Hospital In Quito Research Articles

Characterization and evaluation of the use of dangerous abbreviations in a hospital in Quito, Ecuador

Introduction. The dangerous abbreviations not allowed used in the record of the Clinical History, due to an erroneous interpretation, could trigger associated adverse events in health care. Methods. Cross-sectional descriptive study, 15 786 cases registered in the Medical Records of Hospital General del Sur de Quito of 42 clinical and surgical units were reviewed, the use of dangerous abbreviations was included, the acronyms allowed according to the regulations of the Ministry of Public Health of Ecuador were excluded. The information was consolidated in a database in Excel 2017 format and the compliance and frequencies of abbreviations used with the SPSS Version 22.0 program were analyzed. Results. 69,84% (n=11 026 services) complied with the proper use of allowed abbreviations, the clinical area with 74,9% and the surgical area with 62,62%. 6 199 dangerous abbreviations were found, the most frequent being “(…) FR, FC, LPM, RPM, TA, TAM, RX, GSRN, CD4, M2, CD8, ASC, ECG, AQX, NPO, VIH, BH, FUM, HTA, RHB, SAT, GSM, TAC, RHA, DH, RP, APP, AM, TTO, IDG (…)”. Conclusions. Percentages of higher compliance were determined in the clinical units, followed by the surgical ones. The abbreviations used in the records of the Clinical Histories are not included in Ministerial Agreement 00000115, Patient Safety Manual - User, of the Ministry of Public Health of Ecuador.

Cutaneous tuberculosis, different clinical spectrum of the same disease: the importance of pre-test probability.

This report presents three cases of cutaneous tuberculosis that were identified at the Calderon Hospital in Quito, Ecuador. The first case involved a 44-year-old man who had tuberculosis verrucosa cutis, characterized by circinate erythematous areas, ulcerated nodules, and verruciform plaques extending from the right lower limb to the hip. In the second case a 50-year-old woman with a 1-year history of pruritic dermatosis in the left ciliary area was diagnosed with lupus vulgaris. In the third case, a 23-year-old man with erythematous nodules draining caseous material at the neck, thorax, and axillary region was diagnosed with scrofuloderma. It was discovered that nearly every laboratory test that was accessible had drawbacks as a diagnostic technique. Correlating clinical and epidemiological features with the pretest probability is crucial for optimizing indicators and confirming or ruling out the diagnosis in immunocompromised and high-risk individuals with atypical lesions.

Differentiated Thyroid Carcinoma Long-Term Prognostic Factors.

Thyroid cancer is the most common cancer in women in Ecuador. The aim of this study was to determine the demographics and clinical and treatment variables of patients with papillary or follicular thyroid cancer, referred to as differentiated thyroid cancer (DTC), treated at a third-level hospital in Quito, Ecuador. We reviewed retrospectively the medical records of patients with DTC, who underwent surgical treatment, from 1990 to 2019. Data included demographics, pathological information, clinical stage, type of surgery, and radioactive iodine (RAI) adjuvant therapy. Patients were monitored for up to 29 years (median follow-up time 6.9 years). The corrected overall 5-, 10-, 20-, and 30-year survival rates (Kaplan-Meier) were 93%, 85%, 70%, and 63%, respectively. On univariate analysis, age, histological type, tumor grade, histological variants, capsular invasion, vascular invasion, tumor size, clinical stage, distant metastases at diagnosis, surgical margins, extrathyroidal invasion, radioactive iodine adjuvant treatment, and locoregional recurrence were found to be significant prognostic factors. In a multivariate analysis, the following independent variables: age over 55 years, extrathyroidal spread, metastasis at diagnosis, and stage II to IV raised the risk of death (hazard risk) (HR). Age over 55 years, extrathyroidal spread, metastasis at diagnosis, and advanced clinical stage were found to have a harmful prognosis and an increased risk of death in a series of Ecuadorian patients surgically treated for a DTC.

