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Carpio A.,University of Cuenca | Carpio A.,Columbia University | Fleury A.,Instituto Nacional Of Neurologia Y Neurocirugia | Fleury A.,National Autonomous University of Mexico | And 11 more authors.
Annals of Neurology | Year: 2016

Objective: The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. Methods: A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity. Results: Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. Interpretation: These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434–442. © 2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.


Moncayo J.,International University of Ecuador | Moncayo J.,Eugenio Espejo Hospital
Frontiers of Neurology and Neuroscience | Year: 2012

The vascular supply of this small brainstem structure is complex. Although midbrain infarcts and particularly hemorrhages are uncommon, their clinical manifestations are diverse mainly because the vertical gaze centers and two of three nuclei of the extraocular muscles lie primarily in the midbrain. Consequently, eye movement disturbances are often the hallmark clinical findings in midbrain stroke. The main clinical patterns, etiology and outcome of infarcts limited to the midbrain are summarized according to defined vascular territories along with the clinical findings of midbrain hemorrhage. Copyright © 2012 S. Karger AG, Basel.


Coral-Almeida M.,Institute of Tropical Medicine | Coral-Almeida M.,Ghent University | Coral-Almeida M.,International University of Ecuador | Coral-Almeida M.,University of the Americas in Ecuador | And 7 more authors.
PLoS Neglected Tropical Diseases | Year: 2015

Background Taenia solium cysticercosis is a zoonotic neglected disease responsible for severe health disorders such as seizures and death. Understanding the epidemiology of human cysticercosis (HCC) in endemic regions will help to expose critical information about the transmission of the disease, which could be used to design efficient control programs. This review gathered serological data on apparent prevalence of T. solium circulating antigens and/or seroprevalence of T. solium antibodies, apparent prevalence of human taeniasis and risk factors for HCC from endemic communities in order to understand the differences in exposure to the parasite and active infections with T. solium metacestodes in endemic areas around the world. Methods Three databases were used to search sero-epidemiological data from community-based studies conducted between 1989 and 2014 in cysticercosis endemic communities worldwide. The search focused on data obtained from T. solium circulating antigen detection by monoclonal antibody-based sandwich ELISA and/or T. solium antibody seroprevalence determined by Enzyme-linked Immunoelectrotransfer Blot (EITB). A meta-analysis was performed per continent. Principal Findings A total of 39,271 participants from 19 countries, described in 37 articles were studied. The estimates for the prevalence of circulating T. solium antigens for Africa, Latin America and Asia were: 7.30%(95% CI [4.23–12.31]), 4.08% (95% CI [2.77–5.95]) and 3.98% (95% CI [2.81–5.61]), respectively. Seroprevalence estimates of T. solium antibodies were 17.37% (95% CI [3.33–56.20]), 13.03% (95% CI [9.95–16.88]) and 15.68% (95% CI [10.25–23.24]) respectively. Taeniasis reported prevalences ranged from 0 (95% CI [0.00–1.62]) to 17.25% (95% CI [14.55–20.23]). Significance A significant variation in the sero-epidemiological data was observed within each continent, with African countries reporting the highest apparent prevalences of active infections. Intrinsic factors in the human host such as age and immunity were main determinants for the occurrence of infections, while exposure was mostly related to environmental factors which varied from community to community. © 2015 Coral-Almeida et al.


PubMed | Federal University of Rondônia, Federal University of Säo João del Rei, International University of Ecuador and University of Campinas
Type: | Journal: Toxicon : official journal of the International Society on Toxinology | Year: 2016

Commonly, phospholipases A2 (PLA2s) play key roles in the pathogenesis of the local tissue damage characteristic of crotaline and viperine snake envenomations. Crotalus oreganus lutosus snake venom has not been extensively studied; therefore, the characterization of its components represents a valuable biotechnological tool for studying pathophysiological processes of envenoming and for gaining a deeper understanding of its biological effects. In this study, for the first time, a basic PLA2 myotoxin, ColTx-I, was purified from C.o. lutosus through two chromatographic steps. ColTx-I is monomeric with calculated molecular mass weight (Mw) of 14,145Da and a primary structure closely related to basic PLA2s from viperid venoms. The pure enzyme has a specific activity of 15.870.65nmol/min/mg at optimal conditions (pH 8.0 and 37C). ColTx-I activity was found to be dependent on Ca(2+), as its substitution by other ionic species as well as the addition of chelating agents significantly reduced its phospholipase activity. Invivo, ColTx-I triggered dose-dependent inflammatory responses, measured using the paw edema model, with an increase in IL-6 levels, systemic and local myotoxicity, characterized by elevated plasma creatine kinase activity. ColTx-I induced a complex series of degenerative events associated with edema, inflammatory infiltrate and skeletal muscle necrosis. These biochemical and functional results suggest that ColTx-I, a myotoxic and inflammatory mediator, plays a relevant role in C.o. lutosus envenomation. Thus, detailed studies on its mechanism of action, such as evaluating the synergism between ColTx-I and other venom components may reveal targets for the development of more specific and effective therapies.


