Examinando por Autor "Parajeles-Vindas, Alexander"

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Estudio epidemiológico de la esclerosis múltiple en América Central y el Caribe (estudio ENHANCE): resultados parciales de Costa Rica
(Acta Médica Costarricense, 2024) Balmaceda-Meza, Andrea; Sanabria-Castro, Alfredo; Román-Garita, Norbel; Rodríguez-Moreno, Virginia; Monterrey-Álvarez, Priscilla; Miranda-Loría, Gustavo; Echeverri-McCandless, Ann; Rojas-Chaves, Sebastián; Duarte-Ulloa, Tatiana; Parajeles-Vindas, Alexander
Objetivo: este estudio tuvo como objetivo describir la incidencia y analizar las principales características demográficas, epidemiológicas, clínicas, de diagnóstico y tratamiento; así como la presencia de factores de riesgo y pronósticos conocidos en pacientes costarricenses con esclerosis múltiple, atendidos en tres hospitales, y que participaron en el estudio internacional denominado ENHANCE. Métodos: el estudio fue de naturaleza observacional, se analizaron de forma retrospectiva los registros médicos de pacientes mayores de 18 años Diagnosticados con esclerosis múltiple atendidos en tres hospitales de la Caja Costarricense de Seguro Social, específicamente el Hospital San Juan de Dios, el Hospital San Rafael de Alajuela y el Hospital de San Carlos, durante el periodo comprendido entre enero 2014 y diciembre 2019. La totalidad de los casos se utilizó para determinar las características clínicas y sociodemográficas, mientras que para los cálculos de incidencia se tomó en cuenta solo los casos nuevos del periodo de estudio. Los resultados clínicos y de tratamiento se obtuvieron a partir de un subconjunto de pacientes con seguimiento activo de al menos 5 años. Resultados: se registró un total de 147 casos, de los cuales 72 eran nuevos en el periodo de estudio y 75 eran incidentes o prevalentes en el 2014 que contaban con seguimiento documentado de al menos 5 años. La edad promedio al inicio de síntomas fue de 31,9 años y de 35,0 años al momento del diagnóstico. Se encontró un predominio de casos en el sexo femenino 69.4% (n=102) y los pacientes presentaron un puntaje variable en la Escala de Discapacidad Extendida que osciló entre 0 y 8,5. La incidencia anual en la población analizada varió entre 0,32 y 1,28 casos por cada 100.000 habitantes. La principal forma clínica identificada fue la recurrente-remitente 87,8% (n=129) y las principales afectaciones reportadas fueron motoras y sensitivas. Las lesiones centrales más frecuentes documentadas en la resonancia magnética fueron las periventriculares 35% (n=45) y se encontró que la mayoría de los pacientes presentaban niveles bajos de vitamina D. Con relación al manejo terapéutico se observó un descenso en el uso de tratamientos tradicionales (comúnmente llamados de primera línea) y un aumento en la utilización de nuevas alternativas o de segunda línea, tales como ocrelizumab y natalizumab. Conclusión: los datos obtenidos en el presente estudio sugieren que la población analizada se comporta de forma similar a lo reportado en otros estudios de carácter internacional y no difiere de forma considerable con lo reportado previamente en el país
Multiple sclerosis in Central America and Caribbean countries: frequency and clinical characterization of an emergent disease
