Ecuadorian Hospital Research Articles

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

S2688 Unveiling a Rare Complication: Intrabiliary Hem-o-lok Clip Migration Following Laparoscopic Cholecystectomy at an Ecuadorian Hospital

S2688 Unveiling a Rare Complication: Intrabiliary Hem-o-lok Clip Migration Following Laparoscopic Cholecystectomy at an Ecuadorian Hospital

Salud Mental y Burnout en Profesionales de Enfermería en Hospitales Ecuatorianos

The study addresses the prevalence of burnout and mental health among nursing professionals in Ecuadorian hospitals, highlighting critical factors that contribute to this phenomenon. The results indicate a high prevalence of burnout, with significant differences between regions and types of hospitals. Sociodemographic factors such as youth, inexperience, and female gender are associated with higher levels of burnout. Excessive workload, night shifts, and lack of administrative support are work-related factors that aggravate the problem. Effective intervention strategies include psychological support programs, ongoing training, and improvements in working conditions. The implementation of these strategies is crucial to improve nurses' well-being and the quality of patient care.

Spatial dependence in patient migration flows

ABSTRACT This study analyses whether higher efficiency performance of Ecuadorian hospitals attracts larger inflows of interregional patients to a given hospital and assesses the existence of spatial dependence in the patient migration network. We develop an innovative two-stage approach. In the first stage, we use conditional order-m estimations to obtain robust hospital efficiency. In the second stage, we apply a spatial Durbin interaction model to estimate the effect of hospital efficiency on patient migration flows and disentangle the spillover effects. We identify the positive effect of specialized hospitals’ efficiency in attracting patients from other regions alongside spillover effects in the migration dyad.

Ethnodemographic characterization of stroke incidence and burden of disease in hospital discharge records in Ecuador.

Stroke is the second most common cause of death and disability-adjusted life years (DALYs) globally. However, the incidence and impact of stroke by ethnicity and gender is frequently distinct. This is particularly the case in Ecuador where geographic and economic marginalization are often correlated with ethnic marginalization and the extent to which females lack the same opportunities as their male counterparts. The aim of this paper is to investigate the differential impacts in terms of stroke diagnosis and burden of disease by ethnicity and gender, using hospital discharge records over the years 2015-2020. This paper calculates stroke incidence, and fatality rates using hospital discharge and death records over the years 2015-2020. The DALY package in R was employed to calculate the Disability Adjusted Life Years lost due to stroke in Ecuador. The results show that while the incidence rate of stroke in males (64.96 per 100,000 persons-year) is higher than that for females on average (57.84 per 100,000 persons-year), males accounted for 52.41% of all stroke cases and 53% of all surviving cases. Thus, hospital data suggests that females had a higher death rate when compared to males. Case fatality rates also differed significantly by ethnicity. The highest fatality rate corresponded to the Montubio ethnic group (87.65%), followed by Afrodescendants (67.21%). The estimated burden of disease of stroke calculated using Ecuadorian hospital records (2015-2020) varied from 1,468 to 2,991 DALY per 1,000 population on average. Differences in the burden of disease by ethnic group are likely to reflect differential access to care by region and socio-economic group, both of which are frequently correlated with ethnic composition in Ecuador. Equitable access to health services remains an important challenge in the country. The gender discrepancy in fatality rates suggests that there is a need for targeted educational campaigns to identify stroke signs early, especially in the female population.

Mannheim Index versus APACHE II Score as Predictors of Mortality in Abdominal Sepsis in a 4th Level Ecuadorian Hospital

Introduction: In the last 30 years, scoring systems have been developed to determine patients’ illness severity or prognosis. In the present work, the role of the Mannheim Prognostic Index (MPI) to predict the risk of mortality, complications, prolonged hospital-stay, and the need for ICU was determined in all the patients who presented secondary peritonitis, and to validate the test as a useful and an easy tool to apply in the clinical practice of the surgeon and critical care physician. Materials and methods: An observational, retrospective, cross-sectional and analytical study was conducted. Results: The effectiveness of the MPI was compared to another widely used mortality prediction system such as Apache II; 279 patients from the Luis Vernaza were included. The prediction rate was 93.3% and 86.9%, respectively. Conclusions: Although Mannheim presents an excellent response as a predictor of mortality, its assessment is not infallible since other factors remain unconsidered; and these may cause a patient who was assessed as having a low risk of mortality to be deceased.

