Browsing by Autor "Delly Espejo-Alanoca"

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Attention Deficit Hyperactivity Disorder: Advances in Epidemiology, Pathogenesis, and Neurobiology
(2025) Freddy Ednildon Bautista-Vanegas; Rodolfo R. Rosales; Ingrid Neysa Cabezas-Soliz; Daniel Ramiro Elías Vallejos-Rejas; Carmen Julia Salvatierra Rocha; Jhossmar Cristians Auza-Santiváñez; L. Castedo; Delly Espejo-Alanoca; Isaura Oberson Santander
Introduction. ADHD is a neurodevelopmental condition that affects approximately 5-7% of children and adolescents and persists in a significant number of cases into adulthood, with an estimated prevalence of 2.5% in adults globally. The impact goes far beyond school or work performance; it is associated with an increased risk of accidents, risky behaviors, comorbid disorders such as anxiety, depression, substance use disorders, and a significant reduction in quality of life. Methods. A search was conducted in the databases SciELO, Scopus, PubMed/MedLine, Google Scholar, Cochrane Library, as well as Clinical Keys services. The search terms for the search formulation were "ADHD", "Attention Deficit Disorder", "Hyperactivity", "depression", "autism spectrum", "anxiety", as well as their translations into English. Results. The reported prevalence of ADHD in children ranges from 2 to 18 percent depending on the diagnostic criteria and the population studied. The prevalence in school-aged children is estimated to be between 9 and 15 percent, making it one of the most common childhood disorders. Possible etiological factors include comorbid disorders, oppositional defiant disorder, conduct disorder, anxiety disorder, depression, developmental coordination disorder, autism spectrum disorder, and sleep disorders. Conclusion: ADHD constitutes a complex neurodevelopmental condition whose impact transcends clinical boundaries to become a multifaceted challenge for public health, neuroscience, and social justice.
Impact of Altitude on Cardiovascular Physiology: Literature Review and Update
(2025) Jhossmar Cristians Auza-Santiváñez; Henrry Temis Quisbert Vasquez; Freddy Ednildon Bautista-Vanegas; Delly Espejo-Alanoca; Ponciano Chiri-Chambi; Victor Hugo Mamani Huarachi; Benito Aguirre-Cruz; Katrin Daniela Sivila-Marquez; Jose Luis Diaz-Guerrero
Introduction: More than 140 million people in the world live at high altitudes, above 2,500 meters (m) above sea level. Oxygen is vital for cellular metabolism; therefore, hypoxic conditions found at high altitude affect all physiological functions. Metods: A search for information was carried out in the SciELO, Scopus, PubMed/MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. Advanced search strategies were used to retrieve the information, by structuring search formulas using the terms "Cardiovascular Physiology", "Cardiovascular Physiology at Altitude", as well as their translations into Spanish " Fisiología Cardiovascular " and " Fisiología Cardiovascular en la altitud ". Results discussion: The heart is composed of three main types of cardiac muscle: atrial muscle, ventricular muscle, and specialized excitatory and conductive muscle fibers. The efficiency and work of the heart as a pump is often measured in terms of cardiac output, or the amount of blood the heart pumps per minute. Cardiac output is the product of stroke volume and heart rate Cardiovascular Changes at Altitude It is possible to think of the goal of acclimatization as maintaining oxygen delivery to the tissues as close to normal as possible. The cardiovascular system is central to this. Acute exposure to high altitude produces an increase in heart rate and cardiac output both at rest and for a given amount of work compared with sea level. In general, the normal heart tolerates even severe hypoxia very well. The heart, as a hemodynamic pump, has two mechanisms at its disposal to enhance its performance: heart rate and stroke volume, which together constitute cardiac output. The altitude electrocardiogram shows a variably increased amplitude of the P wave, deviation of the QRS axis to the right, and signs of right ventricular overload and hypertrophy. Conclusions: Advances in high-altitude research have shown that the cardiovascular system deploys some efficient mechanisms of acclimatization to oxygen deprivation, and the healthy heart adapts to hypoxia, even when severe, with preservation of systolic function and only minor impairment of LV and RV diastolic function. With acclimatization, desensitization of the adrenergic system, together with increased parasympathetic influence, leads to a decrease in maximum heart rate and protection of the myocardium against potentially damaging energy imbalances. Acute exposure to high altitude stimulates the adrenergic system, increasing heart rate and cardiac output; although arterial pressure remains stable, pulmonary artery pressure increases due to hypoxic pulmonary vasoconstriction. Our improved understanding of the effect of altitude hypoxia on the cardiovascular system will allow better-informed, evidence-based advice for patients with pre-existing cardiovascular disease
