Oscar Del Brutto

Universidad de Especialidades Espíritu Santo · School of Medicine

Background Street violence has detrimental effects on cardiovascular health (CVH). However, the significance of these consequences have not been systematically evaluated. In this study, we aimed to assess the impact of fear of crime on CVH status among community-dwellers aged ≥40 years living in a rural village stricken by violence. Methods Partic...

Neurocysticercosis is one of the main risk factors of seizures and epilepsy in many regions of the world, which are Taenia solium-endemic but resource-constrained to control the parasite. The nosology of seizures and the classification of epilepsy in the context of neurocysticercosis are somewhat uncertain. Many seizures associated with the infecti...

Introduction: Calcifications are the end stage of many parenchymal brain cysticerci and may occur either spontaneously or as the result of treatment with cysticidal drugs. These lesions, traditionally considered inert and asymptomatic, have been associated with several complications that seem to be mostly related to brain damage and inflammation e...

Background Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted...

Calcified cysticerci are often associated with hippocampal atrophy (HA). While most studies suggest that repetitive seizures cause HA in these patients, others have demonstrated that HA may also occur in persons without epilepsy. Little is known about mechanisms triggering HA in seizure-free individuals with calcified cysticerci. Here, we aimed to...

Background and Purpose Brain arterial luminal diameters are reliably measured with automated imaging software. Nonautomated imaging software alternatives such as a Picture Archiving Communication System are more common bedside tools used for manual measurement. This study is aimed at validating manual measurements against automated methods. Method...

Reports addressing the effects of oily fish intake on bone health are inconsistent. This study shows that consumption of ≥ 5.2 oily fish servings/week (728 g) is associated with lower prevalence of osteopenia/osteoporosis in elderly women of Amerindian ancestry. Results suggest a beneficial effect of oily fish intake in this population. Oily fish i...

Introduction Sleep-related symptoms have been associated with adverse health outcomes, including increased mortality risk. Studies that analyzed the correlation between sleep and mortality focused on the single effect of self-reported sleep duration or relied on nonstructured questionnaires about sleep. In order to evaluate the detrimental effects...

Background and Purpose Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)—as a surrogate of choroid plexus dysfunction—and sev...

Introduction: Apolipoprotein E4 (ApoE4) allele is linked to increased LDL-Cholesterol, one of the main risk factors for intracranial large artery stenosis (ICAS). Evidence shows that in diabetic men, intima-media thickness is significantly higher in those with ApoE4 than those with ApoE3. While the link between ApoE4 and extracranial atherosclerosi...

Background Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador. Methods Participants were selected from community-dwelling older adults who were included in previous studies targeting...

Background: Neck circumference (NC) has been associated with mortality secondary to cardiovascular diseases and other conditions. However, information on this association in the population at large is limited. We aimed to assess this association in community dwellers living in rural Ecuador. Methods: Individuals aged ≥40 y who were enrolled in t...

The external capsule is a band of longitudinal fibers (white matter) limited by two deep gray matter structures, the putamen medially and the claustrum laterally (Figure 1). This structure is mainly composed of axons that connect different areas of the cerebral cortex with the tegmentum (corticotegmental fibers). Ischemic strokes confined to the ex...

Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles...

Background and Purpose Brain arterial diameters are markers of cerebrovascular disease. Demographic and anatomical factors may influence arterial diameters. We hypothesize that age, sex, height, total cranial volume (TCV), and persistent fetal posterior cerebral artery (fPCA) correlate with brain arterial diameters across populations. Methods Part...

La circunferencia del cuello es un índice antropométrico recientemente introducido como predictor de enfermedades cardio y cerebrovasculares. Es un determinante de depósito de grasa subcutánea en la parte superior del cuerpo y un marcador de riesgo para el futuro desarrollo de enfermedad coronaria, fibrilación auricular y diabetes mellitus, entre o...

Existen varios factores que han condicionado un aumento importante en la frecuencia de trastornos de sueño en grandes centros urbanos, entre los que se encuentran los cambios en el estilo de vida, el sedentarismo, el aumento en los turnos de trabajos nocturnos y la contaminación visual nocturna. Esta última parece ser un determinante fundamental de...