Moncayo J.,International University of Ecuador | Bogousslavsky J.,Center for Brain and Nervous System Disorders
Frontiers of Neurology and Neuroscience | Year: 2012

Generation and control of eye movements requires the participation of the cortex, basal ganglia, cerebellum and brainstem. The signals of this complex neural network finally converge on the ocular motoneurons of the brainstem. Infarct or hemorrhage at any level of the oculomotor system (though more frequent in the brain-stem) may give rise to a broad spectrum of eye movement abnormalities (EMAs). Consequently, neurologists and particularly stroke neurologists are routinely confronted with EMAs, some of which may be overlooked in the acute stroke setting and others that, when recognized, may have a high localizing value. The most complex EMAs are due to midbrain stroke. Horizontal gaze disorders, some of them manifesting unusual patterns, may occur in pontine stroke. Distinct varieties of nystagmus occur in cerebellar and medullary stroke. This review summarizes the most representative EMAs from the supratentorial level to the brainstem. Copyright © 2012 S. Karger AG, Basel.


PubMed | Oswaldo Cruz Foundation, University of Talca, University of Campinas and International University of Ecuador
Type: | Journal: Toxicon : official journal of the International Society on Toxinology | Year: 2017

Phospholipases A


Introduction: metabolic syndrome is a group of metabolic abnormalities that increase the risk of developing type 2 diabetes and cardiovascular disease. There are several criteria for diagnosis; the most used are the International Diabetes Federation (IDF) and the Adult Treatment Panel III (ATP III). An early treatment may prevent its associated complications and improve the quality and life expectancy of the person; it must be focused on changes in lifestyle such as healthy eating and regular physical activity. Objective: to determine the prevalence of metabolic syndrome according to the diagnostic criteria of the International Diabetes Federation (IDF) and the Adult Treatment Panel III (ATP III) Methodology: it was a cross-sectional study in which participate 128 people (55 women and 73 men) aged between 18 and 75 years, who were given a nutritional history, anthropometric measures and biochemical tests. Results: the prevalence of overweight was 63% (48% overweight and 15% obese). The prevalence of metabolic syndrome according to IDF was 15.6% and 14.8% according ATPIII. Conclusions: among the employees is clear the high prevalence of overweight and metabolic syndrome. So it is a priority to work on the implementation of preventive measures to stop this trend and cardiometabolic disorders. © 2015, Grupo Aula Medica S.A. All rights reserved.


PubMed | International University of Ecuador and San Francisco de Quito University
Type: | Journal: Experimental parasitology | Year: 2016

Tapeworms Taenia solium and Taenia saginata are the causative agents of taeniasis/cysticercosis. These are diseases with high medical and veterinary importance due to their impact on public health and rural economy in tropical countries. The re-emergence of T. solium as a result of human migration, the economic burden affecting livestock industry, and the large variability of symptoms in several human cysticercosis, encourage studies on genetic diversity, and the identification of these parasites with molecular phylogenetic tools. Samples collected from the Ecuadorian provinces: Loja, Guayas, Manab, Tungurahua (South), and Imbabura, Pichincha (North) from 2000 to 2012 were performed under Maximum Parsimony analyses and haplotype networks using partial sequences of mitochondrial DNA, cytochrome oxidase subunit I (COI) and NADH subunit I (NDI), from Genbank and own sequences of Taenia solium and Taenia saginata from Ecuador. Both species have shown reciprocal monophyly, which confirms its molecular taxonomic identity. The COI and NDI genes results suggest phylogenetic structure for both parasite species from south and north of Ecuador. In T. solium, both genes gene revealed greater geographic structure, whereas in T. saginata, the variability for both genes was low. In conclusion, COI haplotype networks of T. solium suggest two geographical events in the introduction of this species in Ecuador (African and Asian lineages) and occurring sympatric, probably through the most common routes of maritime trade between the XV-XIX centuries. Moreover, the evidence of two NDI geographical lineages in T. solium from the north (province of Imbabura) and the south (province of Loja) of Ecuador derivate from a common Indian ancestor open new approaches for studies on genetic populations and eco-epidemiology.


Moncayo J.,International University of Ecuador
Frontiers of Neurology and Neuroscience | Year: 2012

The vascular supply of this small brainstem structure is complex. Although midbrain infarcts and particularly hemorrhages are uncommon, their clinical manifestations are diverse mainly because the vertical gaze centers and two of three nuclei of the extraocular muscles lie primarily in the midbrain. Consequently, eye movement disturbances are often the hallmark clinical findings in midbrain stroke. The main clinical patterns, etiology and outcome of infarcts limited to the midbrain are summarized according to defined vascular territories along with the clinical findings of midbrain hemorrhage. © 2012 S. Karger AG, Basel.


Moncayo J.,International University of Ecuador
Frontiers of Neurology and Neuroscience | Year: 2012

Pontine infarcts are often part of a large ischemia involving the brainstem, although infarcts may be restricted to the pons. In both cases, infarcts in the pons are characterized by interesting clinical patterns resulting from a variety of cranial nerve dysfunctions, eye movement disorders and motor, sensory and cerebellar manifestations, either isolated or in combination. The anteromedial and anterolateral territories are the most commonly involved. Penetrating branch artery disease is the most common etiology. Ten percent of all intracerebral hemorrhages are located in the pons, and small hemorrhages in this brainstem structure may, in some instances, give rise to unusual clinical manifestations. © 2012 S. Karger AG, Basel.

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