Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to i... more Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to improve the quality of healthcare delivery. The CPD of medical and nursing staff in high income countries (HICs) is commonplace. CPD of administrative staff is less common, but increasingly frequent. In low-and middle-income countries (LMICs), CPD of any kind is infrequent, particularly in rural and remote areas. Objective: The aim of this study was to describe a hospital-based e-learning CPD program for clinical and non-clinical personnel as a unique example of a successful, ongoing educational pilot, quality improvement program involving a broad cohort of employees, in a country that does not require such activities. Methods: Using the online educational platform Chamilo, e-learning modules were created for eight groups including clinical and non-clinical employees. Upon completion of each module, one to two paragraph discussions were provided for each incorrect answer submitted. Two additional chances were offered for the employee to achieve a passing score of 70%. This study reports on the first 10-month period of the program. Findings: All participants achieved the 70% passing threshold after the first or second attempt. There was 100% participation by the employees required to complete the e-learning modules. Employee feedback suggested the modules were good for continuing education, but some felt the CPD was imposed on them. Conclusion: E-learning CPD is an important and emerging element for CPD and may provide opportunities for healthcare service quality improvement as part of broader pedagogical modalities, such as conferences and directed readings, in rural and remote areas of LMICs. These pilot programs could provide important information to develop Spanish-language e-learning CPD programs across a broader region, promote collaboration with regional professional societies, and possibly contribute to the establishment of national health program CPD standards.
Season is a major determinant of infectious disease rates, including arboviruses spread by mosqui... more Season is a major determinant of infectious disease rates, including arboviruses spread by mosquitoes, such as dengue, chikungunya, and Zika. Seasonal patterns of disease are driven by a combination of climatic or environmental factors, such as temperature or rainfall, and human behavioral time trends, such as school year schedules, holidays, and weekdayweekend patterns. These factors affect both disease rates and healthcare-seeking behavior. Seasonality of dengue fever has been studied in the context of climatic factors, but short-and long-term time trends are less well-understood. With 2009-2016 medical record data from patients diagnosed with dengue fever at two hospitals in rural Ecuador, we used Poisson generalized linear modeling to determine short-and long-term seasonal patterns of dengue fever, as well as the effect of day of the week and public holidays. In a subset analysis, we determined the impact of school schedules on school-aged children. With a separate model, we examined the effect of climate on diagnosis patterns. In the first model, the most important predictors of dengue fever were annual sinusoidal fluctuations in disease, longterm trends (as represented by a spline for the full study duration), day of the week, and hospital. Seasonal trends showed single peaks in case diagnoses, during mid-March. Compared to the average of all days, cases were more likely to be diagnosed on Tuesdays (risk ratio (RR): 1.26, 95% confidence interval (CI) 1.05-1.51) and Thursdays (RR: 1.25, 95% CI 1.02-1.53), and less likely to be diagnosed on Saturdays (RR: 0.81, 95% CI 0.65-1.01) and Sundays (RR: 0.74, 95% CI 0.58-0.95). Public holidays were not significant predictors of dengue fever diagnoses, except for an increase in diagnoses on the day after Christmas (RR: 2.77, 95% CI 1.46-5.24). School schedules did not impact dengue diagnoses in school-aged children. In the climate model, important climate variables included the monthly total precipitation, an interaction between total precipitation and monthly absolute minimum temperature, an interaction between total precipitation and monthly precipitation days, and a three-way interaction between minimum temperature, total precipitation, and precipitation
During the COVID pandemic, biomedicine and the rapid development of anti-COVID vaccines has been ... more During the COVID pandemic, biomedicine and the rapid development of anti-COVID vaccines has been widely praised, while the global public health response has been questioned. Fifteen United States based combined experts in primary healthcare and public health responded to an open question focusing on this issue. Eleven of these experts responded. Four major themes emerged from their answers, including: fragmentation between public health and biomedicine; underfunding of public health; lack of centralized public health authority; business interests over the public good and well-being.