Purpose of Review The glymphatic system is hypothesized to act as the brain’s filtration system to remove toxic solutes that accumulate throughout the day. Perivascular spaces (PVSs) play a fundamental role in the ability of the glymphatic system to function, and sleep influences the effectiveness of this system. This article reviews the complexity...

Background: Evidence on the association between anatomical variants of the circle of Willis (CoW) and severity of white matter hyperintensities (WMH) of presumed vascular origin is inconclusive, and no study has evaluated the role of incompleteness of CoW on WMH progression in the follow-up. This study aims to assess the impact of incomplete confi...

Background: Information on the association between the systemic immune-inflammation index (SII) and white matter hyperintensities (WMH) of presumed vascular origin is confined to cross-sectional studies. We sought to evaluate the impact of SII on WMH progression in community-dwelling older adults. Methods: Following a longitudinal prospective st...

Background: Earlobe crease (ELC) has been associated with coronary atherosclerosis. Recently, ELC has been associated with white matter hyperintensities (WMH) of presumed vascular origin. However, the results are heterogeneous among studies. We aimed to assess whether ELC is associated with WMH severity and progression in community-dwelling older a...

Cerebral small vessel disease (SVD) is common during ageing and can present as stroke, cognitive decline, neurobehavioural symptoms, or functional impairment. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive and other symptoms and affect activities of daily living. Standards for Reporting Vascular Changes on Neur...

Background: Information on the relationship between tooth loss and mortality among individuals living in rural settings is limited. Methods: In this prospective cohort study, Atahualpa residents ≥40 y of age (n=933) were followed for a mean of 7.3±3.2 y to estimate mortality risk according to whether they had severe tooth loss (<10 remaining tee...

Research Letter Periodic limb movements in sleep (PLMS) are defined as repetitive, stereotyped, and involuntary muscle contractions of the upper or lower extremities that last up to 5 seconds and are separated by intervals of 5 to 90 seconds [1]. PLMS are often seen in otherwise healthy older adults, but have also been associated with breathing and...

Señora editora: Los programas de control destinados a erradicar la cisticercosis humana son dignos de elogio. En el programa más grande y probablemente mejor diseñado de los realizados hasta la fecha, se seleccionaron seres humanos y cerdos como objetivos de intervención. Los seres humanos recibieron varias rondas de niclosamida y los cerdos recibi...

Background: Accidental falls are a major cause of disability and death in older adults. However, the reliability of instruments designed to estimate the risk of future falls has not been adequately established in community dwellers. Methods: Departing from a previous cross-sectional study of older adults living in rural Ecuador that estimated the...

Introduction: Dolichoectasia of brain arteries has significant clinical implications. It can be measured with automated imaging software such as LKEB Automated Vessel Analysis (LAVA). However, this is not currently used as part of standard clinical practice. Non-automated alternatives such as a Picture Archiving Communication System like RadiAnt ar...

Objectives: Brain arterial dilation is an increasingly recognized cerebrovascular disease marker. However, demographic and anatomical factors may influence brain arterial diameters within the normal spectrum. We hypothesize that age, sex, height, total cranial volume (TCV) and fetal posterior cerebral arteries (fPCA) presence correlate with brain a...

High social risk has been associated with mortality, but information on this relationship in remote rural communities is limited. Using the social determinants of health (SDH) specified in the Gijon's social-familial evaluation scale (SFES), we aimed to assess mortality risk according to levels of social risk in community-dwelling older adults livi...

Background Information on the association between disability and severity of white matter hyperintensities (WMH) among stroke-free individuals is limited. We aimed to assess this association in apparently healthy older adults.Methods Following a population-based cross-sectional design, community-dwelling older adults received a brain MRI to grade W...

PurposeTo assess the relationship between dietary oily fish intake and all-cause mortality in a population of frequent fish consumers of Amerindian ancestry living in rural Ecuador.Methods Individuals aged ≥ 40 years enrolled in the prospective population-based Atahualpa Project cohort received annual questionnaires to estimate their dietary oily f...