Knowledge, attitudes and behaviors regarding nutrition among students of the School of Public Health - Tekove Katu in Bolivia
(2025) Paola Kattya Barrientos Lujan; Blas Apaza-Huanca; Iris Ingrid Carrillo-Campos; Benito Aguirre-Cruz; Delly Espejo-Alanoca; Rodolfo R. Rosales; Lisbet Carolay Cordova Mamani; Jhossmar Cristians Auza-Santiváñez
Introduction: Food is an essential component in the socio-cultural and economic context of communities. In Bolivia, malnutrition and food security problems are prevalent, especially in indigenous communities. The "Tekove Katu" Health School is an ideal setting for the implementation of nutritional education programs, given its intercultural approach and the potential impact on the food practices of students and their communities.Methods: Study design: Descriptive, cross-sectional observational study in students from indigenous communities during the month of February - December 2023. Universe and sample: 100% of students enrolled in 2023 were included. Exclusion criteria: Not wanting to participate in the research Not attending during the days in which the questionnaire was applied. Procedure: The data were collected through a self-administered questionnaire.Results and discussion: The results indicated that 82.55% of the participants expressed an appropriate conceptualization of healthy eating; However, a significant dissonance was evident between theoretical understanding and eating behaviors. Consumption patterns characterized by a dichotomy between the recognition of nutritional principles (91.86% expressed interest in healthy eating) and suboptimal eating practices (95.38% consumption of sweets, 83.07% consumption of hamburgers).Conclusions: At the "TEKOVE KATU" Health School, there is a predominance of the female gender and a higher concentration of students in the age range of 17 to 19 years. The parents of the students have a low educational level, and most of the students live with more than four people. A positive attitude towards the interest in eating healthily is highlighted, although a preference for foods rich in fats, refined sugars and sodium is also observed, despite recognizing that these are unhealthy. A large majority of students receive limited and unreliable information on food and nutrition, which highlights the need for a more solid nutritional education. It is clear that, in the absence of nutritional education and healthy eating programs, students do not have a solid foundation to consolidate healthy eating habits, which constitutes a public health problem with implications for morbidity and mortality, quality of life, health expenditure and an increase in chronic non-communicable diseases
Overweight, Obesity and High Blood Pressure: Early Atherogenic Signs in Children Aged 3 to 7 Years
(2025) Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; Ingrid Neysa Cabezas-Soliz; Henrry Temis Quisbert Vasquez; Yenifer Zelaya-Espinoza; Jorge Márquez-Molina; Delly Espejo-Alanoca; Paola Kattya Barrientos Lujan; Isaura Oberson Santander
Introduction: Human atherosclerosis has been considered for centuries as one of the greatest predators of health, its distribution on the planet is so wide that it overwhelmingly surpasses any other pathological process and reaches epidemic proportions, both in economically developed populations and in the process of becoming so.Objective: To identify the presence of overweight, obesity and arterial hypertension as early signs of atherosclerosis in children aged 3-7 years.Methods: A descriptive-analytical cross-sectional epidemiological study was carried out in 5 clinics of the "19 de abril" University Polyclinic, in the Plaza de la Revolución municipality, Havana City, during the period 2022-2023. The sample consisted of 152 children aged 3 to 7 years who met the inclusion criteria. The data were collected using the new model (AtecomR) and stored in an automated database in Microsoft Access. Statistical processing was performed using the SPSS statistical package, through a Toshiba Intel (R) Pentium IV microprocessor.Conclusion: This study constitutes a preamble for other investigations that address the problem of cardiovascular disease from the perspective of intrauterine life. The results have provided certain evidence, which, together with a review of the literature, has allowed us to propose the following conclusions. A high frequency of obesity, overweight and high blood pressure levels was identified in the study population. It was observed that in the obese and overweight group they had a tendency to increase with age, being higher their frequency between five and six years respectively. It was shown that overweight and obesity in children were factors for the presence of alterations in blood pressure.