Este atículo presenta la última evidencia encontrada hasta el cierre de la edición y forma parte ... more Este atículo presenta la última evidencia encontrada hasta el cierre de la edición y forma parte de la serie de actualizaciones clínicas, publicadas en los dos números anteriores de la Revista Practica Familiar Rural, el objetivo, es poner a la disposición de profesionales en salud, información actualizada alrededor de la epidemiologia, la transmisión comunitaria, el riesgo de infección de personal de salud la fisiopatología y las manifestaciones clínicas extra-pulmonares, tomado en cuenta que en la primera etapa de la pandemia se puso mucho enfoque sobre el aparato respiratorio. Finalmente trascribimos las guías sobre el apoyo ventilatorio en pacientes que pueden requerir Cuidados Intensivos y las nuevas recomendaciones sobre el tratamiento farmacológico.
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2018
Introduction: Although community acquired MRSA has been well described in many areas around the g... more Introduction: Although community acquired MRSA has been well described in many areas around the globe, little information is available about the prevalence of MRSA infections in rural areas of the Andean Region of South America. This study characterizes wound infections from a rural community hospital in Ecuador. Methods: A retrospective review of 235 bacterial isolates from infected wounds that included wound type, site, gender, etc... Results: Ninety-two (39.1%) isolates were Staphylococcus aureus. Of these, forty-two (44.7%) were methicillin resistant S. aureus (MRSA). Conclusion: community acquired MRSA wound infections rates appear to warrant the use of empiric antibiotics that cover MRSA infections. If wound infections reflect a bacterial epidemiology similar to that of skin and soft tissues infections, empiric anti-MRSA antibiotic coverage is also warranted. In Ecuador, national antibiotic guidelines do not provide for such empiric coverage.
Objetivo. Comparar los resultados del tratamiento del síndrome coronario agudo (SCA), en una pobl... more Objetivo. Comparar los resultados del tratamiento del síndrome coronario agudo (SCA), en una población rural del Noroccidente de la provincia de Pichincha en Ecuador, con relación a las intervenciones asumidas como el tratamiento convencional en el primer mundo. Metodología. Se realizó un estudio descriptivo de 316 historias clínicas de pacientes atendidos en un periodo de 6 años, desde enero del 2010 a enero del 2017 en los cuales se reportó el diagnóstico de síndrome coronario agudo, o sus variantes según la Clasificación Internacional de Enfermedades Edición 10 (CIE-10). Se aplicó una encuesta que extrajo datos demográficos, enfermedades previas, exámenes realizados en el diagnóstico inicial, tratamiento recibido en emergencia, tiempo promedio desde el inicio de los síntomas hasta ingresar a la unidad de cuidados coronarios y mortalidad. Resultados. La edad media del episodio isquémico fue de 62.8 años. Los factores de riesgo identificados fueron: hipertensión arterial (55%), diabetes (31%), Dislipidemia (4.8%), y tabaquismo (12%). El 9.5 % refirieron antecedentes de IAM.
Se realiza una revisión de la evolución de las heridas traumáticas para comprender el manejo de l... more Se realiza una revisión de la evolución de las heridas traumáticas para comprender el manejo de las mismas en emergencia. Cada herida requiere una evaluación completa para determinar el manejo inicial. El uso de solución salina bajo presión, en vez de agentes tóxicos tisulares para la irrigación, es de suma importancia. Palabras clave Heridas traumáticas, emergencia Traumatic injuries in emergency: pathophysiology and controversies in its management Summary A review of the evolution of traumatic injuries is made to understand the management of these in emergency. Each wound requires a complete evaluation to determine initial management. The use of saline under pressure, instead of toxic tissue agents for irrigation, is of utmost importance.
Given the great worldwide expectation for the new coronavirus epidemic, the magazine Rural Family... more Given the great worldwide expectation for the new coronavirus epidemic, the magazine Rural Family Practice makes available to students and health professionals, and society in general, a critical reading of the updated evidence on the new epidemic.
