Papers by Robertino M Mera Giler
PLOS ONE, 2021
Background The COVID-19 pandemic remains a significant global threat. However, despite urgent nee... more Background The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments. Methods Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromyc...
High Blood Pressure & Cardiovascular Prevention, 2021
Introduction Hypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian ... more Introduction Hypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian populations. However, little is known about HTRP impact in other ethnic groups. Aim We sought to estimate the mortality risk according to HTRP severity in older adults of Amerindian ancestry living in rural Ecuador. Methods This prospective study enrolled individuals aged ≥ 60 years with baseline blood pressure ≥ 120/≥ 80 mmHg from the ongoing Atahualpa Project cohort who received retinal photographs (for HTRP grading) and a brain MRI. We ascertained all-cause mortality after a mean of 5.2 ± 1.2 years of follow-up. Cox-proportional hazards models adjusted for demographics, cardiovascular risk factors, neuroimaging signatures of cerebral small vessel disease, blood pressure determinations during follow-up and incident strokes, were obtained to estimate mortality risk according to HTRP severity. Results Analysis included 236 participants (mean age 69.3 ± 7.3 years). HTRP Grade 2 or higher was determined in 42 (18%) individuals. Fifty participants (21%) died during the follow-up, resulting in an overall unadjusted crude mortality rate of 4.1 per 100 person-years. Mortality rate in subjects with HTRP Grade 2 or higher was 7.2 and in those with no HTRP or Grade 1 only was 3.4 per 100 person-years. An adjusted Cox-proportional hazard model showed that individuals with HTRP Grade 2 or higher maintained a greater than twofold mortality risk (HR 2.08; 95% C.I. 1.04-4.15; p = 0.038) when compared to those with no HTRP or Grade 1 only. Conclusion Study results show that HTRP severity predicts mortality in this population of older adults.
The American Journal of Tropical Medicine and Hygiene, 2020
The SARS-CoV-2 pandemic is now expanding into the developing world with devastating consequences.... more The SARS-CoV-2 pandemic is now expanding into the developing world with devastating consequences. Departing from a population-based study in rural Ecuador where all adult individuals (aged 40 years or older) were tested for SARS-CoV-2 IgG and IgM antibodies, we expanded it to include a house-based case-control component assessing in-house clustering and other variables potentially associated with infection. We selected houses where exactly two study participants lived and were both seropositive (case-houses), and matched 1:1 to control-houses where both were seronegative. Younger household members had an antibody test performed. Infected household members were found in 33 (92%) case-houses and in only six (17%) control-houses. In 28/29 discordant house pairs, the case-house had seropositive household members and the control-house did not (odds ratio: 28; 95% CI: 4.6-1,144). Our data demonstrate strong in-house clustering of infection in community settings, stressing the importance of early case ascertainment and isolation for SARS-CoV-2 control.
The American Journal of Tropical Medicine and Hygiene, 2018
Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been larg... more Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been largely overlooked. We aimed to assess the presence, characteristics, and diagnosis of headache across patients with calcified NCC and their matched controls. In this case-control study nested to a population-based cohort, Atahualpa residents aged ³ 20 years with calcified NCC were identified as case patients and paired 1:1 to age-and gender-matched randomly selected controls. A culturally adapted questionnaire was derived from the EUROLIGHT. Headache diagnosis was established according to the International Classification of Headache Disorders, 3rd edition. Conditional logistic regression models for matched paired data were fitted to assess the independent association between calcified NCC (as the exposure) and headache variables, after adjusting for education, alcohol intake, depression, and epilepsy. The selection process generated 106 case patients and their matched controls. Lifetime headache prevalence (odds ratio [OR]: 4.18; 95% Confidence Interval [CI]: 1.79-9.75; P = 0.001), current headaches (OR: 4.19; 95% CI: 1.92-9.16; P < 0.001), and intense headaches (OR: 9.47; 95% CI: 2.88-31.19; P < 0.001) were more frequent among cases than in controls. In addition, migraine (but not other forms of headache) was more frequent among subjects with calcified NCC (OR: 4.89; 95% CI: 2.36-11.39; P < 0.001). This study shows a robust epidemiological association between headache-particularly migraine-and calcified NCC.