Background: Information of the effect of social risk on the cardiovascular health (CVH) status among individuals living in rural settings is limited. We aim to assess this effect in participants of the Three Villages Study cohort. Methods: Following a longitudinal prospective design, older adults living in rural Ecuador received baseline social...

Background and purpose: Prospective studies on cerebral microbleeds (CMB) have departed from individuals who already have CMB at baseline. Therefore, main outcomes have usually been the composite of new lesions appearing on the follow-up among patients who already had CMB together with those who de novo developed CMB. Using the Atahualpa Project C...

A 45-year-old man was evaluated one week after the acute onset of pain and numbness in the right side of the face. On examination, he had a right watery eye, which has been present for several weeks. The patient denied history of eye trauma or previous episodes of inflammatory or infected conditions affecting the lacrimal drainage complex.

Objective: Abnormal ankle-brachial index (ABI) determinations may be associated with an increased risk of incident strokes. However, the impact of previous strokes in this relationship is unknown. We estimated the role of previous strokes on the association between abnormal ABI determinations and incident stroke risk in community-dwelling older ad...

Human cysticercosis is caused by ingestion of T. solium eggs from taenia carriers. Neurocysticercosis (NCC), defined as the infection of the CNS and the meninges by the larval stage of Taenia solium, is the most common helminthic infection of the CNS worldwide. Parasites may lodge in brain parenchyma, subarachnoid space, ventricular system, or spin...

Objective Arterial stiffness – as measured by the aortic pulse wave velocity (aPWV) – has been associated with biomarkers of cerebral small vessel disease (cSVD), in particular with white matter hyperintensities (WMH) of presumed vascular origin. Most studies have been conducted in White and Asian populations, and information on this relationship i...

Purpose of Review Human cysticercosis is caused by ingestion of Taeniasolium eggs from asymptomatic taenia carriers and not by eating undercooked pork. Neurocysticercosis (NCC), a disease caused by the invasion of the CNS and its coverings by the larval stage of Taenia solium, has trespassed the boundaries of tropical regions and is the most common...

Background Progression of cerebral small vessel disease (cSVD) markers has been studied in different races/ethnic groups. However, information from individuals of Amerindian ancestry is lacking. We sought to evaluate progression patterns of cSVD markers in community-dwelling older adults of Amerindian ancestry.Methods Following a longitudinal prosp...

Objectives Evidence on the role of autonomic dysfunction on white matter hyperintensities (WMH) progression is limited. This study aims to assess the impact of a low nighttime heart rate variability (HRV) on WMH progression in community-dwelling older adults. Materials and methods Following a prospective longitudinal study design, all individuals...

Introduction Oily fish intake may reduce the progression of white matter hyperintensities (WMH) of presumed vascular origin due to their high content of omega-3 polyunsaturated fatty acids and other nutrients. However, information on this relationship is limited. We aimed to assess the association between oily fish intake and WMH progression in old...

Un hombre de 77 años desarrolló de manera progresiva lenguaje traposo, temblor de acción en ambas extremidades superiores, bradicinesia generalizada y marcha inestable, varias semanas después de ingesta masiva y sostenida de alcohol, seguido de un estado de inconsciencia en el cual el paciente no respondía a órdenes verbales o estímulos dolorosos....

Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador. Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Mu...

BACKGROUND Information on cerebrovascular consequences of high social risk, as determined by the social determinants of health, is limited. We sought to evaluate the impact of high social risk on the progression of white matter hyperintensities (WMHs) of presumed vascular origin. METHODS Following a longitudinal prospective study design, participa...

Background Both frailty and white matter hyperintensities (WMH) of presumed vascular origin are associated with enhanced expression of inflammatory biomarkers. Therefore, it is possible that pre-existing frailty predisposes to WMH progression. However, this relationship has not been explored. This population-based longitudinal prospective study aim...

Background and purpose Lacunes of presumed vascular origin are perceived as biomarkers of cerebral small vessel disease (cSVD), although they may also be related to other pathogenetic mechanisms. We aimed to assess whether lacunes are more often associated with intracranial artery stenosis (IAS) than with white matter hyperintensities (WMH) of pres...