Introducción: Las lesiones oculares pueden ser una complicación que presenten pacientes con infec... more Introducción: Las lesiones oculares pueden ser una complicación que presenten pacientes con infección por Chikungunya. Los médicos que atienden a pacientes expuestos a Chikungunya deben estar conscientes de las complicaciones además de las ya conocidas, estas oculares, que pueden presentar durante la infección aguda hasta meses después.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Jul 1, 2003
To investigate the potential protective effects of Bacille Calmette-Gu6rin (BCG) vaccination scar... more To investigate the potential protective effects of Bacille Calmette-Gu6rin (BCG) vaccination scar and sensitization to tuberculin against geohelminth infections, we conducted a cross-sectional study among school age children in rural communities in Pichincha Province in Ecuador where BCG vaccination is routinely given at birth. A total of 944 children aged 8-14 years were evaluated for the presence of BCG scars and sensitization to tuberculin, and underwent faecal examination for geohelminth parasites. BCG scars were present in 88.2% of children and positive Mantoux tests were observed in 19.1% of children. Geohelminth prevalence was high with 70.3 % infected with any parasite, 52.1% with Ascaris lumbricoides, 52.3% with Trichuris trichiura, 7.6% with Ancylostoma duodenale, and 3.0% with Strongyloides stereoralis. In multivariate analyses, the presence of BCG vaccine scars was not significantly associated with infections with any geohelminth parasite (adjusted odds ratio [AOR] = 0.74, 95% CI 0.43-1.28, P = 0.28), but an inverse association was observed for infections with S. stercoralis that was of borderline statistical significance (AOR = 0.38, 95 % CI 0.15-1.00, P = 0.05). There were no associations between sensitization to tuberculin and infection with geohelminth parasites. The data provide little support for an important protective role of neonatal BCG vaccination or current mycobacterial sensitization against geohelminth infections.
Se realiza una actualización del conocimiento medico científico sobre el COVID-19 en relación, a ... more Se realiza una actualización del conocimiento medico científico sobre el COVID-19 en relación, a la epidemiologia, factores de riesgo y comorbilidades, fisiopatología, utilidad de los exámenes de imagen, tratamiento, y vacunas.
Cómo citar este artículo Gaus, D., Larco, D. La epidemiologia microbiológica de una unidad rural ... more Cómo citar este artículo Gaus, D., Larco, D. La epidemiologia microbiológica de una unidad rural de cuidados intensivos en Ecuador. Práctica Familiar Rural. 2021 marzo; 6(1). Compartir en:. . Resumen Objetivo. Existe mucha información sobre las causas de infecciones bacterianas en Unidades de Cuidados Intensivos (UCI) en paises de altos ingresos. Por otro lado, hay una carencia de la misma información de UCIs en países de bajos y medianos ingresos (PBMI). Además, existe una escasez de estos datos de UCIs rurales en PBMI. Metodología. Se presenta un estudio retrospectivo y descriptivo del perfil bacteriano de una nueva UCI rural en Ecuador que cuenta con un laboratorio de microbiología durante un periodo de tres años.
Background: Chronic Kidney Disease of Undetermined Causes (CKDu) is an emerging global health epi... more Background: Chronic Kidney Disease of Undetermined Causes (CKDu) is an emerging global health epidemic affecting low-income agricultural workers. Comprehensive studies are lacking from many countries where CKDu is suspected, such as Ecuador. Methods: We analyzed publicly-available data for Ecuador containing morbidity records of hospitalized individuals from 2010-2015 by province (n=24). Province-level records for chronic kidney disease (CKD) (N18, ICD-10) in male working adults (ages 18-45) were matched to age-specific province population projections from 2010-2015 national census data to calculate CKD rates. A national survey of agriculture (2012-2015) was used to calculate the proportion of each province's working adult population involved in agriculture. Results: Over 2010-2015, we found an increasing trend in the CKD rate in male working adults (p=0.017). In 2010 and 2011, the highest rates of CKD were observed in Tungurahua (10.5 and 8.5 per 100,000 people, respectively). In 2012, the highest rate was in Galápagos (20.1 per 100,000 people). In 2013 and 2014, the highest rates were in Napo (18.0 and 14.0 per 100,000 people, respectively); in 2015 the highest rate was in Pastaza (19.9 per 100,000 people). The highest proportion of the population involved in agriculture in 2012-2015 was in Bolivar Province (51.3% to 54.8% of the population aged 15-49). Conclusions: This ecological analysis is the first examination of potential CKDu in Ecuador. Analysis is ongoing and next steps include a spatial autoregressive analysis to study agriculture, temperature and CKD, while adjusting for potential confounders.