The American Journal of Tropical Medicine and Hygiene, 2018
Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairmen... more Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairment remain unknown. Atahualpa residents aged ³ 40 years with calcified NCC were identified as case patients and paired 1:1 to age-and gender-matched controls. The selection process generated 79 pairs. Cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). A conditional logistic regression model revealed no differences in MoCA scores across case patients and controls, after adjusting for education, epilepsy, depression, and hippocampal atrophy. The single covariate remaining significant was hippocampal atrophy. When participants were stratified according to this covariate, linear models showed lower MoCA scores among case patients (but not controls) with hippocampal atrophy. In a fully adjusted linear regression model, age remained as the single covariate explaining cognitive impairment among NCC patients. This study demonstrates an association between hippocampal atrophy and poor cognitive performance among patients with calcified NCC, most likely attributable to the effect of age.
Neurology, Apr 8, 2014
OBJECTIVE: We aimed to assess the prevalence of sleep-related symptoms in community-dwelling elde... more OBJECTIVE: We aimed to assess the prevalence of sleep-related symptoms in community-dwelling elders living in a rural South American population, and to determine whether these subjective factors are associated with a poor cardiovascular health (CVH) status. BACKGROUND: There is scarce information on the role of sleep disorders in the increased prevalence of cerebrovascular diseases in the developing world. DESIGN/METHODS: Door-to-door survey to evaluate all Atahualpa’s residents aged 蠅60 years. CVH status was classified - according to the American Heart Association - in ideal/intermediate and poor. This entire population was also screened with validated Spanish versions of four questionnaires to evaluate sleep duration, sleep quality, daytime somnolence, and insomnia. RESULTS: A total of 310 persons aged 蠅60 years (mean age 70.6 ± 8.5 years; 43% male) were included. Mean sleep duration was 7.3 ± 1.3 hours. A poor sleep quality was present in 34% of the subjects (95% C.I. 29-39%), excessive daytime somnolence in 25% (95% C.I. 20-29%), and clinically significant insomnia in 14% (95% C.I. 10-18%). These sleep disorders were influenced by age but not for sex or alcohol intake. A poor CVH was noted in 75% persons. Odds for ideal/intermediate CVH status were 5.8% worse (95% C.I. 2.2-8.9%) with each year of advancing age, but sex and alcohol intake were not important covariates. After controlling for age, sex and alcohol intake, sleep duration (p=0.720), sleep quality (p=0.769), daytime somnolence (p=0.410) and insomnia (p=0.309) were not significantly associated with a poor CVH status. CONCLUSIONS: Short or long sleep duration, poor sleep quality, excessive daytime somnolence and clinically significant insomnia were not associated with a poor CVH status in this population-based survey, suggesting that sleep-related symptoms may not be independently linked to vascular events at the rural level. These findings provide useful insights for setting regional cardiovascular prevention priorities. Study Supported by: Partially supported by Universidad Espiritu Santo - Ecuador, Guayaquil, Ecuador Disclosure: Dr. Castillo has nothing to disclose. Dr. Del Brutto has received personal compensation for activities with FERRER Group. Dr. Mera has nothing to disclose. Dr. Del Brutto has nothing to disclose.
Journal of Neurosciences in Rural Practice, 2015
Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where... more Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where magnetic resonance imaging (MRI) is not available. Hospital-based studies in high-risk or stroke patients have found an association between the pulsatility index (PI) of intracranial arteries - as derived from transcranial Doppler (TCD) - and white matter hyperintensities (WMH) of presumed vascular origin. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of SVD. Methods: A representative sample of stroke-free Atahualpa residents aged ≥65 years investigated with MRI underwent TCD. Using generalized linear models, we evaluated whether the PI of major intracranial arteries correlate with WMH (used as a proxy of diffuse SVD), after adjusting for demographics and cardiovascular risk factors. Results: Out of 70 participants (mean age 70.6 ± 4.6 years, 57% women), 28 (40%) had moderate-t...