Background Several studies have attempted to clarify the role of social determinants of health (SDH) on nutritional status of older adults, but results are inconsistent due to differences in SDH assessments at different levels of population development. In this study, we assessed this association in community-dwelling older adults living in rural E...

Life’s Simple 7 is an initiative of the American Heart Association developed for stratifying risk factors associated with adverse vascular outcomes and premature mortality. While this scale has been widely used, there is limited information on its applicability to individuals living in remote communities where risk factors and lifestyles differ fro...

Background: This study assesses whether pineal gland calcification (PGC) – a surrogate for reduced endogenous melatonin production – is associated with significant stenosis of large intracranial arteries – a biomarker of intracranial atherosclerotic disease (ICAD). Methods: Individuals aged ≥60 years enrolled in the Three Villages Study received he...

Objectives There is limited information on factors associated with poor cognitive performance in rural settings of Low and Middle-Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador. Methods Atahualpa, El Tam...

Background Cognitive decline is a recognized manifestation of long COVID, even among patients who experienced mild disease. However, there is no evidence regarding the length of cognitive decline in these patients. This study aimed to assess whether COVID-19-related cognitive decline is a permanent deficit or if it improves over time. Methods Cogn...

Background Various anthropometric measurements have been inversely associated with atherosclerosis, giving rise to the concept of an “obesity paradox” However, inconsistent study results make it difficult to determine the best anthropometric measurement with which to assess such inverse relationship. Height has been inversely associated with athero...

Neurocysticercosis (NCC), the infection of the nervous system by the cystic larvae of Taenia solium, is a highly pleomorphic disease because of differences in the number and anatomical location of lesions, the viability of parasites, and the severity of the host immune response. Most patients with parenchymal brain NCC present with few lesions and...

Introduction Cerebral small vessel disease (SVD) predicts all-cause mortality in Eastern Asian and Caucasian populations. However, little is known about SVD impact in individuals of different races/ethnic groups. In this study, we sought to estimate the mortality risk according to the total SVD (tSVD) score in older adults of Amerindian ancestry....

Background: The SARS-CoV-2 pandemic is affecting millions of people living in rural areas of Low- and Middle-Income Countries and is causing an already anticipated devastating effect on the health and economics of these populations. More information is needed to modify behaviors that may counterbalance the consequences of mass spread of the virus...

IntroductionHypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian populations. However, little is known about HTRP impact in other ethnic groups.AimWe sought to estimate the mortality risk according to HTRP severity in older adults of Amerindian ancestry living in rural Ecuador.Methods This prospective study enrolled i...

Magnetic resonance images from 197 patients with calcified neurocysticercosis (NCC), 38 with viable NCC and 197 NCC-free healthy rural villagers were evaluated to compare the frequency of hippocampal atrophy/sclerosis (HAS) across these populations. Scheltens' medial temporal atrophy scale was used for hippocampal rating. The median age of the 432...

This prospective cohort study aimed to assess incidence and etiology of adult-onset epilepsy in previously seizure-free Atahualpa residents aged ≥ 20 years. Persons with adult-onset epilepsy occurring over 5 years were identified from annual door-to-door surveys and other overlapping sources. Those who emigrated or declined consent were excluded at...

La pandemia de Enfermedad por Coronavirus 2019 (COVID-19) causada por el Síndrome Respiratorio Agudo Severo por Coronavirus-2 (SARS-CoV-2) ha afectado a más de 150 millones de personas hasta finales de abril de 2021, y se espera que afecte a muchos más durante el próximo año. Con una tasa de mortalidad de alrededor del 2% en las personas infectadas...

Antecedentes/objetivo: Los dedos de Dawson, tradicionalmente asociados con esclerosis múltiple, han sido - además - recientemente vinculados con hiperintensidades de sustancia blanca causadas por enfermedad de pequeño vaso cerebral. En este contexto, dichas lesiones corresponderían a daño venular, podrían representar estadíos avanzados de enfermeda...