SummaryBackground Infection with common childhood infectious diseases including geohelminth infec... more SummaryBackground Infection with common childhood infectious diseases including geohelminth infections may provide protection against the development of atopy and allergic disease. Few studies have investigated risk factors for atopy among children living in rural areas of Latin America.Objective To identify risk factors associated with atopy among school‐age children in a rural area of Latin America.Methods Analytic cross‐sectional study of school‐age children conducted in seven rural schools in Pichincha Province in Ecuador. Detailed risk factor information was obtained by questionnaire, stool samples were collected for identification of geohelminth parasites, and Mantoux testing was performed to determine tuberculin sensitization.Results A total of 1002 children from seven rural schools were recruited. The prevalence of geohelminth infections was high (70.1% were infected with at least one geohelminth parasite) and the prevalence of allergic sensitization was high (20.0% had evid...
La falla Cardiaca (FC) es un síndrome caracterizado por disnea, cansancio, y frecuentemente con s... more La falla Cardiaca (FC) es un síndrome caracterizado por disnea, cansancio, y frecuentemente con signos de hipervolemia. Una mayor esperanza de vida, la hipertensión arterial, y la diabetes, junto con la enfermedad cardiaca reumática contribuyen a su prevalencia creciente en Ecuador. La clasificación de la American Heart Asociación (AHA) permite una estrategia terapéutica mas proactiva que la antigua clasificación de NYHA. Las cinco causas de FC son distintas a los desencadenantes. La ecocardiografía es el estándar de oro para confirmar el diagnóstico cuando está disponible. El tratamiento farmacológico con Inhibidores del Enzima de Convertidor de Angiotensina (IECAs), Beta bloqueadores, y Diuréticos está dirigido a la fisiopatología neuro-hormonal de la enfermedad. Nuevos fármacos que demuestran beneficio en ciertos pacientes incluyen los antagonistas de receptores de angiotensina/inhibidor de Neprilysina y moduladores del nodo sinusal. Otros fármacos como Digoxina, Espironolactona, y Isosorbida Dinitrato/Hidralazina están indicados en ciertos pacientes.
Influenza, es una epidemia recurrente en el mundo desde hace varios siglos, a pesar de los esfuer... more Influenza, es una epidemia recurrente en el mundo desde hace varios siglos, a pesar de los esfuerzos médicos cada cierto tiempo se producen epidemias y es un motivo de consulta frecuente en el servicio de Emergencia y Consulta Externa produciendo varias muertes al año en todos los países del planeta. El conocimiento que tenemos alrededor de esta enfermedad es el que se publica en los países del primer mundo, no contamos con investigaciones grandes en Latinoamérica y este conocimiento nunca es adecuadamente contextualizado. El objetivo es realizar una revisión bibliográfica sobre el tema y contextualizar este conocimiento para los países tropicales. Método Usamos el método de lectura crítica es la lectura realizada de un modo analítico. Esto significa que además de comprender los que se dice en un texto determinado, se intenta analizar lo expresado para verificar sus aciertos, sus errores y los modos en que se presenta la información. Se buscar tener una visión propia de los hechos presentados, intentando corroborar lo que se afirma con otras fuentes. Palabras clave Influenza, influenza actualización, países tropicales, lectura critica.
Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to i... more Background: E-learning Continuing Professional Development (CPD) is an activity demonstrated to improve the quality of healthcare delivery. The CPD of medical and nursing staff in high income countries (HICs) is commonplace. CPD of administrative staff is less common, but increasingly frequent. In low-and middle-income countries (LMICs), CPD of any kind is infrequent, particularly in rural and remote areas. Objective: The aim of this study was to describe a hospital-based e-learning CPD program for clinical and non-clinical personnel as a unique example of a successful, ongoing educational pilot, quality improvement program involving a broad cohort of employees, in a country that does not require such activities. Methods: Using the online educational platform Chamilo, e-learning modules were created for eight groups including clinical and non-clinical employees. Upon completion of each module, one to two paragraph discussions were provided for each incorrect answer submitted. Two additional chances were offered for the employee to achieve a passing score of 70%. This study reports on the first 10-month period of the program. Findings: All participants achieved the 70% passing threshold after the first or second attempt. There was 100% participation by the employees required to complete the e-learning modules. Employee feedback suggested the modules were good for continuing education, but some felt the CPD was imposed on them. Conclusion: E-learning CPD is an important and emerging element for CPD and may provide opportunities for healthcare service quality improvement as part of broader pedagogical modalities, such as conferences and directed readings, in rural and remote areas of LMICs. These pilot programs could provide important information to develop Spanish-language e-learning CPD programs across a broader region, promote collaboration with regional professional societies, and possibly contribute to the establishment of national health program CPD standards.
Season is a major determinant of infectious disease rates, including arboviruses spread by mosqui... more Season is a major determinant of infectious disease rates, including arboviruses spread by mosquitoes, such as dengue, chikungunya, and Zika. Seasonal patterns of disease are driven by a combination of climatic or environmental factors, such as temperature or rainfall, and human behavioral time trends, such as school year schedules, holidays, and weekdayweekend patterns. These factors affect both disease rates and healthcare-seeking behavior. Seasonality of dengue fever has been studied in the context of climatic factors, but short-and long-term time trends are less well-understood. With 2009-2016 medical record data from patients diagnosed with dengue fever at two hospitals in rural Ecuador, we used Poisson generalized linear modeling to determine short-and long-term seasonal patterns of dengue fever, as well as the effect of day of the week and public holidays. In a subset analysis, we determined the impact of school schedules on school-aged children. With a separate model, we examined the effect of climate on diagnosis patterns. In the first model, the most important predictors of dengue fever were annual sinusoidal fluctuations in disease, longterm trends (as represented by a spline for the full study duration), day of the week, and hospital. Seasonal trends showed single peaks in case diagnoses, during mid-March. Compared to the average of all days, cases were more likely to be diagnosed on Tuesdays (risk ratio (RR): 1.26, 95% confidence interval (CI) 1.05-1.51) and Thursdays (RR: 1.25, 95% CI 1.02-1.53), and less likely to be diagnosed on Saturdays (RR: 0.81, 95% CI 0.65-1.01) and Sundays (RR: 0.74, 95% CI 0.58-0.95). Public holidays were not significant predictors of dengue fever diagnoses, except for an increase in diagnoses on the day after Christmas (RR: 2.77, 95% CI 1.46-5.24). School schedules did not impact dengue diagnoses in school-aged children. In the climate model, important climate variables included the monthly total precipitation, an interaction between total precipitation and monthly absolute minimum temperature, an interaction between total precipitation and monthly precipitation days, and a three-way interaction between minimum temperature, total precipitation, and precipitation
During the COVID pandemic, biomedicine and the rapid development of anti-COVID vaccines has been ... more During the COVID pandemic, biomedicine and the rapid development of anti-COVID vaccines has been widely praised, while the global public health response has been questioned. Fifteen United States based combined experts in primary healthcare and public health responded to an open question focusing on this issue. Eleven of these experts responded. Four major themes emerged from their answers, including: fragmentation between public health and biomedicine; underfunding of public health; lack of centralized public health authority; business interests over the public good and well-being.
