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 18

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Microtia, Hearing Disability, and Health Inequity: Socioeconomic Disparities in Rehabilitation and Specialized Care in Ecuador
(MDPI AG, 2026-07-25)
González Andrade, Fabricio
;
Coello, Fausto
;
Vásconez, Henry
Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. © 2026 by the authors.
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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.
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Demographic, Functional, and Risk Factors Characterization in Ecuadorian Mestizo Patients With Microtia: A Retrospective Study
(2024)
González Andrade, Fabricio
;
Fausto Coello
;
Ramiro López-Pulles
;
Guillermo Fuenmayor
;
Edwin Andrade
Objective: This paper compares demographic, morphological, functional, and risk factors between isolated and familial forms of microtia in Ecuadorian mestizo patients. Methods: The authors did an epidemiological, and retrospective study with 112 patients divided into isolated microtia (n = 91) and familial microtia (n = 21). Patients with syndromic microtia were not included. Results: In isolated microtia, the mean age was 11.80 ± 16.9, and the most prevalent age group was from 5 to 9 years, with 45.0%; males were 58.2%, and 91.2% of patients were born in a city above 2500 meters about sea level. In familial microtia, the mean age was 15.57 ± 17.2. There were no statistically significant differences between the analyzed variables. In isolated microtia, 41.8% of patients had bilateral involvement, 40.7% had grade 1 microtia in the right ear (RE), and grade 1 in the left ear was 47.3%; external auditory canal atresia of RE was present in 62.6%, and in left ear in 31.6%. External auditory canal atresia sidedness was mostly unilateral in both groups. Most patients did not have tags or pits (78% and 81% in RE and 85.7% and 71.4%). Most patients had moderate hearing loss in both ears. Conclusion: The authors found an association between both microtia forms with external auditory canal atresia in RE; only 20% of patients had unilateral auricular tags or pits in both groups. The authors also found a high incidence (18.75%) of familial microtia, which suggests a distinct pathological genetic component than the more prevalent isolated cases. The authors found a high association of microtia cases from the Ecuadorian highlands above 2500 meters about sea level (over 90%). The presence of “social” intake of alcohol during pregnancy showed over twice the chance of having a child born with microtia.
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Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients
(2025)
Julio Quispe-Alcocer
;
Antonio Biroli
;
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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Time-to-treatment in traumatic brain injury: unraveling the impact of early surgical intervention on patient outcomes
(2025)
María Inés Egas Terán
;
González Andrade, Fabricio
Background: Traumatic brain injury (TBI) remains a major public health concern due to its high morbidity and mortality. The ‘golden hour’ principle suggests that outcomes improve with rapid access to definitive care. However, the role of prehospital transport time in TBI prognosis remains unclear, particularly in resource-limited settings. This study evaluates the relationship between hospital arrival time and functional prognosis in TBI patients. Methods: A cross-sectional observational study was conducted in two Ecuadorian trauma centers from 2017 to 2020. Patients were categorized into early (<8 h) and late (>8 h) hospital arrival groups. Demographic, clinical, radiological, and surgical variables were analyzed. The primary outcome was functional prognosis, measured by the Glasgow Outcome Scale (GOS) at hospital discharge. Logistic regression was used to adjust for confounding variables. Results: A total of 373 TBI patients were analyzed. The early-care group presented with more severe injuries, lower Glasgow Coma Scale (GCS) scores, and higher rates of abnormal pupillary responses. Late-arriving patients had better initial neurological status and were more likely to have received prehospital stabilization. Surgical intervention was delayed in both groups, with 67.8% of early-care patients undergoing surgery 8–24 h post-trauma. Adjusted analysis showed no significant difference in functional outcomes between early and late-care groups (OR 1.95, p = 0.08). Conclusion: Hospital arrival time alone does not significantly influence TBI outcomes. Instead, prehospital stabilization, initial GCS, and timely surgical intervention are stronger prognostic factors. Trauma care strategies should prioritize improving prehospital management and reducing in-hospital delays rather than strictly adhering to the ‘golden hour’ paradigm.