The American Journal of Tropical Medicine and Hygiene, 2020
The American Journal of Tropical Medicine and Hygiene, 2018
Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been larg... more Headache in patients with calcified neurocysticercosis (NCC) is probably common but has been largely overlooked. We aimed to assess the presence, characteristics, and diagnosis of headache across patients with calcified NCC and their matched controls. In this case-control study nested to a population-based cohort, Atahualpa residents aged ³ 20 years with calcified NCC were identified as case patients and paired 1:1 to age-and gender-matched randomly selected controls. A culturally adapted questionnaire was derived from the EUROLIGHT. Headache diagnosis was established according to the International Classification of Headache Disorders, 3rd edition. Conditional logistic regression models for matched paired data were fitted to assess the independent association between calcified NCC (as the exposure) and headache variables, after adjusting for education, alcohol intake, depression, and epilepsy. The selection process generated 106 case patients and their matched controls. Lifetime headache prevalence (odds ratio [OR]: 4.18; 95% Confidence Interval [CI]: 1.79-9.75; P = 0.001), current headaches (OR: 4.19; 95% CI: 1.92-9.16; P < 0.001), and intense headaches (OR: 9.47; 95% CI: 2.88-31.19; P < 0.001) were more frequent among cases than in controls. In addition, migraine (but not other forms of headache) was more frequent among subjects with calcified NCC (OR: 4.89; 95% CI: 2.36-11.39; P < 0.001). This study shows a robust epidemiological association between headache-particularly migraine-and calcified NCC.
The American Journal of Tropical Medicine and Hygiene, 2018
Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairmen... more Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairment remain unknown. Atahualpa residents aged ³ 40 years with calcified NCC were identified as case patients and paired 1:1 to age-and gender-matched controls. The selection process generated 79 pairs. Cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). A conditional logistic regression model revealed no differences in MoCA scores across case patients and controls, after adjusting for education, epilepsy, depression, and hippocampal atrophy. The single covariate remaining significant was hippocampal atrophy. When participants were stratified according to this covariate, linear models showed lower MoCA scores among case patients (but not controls) with hippocampal atrophy. In a fully adjusted linear regression model, age remained as the single covariate explaining cognitive impairment among NCC patients. This study demonstrates an association between hippocampal atrophy and poor cognitive performance among patients with calcified NCC, most likely attributable to the effect of age.
Neurology, Apr 8, 2014
OBJECTIVE: We aimed to assess the prevalence of sleep-related symptoms in community-dwelling elde... more OBJECTIVE: We aimed to assess the prevalence of sleep-related symptoms in community-dwelling elders living in a rural South American population, and to determine whether these subjective factors are associated with a poor cardiovascular health (CVH) status. BACKGROUND: There is scarce information on the role of sleep disorders in the increased prevalence of cerebrovascular diseases in the developing world. DESIGN/METHODS: Door-to-door survey to evaluate all Atahualpa’s residents aged 蠅60 years. CVH status was classified - according to the American Heart Association - in ideal/intermediate and poor. This entire population was also screened with validated Spanish versions of four questionnaires to evaluate sleep duration, sleep quality, daytime somnolence, and insomnia. RESULTS: A total of 310 persons aged 蠅60 years (mean age 70.6 ± 8.5 years; 43% male) were included. Mean sleep duration was 7.3 ± 1.3 hours. A poor sleep quality was present in 34% of the subjects (95% C.I. 29-39%), excessive daytime somnolence in 25% (95% C.I. 20-29%), and clinically significant insomnia in 14% (95% C.I. 10-18%). These sleep disorders were influenced by age but not for sex or alcohol intake. A poor CVH was noted in 75% persons. Odds for ideal/intermediate CVH status were 5.8% worse (95% C.I. 2.2-8.9%) with each year of advancing age, but sex and alcohol intake were not important covariates. After controlling for age, sex and alcohol intake, sleep duration (p=0.720), sleep quality (p=0.769), daytime somnolence (p=0.410) and insomnia (p=0.309) were not significantly associated with a poor CVH status. CONCLUSIONS: Short or long sleep duration, poor sleep quality, excessive daytime somnolence and clinically significant insomnia were not associated with a poor CVH status in this population-based survey, suggesting that sleep-related symptoms may not be independently linked to vascular events at the rural level. These findings provide useful insights for setting regional cardiovascular prevention priorities. Study Supported by: Partially supported by Universidad Espiritu Santo - Ecuador, Guayaquil, Ecuador Disclosure: Dr. Castillo has nothing to disclose. Dr. Del Brutto has received personal compensation for activities with FERRER Group. Dr. Mera has nothing to disclose. Dr. Del Brutto has nothing to disclose.