Behavioural intention of hand hygiene compliance in an average Ecuadorian hospital.

SUMMARYOBJECTIVE:This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city.METHODS:This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model.RESULTS:The average age of participants was 34 years (Q1 32.1–Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters).CONCLUSION:The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Neuroendocrine Tumors: An Analysis of Prevalence, Incidence, and Survival in a Hospital-Based Study in Ecuador.

Neuroendocrine tumors (NETs) represent a heterogeneous malignancy group of neoplasms, with a limited amount of data from Latin America. Thus, this observational study aimed to provide data about the prevalence, incidence, and survival rates for NET in Ecuadorian hospitals. The study was conducted using data from the Society for the Fight Against Cancer (SOLCA). We evaluated patients with NETs (2000–2020) using the HJ-Biplot method and Cox proportional hazards. Annual age-adjusted incidence and limited-duration prevalence in multivariable analyses as well as hazard ratios (HRs) for mortality and survival were obtained. In the years 2000–2020, the age-adjusted incidence rate increased by 9-fold in the stomach and by 7-fold in the breast. The incidence rates were 1.38 per 100,000 persons in the lung and at 1.79 per 100,000 persons in gastroenteropancreatic sites (rectum, stomach, and pancreas). The prevalence increased from 0.0027% in 2000 to 0.0736% in 2019 and 0.0245% in 2020. Overall survival was worse for metastatic NETs (HR, 4.061; 95% CI, 1.932–8.540; p < 0.001) and advanced local NETs (HR, 2.348; 95% CI, 1.007–5.475 p < 0.048) than for localized NETs. In conclusion, the NET incidence increased in the last 20 years and survival decreased over time, especially for metastatic tumors in the pancreas and the nostril.

Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective study.

To investigate risk factors for mortality from sepsis in an intensive care unit (ICU) in Quito-Ecuador and their association to adherence to Surviving Sepsis Campaign recommendations.Prospective cohort study of patients with severe sepsis/septic shock admitted to the ICU of a public Ecuadorian hospital from March, 2018 to March, 2019. Demographic, clinical, treatment, and outcome data were collected from patients' health records. Patients were divided into 2 groups according to ICU survival or death. Log-binomial regression models were used to identify risk factors for mortality.In total, 154 patients were included. Patients who died in the ICU (n = 42; 27.3%) had higher sequential organ failure assessment score (median 11.5 vs 9; P<.01), more organ dysfunction (median 4 vs 3; P<.0001), and received greater volumes of fluid resuscitation in the first 6 hours (median 800 vs 600 mL; P = .01). Dysfunction of > 2 organs was a risk factor for mortality (relative risks [RR] 3.80, 95% CI 1.33-10.86), while successful early resuscitation (RR 0.32, 95% CI 0.15-0.70), successful empirical antibiotic treatment (RR 0.38, 95%CI 0.18-0.82), and antibiotic de-escalation (RR 0.28, 95%CI 0.13-0.61) were protective factors.Dysfunction of >2 organs was a risk factor for mortality from sepsis while successful early resuscitation and appropriate antibiotic treatment were protective.

