotid siphon in 25% participants. In an adjusted model, individuals with normal weight had a trend for presenting with more severe CSC than those overweight (p = 0.06), and those ones had significantly more severe CSC than obese participants (p = 0.04). Predictive margins of BMI were higher in individuals with low calcium content in the carotid siphon. A contour plot with Shepard interpolation showed that the paradox disappeared in older individuals and in those with severe obesity, irrespective of age. Conclusions BMI inversely associates with severity of CSC. This paradox is relevant in younger individuals and in those without severe obesity, irrespective of age. © 2017 Elsevier B.V.


Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto O.H.,Espiritu Santo University, Guayaquil | Del Brutto V.J.,Hospital Clinica Kennedy
International Journal of Stroke | Year: 2014

Recent stroke registries suggest that the rate of cerebral hemorrhages is declining among stroke patients in South America. High rates of cerebral hemorrhages (approaching 40% of stroke cases) reported in pioneer registries during the 1990s have not been duplicated in more recent studies. In contrast, almost all studies recruiting patients from 2003 on, reported less than 20% of cerebral hemorrhages among their stroke patients. Intermediate rates of hemorrhagic strokes (from 25% to 27%) were noted among registries recruiting patients by the end of the 20th century and the start of the new Millennium. We also noted a significant declining rate of hemorrhagic stroke over the past 20 years at our Institution. In a series of 651 consecutive first-ever stroke patients included in the Hospital-Clínica Kennedy stroke registry (Guayaquil), cerebral hemorrhages accounted for 26·3% of patients recruited between 1990 and 1994 but for only 16·5% of those seen between 2005 and 2009 (P=0·03). More longitudinal studies are needed to confirm these findings and to determine whether the reported declining rate of hemorrhagic strokes in South America is related to increase life expectancy of the population, or to changes in lifestyle, dietary habits, or some other specific stroke risk factors not well evaluated so far. © 2013 World Stroke Organization.


Garcia H.H.,Instituto Nacional Of Ciencias Neurologicas | Garcia H.H.,Cayetano Heredia Peruvian University | Nash T.E.,National Institute of Allergy and Infectious Diseases | Del Brutto O.H.,Espiritu Santo University, Guayaquil | Del Brutto O.H.,Hospital Clinica Kennedy
The Lancet Neurology | Year: 2014

The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury. © 2014 Elsevier Ltd.


Del Brutto O.H.,Espiritu Santo University, Guayaquil
Handbook of clinical neurology | Year: 2014

Known as a disease of swine in ancient civilizations, cysticercosis is currently considered the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a Taenia carrier by the fecal-oral route. Once in the human intestine, Taenia eggs evolve to oncospheres that, in turn, cross the intestinal wall and lodge in human tissues - especially the nervous system - where cysticerci develop. The brain is a hostile environment in which parasites attempt to escape the immune surveillance while the host is trying to drive out the infection. In some cases, cysticerci are destroyed by this immunological attack, while in others, parasites may live unchanged for years. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a myriad of pathologic changes that are the main changes responsible for the clinical pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation of the disease, but some patients present with focal deficits, intracranial hypertension, or cognitive decline. With the exception of cystic lesions showing the scolex as an eccentric nodule, neuroimaging findings of neurocysticercosis are nonspecific and may be seen in other diseases of the nervous system. Likewise, immune diagnostic tests have been faced with problems related to poor sensitivity or specificity. Accurate diagnosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests, in a proper epidemiologic scenario. The introduction of cysticidal drugs has changed the prognosis of neurocysticercosis. Praziquantel and albendazole have been shown to reduce the burden of infection in the brain (as seen on neuroimaging studies) and to improve the clinical course of the disease in most patients. Further efforts should be directed towards eradicating this disease through the implementation of control programs for all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment. © 2014 Elsevier B.V. All rights reserved.


Del Brutto O.H.,Espiritu Santo University, Guayaquil | Mera R.M.,Vanderbilt University | Farfan R.,Espiritu Santo University, Guayaquil | Castillo P.R.,Sleep Disorders Center
Journal of Stroke and Cerebrovascular Diseases | Year: 2014

Little is known on the role of sleep disorders in the increased prevalence of cerebrovascular diseases in the developing world. Aims: The aim of this study is to assess the prevalence of major sleep disorders in a rural South American population and to determine whether these conditions are associated with stroke, ischemic heart disease, or with a poor cardiovascular health (CVH). Design: Three-phase, population-based, door-to-door survey in Atahualpa. During phase I, all residents aged 40 years or older will be screened with validated Spanish versions of 5 questionnaires to evaluate major sleep disorders. In phase II, neurologists will examine persons suspected of having a sleep disorder and a random sample of negative individuals to assess the prevalence of these conditions and to validate the accuracy of questionnaires. In phase III, patients with a confirmed sleep disorder will undergo nocturnal polysomnography for achieving a more specific diagnosis. The occurrence of sleep disorders will be correlated with the CVH of the population and with the presence of stroke and ischemic heart disease. Discussion: This epidemiologic study may prove cost-effective in improving sleep conditions of people living in rural areas of developing countries and may be used as a model for the evaluation of sleep disorders and their cerebrovascular correlates in these populations. © 2014 by National Stroke Association.


