A time-series analysis of morbidity and mortality of viral hepatitis in Venezuela, 1990-2016.

BACKGROUND: Viral hepatitis (VH) is a leading contributor to morbidity and mortality worldwide, constituting a public health problem associated with the level of human development. In recent years, Venezuela has experienced a political, social, and economic crisis and has been impacted by natural disasters that have led to the deterioration of sanitary and health infrastructures modifying the determinants of VH. Despite epidemiological studies conducted in specific regions of the country or populations, the national epidemiological behaviour of VH remains unclear. METHODS: This is a time series study involving records of morbidity and mortality by VH in Venezuela reported during the period from 1990 to 2016. The Venezuelan population was taken as the denominator of the morbidity and mortality rates, according to the Venezuelan National Institute of Statistics and the 2016 population projections from the latest census published on the website of the responsible Venezuelan agency. RESULTS: During the study period, 630,502 cases and 4,679 deaths from VH in Venezuela were analysed. Most of the cases (n = 457,278; 72.6%) were classified as unspecific VH (UVH). The deaths were mainly attributed to VHB (n = 1,532; 32.7%), UVH (n = 1,287; 27.5%), and sequelae of VH (n = 977; 20.8%). The mean rates of cases and deaths from VH in the country were 95 ± 40.4 cases per 100,000 inhabitants and 0.7 ± 0.1 deaths per 100,000 inhabitants, respectively, showing a large dispersion that is evident from the calculation of the coefficients of variation. There was document a strong correlation between UVH and VHA cases (0.78, p < 0.01) morbidity rates. VHB mortality rate was very strongly correlated with sequelae of VH (-0.9, p < 0.01). CONCLUSIONS: VH is a major burden of morbidity and mortality in Venezuela with an endemic-epidemic trend and an intermediate prevalence for VHA, VHB, and VHC. Epidemiological information is not published in a timely manner and diagnostic tests are insufficient in primary health services. There is an urgent need to resume epidemiological surveillance of VH and to optimise the classification system for a better understanding of UVH cases and deaths due to sequelae of VHB and VHC.

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas.

Venezuela's tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela's health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

Diphtheria Outbreak in Amerindian Communities, Wonken, Venezuela, 2016-2017.

In February 2017, a diphtheria outbreak occurred among Amerindians of the Pemón ethnic group in Wonken, Venezuela. A field investigation revealed ≈10 cases; clinical presentation did not include cutaneous or neurologic signs or symptoms. To prevent future outbreaks in Venezuela, Amerindian communities need better access to vaccination and healthcare.

APPLICATION OF THE AACE/ACE ADVANCED FRAMEWORK FOR THE DIAGNOSIS OF OBESITY AND CARDIOMETABOLIC DISEASE STAGING IN A GENERAL POPULATION FROM 3 REGIONS OF VENEZUELA: THE VEMSOLS STUDY RESULTS.

OBJECTIVE: To determine the prevalence of obesity according to the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) framework based on a complications-centric model with further application of the Cardiometabolic Disease Staging (CMDS) system in a Venezuelan population. METHODS: A total of 1,320 adults were randomly selected from 3 regions. The AACE/ACE framework definitions were as follows: overweight, body mass index (BMI) 25 to 29.9 kg/m2 and no obesity-related complications (ORC); obesity stage 0, BMI ≥30 and no ORC; stage 1, BMI ≥25 and 1 or more mild-to-moderate ORC; and stage 2, BMI ≥25 and 1 or more severe ORC. CMDS definitions were as follows: stage 0, no metabolic syndrome (MS) components; stage 1, 1 to 2 MS components without impaired fasting glucose (IFG); stage 2, IFG or ≥3 MS components but without IFG; stage 3, IFG and MS; and stage 4, type 2 diabetes (T2D) or cardiovascular disease. RESULTS: The mean age was 44.8 ± 0.4 years, and 68.5% were female. The prevalence of obesity according to the AACE/ACE framework was 63.1%: overweight 3.0% (95% confidence interval [CI]: 2.1-3.9); obesity stage 0: 0.1% (0.07-0.27); obesity stage 1: 26.6% (24.2-29.0); and obesity stage 2: 36.4% (33.8-39.0). Most subjects with a BMI <25 were CMDS 0 or 1. In those with BMI ≥ 25, only 4.6% were CMDS 0. The prevalence of obesity according to the World Health Organization (WHO, BMI ≥30) was 29.3% (24.7-33.7). CONCLUSION: In a general population study, applying the AACE/ACE framework for obesity and CMDS increased the detection of ORC and therefore higher risk subjects compared to classic anthropometric measurements. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CMDS = Cardiometabolic Disease Staging; DALY = disability-adjusted life years; LA = Latin America; MS = metabolic syndrome; ORC = obesity-related complications; WC = waist circumference; WHO = World Health Organization.

