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 14

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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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Maternal and neonatal outcomes among adolescent mothers in a high-risk NICU population in Ecuador
(2026)
Mónica Sánchez-Moreira
;
González Andrade, Fabricio
Background: Adolescent pregnancy remains a public health concern in Ecuador, particularly among socially vulnerable populations. Evidence from high-risk neonatal settings suggests that adverse neonatal outcomes associated with adolescent pregnancy may be strongly influenced by structural and healthcare-related factors rather than maternal age alone. However, data from neonatal intensive care units (NICUs) in low- and middle-income countries remain limited. Objective: To compare maternal characteristics, obstetric practices, and neonatal outcomes between adolescent and adult mothers in a high-risk NICU population in Ecuador, stratified by term (37–41 weeks) and preterm (< 37 weeks) births, and to identify clinical predictors of neonatal distress. Methods: A cross-sectional observational study was conducted using medical records from the Neonatal Intensive Care Unit of Pablo Arturo Suárez General Hospital (Quito, Ecuador) between 2018 and 2021. The study included 288 neonates admitted with prenatal, perinatal, or postnatal risk factors for pulmonary hypertension. Four groups were analyzed: term and preterm neonates born to adolescent mothers and to adult mothers (n = 72 per group). Neonatal distress was operationally defined by adverse early clinical indicators, including low APGAR score, low birth weight for gestational age, and the presence and severity of pulmonary hypertension. Multivariate ordinal logistic regression models were used to identify predictors of neonatal distress. Results: Adolescent mothers had significantly lower educational attainment, lower socioeconomic status, and fewer prenatal care visits compared with adult mothers (p < 0.001). Cesarean section rates were markedly higher among preterm adolescent pregnancies (91.7% vs. 25.0% in adults). Neonatal outcomes differed across groups: among term births, only 26.4% of infants born to adolescent mothers had normal APGAR scores compared with 75.0% among adults (p < 0.001), and low birth weight was more frequent (65.3% vs. 25.0%). In multivariate analyses, low birth weight and moderate-to-severe pulmonary hypertension were the strongest independent predictors of neonatal distress, whereas maternal age showed no direct effect after adjustment. Conclusions: In this high-risk NICU population, adolescent mothers experienced greater socioeconomic disadvantage, inadequate prenatal care, and higher rates of obstetric intervention, which were associated with poorer neonatal indicators. Adverse outcomes were primarily driven by clinical and structural factors—particularly low birth weight and pulmonary hypertension—rather than maternal age itself. These findings highlight the need for targeted improvements in prenatal care and social support for adolescent mothers within high-risk clinical settings. © The Author(s) 2026.
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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
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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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MRI reveals scoliosis as a silent driver of lumbar facet joint degeneration in aging Ecuadorian adults
(2025)
Pablo Cueva-Medina
;
Jorge Silva-Hidalgo
;
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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Hearing Loss Profiles in Sporadic and Familial Microtia: Clinical Insights From an Ecuadorian Cohort
(2025)
González Andrade, Fabricio
;
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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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
;
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
;
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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