González Andrade, Fabricio

Preferred name

Main Affiliation

Facultad de Ciencias de la Salud y Bienestar Humano

Quito

fabriciogonzalez@uti.edu.ec

ORCID

0000-0002-2091-9095

Scopus Author ID

8720668100

Now showing 1 - 10 of 21

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Distinguishing Isolated From Familial Microtia: Demographic, Clinical, and Anatomical Insights From Ecuador
(SAGE Publications, 2026-06-29)
González Andrade, Fabricio
;
Coello, Fausto
;
Ortiz-Campoverde, Pamela Estefanía
;
Vásconez, Henry
;
Aguinaga-Romero, Gabriela
Background: Microtia is a congenital defect of the external ear, ranging from structural auricular deficiency to anotia, and is frequently associated with hearing impairment. Its prevalence varies geographically, with notably higher rates reported in high-altitude regions of Ecuador. However, clinical, and anatomical comparisons between isolated and familial microtia in Ecuador remain limited. Objective: To analyze the demographic, clinical, and anatomical characteristics of Ecuadorian patients with microtia, emphasizing differences between isolated and familial cases. Methods: A cross-sectional observational study was conducted in 2024, including 146 patients with confirmed microtia. Patients were classified as isolated or familial according to family history. Demographic, clinical, anatomical, and audiological variables were collected. Minor auricular findings, including auricular nodules, preauricular sinus, Darwin tubercle, and prominent ear, were recorded separately as associated anatomical observations and were not considered diagnostic criteria or severity indicators. Data were analyzed using descriptive statistics, chi-square, and Mann-Whitney tests, and multivariate logistic regression. Results: Median age was 10 years (IQR 8-14), with no significant age differences between groups. Isolated microtia was more frequent in males than familial microtia (72.32% vs 52.94%; P = .034). Familial cases showed more Grade 1 right-ear microtia (26.7% vs 11%; P = .003), whereas isolated cases more commonly presented Grade 3 microtia. Left auricular nodules, or mamelons, were significantly associated with isolated microtia (P = .024; OR = 8.07; 95% CI: 1.05-62.24). Conclusion: Isolated and familial microtia showed distinct demographic and anatomical patterns. Auricular nodules were associated with isolated microtia but should be interpreted as associated anatomical findings, not diagnostic or severity markers. © The Author(s) 2026
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Reflux Grade Is Associated with Postoperative Outcomes After Ureteral Reimplantation in Children: A Retrospective Cohort Study from a Middle-Income Healthcare Setting
(MDPI AG, 2026-06-29)
Canelos-Dueñas, Andrea
;
González Andrade, Fabricio
Background: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder associated with recurrent febrile urinary tract infections, renal scarring, hypertension, and potential long-term renal morbidity. Postoperative outcomes after ureteral reimplantation may be influenced by reflux grade, reflux etiology, bladder function, renal status, operative technique, surgeon experience, and follow-up intensity. However, real-world evidence from low- and middle-income healthcare settings remains limited, particularly for surgically treated children with high-grade VUR. Objective: To describe postoperative outcomes after ureteral reimplantation in children with Grade III–V VUR and to explore the association of VUR grade and surgical approach with reflux resolution, recurrence, and reintervention in a surgically selected pediatric cohort. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Ecuador. The study included 90 children aged 0 to 15 years with Grade III–V VUR confirmed by voiding cystourethrography who underwent open or laparoscopic ureteral reimplantation between January 2019 and January 2024. Demographic, clinical, imaging, and surgical variables were extracted from medical records. Postoperative outcomes included reflux resolution, recurrence, and reintervention. Logistic regression models were used as exploratory analyses only. Because the cohort included only operated patients, treatment allocation was nonrandomized, event numbers were limited, and several relevant prognostic variables were incompletely documented, adjusted estimates were interpreted cautiously and were not used to infer causality. Results: Overall reflux resolution was achieved in 68 of 90 patients (75.6%), recurrence occurred in 12 patients (13.3%), and reintervention was required in 8 patients (8.9%). Resolution rates were similar after open and laparoscopic surgery (44/59, 74.6% vs. 24/31, 77.4%; p = 0.766). Recurrence was numerically lower after laparoscopic than open reimplantation, but the difference was not statistically significant (2/31, 6.5% vs. 10/59, 16.9%; p = 0.164). Reintervention rates were also similar between groups (3/31, 9.7% vs. 5/59, 