Del Brutto O.H.,Espiritu Santo University, Guayaquil
Handbook of Clinical Neurology | Year: 2014

Known as a disease of swine in ancient civilizations, cysticercosis is currently considered the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of the tapeworm Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a Taenia carrier by the fecal-oral route. Once in the human intestine, Taenia eggs evolve to oncospheres that, in turn, cross the intestinal wall and lodge in human tissues - especially the nervous system - where cysticerci develop. The brain is a hostile environment in which parasites attempt to escape the immune surveillance while the host is trying to drive out the infection. In some cases, cysticerci are destroyed by this immunological attack, while in others, parasites may live unchanged for years. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a myriad of pathologic changes that are the main changes responsible for the clinical pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation of the disease, but some patients present with focal deficits, intracranial hypertension, or cognitive decline. With the exception of cystic lesions showing the scolex as an eccentric nodule, neuroimaging findings of neurocysticercosis are nonspecific and may be seen in other diseases of the nervous system. Likewise, immune diagnostic tests have been faced with problems related to poor sensitivity or specificity. Accurate diagnosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests, in a proper epidemiologic scenario. The introduction of cysticidal drugs has changed the prognosis of neurocysticercosis. Praziquantel and albendazole have been shown to reduce the burden of infection in the brain (as seen on neuroimaging studies) and to improve the clinical course of the disease in most patients. Further efforts should be directed towards eradicating this disease through the implementation of control programs for all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment. © 2014 Elsevier B.V.


Del Brutto O.H.,Espiritu Santo University, Guayaquil
Pediatric Neurology | Year: 2013

Neurocysticercosis in infants and toddlers has received little attention in the literature, and little is known about the mechanisms of disease acquisition and clinical forms of presentation of the disease in this age group. All patients aged ≤3 years with neurocysticercosis evaluated at Hospital-Clínica Kennedy, Guayaquil, over a 22-year period were included in this study. Their household contacts were screened to detect Taenia solium carriers, which may represent the source of infection. A literature search on neurocysticercosis in infants and toddlers was also performed to compare personal cases with those described elsewhere. A total of 25 infants and toddlers with neurocysticercosis were included (seven from our institution and 18 from the literature). All patients had seizures as the primary manifestation of the disease, and neuroimaging studies showed one or two parenchymal brain cysticerci in the colloidal stage in 88% of patients. The source of infection was investigated in 11 houses, including the seven households of the present series, and only four of the 18 reported in the literature. A Taenia carrier was found in five (45%) of these households, including three from the present series and two from the literature. A sizable proportion of infants and toddlers with neurocysticercosis have been infected at home. Compulsory search of Taenia carriers among household contacts will allow the detection of the potential source of infection and will reduce further spread of the disease. The search must not be limited to family members, but also extended to domestic employees who are in daily contact with the children. © 2013 Elsevier Inc. All rights reserved.


Del Brutto O.H.,Hospital Clinica Kennedy | Del Brutto O.H.,Espiritu Santo University, Guayaquil
Current Opinion in Neurology | Year: 2013

Purpose of Review: This review comments on the recent advances in the understanding of the controversial aspects of neurocysticercosis (NCC). Recent Findings: The number of autochthonous cases of NCC in nonendemic countries has increased during the last few years: it is likely that the migration of Taenia carriers from endemic areas is responsible for the increased prevalence of locally acquired NCC in these regions. NCC is mostly acquired from person to person, and the old theories crediting the environment as the main source of human infection with Taenia solium eggs must be abandoned. There is growing evidence suggesting that cysticercus granulomas (one of the most common forms of presentation of NCC) represent fresh infections and not old infections resulting from spontaneous destruction of viable cysticerci. Calcifications, often seen as inactive lesions producing no symptoms, are responsible for a sizable proportion of NCC-related seizures or headache. It is likely that exposure of parasitic antigens to the hostÊs immune system is the cause of these manifestations. Summary: During the last few years, there has been an increased knowledge on the controversial aspects of NCC, including epidemiology, mechanisms of disease acquisition, the natural involution of lesions in the brain parenchyma, and the role of calcifications as responsible for symptom occurrence. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Del Brutto O.H.,Espiritu Santo University, Guayaquil | Del Brutto O.H.,Air Center 3542
Expert Review of Neurotherapeutics | Year: 2014

Neurocysticercosis is the most common helminthic disease of the nervous system and a leading cause of acquired epilepsy worldwide. Differences in the number and location of lesions as well as in the severity of the immune response against the parasites, makes neurocysticercosis a complex disease. Therefore, a single therapeutic approach is not expected to be useful in every patient. Introduction of cysticidal drugs-praziquantel and albendazole-have changed the prognosis of thousands of patients with neurocysticercosis. While pioneer trials of therapy were flawed by a poor design, recent studies have shown that cysticidal drugs results in disappearance of lesions and clinical improvement in most cases. Nevertheless, some patients with parenchymal neurocysticercosis may be left with remaining cysts and may develop recurrent seizures after therapy, and many patients with subarachnoid cysts may need repeated courses of therapy. In addition, not all forms of the disease benefit from cysticidal drugs. © 2014 Informa UK Ltd.


Del Brutto O.H.,Espiritu Santo University, Guayaquil | Lama J.,Hospital Clinica Kennedy Imaging
American Journal of Tropical Medicine and Hygiene | Year: 2013

There is limited information on the prevalence of neurocysticercosis (NCC) among stroke patients, and no community-based survey has addressed this issue.We performed a 3-Phase, population-based study, to assess the prevalence and pathogenesis of stroke in a rural village of coastal Ecuador,where cysticercosis is highly endemic. Twenty stroke patients were found among 642 individuals ≥ 40 years of age. Eighteen of these patients underwent neuroimaging studies and no patient had evidence ofNCCor angiitis of intracranial vessels. The serumimmunoblot test for the detection of anticysticercal antibodies, performed in 15 of these 20 patients during a previous survey,were negative in 13 cases and the remaining two had a normal computed tomography of the head. This study suggests that NCC is not responsible for the increasing burden of stroke in rural areas of developing countries. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.

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