Una mujer de 74 años con diagnóstico reciente de enfermedad de Alzheimer fue medicada con donepezilo 5mg al día (en horario nocturno).

Background and purpose Information on the association between anatomical variants of the Circle of Willis (CoW) and intracranial atherosclerotic disease (ICAD) is limited and results are controversial. In this population-based study, we aimed to assess whether an incomplete CoW is associated with high calcium content in carotid siphons (a reliable...

A total of 590 older adults of Amerindian ancestry living in rural Ecuador received anthropometric measurements and a brain magnetic resonance imaging to estimate the total cerebral small vessel disease (cSVD) score. A fully adjusted ordinal logistic regression model, with categories of the total cSVD score as the dependent variable, disclosed sign...

Transcranial Doppler (TCD) is a non-invasive procedure that is increasingly used for diagnostic and prognostic purposes in patients with an acute stroke. In addition, TCD enhances the effect of thrombolysis by exposing thrombi surfaces to circulating rTPA. However, insonation problems through acoustic windows limit the diagnostic efficiency of TCD....

Objective. Calcified neurocysticercosis has been associated with hippocampal atrophy (HA). However, the pathogenesis of this association is still elusive. This study assessed the role of epilepsy or interictal EEG abnormalities in the occurrence of HA in the Atahualpa Project cohort. Methods. Atahualpa residents aged ≥20 years, identified by means...

Background Oily fish is a major dietary source of omega-3 polyunsaturated fatty acids and other nutrients that may reduce the expression of cerebral small vessel disease (cSVD) biomarkers, including white matter hyperintensities (WMH) of presumed vascular origin. However, information on this relationship is limited. We aimed to assess the associati...

Objective To assess the association between SARS‐CoV‐2 infection and decreased hand grip strength (HGS). Design Longitudinal population‐based study. Setting Community‐dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS‐CoV‐2 pandemic. Participants Of 282 enrolled individuals, 254 (90%) finished the stud...

High social risk, as measured by the social determinants of health (SDH), may increase the risk of SARS-CoV-2 infection. However, this association has not been studied in rural communities. Using the Atahualpa Project cohort, we aimed to assess the association between SDH and SARS-CoV-2 seropositivity in community-dwelling older adults living in ru...

Objective In view of the high prevalence of obstructive sleep apnea (OSA) and the increasing global pandemic of SARS-CoV-2 infection, it is likely that many patients with OSA get exposed to this virus. Besides theoretical assumptions, there is no evidence that OSA may favor SARS-CoV-2 acquisition or may lead to a more severe disease. Taking the opp...

Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modificati...

Study objectives This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community-dwellers enrolled in the Atahualpa Project. Methods Atahualpa residents aged ≥40 were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) nine months before the pandemic and a lateral flow-based test for identifi...

Background and purpose Neurological complications of SARS‐CoV‐2 infection are noticed among critically‐ill patients soon after disease onset. Information on delayed neurological sequelae of SARS‐CoV‐2 infection is nil. Following a longitudinal study design, we assessed the occurrence of cognitive decline among individuals with a history of mild sym...

Information about factors potentially favoring the spread of SARS-CoV-2 in rural settings is limited. Following a case-control study design in a rural Ecuadorian village that was severely struck by the pandemic, SARS-CoV-2 RNA were detected by real-time PCR in swabs obtained from inner and upper walls in 24/48 randomly selected latrines from case-h...

Background Inability to encircle the neck by hands (neck grasp) has been proposed as an indicator of obstructive sleep apnea (OSA) that would be useful for recognition of candidates for polysomnography (PSG). We assessed the value of neck grasp for predicting OSA in community-dwelling older adults of Amerindian ancestry. Methods Neck grasp was eva...

Background: Information on the association between tooth loss and intracranial atherosclerotic disease (ICAD) is limited. Here, we aimed to assess whether non-traumatic severe tooth loss - as a surrogate for chronic inflammatory periodontal disease - is associated with ICAD in a cohort of older adults (aged ≥60 years) living in rural Ecuador. Meth...

Background Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry. Methods The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living...