Pentalogy of Cantrell: A challenge in prenatal diagnosis. A case report in Bolivia
(2025) Benito Aguirre-Cruz; Jhossmar Cristians Auza-Santiváñez; Elizeth Mendoza-Contreras; R. Sarmiento; A. Léon; Delly Espejo-Alanoca; Blas Apaza-Huanca; Dilma Villca-Villca
Introduction. Pentalogy of Cantrell is a rare congenital anomaly with an incidence of less than one in 100,000 pregnancies. It is characterized by a defect in the abdominal wall at the level of the supraumbilical midline, the lower segment of the sternum, the anterior diaphragm, the diaphragmatic pericardium, and cardiac abnormalities such as ectopia cordis. Few cases of this entity have been reported in the literature in Bolivia. It is a constellation of congenital defects that pose a unique challenge, hence the importance of diagnosis in the prenatal stage. Clinical Case and Discussion. An 18-year-old pregnant woman came to our hospital, was consulted by Gynecology and Obstetrics, and an ultrasound was performed which revealed a defect in the anterior abdominal wall with viscera outside the fetal cavity (liver, heart, stomach and intestinal loops, 24.3 weeks of pregnancy and multiple fetal malformations. A discussion of the case was held with specialists in Gynecology and Obstetrics, Pediatrics, Genetics, Family Physician, Imaging and Psychology. Taking into account the poor prognosis and the complexity of the anomalies, the patient was told that this could represent a threat and risk for her. At the request of the parents and with prior informed consent, the patient was admitted to the gynecology service, prepared and admitted to the operating room for cesarean section. A female product was obtained, with multiple malformations, a large defect in the anterior thoracoabdominal wall from the navel to the upper third of the body of the sternum, omphalocele. Part of the heart outside the thoracic cavity, presence of a uterine cavity, and a large thoracic cavity. of defects in the diaphragm, liver and intestinal loops outside the abdominal cavity. Conclusions. The case highlights the importance of early prenatal diagnosis, even in settings with limited resources. Despite the lack of access to more complex studies, the appropriate use of ultrasound, combined with the expertise of the operator, allowed this complex congenital malformation to be identified at an early stage. The timely identification of these conditions not only facilitates multidisciplinary counseling for the pregnant woman and her family, but also opens the possibility of making informed decisions, including the option of terminating the pregnancy before the period of viability, if the parents so consider. In severe cases, such as ours, where the prognosis is generally unfavorable, an early diagnosis can better prepare families emotionally and psychologically, as well as allowing them to consider all possible options with due ethical and medical guidance.
Ramsay Hunt Syndrome in a Pediatric Patient with Atypical Presentation: Case Report
(2025) C. Roman; Paola Nielsen Fuentes Luzcuber; Jhossmar Cristians Auza-Santiváñez; Carmen Julia Salvatierra Rocha; Edson Grover Sañez Liendo; Henrry Temis Quisbert Vasquez; Mildred Ericka Kubatz La Madrid; Benito Aguirre-Cruz; Delly Espejo-Alanoca
The case of a preschooler with Ramsay Hunt Syndrome (RHS) is reported, an infrequent pediatric neurological condition caused by the reactivation of the varicella-zoster virus, whose atypical manifestation represented a diagnostic challenge. The patient, a 3-year and 4-month-old male, presented with vesicular lesions on the forehead and periorbital region, without the classic auricular rash, which led to a delayed diagnosis. Once RHS with bacterial superinfection was confirmed, acyclovir, prednisone, and antibiotics were administered, achieving a favorable evolution. The atypical presentation highlights the diagnostic challenges in children and the risk of delayed management. Therefore, it is crucial to maintain a high index of suspicion for RHS in pediatrics, even with unusual presentations, to ensure early treatment and prevent severe long-term complications.
Unraveling ADHD: Evidence, controversies, and new therapeutic opportunities
(2025) Fidel Aguilar-Medrano; Freddy Ednildon Bautista-Vanegas; Isis Scarleth Funes Galindo; Carmen Julia Salvatierra Rocha; Henrry Temis Quisbert Vasquez; Reyna Georgina Gonzales; Ingrid Neysa Cabezas-Soliz; Delly Espejo-Alanoca; Jhossmar Cristians Auza-Santiváñez
Introduction. ADHD is one of the most common neurodevelopmental disorders, affecting millions of children and adults worldwide. The significance of ADHD extends far beyond its prevalence. It impacts multiple areas of life, including academic achievement, job performance, relationships, and mental health. Significant challenges remain in terms of diagnosis and treatment. Methods. A search for information was conducted from January to June 2025 in the databases SciELO, Scopus, PubMed/MedLine, Google Scholar, Cochrane Library, as well as Clinical Keys services. From the resulting documents, those written in the last 10 years were selected; this time range was prioritized; some systematic reviews covered broader periods, such as the last 5 years, the last 10 years, or even did not apply a specific date limit. Conclusions. Attention-Deficit Hyperactivity Disorder (ADHD) represents a multifactorial challenge that transcends the clinical context to involve neurobiological, psychosocial, and cultural dimensions. Empowering patients and their families through psychoeducation strengthens understanding of the disorder, especially in vulnerable populations such as children, adolescents, and young adults. Investing in research, therapeutic innovation, and equitable public policies will be key to transforming ADHD care into a real opportunity to improve the quality of life for those who suffer from it.