Clinical profiling of pediatric microtia patients: A cross-sectional analysis at a leading pediatric hospital in Ecuador (2015-2022).

Microtia is a frequent congenital deformity of the pinna, often with hearing loss. This study reviews the clinical profiles of microtia pediatric patients treated at a referral hospital in Quito, Ecuador, from 2015 to 2022. A cross-sectional descriptive study was carried out based on the analysis of medical records of pediatric patients with microtia treated between January 2015 and December 2022 at the Hospital Pediátrico Baca Ortiz in Quito, Ecuador. Descriptive statistics were used, and the Chi-square test assessed associations between categorical variables. Of the 235 patients evaluated, 59.6% were male, 83.4% lived at high altitudes (2500-3500 m), and 19.1% had a family history of microtia. Grade III microtia was diagnosed in 63.8%, predominantly on the right side. Nearly all (99.1%) had hearing loss. Other anatomical alterations were observed in 27.7%, primarily the preauricular appendage. Bone vibrator implantation was a common treatment for 24.3%. Altitude did not show a significant correlation with microtia characteristics. Most patients had grade III microtia with associated hearing loss. Despite the high prevalence at elevated altitudes, no significant altitude-disease correlation was found. The study highlights the need for further research on microtia in regions like Ecuador.

Examining the Relationship between Dietary Intake, Socioeconomic Status, and Systolic Blood Pressure of Adults on Hemodialysis in Quito, Ecuador

BackgroundIn Ecuador, the number of adults on hemodialysis (HD) continues to rise. Currently, the effect dietary habits and socioeconomic status (SES) have on blood pressure is not known for those on HD. ObjectivesThe objectives of this study focused on adults on HD in Quito, Ecuador to 1) assess the relationship between dietary intake and SES; 2) compare dietary intake to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines; and 3) explore the relationship between dietary intake and systolic blood pressure. MethodsThis cross-sectional study was conducted at the dialysis center within Eugenio Espejo Specialties Hospital in Quito, Ecuador between May and June 2022 among 50 adults on HD. Three 24-h recalls were used to determine average dietary intake and the 25-item Instituto Nacional de Estadística y Censos-Stratification of SES was used to determine SES. Electrolytes and 2 blood pressure readings were collected. Qualitative narrative data analysis was performed to identify themes using NVivo v12. T-tests of independence, simple, and multiple linear regressions using age and sex as confounders were conducted using R and a P < 0.05 was deemed as statistically significant. ResultsOn an average, 76% of participants consumed <25 kcal/kg body weight energy and 64% consumed <1 g protein/kg body weight. Participants consumed less energy and protein compared with the KDOQI guidelines (P < 0.05). Positive relationships were observed with potassium and blood pressure (β = 0.020, P < 0.05) and SES with energy, protein, and phosphorus (P < 0.05). Themes that were identified as contributing to dietary intake were limited knowledge, lack of consistency with dietary information, and limited appetite. ConclusionsFindings from this study indicate that the focus should be on improving energy and protein intake for this population.

Características clínicas y demográficas de los pacientes con enfermedades desmielinizantes en Ecuador

IntroductionMS and NMOSD are chronic demyelinating diseases mediated by the immune system, related to demyelinating attacks on the brain, optic nerve and spinal cord, which can cause severe disability in young people. In LATAM there is few reports on the demographic and clinical characteristics of both diseases. ObjectiveTo establish and compare the clinical and demographic characteristics of MS and NMOSD patients. Materials and methodsThis is a descriptive and transversal study which included MS and NMOSD patients who were attended in the Carlos Andrade Marin hospital in Quito, Ecuador. Univariate and multivariate analysis were performed using SPSS. ResultsWe included 151 patients with MS and NMOSD, the predominant sex in the two diseases was female, mestizo ethnicity was common in both diseases, higher education was frequent in both conditions specially in MS. The average age was 42.3 years in EM and 49.8 years in TENMO (p < 0.005). Fatigue was more common in MS than NMOSD. There was a predominance of mild disability in EM and moderate disability in TENMO with a mean of EDSS 2.5 and 4.2, respectively (p < 0.005). The presence of comorbidities was infrequent in both diseases. ConclusiónThe clinical and demographic characteristics in our study is very similar to finding around the world. However, the mestizo ethnicity was common in both conditions. We found lower frequency of fatigue, motor and sensory symptoms in comparison with previous reports. NMOSD patients had higher disability than MS patients.