8.5%; p = 0.849). In exploratory multivariable analysis, Grade V VUR was associated with lower odds of reflux resolution (OR, 0.06; 95% CI, 0.01–0.40; p = 0.003) and higher odds of recurrence (OR, 16.69; 95% CI, 1.88–148.32; p = 0.012) compared with Grade III VUR. Surgical approach was not independently associated with resolution, recurrence, or reintervention. The small Grade V subgroup, the limited number of recurrence and reintervention events, and the wide confidence intervals indicate substantial statistical imprecision. Conclusions: In this surgically treated pediatric cohort from a tertiary referral center in Ecuador, ureteral reimplantation was associated with reflux resolution in approximately three-quarters of patients. Higher reflux grade, particularly Grade V disease, was associated with less favorable postoperative outcomes in exploratory analyses, but these findings should not be interpreted as causal or definitive because of the small subgroup size, limited event numbers, selection bias, and incomplete documentation of reflux etiology, bladder dysfunction, renal scarring, renal function, surgeon experience, and follow-up duration. Open and laparoscopic approaches showed comparable resolution and reintervention rates, while the lower recurrence observed after laparoscopy did not reach statistical significance. Future prospective studies should standardize outcome definitions, distinguish imaging-confirmed from clinically documented resolution, report follow-up duration, and account for reflux etiology, bladder function, renal status, surgical experience, and healthcare access. © 2026 by the authors.
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Association of opioid-based and opioid-free multimodal analgesia with hospital length of stay and postoperative pain in outpatient aesthetic plastic surgery: a retrospective cohort study
(Elsevier BV, 2026-11)
Jarrín-Navarro, Stephanie
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González Andrade, Fabricio
Background: Outpatient aesthetic plastic surgery has expanded significantly, increasing the importance of effective perioperative pain management strategies. Multimodal analgesia is widely used to improve postoperative outcomes and reduce opioid exposure; however, evidence comparing opioid-based and opioid-free approaches in real-world ambulatory plastic surgery settings remains limited. Objective: To evaluate the association between opioid-based and opioid-free multimodal analgesia and postoperative pain and hospital length of stay in patients undergoing outpatient aesthetic plastic surgery under general anesthesia. Methods: A retrospective cohort study was conducted including 208 patients undergoing outpatient aesthetic plastic surgery between November 2022 and March 2024 in Quito, Ecuador. Patients were classified into opioid-free or opioid-based multimodal analgesia groups (n = 104 each) based on intraoperative anesthetic records. Primary outcomes included postoperative pain and hospital length of stay. Analyses included descriptive statistics, regression models, and stratification by surgical group to address procedural heterogeneity. Results: Baseline characteristics differed between groups, particularly in surgical procedure type, age, body mass index, and comorbidities. Opioid-based multimodal analgesia was associated with higher odds of moderate pain at operating room exit (OR 21.15, 95% CI 9.76–45.84) and at 15 min (OR 3.91, 95% CI 1.22–12.52), increased need for rescue analgesia (OR 2.57, 95% CI 1.20–5.49), and prolonged hospital length of stay (OR 5.42, 95% CI 2.36–12.45). These associations remained significant in multivariable models for most outcomes. Stratified analyses by surgical group showed consistent associations, although effect sizes varied according to procedure type. Conclusion: Multimodal analgesic strategy was associated with differences in postoperative pain and hospital length of stay in outpatient aesthetic plastic surgery. Opioid-based regimens were more frequently used in more extensive procedures and were associated with worse early postoperative outcomes, whereas opioid-free strategies were predominantly used in less invasive procedures. These findings highlight the importance of procedure-specific and patient-centered analgesic approaches. Due to the observational design and baseline heterogeneity, results should be interpreted as associative rather than causal. © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/
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Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients
(2025)
Julio Quispe-Alcocer
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Antonio Biroli
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González Andrade, Fabricio
Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates the impact of arrival time on mortality, disability, and clinical outcomes in Ecuadorian patients with TBI. A cross-sectional and observational study was conducted, analyzing 383 adult patients diagnosed with TBI. Patients were categorized into two cohorts: those who arrived at a specialized trauma unit within five hours post-injury and those who arrived between five and 24 h. Demographic, clinical, and radiological characteristics were analyzed, including Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Marshall Scale classification, and presence of subarachnoid hemorrhage (SAH). Logistic regression models were used to identify predictors of mortality and disability. Longer transfer times were associated with increased mortality (3.34 times higher for ≥5 h, p < 0.05) and disability (2.92 times higher for ≥5 h, p < 0.05). Patients with Marshall Diffuse Injury III and IV had an 8.80- and 9.05-fold increased risk of mortality, respectively. SAH was an independent predictor of mortality (4.53 times higher), and GCS between 9–13 increased the likelihood of death by 6.49 times. Delayed transfers were associated with lower GCS at admission, longer ICU stays, and increased surgical complications. Although some survivors experienced improvement over time, disability in TBI can persist for many years or even lifelong, underscoring the burden of delayed trauma care. Despite delays, overall survival remained higher than reported in high-income countries, suggesting compensatory factors in hospital-based management. Delayed hospital arrival in TBI patients significantly increases mortality and disability. Early transfer within five hours is essential to reduce secondary brain injury and improve functional outcomes. Findings suggest that in resource-limited settings, optimizing pre-hospital care and transport efficiency is crucial to minimizing long-term disability.
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Rituximab-associated cryptococcal meningitis in systemic lupus erythematosus: A case report
(2026)
Sheyla Cadena
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Ricardo Bedón-Galarza
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Miguel Cachumba
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González Andrade, Fabricio
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Lucy Baldeón-Rojas
We report a 41-year-old woman with systemic lupus erythematosus who developed cryptococcal meningitis five months after a second rituximab cycle. Initial symptoms mimicked an SLE flare, delaying diagnosis. Worsening neurologic deficits prompted lumbar puncture, revealing findings consistent with fungal meningitis and CSF culture positive for Cryptococcus neoformans. Treatment with amphotericin B and fluconazole resulted in clinical improvement, highlighting the diagnostic challenges and the need for early evaluation in immunosuppressed SLE patients. © 2026 The Authors
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MRI reveals scoliosis as a silent driver of lumbar facet joint degeneration in aging Ecuadorian adults
(2025)
Pablo Cueva-Medina
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Jorge Silva-Hidalgo
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González Andrade, Fabricio
Lumbar facet arthropathy (LFA) is a degenerative condition of the facet joints that contributes significantly to chronic low back pain (CLBP) yet remains underrecognized in standard diagnostic protocols. While aging and disc degeneration are established factors in the progression of LFA, the potential role of spinal deformities such as scoliosis has not been thoroughly investigated. This cross-sectional study examined the association between scoliosis severity and LFA in a non-surgical population of 284 Ecuadorian adults aged 30 to 80 years. Participants were classified by Cobb angle into normal, mild, moderate, and severe scoliosis categories and underwent MRI to assess facet joint degeneration at the L3–L4, L4–L5, and L5–S1 levels. Findings revealed that moderate scoliosis significantly increased the odds of severe LFA across all lumbar levels, particularly at L3–L4 (OR = 6.72) and L5–S1 (OR = 5.57). Mild scoliosis also posed a notable risk, with a threefold increase at L4–L5 and a twofold increase at L5–S1. Additionally, degeneration was more severe on the concave side of the scoliotic curve. Older age and female sex were also independently associated with more advanced degeneration. These results suggest that scoliosis, even in its mild forms, plays a significant role in the development and progression of LFA. The findings highlight the importance of including facet joint evaluation in routine scoliosis assessment and CLBP workups, particularly using MRI. Early identification of individuals at risk could inform preventive strategies and reduce long-term disability related to degenerative spinal disease.
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Angiographic Predictors of Intracranial Aneurysm Rupture: A Morphological and Epidemiological Study in Ecuadorian Patients
(2025)
Luis Nuñez-Del-Arco