High SARS-CoV-2 attack rates among asymptomatic hospital workers from Ecuador

PurposeTo determine the SARS-CoV-2 risk of infection in Ecuadorian hospital. This study aims to describe the SARS-CoV-2 attacks rate and viral loads among patient care workers and other staff from Ecuadorian hospitals during the first wave of COVID-19 pandemic.Methods & Materials: Study design and setting. We carried out a cross-sectional study to describe the attack rate of SARS-CoV-2 infection among patient care workers (physicians, nurses and nursing assistants) and other healthcare personnel (administrative and services staff) from 9 hospitals of the Andean and Costal Regions of Ecuador from May to October 2020.Sample collection, RNA Extraction and RT-qPCR for SARS-CoV-2 diagnosis using the CDC protocol. The samples were processed in the BSL2 certified molecular biology laboratory at Universidad de Las Americas. Nasopharyngeal swabs were collected on 0.5mL TE pH 8 buffer for SARS-CoV-2 diagnosis by RT-qPCR following an adapted version of the CDC protocol.Statistical analysis. Chi cuadrado with the statistic program SPSSResultsA total of 1243 patient care workers and 428 of other healthcare staff were tested for SARS-CoV-2 infection. The SARS-CoV-2 attack rate was 12% (145/1243) for patient care workers and 19% (80/428) for other healthcare personnel, being this difference statistically significant (p<0.05). For each hospital, the following SARS-CoV-2 attack rates were obtained for patient care workers and other staff: 35% and 50% in “Hogar ABEI”, 21% and 26% in “Clínica Nuestra Señora de Guadalupe”, 15% and 18% in “Hospital de Atención Integral al Adulto Mayor”, 5% and 11% in “Hospital de Especialidades Eugenio Espejo”, 12% and 22% in “Hospital Geriátrico Dr. Bolívar Arguello”, 13% and 22% in “Hospital Dr. Gustavo Domínguez”, 22% and 12% in “Hospital General Dr. Napoleón Dávila”, 9% and 14% in “Hospital Pablo Arturo” and 5% and 13% in “Hospital San Francisco de Quito”. Moreover, we found 47 individuals (19 among patient care workers and 28 among other staff) with viral loads larger than 108 copies/mL that may be considered super spreaders.ConclusionEcuadorian hospital workers at a high-risk group for SARS-CoV-2 infection. Regular SARS-CoV-2 testing should be mandatory for this group as even asymptomatic SARS-CoV-2 super spreaders can be detected.

Definition of Strategies in Ecuadorian Hospitals in a Plithogenic Environment

The modeling of a SWOT matrix in a plithogenic environment is an excellent decision support tool that allows selecting alternatives most effectively and optimally. Then, it gives rise to the approach of how to develop an adequate SWOT matrix for hospitals that allows the study and definition of strategies in a plithogenic environment. To solve the problem, the main objective of the research is to develop a SWOT matrix using plithogenic sets. Given the fact that if an adequate strategy that includes uncertainty is implemented, it will be possible to provide an effective tool that optimizes the decision-making process. A theoretical framework of the SWOT matrix will be developed to achieve this objective, and a method for its processing in a neutrosophic environment will be implemented. Afterward, it will be applied to the actual situation of Ecuadorian hospitals and pertinent strategies will be proposed.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

BackgroundPreoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences.MethodsA retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25.ResultsThe study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations.ConclusionsSurgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Policies influencing access to new targeted oncologic drugs in Ecuadorian hospitals: an interrupted time series analysis

Objective and methods: An interrupted time series analysis was performed to measure the impact of two policy interventions on the accessibility to new targeted oncologic drugs in Ecuador. The first intervention decentralized the selection process allowing drug and therapeutic committees (DTCs) to directly select new drugs. The second brought back the final decision to a central body but kept the first decision level in hospitals. Five-year (2010-2014) individual dispensing data from the six largest Ecuadorian cancer hospitals were analysed. Monthly incidence rate of targeted oncologic drug users (per 1000 cancer patients) was defined as the unit of analysis. Level and slope changes after policy interventions were studied; P value <0.05 was considered statistically significant. Key findings: In public hospitals, incidence rate immediately dropped (level) after the first policy intervention (P < 0.05). The slope increased not significantly until the second policy. After the second intervention, the incidence level dropped, and the slope was negative (both not significant). In private hospitals, the incidence level dropped significantly after the first policy, followed by a significant slope increase. After the second intervention, the incidence level dropped, and the slope was negative (both significant). Conclusions: Transferring to DTCs the responsibility to select new drugs produced an increase in prescription intensity of targeted oncologic drugs, mainly in the private sector. The second intervention changed this trend. Combination of different levels of decision, meaning a DTC analysis plus a reanalysis by a central body, seems to limit new prescriptions of targeted oncologic drugs.