Interfragmentary screws in Danis and Weber type B ankle fractures: is it necessary to maintain the stability of the joint?

OBJECTIVE: This study aimed to investigate whether the presence or absence of an interfragmentary screw significantly impacts surgical time, bleeding, consolidation, complications, and overall recovery in patients with Weber type B ankle fractures. METHODS: A cross-sectional analytical study was conducted, involving 47 patients with Weber type B ankle fractures between January 2022 and January 2023 at San Francisco General Hospital in Quito. Patients with multi-fragment fractures were excluded. and two groups were established: patients with interfragmentary screws and those without. Variables such as surgical time, bleeding, complications, and consolidation time were assessed using JASP 0.16.0.0 software and statistical tests. RESULTS: Out of all patients, 53.19% were treated with interfragmentary screws, while 46.80% were not. No statistically significant differences were observed between the two groups. Complications occurred in 7 out of 25 patients with interfragmentary screws and in 4 out of 22 patients without them, with average follow-up periods of 82.81 and 76.8 days, respectively. Consolidation time was similar in both groups, with no statistical differences. CONCLUSION: Although interfragmentary screws are beneficial for achieving primary consolidation, this study suggests that they may not be universally necessary, especially when precise anatomical reduction is accomplished. Anatomical reduction remains pivotal in fracture management. While interfragmentary screws can provide compression, their use may increase costs, recovery time, and complications.

Emergence of Raoultella ornithinolytica in human infections from different hospitals in Ecuador with OXA-48-producing resistance.

The purpose of this study was to highlight the clinical and molecular features of 13 Raoultella ornithinolytica strains isolated from clinical environments in Ecuador, and to perform comparative genomics with previously published genomes of Raoultella spp. As Raoultella is primarily found in environmental, clinical settings, we focused our work on identifying mechanisms of resistance that can provide this bacterium an advantage to establish and persist in hospital environments. We analyzed 13 strains of Raoultella ornithinolytica isolated from patients with healthcare associated infections (HAI) in three hospitals in Quito and one in Santo Domingo de Los Tsáchilas, Ecuador, between November 2017 and April 2018. These isolates were subjected to phenotypic antimicrobial susceptibility testing, end-point polymerase chain reaction (PCR) to detect the presence of carbapenemases and whole-genome sequencing. Polymerase chain reaction revealed that seven isolates were positive isolates for blaOXA-48 and one for blaKPC-2 gene. Of the seven strains that presented the blaOXA-48 gene, six harbored it on an IncFII plasmid, one was inserted into the bacterial chromosome. The blaKPC gene was detected in an IncM2/IncR plasmid. From the bioinformatics analysis, nine genomes had the gene blaOXA-48, originating from Ecuador. Moreover, all R. ornithinolytica strains contained the ORN-1 gene, which confers resistance for β-lactams, such as penicillins and cephalosporins. Comparative genome analysis of the strains showed that the pangenome of R. ornithinolytica is considered an open pangenome, with 27.77% of core genes, which could be explained by the fact that the antibiotic resistance genes in the ancestral reconstruction are relatively new, suggesting that this genome is constantly incorporating new genes. These results reveal the genome plasticity of R. ornithinolytica, particularly in acquiring antibiotic-resistance genes. The genomic surveillance and infectious control of these uncommon species are important since they may contribute to the burden of antimicrobial resistance and human health.