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González Andrade, Fabricio
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Gabriel Flores-Enderica
;
Franz Durán-Carrillo
;
Germán Abdo-Sarras
Intracranial aneurysms (IAs) pose a significant public health threat due to their potential to rupture, causing subarachnoid hemorrhage (SAH) and high rates of morbidity and mortality. In Ecuador, limited access to endovascular treatment heightens the need for early risk identification. To analyze the morphological and demographic characteristics associated with aneurysm rupture in Ecuadorian patients and to develop a predictive model for rupture risk. A retrospective, cross-sectional study was conducted involving 236 patients with 302 intracranial aneurysms diagnosed at a tertiary center in Quito, Ecuador. Data collected included demographics, comorbidities, aneurysm morphology (size, angulation, location), and treatment approach. Logistic regression was used to identify rupture predictors, and a predictive model was developed. The mean age was 48.42 years; most patients were female (69.49%) and mestizo (98.3%). Hypertension was the most common comorbidity (41.1%). Rupture was observed in 72.45% of aneurysms, with SAH being the most frequent presentation. Aneurysms in the PComm (OR: 2.71, p < 0.001) and AComA (OR: 3.63, p = 0.001), with a length > 4.43 mm (OR: 3.68, p = 0.0001) or Type 2 angle (45–90°, OR: 1.81, p = 0.01), had significantly higher rupture risk. The final model showed 64.6% accuracy (AUC: 0.692). Morphological features are strong predictors of rupture and may guide early intervention. The proposed model is simple and practical, with potential for integration into triage protocols, especially in resource-limited settings. These findings highlight the importance of morphology-based risk assessment in improving aneurysm outcomes.
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Does living in the Andes make cerebral arteriovenous malformations more dangerous? high altitude fails to predict hemorrhage in a large Ecuadorian cohort
(2026)
Frank David Chamba-Vozmediano
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Germán Abdo-Sarras
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Franz Durán
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Carlos Flores-Enderica
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Tatiana Lemos-Garrido
Background: Chronic residence at high altitude (≥2500 masl) induces sustained physiological adaptations in cerebrovascular regulation, including hypoxia-driven angiogenesis, altered hemodynamics, and vascular remodeling. These mechanisms support the hypothesis that lifelong exposure to hypobaric hypoxia in the Ecuadorian Andes could modify the clinical presentation of cerebral arteriovenous malformations (AVMs), although direct evidence remains limited. Objective: To evaluate whether chronic residence at high altitude is associated with hemorrhagic presentation of cerebral AVMs in adult patients treated at a national tertiary referral center in Quito, Ecuador. Methods: We conducted an observational, cross-sectional study of 229 adults diagnosed with cerebral AVMs by digital subtraction angiography between 2016 and 2023. Demographic characteristics, residential altitude during early life (first 18 years) and recent adulthood (preceding 10 years), vascular risk factors, AVM intrinsic vascular morphological features, and Spetzler–Martin and Spetzler–Ponce classifications were analyzed. Associations with hemorrhagic presentation at diagnosis were assessed using chi-square or Fisher’s exact tests, Student’s t-tests, and descriptive modeling. Multivariable regression was explored but not performed due to limited variability in altitude exposure and collinearity among anatomical predictors. Results: Hemorrhagic presentation occurred in 61.1% of patients. >80% of the cohort resided at high altitude during both exposure periods. No statistically significant association was observed between high-altitude residence, either during early life or recent adulthood, and hemorrhagic presentation (p > 0.05). In contrast, intrinsic vascular morphological features showed significant associations with hemorrhage, including deep or subcortical nidus location and higher Spetzler–Martin and Spetzler–Ponce grades (p < 0.05). Traditional vascular risk factors, including hypertension and smoking, did not differ between altitude exposure groups. Conclusion: In this predominantly high-altitude Andean cohort, chronic residence at high altitude was not detectably associated with hemorrhagic presentation of cerebral AVMs. Instead, established intrinsic vascular morphological features remained the dominant predictors of rupture at diagnosis. Given the homogeneity of altitude exposure, these findings likely reflect limited power to detect subtle effects rather than definitive absence of an altitude influence. Multicenter studies with broader altitude variability, physiological markers of hypoxia, and longitudinal follow-up are needed to further clarify the role of environmental hypoxia in AVM natural history. © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/