High prevalence and poor control of hypertension in five venezuelan populations: the VEMSOLS study.

The prevalence of hypertension in multiple regions of Venezuela is unknown. The objective of this study was to estimate the prevalence of hypertension in five populations from three regions. During 2006 to 2010, 1392 subjects aged 20 or older were selected by multistage stratified random sampling from all households in five municipalities from: Lara State (Western region), Merida State (Andean region), and Capital District (Capital region). Anthropometric measurements, blood pressure, and biochemical analysis were obtained from each participant. Mean age was 45.2 ± 0.4 years and 68% were females. The overall prevalence of hypertension was 31.3% (CI 95% 28.9 ­ 33.8), it was higher in men than women (38.1% [33.5 ­ 42.8] vs. 28.2% [25.4 ­ 31.2], respectively; p <0.001). The hypertensive participants were older, with higher body mass index (BMI), glucose, total cholesterol, LDL-c, and triglycerides; and lower values of HDL-c, than pre-hypertensive and normotensive participants (p < 0.05). In women, hypertension prevalence increased linearly for every decade of life and by category of BMI; whereas in men it increased until the fifth decade of life, and was similar in patients with overweight and obesity. The risk of hypertension increased with age, the presence of obesity, diabetes, overweight and family history of hypertension. Only 17.7% of the hypertensive subjects were both treated and controlled. In conclusion, about one third of the subjects evaluated had hypertension and about one fifth of them had their hypertension under control. In Venezuela, hypertension is a serious public health problem exacerbated by age and overweight.

Should we be concerned about Venezuelan hemorrhagic fever? - A reflection on its current situation in Venezuela and potential impact in Latin America amid the migration crisis.

Venezuelan Haemorrhagic Fever is an endemic zoonosis exhibiting a high lethality. Discovered decades ago, it is still causing seasonal hemorrhagic fever outbreaks. With the ongoing migration crisis, transmission and spreading to other countries in Latin America remains a latent threat that should be monitored, particularly in light of recent cases.

Mortalidad en accidentes por moto en Venezuela, y su relación con Políticas Públicas de seguridad vial y preventiva,1996-2018 / Mortality in motorcycle accidents in Venezuela and relationship with public road safety and preventive policies, 1996 - 2018

Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

Prevalence of Dyslipidemias in Three Regions in Venezuela: The VEMSOLS Study Results.

BACKGROUND: The prevalence of dyslipidemia in multiple regions of Venezuela is unknown. The Venezuelan Metabolic Syndrome, Obesity and Lifestyle Study (VEMSOLS) was undertaken to evaluate cardiometabolic risk factors in Venezuela. OBJECTIVE: To determine the prevalence of dyslipidemia in five populations from three regions of Venezuela. METHODS: During the years 2006 to 2010, 1320 subjects aged 20 years or older were selected by multistage stratified random sampling from all households in five municipalities from 3 regions of Venezuela: Lara State (Western region), Merida State (Andean region), and Capital District (Capital region). Anthropometric measurements and biochemical analysis were obtained from each participant. Dyslipidemia was defined according to the NCEP/ATPIII definitions. RESULTS: Mean age was 44.8 ± 0.39 years and 68.5% were females. The prevalence of lipids abnormalities related to the metabolic syndrome (low HDL-c [58.6%; 95% CI 54.9 - 62.1] and elevated triglycerides [39.7%; 36.1 - 43.2]) were the most prevalent lipid alterations, followed by atherogenic dyslipidemia (25.9%; 22.7 - 29.1), elevated LDL-c (23.3%; 20.2 - 26.4), hypercholesterolemia (22.2%; 19.2 - 25.2), and mix dyslipidemia (8.9%; 6.8 - 11.0). Dyslipidemia was more prevalent with increasing body mass index. CONCLUSION: Dyslipidemias are prevalent cardiometabolic risk factors in Venezuela. Among these, a higher prevalence of low HDL is a condition also consistently reported in Latin America.