Prevalence of Helicobacter pylori genotypes: cagA, vacA (m1), vacA (s1), babA2, dupA, iceA1, oipA and their association with gastrointestinal diseases. A cross-sectional study in Quito-Ecuador

BackgroundThe most prevalent stomach infection in the world is caused by Helicobacter pylori (H. pylori). Several pathogenicity genes, including cagA, vacA, babA2, dupA, iceA, and oipA, are associated with an increased risk of gastrointestinal disease such as peptic ulcer and stomach cancer. This research aims to determine the prevalence of different H. pylori genotypes and correlate their risk in the development of gastrointestinal diseases in the Ecuadorian population.MethodsA cross-sectional research of 225 patients at the Calderón Hospital in Quito, Ecuador, was conducted. End point PCRs were run to determine the presence of 16S rRNA, cagA, vacA (m1), vacA (s1), babA2, dupA, iceA1, and oipA virulence genes. Chi-square test, odds ratios (OR) and 95% confidence intervals (CI) were utilized for the statistical analysis.ResultsH. pylori infection was present in 62.7% of people. Peptic ulcers were seen in 22.2% and malignant lesions in 3.6% of patients. Genes oipA (93.6%), vacA (s1) (70.9%), and babA2 (70.2%) were the most prevalent. cagA/vacA (s1m1) and cagA/oipA (s1m1) combinations were found in 31.2% and 22.7% of the cases, respectively. Acute inflammation has a significant correlation with the genes cagA (OR = 4.96 95% CI: 1.1–22.41), babA2 (OR = 2.78 95% CI: 1.06–7.3), and the cagA/oipA combination (OR = 4.78, 95% CI: 1.06–21.62). Follicular hyperplasia was associated with iceA1 (OR = 3.13; 95% CI: 1.2–8.16), babA2 (OR = 2.56; 95% CI: 1.14–5.77), cagA (OR = 2.19; 95% CI: 1.06–4.52), and the cagA/oipA combination (OR = 2.32, 95% CI: 1.12–4.84). The vacA (m1) and vacA (s1m1) genes were associated with gastric intestinal metaplasia (OR = 2.71 95% CI: 1.17–6.29) (OR = 2.33 95% CI: 1.03–5.24). Finally, we showed that cagA/vacA (s1m1) gene combination increased the risk of duodenal ulcer development (OR = 2.89, 95% CI 1.10–7.58).ConclusionThis study makes a significant contribution by offering genotypic information regarding H. pylori infection. The presence of several H. pylori genes was associated with the onset of gastrointestinal illness in the Ecuadorian population.

Dog and cat-related attacks on wildlife in the Metropolitan District of Quito, Ecuador: an integrative approach to reduce the impact

ABSTRACT Surveillance and control of dogs and cats (D&C) have become increasingly important for the conservation of biodiversity in protected areas. However, despite the increase in densities of free-roaming D&C in urban areas, especially in developing countries, the impact on wildlife is poorly documented. The Metropolitan District of Quito (MDQ) in Ecuador, contains a high biodiversity of native fauna, but free-roaming dog populations have tripled in recent years, with no published information about possible consequences on wildlife. We conducted a retrospective analysis of patients admitted to a Veterinary Hospital in Quito between July 2017 and June 2022 to determine the incidence of D&C attacks on wildlife from the MDQ. A total of 429 wild specimens (79.5% birds, 17.2% mammals and 3.3% reptiles), including 59 species (4 vulnerable, 1 endangered and 1 critically endangered), were treated for injuries inflicted by D&C. Attacks increased every year on record, and 79% of specimens did not survive. Given that current governmental regulations for the control of domestic animals have not been effective, we propose to address the global issue from a multidisciplinary perspective, considering predation by D&C, biodiversity conservation, animal welfare, human health, and public policies as intertwined phenomena. The goal of this approach is to achieve greater awareness and increase the effectiveness of management programs, while improving the health of animals, humans, and the environment in which they live. Additionally, we recommend government support to replicate this research in other wildlife rehabilitation and rescue centers to understand the scope of the issue nationally.