Journal of Neurosciences in Rural Practice, 2015
Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where... more Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where magnetic resonance imaging (MRI) is not available. Hospital-based studies in high-risk or stroke patients have found an association between the pulsatility index (PI) of intracranial arteries - as derived from transcranial Doppler (TCD) - and white matter hyperintensities (WMH) of presumed vascular origin. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of SVD. Methods: A representative sample of stroke-free Atahualpa residents aged ≥65 years investigated with MRI underwent TCD. Using generalized linear models, we evaluated whether the PI of major intracranial arteries correlate with WMH (used as a proxy of diffuse SVD), after adjusting for demographics and cardiovascular risk factors. Results: Out of 70 participants (mean age 70.6 ± 4.6 years, 57% women), 28 (40%) had moderate-t...
International Journal of Cardiology, 2014
International Journal of Cardiology, 2014
Sleep Medicine, 2015
Background/Objectives: Evidence of a relationship between non-breathing-related sleep symptoms an... more Background/Objectives: Evidence of a relationship between non-breathing-related sleep symptoms and silent markers of cerebral small vessel disease (SVD) is scarce. The present study aimed to evaluate this association in older people living in rural Ecuador, where the burden of stroke is on the rise. Methods: A group of Atahualpa residents, aged ≥60 years, were interviewed with a validated Spanish version of the Pittsburgh Sleep Quality Index, and underwent magnetic resonance imaging (MRI) for identification of silent markers of SVD. Using multinomial logistic regression analysis, after adjusting for demographics and cardiovascular health status, it was evaluated whether sleep quality is associated with the severity of white matter hyperintensity (WMH), lacunar infarcts, and deep microbleeds. Results: Out of 311 people aged ≥60 years, 237 (76%) were enrolled into the study. Mean age was 70 ± 8 years, 59% were women, 83% had primary school education only, and 73% had a poor cardiovascular health status. Seventy-eight (33%) had poor sleep quality. The MRI showed: WMH in 154 (65%) participants (moderate-to-severe in 52); silent lacunar infarcts in 28 (12%); and deep microbleeds in 17 (7%). Poor sleep quality was associated with WMH presence (OR 2.44, 95% CI 1.26 to 4.71, p = 0.008) and severity (β coefficient 0.77, SE 0.37, p = 0.037), but not with silent lacunar infarcts or deep microbleeds. Conclusions: The present study showed an association between poor sleep quality and WMH severity. Further longitudinal studies would help to elucidate the cause and effect of this relationship.