Este atículo presenta la última evidencia encontrada hasta el cierre de la edición y forma parte ... more Este atículo presenta la última evidencia encontrada hasta el cierre de la edición y forma parte de la serie de actualizaciones clínicas, publicadas en los dos números anteriores de la Revista Practica Familiar Rural, el objetivo, es poner a la disposición de profesionales en salud, información actualizada alrededor de la epidemiologia, la transmisión comunitaria, el riesgo de infección de personal de salud la fisiopatología y las manifestaciones clínicas extra-pulmonares, tomado en cuenta que en la primera etapa de la pandemia se puso mucho enfoque sobre el aparato respiratorio. Finalmente trascribimos las guías sobre el apoyo ventilatorio en pacientes que pueden requerir Cuidados Intensivos y las nuevas recomendaciones sobre el tratamiento farmacológico.
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2018
Introduction: Although community acquired MRSA has been well described in many areas around the g... more Introduction: Although community acquired MRSA has been well described in many areas around the globe, little information is available about the prevalence of MRSA infections in rural areas of the Andean Region of South America. This study characterizes wound infections from a rural community hospital in Ecuador. Methods: A retrospective review of 235 bacterial isolates from infected wounds that included wound type, site, gender, etc... Results: Ninety-two (39.1%) isolates were Staphylococcus aureus. Of these, forty-two (44.7%) were methicillin resistant S. aureus (MRSA). Conclusion: community acquired MRSA wound infections rates appear to warrant the use of empiric antibiotics that cover MRSA infections. If wound infections reflect a bacterial epidemiology similar to that of skin and soft tissues infections, empiric anti-MRSA antibiotic coverage is also warranted. In Ecuador, national antibiotic guidelines do not provide for such empiric coverage.
Objetivo. Comparar los resultados del tratamiento del síndrome coronario agudo (SCA), en una pobl... more Objetivo. Comparar los resultados del tratamiento del síndrome coronario agudo (SCA), en una población rural del Noroccidente de la provincia de Pichincha en Ecuador, con relación a las intervenciones asumidas como el tratamiento convencional en el primer mundo. Metodología. Se realizó un estudio descriptivo de 316 historias clínicas de pacientes atendidos en un periodo de 6 años, desde enero del 2010 a enero del 2017 en los cuales se reportó el diagnóstico de síndrome coronario agudo, o sus variantes según la Clasificación Internacional de Enfermedades Edición 10 (CIE-10). Se aplicó una encuesta que extrajo datos demográficos, enfermedades previas, exámenes realizados en el diagnóstico inicial, tratamiento recibido en emergencia, tiempo promedio desde el inicio de los síntomas hasta ingresar a la unidad de cuidados coronarios y mortalidad. Resultados. La edad media del episodio isquémico fue de 62.8 años. Los factores de riesgo identificados fueron: hipertensión arterial (55%), diabetes (31%), Dislipidemia (4.8%), y tabaquismo (12%). El 9.5 % refirieron antecedentes de IAM.
Se realiza una revisión de la evolución de las heridas traumáticas para comprender el manejo de l... more Se realiza una revisión de la evolución de las heridas traumáticas para comprender el manejo de las mismas en emergencia. Cada herida requiere una evaluación completa para determinar el manejo inicial. El uso de solución salina bajo presión, en vez de agentes tóxicos tisulares para la irrigación, es de suma importancia. Palabras clave Heridas traumáticas, emergencia Traumatic injuries in emergency: pathophysiology and controversies in its management Summary A review of the evolution of traumatic injuries is made to understand the management of these in emergency. Each wound requires a complete evaluation to determine initial management. The use of saline under pressure, instead of toxic tissue agents for irrigation, is of utmost importance.
Given the great worldwide expectation for the new coronavirus epidemic, the magazine Rural Family... more Given the great worldwide expectation for the new coronavirus epidemic, the magazine Rural Family Practice makes available to students and health professionals, and society in general, a critical reading of the updated evidence on the new epidemic.