Consenso de la COVID-19 en el embarazo

Después de un año de Pandemia por el virus SARS-CoV-2, causante de la COVID-19, la evidencia demuestra que las embarazadas son un grupo vulnerable a complicaciones durante toda la gestación, en el parto y el puerperio. Aunque el riesgo de transmisión vertical es bajo, la COVID-19 en las embarazadas está asociada a mayor ingreso a la UTI, ventilación mecánica y muerte. En ausencia de un tratamiento específico, la detección temprana y las intervenciones oportunas pueden disminuir el riesgo potencial de complicaciones durante el embarazo. La presente revisión que incluye información epidemiológica, manifestaciones clínicas, diagnóstico y conducta en la embarazada y el recién nacido, y recomendación sobre vacunas, pretende establecer un aporte al equipo de salud que atiende embarazadas y neonatos, para disminuir la morbilidad y mortalidad materno fetal asociada a la COVID-19.

After one year of the Pandemic caused by SARSCoV-2, virus that causes COVID-19, the evidence shows that pregnant women are a group especially vulnerable to complications during the entire gestation, childbirth andpuerperium. Although the risk of vertical transmission is low, COVID-19 in pregnant women is associated with greater admission to the ICU, mechanical ventilation and death. In the absence of specific treatment, early detection and timely interventions can decrease the potential risk of complications during pregnancy. This review, which includes epidemiological information, clinical manifestations and behavior in pregnant women and newborns, aims to establish a contribution to the health team that cares for pregnant women and newborns to reduce maternal-fetal morbidity and mortality associated with COVID-19.

Consenso de inmunizaciones del adulto 2020-2021

La inmunización es el proceso por el que una persona se hace inmune o resistente a una enfermedad infecciosa, por lo general mediante la administración de una vacuna. Las vacunas estimulan el propio sistema inmunitario del cuerpo para proteger a la persona contra infecciones o enfermedades posteriores. La inmunización previene enfermedades, discapacidades y defunciones por enfermedades prevenibles por vacunación, tales como el cáncer cervical, la difteria, la hepatitis B, el sarampión, la parotiditis, la tos ferina, la neumonía, la poliomielitis, las enfermedades diarreicas por rotavirus, la rubéola y el tétanos. La prevención y el control de las enfermedades prevenibles por vacunación (EPVs) es una prioridad de los sistemas de salud de Latinoamerica. Este Consenso ha sido actualizado por profesionales con experiencia en la Vacunación, pertenecientes a la Sociedad Venezolana de Infectología, la Sociedad Venezolana de Puericultura y Pediatría y la Sociedad Venezolana de Salud Pública. El esquema de Vacunas del Adulto aplica a personas desde los 18 años de edad. Se considera esquema completo, cuando se han administrado todas las dosis y/o sus respectivos refuerzos, de acuerdo a su edad correspondiente y riesgos Se presentan los esquemas en forma de calendarios, de manera que los profesionales del sector salud y afines, como la población en general puedan utilizarlos de manera práctica, como esquema de bolsillo para su consulta rápida, como Calendario Vacunal de Adultos 2020 - 2021