Efficacy of pulsed-xenon ultraviolet light for disinfection of high-touch surfaces in an Ecuadorian hospital

BackgroundHospital environment in patient care has been linked on healthcare-associated infections (HAI). No touch disinfection technologies that utilize pulsed xenon ultraviolet light has been recognized to prevent infection in contaminated environments. The purpose of this study was: 1) to evaluate the effectiveness of pulsed-xenon ultraviolet light (PX-UV) disinfection for the reduction of bacteria on environmental surfaces of Hospital General Enrique Garcés, and 2) to evaluate the in-vitro efficacy against multi-drug resistance microorganisms.MethodsThis was a quality-improvement study looking at cleaning and disinfection of patient areas. During the study, a total of 146 surfaces from 17 rooms were sampled in a secondary 329-bed public medical center. Microbiological samples of high-touch surfaces were taken after terminal manual cleaning and after pulsed xenon ultraviolet disinfection. Cleaning staff were blinded to the study purpose and told clean following their usual protocols. For positive cultures PCR identification for carbapenemase-resistance genes (blaKPC, blaIMP, blaVIM, and blaNDM) were analyzed and confirmed by sequencing. The total number of colony forming units (CFU) were obtained and statistical analyses were conducted using Wilcoxon Rank Sum tests to evaluate the difference in CFU between terminal manual cleaning and after pulsed xenon ultraviolet disinfection.ResultsAfter manual disinfection of 124 surfaces showed a total of 3569 CFU which dropped to 889 CFU in 80 surfaces after pulsed xenon disinfection (p < 0.001). Overall, the surface and environmental contamination was reduced by 75% after PX-UV compared to manual cleaning and disinfection. There were statistically significant decreases in CFU counts of high touch surfaces in OR 87% (p < 0.001) and patient rooms 76% (p < 0.001). Four rooms presented serine carbapenemases blaKPC, and metallo beta-lactamases blaNDM, blaVIM, blaIMP. confirmed by PCR and sequencing. The in-vitro testing with endemic strains found that after five minutes of pulsed xenon ultraviolet exposure an 8-log reduction was achieved in all cases.ConclusionThis study is one of the first of its kind in an Ecuador Hospital. We found that pulsed-xenon ultraviolet disinfection technology is an efficacious complement to the established manual cleaning protocols and guidelines in the significant reduction of MDRO.

Immunophenotypic characteristics of diffuse large b-cell lymphoma and expression of C-MYC protein: single Ecuadorian center experience

&#x0D; &#x0D; &#x0D; Background: Diffuse large B-cell lymphoma (DLBCL) makes up from 25% to 40% of all non- Hodgkin lymphomas (NHL) and is the most common histological subtype worldwide. In Ecuador, DLBCL makes up 49% of all NHL cases, but there have been no studies on the immunophenotypic classification of DLBCL in germinal center (GC) and non–germinal center (NGC) subtypes. This study was conducted to ascertain the immunophenotypic profile of DLBCL in an Ecuadorian hospital.&#x0D; Methods: A total of 38 DLBCL cases from 2006 to 2015 were compiled from the Pathology Service at Metropolitan Hospital (HM) in Quito, Ecuador. Eleven of these cases failed to meet the inclusion criteria; thus, the final sample consisted of 27 cases. Manual tissue microarrays were constructed, and three immunohistochemical markers (CD10, BCL6, and MUM1) were applied according to the Hans algorithm; in addition, the expression of the c-myc protein expression was also investigated.&#x0D; Results: The results showed that 77.8% of cases were of the GC subtype, 11.1% were NGC, and 11.1% were unclassifiable according to the Hans algorithm.&#x0D; Conclusions: The most frequent DLBCL subtype was GC, with 21 cases; and 40.7% of these cases overexpressed c-myc.&#x0D; &#x0D; &#x0D;

\u201cFive hundred years of medicine gone to waste\u201d? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes

BackgroundIn Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This included conducting upright deliveries, introducing Traditional Birth Attendants (TBAs) and making physical adaptations to hospital facilities.MethodsUsing qualitative methods, we studied the VB policy implementation in an Ecuadorian hospital to analyse the factors that affect effective implementation of intercultural health policies at the local level. We collected data through observation, in-depth interviews, a focus group discussion, and documentation review. We conducted 46 interviews with healthcare workers, managers, TBAs, key informants and policy-makers involved in maternal health. Data analysis was guided by grounded theory and drew heavily on concepts of “street-level bureaucracy” to interpret policy implementation.ResultsThe VB policy was highly controversial; actors’ values (including concerns over patient safety) motivated their support or opposition to the Vertical Birth policy. For those who supported the policy, managers, policy-makers, indigenous actors and a minority of healthcare workers supported the policy, it was critical to address ethnic discrimination to improve indigenous women’s access to the health service. Most healthcare workers initially resisted the policy because they believed vertical births led to poorer clinical outcomes and because they resented working alongside TBAs. Healthcare workers developed coping strategies and effectively modified the policy. Managers accepted these as a compromise to enable implementation.ConclusionsAlthough contentious, intercultural health policies such as the VB policy have the potential to improve maternity services and access for indigenous women. Evidence-base medicine should be used as a lever to facilitate the dialogue between healthcare workers and TBAs and to promote best practice and patient safety. Actors’ values influenced policy implementation; policy implementation resulted from an ongoing negotiation between healthcare workers and managers.