Introducción: Las lesiones oculares pueden ser una complicación que presenten pacientes con infec... more Introducción: Las lesiones oculares pueden ser una complicación que presenten pacientes con infección por Chikungunya. Los médicos que atienden a pacientes expuestos a Chikungunya deben estar conscientes de las complicaciones además de las ya conocidas, estas oculares, que pueden presentar durante la infección aguda hasta meses después.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Jul 1, 2003
To investigate the potential protective effects of Bacille Calmette-Gu6rin (BCG) vaccination scar... more To investigate the potential protective effects of Bacille Calmette-Gu6rin (BCG) vaccination scar and sensitization to tuberculin against geohelminth infections, we conducted a cross-sectional study among school age children in rural communities in Pichincha Province in Ecuador where BCG vaccination is routinely given at birth. A total of 944 children aged 8-14 years were evaluated for the presence of BCG scars and sensitization to tuberculin, and underwent faecal examination for geohelminth parasites. BCG scars were present in 88.2% of children and positive Mantoux tests were observed in 19.1% of children. Geohelminth prevalence was high with 70.3 % infected with any parasite, 52.1% with Ascaris lumbricoides, 52.3% with Trichuris trichiura, 7.6% with Ancylostoma duodenale, and 3.0% with Strongyloides stereoralis. In multivariate analyses, the presence of BCG vaccine scars was not significantly associated with infections with any geohelminth parasite (adjusted odds ratio [AOR] = 0.74, 95% CI 0.43-1.28, P = 0.28), but an inverse association was observed for infections with S. stercoralis that was of borderline statistical significance (AOR = 0.38, 95 % CI 0.15-1.00, P = 0.05). There were no associations between sensitization to tuberculin and infection with geohelminth parasites. The data provide little support for an important protective role of neonatal BCG vaccination or current mycobacterial sensitization against geohelminth infections.
Se realiza una actualización del conocimiento medico científico sobre el COVID-19 en relación, a ... more Se realiza una actualización del conocimiento medico científico sobre el COVID-19 en relación, a la epidemiologia, factores de riesgo y comorbilidades, fisiopatología, utilidad de los exámenes de imagen, tratamiento, y vacunas.
Cómo citar este artículo Gaus, D., Larco, D. La epidemiologia microbiológica de una unidad rural ... more Cómo citar este artículo Gaus, D., Larco, D. La epidemiologia microbiológica de una unidad rural de cuidados intensivos en Ecuador. Práctica Familiar Rural. 2021 marzo; 6(1). Compartir en:. . Resumen Objetivo. Existe mucha información sobre las causas de infecciones bacterianas en Unidades de Cuidados Intensivos (UCI) en paises de altos ingresos. Por otro lado, hay una carencia de la misma información de UCIs en países de bajos y medianos ingresos (PBMI). Además, existe una escasez de estos datos de UCIs rurales en PBMI. Metodología. Se presenta un estudio retrospectivo y descriptivo del perfil bacteriano de una nueva UCI rural en Ecuador que cuenta con un laboratorio de microbiología durante un periodo de tres años.
Background: Chronic Kidney Disease of Undetermined Causes (CKDu) is an emerging global health epi... more Background: Chronic Kidney Disease of Undetermined Causes (CKDu) is an emerging global health epidemic affecting low-income agricultural workers. Comprehensive studies are lacking from many countries where CKDu is suspected, such as Ecuador. Methods: We analyzed publicly-available data for Ecuador containing morbidity records of hospitalized individuals from 2010-2015 by province (n=24). Province-level records for chronic kidney disease (CKD) (N18, ICD-10) in male working adults (ages 18-45) were matched to age-specific province population projections from 2010-2015 national census data to calculate CKD rates. A national survey of agriculture (2012-2015) was used to calculate the proportion of each province's working adult population involved in agriculture. Results: Over 2010-2015, we found an increasing trend in the CKD rate in male working adults (p=0.017). In 2010 and 2011, the highest rates of CKD were observed in Tungurahua (10.5 and 8.5 per 100,000 people, respectively). In 2012, the highest rate was in Galápagos (20.1 per 100,000 people). In 2013 and 2014, the highest rates were in Napo (18.0 and 14.0 per 100,000 people, respectively); in 2015 the highest rate was in Pastaza (19.9 per 100,000 people). The highest proportion of the population involved in agriculture in 2012-2015 was in Bolivar Province (51.3% to 54.8% of the population aged 15-49). Conclusions: This ecological analysis is the first examination of potential CKDu in Ecuador. Analysis is ongoing and next steps include a spatial autoregressive analysis to study agriculture, temperature and CKD, while adjusting for potential confounders.