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Hearing Loss Profiles in Sporadic and Familial Microtia: Clinical Insights From an Ecuadorian Cohort
(2025)
González Andrade, Fabricio
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Fausto Coello
;
Edwin Andrade
;
Henry Vásconez
Microtia is a congenital anomaly of the external ear that often leads to hearing loss due to associated auditory canal and middle ear malformations. While right‐ear predominance and conductive hearing loss are well‐documented, few studies have compared anatomical and audiological differences between sporadic and familial cases, especially in underrepresented populations.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To compare the clinical, anatomical, and auditory characteristics of patients with sporadic versus familial microtia in an Ecuadorian cohort.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cross‐sectional study was conducted on 146 patients with microtia, classified as either sporadic or familial. Demographic, clinical, and risk factor data were collected through structured interviews. Audiological evaluations included auditory evoked potentials, otoacoustic emissions, tympanometry, pure‐tone audiometry, and speech audiometry, based on patient age and canal patency. Statistical analysis included Mann–Whitney U and Chi‐square tests (<jats:italic>p</jats:italic> < 0.05).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Right‐ear involvement was most common (45.45%). Grade 3 microtia was the most prevalent, while Grade 4 was observed exclusively in familial cases. Conductive hearing loss predominated (74.67% left ear, 83.33% right ear). Although no significant differences in hearing loss type or severity were found between groups, familial cases showed a trend toward more severe impairment. Otoacoustic emissions and stapedial reflexes were more frequently absent in right ears. Pure tone perception and speech recognition were also more impaired on the right side.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Microtia is most commonly right‐sided and associated with significant conductive hearing loss. Familial cases may present with more severe features. Early diagnosis and intervention are essential to mitigate developmental consequences, particularly in resource‐limited settings.
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Predictors of in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Ecuador
(Springer Science and Business Media LLC, 2026-06-16)
Noboa-Salgado, Mariana
;
González Andrade, Fabricio
Background: Neonatal mortality remains a major challenge in low- and middle-income countries, where locally derived evidence from neonatal intensive care units is limited. We aimed to identify factors associated with in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Quito, Ecuador, and to evaluate an internally validated mortality prediction model. Methods: We conducted a retrospective cohort study of inborn neonates aged ≤ 28 days admitted to the NICU of Isidro Ayora Gynecology and Obstetrics Hospital from January 1 to December 31, 2022. Maternal, perinatal, neonatal, early clinical severity, laboratory, respiratory support, clinical course, and resource utilization variables were extracted from medical records. The primary outcome was in-hospital mortality. Bivariate analyses and multivariable logistic regression were performed. Model performance was assessed using discrimination, calibration, bootstrap internal validation, and decision curve analysis. Results: Among 220 critically ill neonates, 87 (39.5%) died. Small-for-gestational-age status was independently associated with mortality after adjustment for birth weight category, gestational age, sex, congenital malformations, and antenatal corticosteroid exposure (adjusted OR, 2.57; 95% CI, 1.29–5.14; P=.01). Birth weight < 1400 g was associated with greater clinical severity and resource use but not independently with mortality. Early hemodynamic instability, metabolic acidosis, higher lactate, higher FiO₂, thrombocytopenia, and higher oxygenation index were more frequent among non-survivors. The final model showed good discrimination (apparent AUC, 0.870; optimism-corrected AUC, 0.854) and acceptable calibration. Among survivors, each additional day of invasive mechanical ventilation was associated with longer NICU stay. Conclusion: In this tertiary Ecuadorian NICU cohort, small-for-gestational-age status was independently associated with mortality. These findings support fetal growth assessment, early severity evaluation, and locally validated neonatal risk stratification. © The Author(s) 2026.

González Andrade, Fabricio

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