UPDATE PREVALENCE AND RISK FACTORS ASSOCIATED WITH SIGMA VOLVULUS

This study aims to determine the prevalence of the disease and identification of the most relevant risk factors, to propose a risk profile and appropriate clinical management. The research is descriptive, analytical,retrospective, was performed at a hospital in Quito, Ecuador. medical records were reviewed with diagnosis of volvulus Sigma, 50 records were reviewed, of which the age range most presentation is between 32 to 60 years with 54.3% also was evident the existence of cases in younger ages although it does not correspond with the literature; males had higher prevalence with 60% of the total cases. In the institution which developed research evidenced complication rate with 78.8% of the total, considering that the most important are the presence of postoperative flanges with 15.3%. Demonstrating the importance of risk factors in the study group to take a closer clinical attitude. independent analysis of the variables, and the use of a wider population recommended

Global medical mission with surgical education objectives: a quality report regarding sustainability in an affiliated hospital in Quito, Ecuador

This report seeks to describe the logistics, outcomes, and push toward building a sustainable model for global surgical missions as viewed through the lens of Northwell Health’s 2020 Surgical Mission composed of both operations and international education. The Northwell-Quito 2020 medical mission to Ecuador was envisioned and successfully executed to help achieve Northwell Health’s goal of becoming a globally recognized leader in high-quality, socially conscious health care, and health education. A Northwell-sponsored team of 30 employees and community volunteers partnered with Hospital Padre Carollo, Fundación Tierra Nueva, and the Ecuadorian Ministry of Public Health to provide surgical services to the indigent and underserved of Quito, Ecuador from January 19 to January 24, 2020. During this mission, a total of 127 patients were evaluated, which included preoperative evaluations, operations, as well as postoperative follow-up from prior missions’ surgical interventions. Of the 56 patients scheduled for surgery, 53 operations were performed, including 30 adult and 23 pediatric procedures. No major complications occurred, and all patients were recovering appropriately at the postoperative evaluation on January 24, 2020. Northwell team members provided didactic and practical training for Ecuadorian health care providers, residents, and students to fulfill the educational mission of providing sustainable perioperative care. For the first time, Northwell’s Center for Global Health partnered with Universidad de San Francisco in Quito to organize a Global Health Week focused on the development of research, education, and mental health outreach and partnerships seeking toward building a sustainable model inclusive of logistics alongside international and cross-cultural care.

E-Learning versus Face-to-Face Methodology for Learning Antimicrobial Resistance and Prescription Practice in a Tertiary Hospital of a Middle-Income Country.

Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMR-half in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p &lt; 0.05) and practices (p &lt; 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p &lt; 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p &lt; 0.001) and targeted treatment of UTI (p &lt; 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.

Prevalence and risk factors of depression, anxiety, and stress in an Ecuadorian outpatient population with type II diabetes mellitus: A cross-sectional study (STROBE).