Effect of effort-reward imbalance and burnout on infection control among Ecuadorian nurses.

BackgroundNurses are frequently exposed to transmissible infections, yet adherence to infection control measures is suboptimal. There has been inadequate research into how the psychosocial work environment affects compliance with infection control measures, especially in low‐ and middle‐income countries.AimTo examine the association between effort‐reward imbalance, burnout and adherence to infection control measures among nurses in Ecuador.IntroductionA cross‐sectional study linking psychosocial work environment indicators to infection control adherence.MethodsThe study was conducted among 333 nurses in four Ecuadorian hospitals. Self‐administered questionnaires assessed demographic variables, perceived infection risk, effort‐reward imbalance, burnout and infection control adherence.ResultsIncreased effort‐reward imbalance was found to be a unique incremental predictor of exposure to burnout, and burnout was a negative unique incremental predictor of nurses' self‐reported adherence with infection control measures.DiscussionResults suggest an effort‐reward imbalance‐burnout continuum, which, at higher levels, contributes to reduce adherence to infection control. The Ecuadorean government has made large efforts to improve universal access to health care, yet this study suggests that workplace demands on nurses remain problematic.ConclusionThis study highlights the contribution of effort‐reward‐imbalance‐burnout continuum to the chain of infection by decreased adherence to infection control of nurses.Implications for Nursing PolicyHealth authorities should closely monitor the effect of new policies on psychosocial work environment, especially when expanding services and increasing public accessibility with limited resources. Additionally, organizational and psychosocial interventions targeting effort‐reward imbalance and burnout in nurses should be considered part of a complete infection prevention and control strategy. Further study is warranted to identify interventions that best ameliorate effort‐reward imbalance and burnout in low‐ and middle‐income settings.

Characterization of the first report of Mycobacterium timonense infecting an HIV patient in an Ecuadorian hospital

Mycobacterium timonense is a non-tuberculous mycobacteria (NTM) described in southern France in 2009, and to our knowledge, not reported again as a human pathogen in indexed literature. The aim of this work was to characterize the first clinical isolate of M. timonense in Ecuador. Time of growth, biochemical tests, thin layer growth test, PCR-RFLP analysis of the hsp65 gene and MALDI-TOF spectra analysis were not able to identify the species. The species identification was achieved through sequencing of rrs, hsp65 and rpoB genes. The results highlight the necessity to set up a sequencing method to identify emerging NTM in Ecuadorian clinical facilities.

State of malnutrition in hospitals of Ecuador.

Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care.

Amyotrophic lateral sclerosis: Analysis of ALS cases in a predominantly admixed population of Ecuador

Recent studies suggest amyotrophic lateral sclerosis (ALS) prevalence, incidence, and age of onset are heterogeneous across populations. These include studies from South America (SA) where lower prevalence, earlier onset, and reduced survival time of ALS are reported. However, the scarcity of epidemiological and clinical data confounds effective comparison. To investigate ALS incidence in the predominantly admixed population of Ecuador, we analyzed patient data. We analyzed case data from two major hospitals. To confirm diagnosis, we evaluated clinical and EMG examinations in a cohort of patients. For 2000–2012, we found 116 patients with ALS diagnosis in the two hospitals. Crude incidence was 0.2–0.6 per 100,000. Median age of onset was 54.3 (+ 15.06 SD). Clinical re-evaluation found misdiagnosis in three cases in the cohort. In conclusion, ALS incidence in the Ecuadorian hospital population is in accord with rates reported in recent studies for other admixed populations, and lower than that in the United States and Europe. Our study found that appropriate EMG administration and interpretation for the purposes of supporting a diagnosis of ALS with current consensus guidelines prevent adequate use of this test as an essential tool in the evaluation and diagnosis of ALS. Training for required standardization in Ecuador is recommended.