Sleep Medicine, 2014
[1] Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sl... more [1] Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Resp Crit Care Med 2013;187(1):99–105. [2] Almendros I, Montserrat JM, Ramirez J, et al. Intermittent hypoxia enhances cancer progression in a mouse model of sleep apnoea. Eur Respir J 2012; 39(1):215–7. [3] Lavie L, Kraiczi H, Hefetz A, et al. Plasma vascular endothelial growth factor in sleep apnea syndrome: effects of nasal continuous positive air pressure treatment. Am J Respir Crit Care Med 2002;165(12):1624–8. [4] Tamisier R, Pepin JL, Remy J, et al. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. Eur Respir J Switzerland 2011;37(1):119–28.
Journal of Clinical Ultrasound, 2015
To assess the role of temporal bone characteristics in transcranial Doppler (TCD) insonation fail... more To assess the role of temporal bone characteristics in transcranial Doppler (TCD) insonation failures in Amerindians living in rural Ecuador. We evaluated thickness and texture of temporal bones in community-dwelling Amerindians ≥65 years old undergoing TCD. Using receiver operator characteristics curve analysis and generalized estimating equations, we investigated factors associated with insonation failures. Of 65 participants (mean age 74.7 ± 6.7 years, 60% women), 32 (49%) had uni- or bilateral insonation failure through temporal windows. Considering temporal bones independently, 57 of 130 (44%) had poor insonation. Mean thickness was higher (4.7 ± 1.2 versus 2.7 ± 0.9, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and texture more often heterogeneous (93% versus 22%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) in bones with poor acoustic windows. Thickness, better predicting poor insonation, was ≥3.6 mm if used alone, and ≥2.7 mm if used together with heterogeneous texture. For every millimeter of increase in thickness, subjects were 2.9 times more likely to have insonation failures. Per se, heterogeneous texture increased by 3.2 times the odds for poor insonation. In all models, being woman increased the odds for poor insonation by six to nine times. Temporal bone thickness and texture are independent predictors of TCD insonation failure in Amerindians. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound, 2015.
International journal of vascular medicine, 2014
Background. Little is known on the prevalence of peripheral artery disease (PAD) in developing co... more Background. Little is known on the prevalence of peripheral artery disease (PAD) in developing countries. Study design. Population-based study in Atahualpa. In Phase I, the Edinburgh claudication questionnaire (ECQ) was used for detection of suspected symptomatic PAD; persons with a negative ECQ but a pulse pressure ≥65 mmHg were suspected of asymptomatic PAD. In Phase II, the ankle-brachial index will be used to test reliability of screening instruments and to determine PAD prevalence. In Phase III, participants will be followed up to estimate the relevance of PAD as a predictor of vascular outcomes. Results. During Phase I, 665 Atahualpa residents aged ≥40 years were enrolled (mean age: 59.5 ± 12.6 years, 58% women). A poor cardiovascular health status was noticed in 464 (70%) persons of which 27 (4%) had a stroke and 14 (2%) had ischemic heart disease. Forty-four subjects (7%) had suspected symptomatic PAD and 170 (26%) had suspected asymptomatic PAD. Individuals with suspected P...
The American Journal of Tropical Medicine and Hygiene
This prospective cohort study aimed to assess incidence and etiology of adult-onset epilepsy in p... more This prospective cohort study aimed to assess incidence and etiology of adult-onset epilepsy in previously seizure-free Atahualpa residents aged ≥ 20 years. Persons with adult-onset epilepsy occurring over 5 years were identified from annual door-to-door surveys and other overlapping sources. Those who emigrated or declined consent were excluded at the administrative censoring date of the last survey when these subjects were interviewed. Persons who died and those who developed incident epilepsy were censored at the time of these outcomes. Poisson regression models adjusted for demographics, education, alcohol intake, and the length of observation time, were used to estimate annual adult-onset epilepsy incidence rate ratio and cumulative incidence. Systematic neuroimaging screening was offered to participants to get insights on the etiology of epilepsy. Individuals enrolled in this cohort (N = 1,480) contributed to 6,811.6 years of follow-up. Seventeen developed incident adult-onset...
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Papers by Robertino M Mera Giler