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Grading the damage: Prognostic significance of diffuse axonal injury severity and hemorrhagic lesions in traumatic brain injury outcomes
(2025)
Nanci Estefanía Bayas-Almeida
;
González Andrade, Fabricio
Background: Diffuse axonal injury (DAI) is a key determinant of prognosis in traumatic brain injury (TBI), yet the interaction between DAI severity and associated hemorrhagic lesions is not well defined, especially in low- and middle-income countries (LMICs). Methods: We conducted a retrospective cohort study of 283 adults with moderate-to-severe TBI admitted to a tertiary hospital in Ecuador (2019–2023). DAI severity was graded anatomically using CT or MRI, and patients were stratified by the presence of hemorrhagic lesions. Demographic, clinical, metabolic, and radiological variables were collected. Outcomes were evaluated at 6 months with the Glasgow Outcome Scale–Extended (GOS-E). Logistic and ordinal regression models identified predictors of mortality and disability. Results: Of 283 patients, 141 had isolated DAI and 142 had DAI with hemorrhage. Baseline demographics were similar. Patients with hemorrhagic lesions had lower median Glasgow Coma Scale scores (6 vs 9, p < 0.001), more frequent hyperglycemia (15.5 % vs 7.1 %, p = 0.045), and greater surgical needs (77.5 % vs 16.3 %, p < 0.001). Complications, including pneumonia and central nervous system infections, were more frequent in the hemorrhagic group (63.9 % vs 45.7 %, p < 0.001). At 6 months, functional outcomes were significantly worse with hemorrhage (median GOS-E 7 vs 8, p < 0.001). Multivariable regression identified Grade III DAI as the strongest predictor of mortality (OR 20.02, 95 % CI 7.99–50.15) and disability (OR 71.59, 95 % CI 23.11–221.77). Hemorrhagic lesions predicted poor functional recovery (OR 2.08, 95 % CI 1.24–3.48) but not mortality. Conclusions: DAI grading is the most powerful prognostic factor in severe TBI, while hemorrhagic lesions primarily worsen disability. In LMICs, CT-based assessment remains essential for prognostic stratification and guiding rehabilitation strategies.
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Rituximab-associated cryptococcal meningitis in systemic lupus erythematosus: A case report
(2026)
Sheyla Cadena
;
Ricardo Bedón-Galarza
;
Miguel Cachumba
;
González Andrade, Fabricio
;
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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Angiographic Predictors of Intracranial Aneurysm Rupture: A Morphological and Epidemiological Study in Ecuadorian Patients
(2025)
Luis Nuñez-Del-Arco
;
González Andrade, Fabricio
;
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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A comprehensive study of Ecuadorian adult patients with a mild and moderate presentation of COViD-19
(2023)
González Andrade, Fabricio
;
Carrero Y.
Aim To characterize non-hospitalized patients with mild and moderate clinical presentation. Methods We performed an epidemiological, observational, descriptive, and cross-sectional study carried out in Ecuador, with 1,447 participants between 18 and 66 years, non-hospitalized, with a molecular RT-PCR test for SARS-CoV2. We analyzed demographic characteristics according to sex, age group, clinical findings, behavior after diagnosis, family and social behavior, sequelae, clinical evolution, type of exposure, and personal history. Results The sample analyzed had a mean age of 37 years (95% CI 18–66), women 713 individuals (49.27%), men 733 individuals (50.66%). Age group distribution was 18–30 years, 524 individuals (36.29%), 31–45, 538 individuals (37.26), and more of 45 years, 382 individuals (26.46%). 1416 individuals were mestizos (97.99%). According to the province of residence from Pichincha were 1019 patients (70.52%), followed by Imbabura, 93 patients (6.44%), and the others 335 (23.15%) patients come from all over the country. In women, the most common findings were fever >38C (54.40%), sputum (27.43%) and hypoxia (16.32%); HTN (5.75%) and hypercholesterolemia (3.69%). Men were more prevalent in all other findings. Comorbidities were more prevalent in all those over 45 years of age. COVID-19 antibodies test was positive in 416 patients (28.85%). Neuropsychiatric symptoms such as sleep disorders, generalized anxiety disorder, depressed mood, and chronic fatigue were more prevalent in men than women. Still, generalized anxiety disorder and chronic fatigue were more common in individuals of 31 to 45 years. 868 patients (60.07%) were in contact with a known infected person, 318 patients (22.02%) were health workers, and 782 patients (57.63%) were informed about work exposure. 545 patients (37.72%) were overweight, primarily women 310 (42.29%). 609 patients (42.65%) showed symptoms after the acute period, and 331 individuals (23.49%) reported some sequelae. Conclusion The epidemiological and clinical behavior of hospitalized and critical patients differs greatly from ambulatory or mild or moderate symptoms. It is essential to highlight those non-hospitalized patients constitute the predominant population of patients, hence the importance of adequate management that would directly affect the development of complicated forms and, consequently, the collapse of healthcare centers. It is vitally important to open more investigations that compare hospitalized and outpatient patients to have a clearer picture of the epidemic. Copyright: © 2023 González-Andrade, Carrero. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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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
;
Germán Abdo-Sarras
;
Franz Durán
;
Carlos Flores-Enderica
;
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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González Andrade, Fabricio

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