SummaryBackground Infection with common childhood infectious diseases including geohelminth infec... more SummaryBackground Infection with common childhood infectious diseases including geohelminth infections may provide protection against the development of atopy and allergic disease. Few studies have investigated risk factors for atopy among children living in rural areas of Latin America.Objective To identify risk factors associated with atopy among school‐age children in a rural area of Latin America.Methods Analytic cross‐sectional study of school‐age children conducted in seven rural schools in Pichincha Province in Ecuador. Detailed risk factor information was obtained by questionnaire, stool samples were collected for identification of geohelminth parasites, and Mantoux testing was performed to determine tuberculin sensitization.Results A total of 1002 children from seven rural schools were recruited. The prevalence of geohelminth infections was high (70.1% were infected with at least one geohelminth parasite) and the prevalence of allergic sensitization was high (20.0% had evid...
La falla Cardiaca (FC) es un síndrome caracterizado por disnea, cansancio, y frecuentemente con s... more La falla Cardiaca (FC) es un síndrome caracterizado por disnea, cansancio, y frecuentemente con signos de hipervolemia. Una mayor esperanza de vida, la hipertensión arterial, y la diabetes, junto con la enfermedad cardiaca reumática contribuyen a su prevalencia creciente en Ecuador. La clasificación de la American Heart Asociación (AHA) permite una estrategia terapéutica mas proactiva que la antigua clasificación de NYHA. Las cinco causas de FC son distintas a los desencadenantes. La ecocardiografía es el estándar de oro para confirmar el diagnóstico cuando está disponible. El tratamiento farmacológico con Inhibidores del Enzima de Convertidor de Angiotensina (IECAs), Beta bloqueadores, y Diuréticos está dirigido a la fisiopatología neuro-hormonal de la enfermedad. Nuevos fármacos que demuestran beneficio en ciertos pacientes incluyen los antagonistas de receptores de angiotensina/inhibidor de Neprilysina y moduladores del nodo sinusal. Otros fármacos como Digoxina, Espironolactona, y Isosorbida Dinitrato/Hidralazina están indicados en ciertos pacientes.
Influenza, es una epidemia recurrente en el mundo desde hace varios siglos, a pesar de los esfuer... more Influenza, es una epidemia recurrente en el mundo desde hace varios siglos, a pesar de los esfuerzos médicos cada cierto tiempo se producen epidemias y es un motivo de consulta frecuente en el servicio de Emergencia y Consulta Externa produciendo varias muertes al año en todos los países del planeta. El conocimiento que tenemos alrededor de esta enfermedad es el que se publica en los países del primer mundo, no contamos con investigaciones grandes en Latinoamérica y este conocimiento nunca es adecuadamente contextualizado. El objetivo es realizar una revisión bibliográfica sobre el tema y contextualizar este conocimiento para los países tropicales. Método Usamos el método de lectura crítica es la lectura realizada de un modo analítico. Esto significa que además de comprender los que se dice en un texto determinado, se intenta analizar lo expresado para verificar sus aciertos, sus errores y los modos en que se presenta la información. Se buscar tener una visión propia de los hechos presentados, intentando corroborar lo que se afirma con otras fuentes. Palabras clave Influenza, influenza actualización, países tropicales, lectura critica.
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