(Los autores, 2024) Gracia, Fernando; Ramírez Navarro, Deyanira A; Ramírez Sánchez, Nicia E; Weiser, Roberto; Parajeles-Vindas, Alexander; Portillo Rivera, Ligia I; López Torres, Ericka; García Valle, Luis A; Sanabria-Castro, Alfredo; Abdón López, César; Araujo, Pahola; Ayerdis Zamora, Maria J; Balmaceda-Meza, Andrea; Benzadon Cohen, Aron; Candelario Cueto, Awilda; Castillo, Diego; Castro-Escobar, Romy; Corea Urbina, Karla Z; Peña Rivas, Anyeri de; Duarte Sotelo, Octavio; Enamorado Claros, Temís; Giroud Benítez, José L; Gracia, Karla; Larreategui, Mario; Martínez Cerrato, Jorge A; Medina Báez, Josmarlin P; Menjivar Samayoa, Carlos E; Miranda-Loria, Gustavo; Monterrey-Alvarez, Priscilla; Morales Arguello, Lilliam A; Ortiz, Michelle; Pérez Baldioceda, Carlos D; Pinilla Aguilar, Lizeth; Rodríguez Salinas, Luis C; Rodríguez-Moreno, Virginia; Rojas-Chaves, Sebastián; Román-Garita, Norbel; Santos Pujols, Biany; Valderrama, Carlos; Van Sijtveld, Ivonne; Zabala Angeles, Indhira; Rivera, Victor M; Armien, Blas
Background: Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results: Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3–3.5 × 100,000 inhabitants, and the lowest, 0.07–0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion: This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged
National alliance for Wilson’s disease: health policy in Costa Rica
(Los autores, 2017) Hevia-Urrutia, Francisco; Alvarado-Echeverría, Ileana; Sanabria-Castro, Alfredo; Sánchez-Molina, Marta; Meza-Sierra, Luis; Parajeles-Vindas, Alexander; Méndez-Blanca, Oscar; Sánchez-Siles, Álvaro; Saborío-Rocafort, Manuel; Barguil-Gallardo, Marcela; Chavarría-Quirós, Iliana; Monge-Bonilla, Cecilia
Wilson’s disease is an inherited disorder in which defective biliary excretion of copper leads to its accumulation, particularly in the liver and brain. Mutations in the ATP7B gene on chromosome 13 cause Wilson’s disease. If left untreated it will cause liver failure, neurological damage, and will be life threatening. It is considered a rare disease afflicting approximately 1 in 30,000 persons worldwide, although this rate is similar in the different countries some places show higher incidence rates. Since Costa Rica reports the highest number of cases per population, essential public health initiatives that promote wellbeing, prevent disease complications, and prolong life among the affected population have been carried out during the last decades. The most recent lead in this matter is the conformation of the Costa Rica’s National Alliance for Wilson’s disease whose main objective is to provide practical, operational, timely and relevant guidance to patients, families, and healthcare professionals in the region for early diagnosis and treatment. The development and implementation of the National Alliance for Wilson’s disease activities is crucial because it will reaffirm that early intervention and appropriate treatment, will reduce if not eliminate the burden of Wilson’s disease
Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study
(Los autores, 2022) Gracia, Fernando; Ramírez, Deyanira; Parajeles-Vindas, Alexander; Díaz, Alejandro; Díaz de la Fé, Amado; Ramírez Sánchez, Nicia Eunice; Castro Escobar, Romy; García Valle, Luis Alberto; Weiser, Roberto; Santos, Biany; Candelario, Awilda; Benzadon, Aron; Araujo, Pahola; Valderrama, Carlos; Larreategui, Mario; Carrillo, Gabriela; Gracia, Karla; Vázquez-Céspedes. Johana; Monterrey-Alvarez, Priscilla; Carazo-Céspedes, Kenneth; Sanabria-Castro, Alfredo; Miranda-Loria, Gustavo; Balmaceda-Meza, Andrea; Portillo Rivera, Ligia Ibeth; Olivera Leal, Irma; Rodriguez Salinas, Luis Cesar; Thompson, Arnold; López Torres, Ericka; Pereira, Daniel Enrique; Zepeda, Carolina; Abdón López, César; Cornejo Valse, Ernesto Arturo; Corea Urbina, Karla Zinica; Urrutia, Marco Antonio; Van Sijtveld, Ivonne; Armien, Blas; Rivera, Victor M
Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0–52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren’s syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0–3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08–0.41) and 0.73/100,000 (incidence 0.02–0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region