Examinando por Autor "Echeverri-McCandless, A"

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Experience with Fingolimod as an Evidence-based Therapy in Relapsing Remitting Multiple Sclerosis: A Central American Case Series
(Los autores, 2019) Gracia-García, F; Treviño-Frenk, I; Díaz-Jiménez A,; Sirias-Baca, AV; Benzadón-Cohen, A; Chinchilla-Weinstok, D; Coulson-Romero, A; Dondis-Camaño, D; Echeverri-McCandless, A; Garro-Zúñiga, M; Martínez-Cerrato, J; Mercader-Mateo, I; Parajeles-Vindas, A; Portillo-Rivera, LI; Rodríguez-Moreno, V; Rosales-Bravo, LG; Santos-Pujols, B; Triana-Bernal, E; Valderrama-Arenilla, C; Valverde-Espinoza, JA; Vargas-Howell, R; Flores, J; Sanabria-Castro, A
Introduction: Central America has an estimated Multiple Sclerosis prevalence rate between 1.0 and 7.1 cases per 100,000 inhabitants. The increase in the global Multiple Sclerosis incidence, the lack of Latin-American representation in clinical studies and the rising availability of therapies to treat this disease, makes it essential to gather regional data. Objective: Obtain real-life evidence data regarding the efficacy and safety of fingolimod in the Central American region, specifically in the countries of Panama, Guatemala and Nicaragua. Patients and Methods: Based on medical records, sociodemographic, clinical, efficacy and safety information of patients with Relapsing Remitting Multiple Sclerosis receiving fingolimod treatment was collected and analyzed. Results: Medical records of 58 patients from Panama, Guatemala and Nicaragua with a diagnosis of Relapsing Remitting Multiple Sclerosis were included. Patients had a mean age of 37.3 ± 10.5 years, 6.98 ± 4.99 years of disease history, a time for diagnosis of 9 months and 22.8 ± 15.1 months of treatment with fingolimod. Under this disease-modifying therapy, a 60.4% reduction in active lesions, a decrease in the number of relapses, an increase in the percentage of remissions, and a 30% reduction in the annualized relapse rate, was observed. Fingolimod´s main indications were: previous treatment failure with other disease-modifying therapies mainly interferons and parenteral administration intolerance. At the time of this analysis, 22.4% of patients treated with fingolimod, experienced at least one adverse event and 92.3% of patients continue treatment with fingolimod. Conclusions: The sociodemographic characteristics, as well as safety and efficacy aspects of fingolimod in the Central American population with Relapsing Remitting Multiple Sclerosis are similar to the results published in postmarketing studies and controlled clinical trials in other regions worldwide
First experience with a supercharged pedicled jejunal interposition for esophageal replacement after caustic ingestion in a middle-income Latin American country
(2023) Alfaro-Pacheco, R; Brenes-Barrantes, R; Juanta-Castro, J; Rojas-Chaves, S; Echeverri-McCandless, A; Brenes-Barquero, P
Caustic or corrosive substance ingestion that results in severe esophageal and gastric lacerations frequently requires surgical management. The most common sequelae after an upper gastrointestinal tract caustic injury include non-responding luminal strictures, which are subject to esophageal replacement. Late corrective surgery may include esophagectomy with gastric pull-up and jejunal or colonic interpositions. Although long-segment esophageal reconstruction with jejunum is technically feasible and has demonstrated good outcomes, the complexity of the surgery has precluded the widespread use of this procedure in low- and middle-income countries. This document summarizes the most relevant aspects of caustic ingestion surgical management and describes the first Latin American experience in the reconstruction of an esophageal-gastric caustic injury using a pedicled jejunal interposition, as a viable and functional option in mid- and lower-income countries with well-established Thoracic Surgery departments and microsurgery access
Spontaneous Intracerebral Hemorrhage: Profile of Patients Treated in the Stroke Unit of a Third Level Hospital
(Los autores, 2018) Sanabria-Castro, Alfredo; Echeverri-McCandless, A; Sibaja-Campos, M; Garro-Zúñiga, M
Introduction: Constituting around 15% of all strokes, intracerebral hemorrhage is the most devastating cerebrovascular event. Despite its impact, only a few regional studies analyze its characteristics separately. Aim: Describe the characteristics of spontaneous intracerebral hemorrhage patients, treated at the Stroke Unit of a tertiary hospital of Costa Rica´s National Social Security Health System (CCSS). Patients and Methods: By reviewing medical charts, a retrospective study and analysis of socio-demographic and clinical characteristics in well defined, arterial, spontaneous, and non-traumatic intracerebral hemorrhage patients, was performed. Results: Clinical records of 74 patients were studied. Age average was 64.4 ± 12.6 years, events were identified predominantly in male patients and all patients presented at least one risk factor; being arterial hypertension the most prevalent. Etiology in 90.5% of the cases corresponds to small vessel disease, 81.0% of the events are consistent with deep intracerebral hemorrhage and 3 months modified Rankin Scale median was 3. The average hospital stay at the unit was one week, around one third of patients presented complications and 90-day mortality was 16.2%. Conclusions: Despite the differences found attributable mainly to ethnic aspects and the nature of the analyzed population, the profile of these patients resembles what has been described elsewhere