Type II diabetes mellitus (DM2) is a worldwide disease with an important economic and health impact. Currently, depression, anxiety and stress are common disorders among diabetic populations but their respective prevalence may well be underestimated. So far, Latin American countries have only reported limited information about the impact of mental diseases on DM2 outpatients. The objective of this study was to evaluate the prevalence and risk factors related to depression, anxiety, and stress among ambulatory DM2 populations from two third-level hospitals in Quito, Ecuador. A cross-sectional study based on a random sample was carried out in two hospitals. Patients were evaluated by the 21-item Depression, Anxiety and Stress Scale (DASS-21). In addition, a validated survey was used to grade socioeconomic, demographic, clinical, and comorbidity variables. Descriptive statistics and multiple logistic regression were used to analyze the data. Statistical analysis was performed by SPSS (version 22.0). STROBE guidelines were used for reporting this trial. A total of 208 adult patients with DM2 were included (women 58%; men 42%). The prevalence of depression, anxiety and stress was 31.7% (95% CI, 25.5–38.5%), 33.7% (95% CI, 27.3–40.5%), and 25.0% (95% CI, 19.3–31.5%), respectively. Male gender was associated with a decreased risk for depression (OR 0.39 [95% CI, 0.18-0.81]; P = .01), anxiety (OR 0.31 [95% CI, 0.16–0.65]; P = .002), and stress (OR 0.35 [95% CI, 0.15–0.77]; P = .009). A higher level of education was associated with low risk for depression (OR 0.23 [95% CI, 0.11–0.46]; P < .001), anxiety (OR 0.47 [95% CI, 0.25–0.90]; P = .02), and stress (OR 0.24 [95% CI, 0.12–0.49]; P = .001). In contrast, patients with DM2 complications were more likely to have depression (OR 2.96 [95% CI, 1.32–6.63]; P = .008) and anxiety (OR 2.56 [95% CI, 1.20–5.48]; P = .01). Finally, an income higher than the basic salary reduced the risk of depression alone (OR 0.39 [95% CI, 0.16–0.91]; P = .03). In conclusion, a high prevalence rate of depression, anxiety, and stress was found in the DM2 outpatient population. Thus, more tailored care surveillance for DM2 patients is needed considering the bio-psycho-social environment to provide an integral health management.

Technological Improvements in Low- and Middle-Income Countries (LMICs): A Review of the Literature and the “Sociedad de Lucha Contra el Cáncer” (SOLCA) Institutional Experience in Neuro-Radiosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic

Neurosurgery is a medical field that requires specialized professionals and equipment, 2 important but scarce resources in low- and middle-income countries. Our goal was to report our experience with the replacement and implementation of linear accelerators with radiosurgery capabilities at "Sociedad de Lucha Contra el Cáncer" (SOLCA) Hospital in Quito, Ecuador, and give some recommendations for future technological replacements (TRs). Two surveys were performed in SOLCA's radiosurgery department, one before the TR was finalized and one after, consisting of an open and multiple-choice questionnaire. Questions focused on the performance of the new equipment, perceptions regarding the training, and the influence of the pandemic on the whole process. In addition, we share our experience regarding the difficulties and benefits of TR at SOLCA. The most-reported limitation was lack of training (48%). By the time of the second survey, 95.2% of the staff had already treated patients or planned a radiosurgical procedure; 42.9% considered training to have been adequate, and 76.2% felt that the pandemic hindered the training process. Currently, 33 radiosurgeries have been done (26 for the central nervous system and 7 stereotactic radiation body therapies). The TR in SOLCA had similarities with other experiences in low- and middle-income countries, but the pandemic brought additional limitations, mainly complicating the staff training. Nevertheless, those limitations can be resolved with a structured training program and international collaboration. Overall, the benefits obtained from a TR result in exponentially better medical care and accessibility to novel treatments.

Predicting mortality in critically ill patients with COVID-19 in the ICU from a secondary-level hospital in Ecuador

Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 &gt;45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration &gt;9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19.

The Shortage of Local Anesthesia and Palliative Care Medications in Minor Postoperative Orthopedic Surgical Procedures in Ecuador

This white paper discusses the Ecuadorian healthcare system specifically the lack of proper anesthesia and post-operative pain medication and touches base with centralized hospitals. This paper articulates the specific problems inhibiting the usage of these proper medications, specifically looking at a hospital in Quito, Ecuador. Present day tribal situations are also discussed as they are a significant part of the population that is affected by the shortages of pain medication and anesthesia. Solutions are presented to solve the problems the country faces and how it is relevant today.

Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations

Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking. We conducted a retrospective study of an antibiotic stewardship programme (ASP) consisting of restrictive measures on carbapenem dispensing pending required pre-authorisation and expert audit. We evaluated antibiotic consumption and its relationship to carbapenem resistance at a 610-bed, tertiary-level hospital in Quito, Ecuador. We used prescription data from 2010-2017 and converted them into defined daily doses (DDD). We then correlated these findings with the nature of service provided and antibiotic resistance data from the microbiology laboratory. We used descriptive statistics and interrupted time series (ITS) analysis. Throughout the study period, we analysed 16 984 355 prescriptions of 8 191 418.57 g of antibiotics (5 760 479.37 DDD). The in-hospital mean antibiotic prescription rate was 148.8 ± 14.8 DDD/100 occupied bed-days and 293.5 ± 65.3 DDD/100 occupied bed-days in the ICU. First-, second- and third-line antibiotic consumption was 38%, 52% and 10%, respectively. Our hospital data showed a high rate of antibiotic prescription in all hospital areas, mainly broad-spectrum antibiotics. Regarding the ASP introduced in 2016, ITS analysis showed a change in the outcome level immediately following the introduction for imipenem [-3.97; 95% confidence interval (CI) -5.31 to -2.61] but not for meropenem (0.66; 95% CI -0.37 to 1.71). Although our institution's ASP was successful in reducing imipenem consumption, a more embracing plan is required for further interventions to avoid unexpected effects.

Newborns physiological differences in low- and high-altitude settings of Ecuador.

Newborns show physiological differences in low- and high-altitude settings of Ecuador; those differences are especially relevant because most important cities in Ecuador are located at high altitude, above 2500 m. This study is an epidemiological, observational, and cross-sectional research performed at San Francisco Hospital in Quito (at 2850 m) and General Hospital in Manta (at 6 m) in the Manabí province. We studied 204 full-term newborns, healthy without any prenatal comorbidities, singleton pregnancy, mestizos, and born of healthy parents born. We found significant differences between the values of red blood cells (RBC), leucocytes, hematocrit, and hemoglobin. There was a difference of 27% more in RBC, 3% at hematocrit, and 0.4 g at hemoglobin in the high-altitude cohort. The leucocyte difference is 1270 cells/µl, which means a difference of 6%. At high-altitude settings, the mean pH was lower than normal values and pO2, pCO2, and HCO3. High-altitude newborns showed RBC of > 4,500,000 cells/µl; leukocytes > 19,000; pO2 ≤ 72 mm Hg; hemoglobin > 17.50 g/dl; and hematocrit > 54%. Both cohorts showed physiological changes of transition to extrauterine life. We observed higher polycythemia, respiratory acidosis, and hypoxemia among high-altitude newborns. High-altitude setting intensifies the physiological changes in hematological and arterial blood gases parameters.

Epidemiological profile of patients on a single waiting list and donors for a kidney transplant in a hospital in Quito, Ecuador

Background. In Ecuador, it is estimated that more than eight hundred people are on the waiting list for organ transplants. For this reason, the aim of this study is to describe the epidemiological profile of patients on the waiting list and donor for a kidney transplant. Methods. A cross-sectional retrospective study was performed on 67 patients who underwent transplants between 2012 and 2019. We included recipients of organs from both deceased and living donors. Age of patients and donors, period in which they underwent dialysis until the transplant, type of donor, cause of chronic kidney failure, comorbidities, type of dialysis, cold ischemia time, blood-type of donors and patients, compatibility, complications after transplant, delayed graft function, and immunosuppression, were studied. Results. A total of 45 patients were male, with age 46.80 ± 11.48 years old. Twenty-two were females, with age of 40.45 ± 12.9 years old. The mean age of the donor was 40.71 ± 13.28 years old. 55.2% of the etiology to develop CKD in patients was unknown. The second most prevalent were diabetic nephropathy and lupus nephritis, both of which registered 7.5%. Furthermore, 92.4% received kidneys from deceased donors, and the mean age of those recipients was 45.2 ± 13.9 years old. Conversely, only 7.6% had kidneys from living donors. Conclusions. The importance of knowing the epidemiological profile is for health strategies. It can be developed for the medical care of the most vulnerable population within this list, and try to reduce morbidity and mortality.