Immunization is the process by which a person becomes immune or resistant to an infectious disease, usually through the administration of a vaccine. Vaccines stimulate the body's own immune system to protect the person against subsequent infections or illnesses. Immunization prevents diseases, disabilities, and deaths from vaccine-preventable diseases such as cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis, pneumonia, polio, rotavirus diarrheal diseases, rubella and tetanus. The prevention and control of vaccine-preventable diseases (VPDs) is a priority of the Latin American health systems. This Consensus has been updated by professionals with experience in Vaccination, belonging to the Venezuelan Society of Infectology, the Venezuelan Society of Childcare and Pediatrics and the Venezuelan Society of Public Health. The Adult Vaccines scheme applies to people from 18 years of age. A complete scheme is considered when all the doses and / or their respective boosters have been administered, according to their corresponding age and risks. The schemes are presented in the form of calendars, so that professionals in the health sector and the like, as well as the general population, can use them in a practical way, as a pocket scheme for quick consultation, such as the Adult Vaccine Calendar 2020 - 2021

Características y evolución clínico-epidemiológica según su gravedad en pacientes ingresados con la COVID 19 confirmado

La infección por SARS-CoV-2, se ha destacado por su fácil transmisión de persona a persona por el aire, principalmente por contacto estrecho y mediante gotículas respiratorias, por contacto directo con personas infectadas, o por aerosoles. Este es un estudio de serie de casos, descriptivo, retrospectivo, que muestra las características epidemiológicas, aspectos clínicos, de tratamiento y de evolución de los pacientes ingresados en Del Sur Policlínica, El Tigre, Anzoátegui, con la COVID-19 confirmada, durante julio-octubre del 2020. De 47 pacientes hospitalizados, se estudiaron 25 con confirmación por prueba PCR positiva. Se revisaron las historias clínicas, los resultados obtenidos se presentaron en tablas, expresados en frecuencias absolutas y relativas. Se hospitalizaron 2 pacientes con clínica leve, 6 con la COVID 19 moderado, 13 severos y 4 críticamente enfermos. El sexo masculino fue el más frecuente (80 %), en edades entre 51 a 70 años (60 %). Las vías de contagio más probables fueron: contacto con caso sospechoso o confirmado en 92 %. La hipertensión arterial sistémica (49 %) fue la comorbilidad más frecuente. El 24 % refirió más de 2 comorbilidades. Los síntomas más registrados fueron disnea, fiebre y tos seca. La anosmia y la disgeusia no se presentaron en casos críticos. El hallazgo tomográfico de vidrio deslustrado estuvo en el 100 %, predominando las lesiones bilaterales, con afectación panlobular (92 %). Los antibióticos, la terapia antitrombótica, antivirales, esteroides y el oxígeno suplementario formaron parte del protocolo de hospitalización. El 80 % de los pacientes egresaron con evolución clínica satisfactoria, sólo el 12 % fallecieron en general, aunque la mortalidad en UCI al estar en VMI, fue alta (75 %)

The SARS-CoV-2 infection has been noted for its easy transmission from person to person through the air, mainly by close contact and by respiratory droplets, by direct contact with infected people, or by aerosols. This is a descriptive, retrospective case series study that describes the epidemiological characteristics, clinical aspects, treatment and evolution of patients admitted to Del Sur Polyclinic, El Tigre, Anzoátegui, with confirmed COVID-19, during July -October 2020. Of 47 hospitalized patients, 25 with confirmation by positive PCR test were studied. The medical records were reviewed, the results obtained were presented in tables, expressed in absolute and relative frequencies. 2 patients with mild symptoms were hospitalized, 6 with moderate COVID 19, 13 severe and 4 critically ill. The male sex was the most frequent (80 %), in ages between 51 to 70 years (60 %). The most probable routes of contagion were: contact with a suspected or confirmed case in 92 %. Systemic arterial hypertension (49 %) was the most frequent comorbidity. 24 % referred more than 2 comorbidities. The most recorded symptoms were dyspnea, fever and dry cough. Anosmia and dysgeusia did not occur in critical cases. The ground glass tomographic finding was 100 %, predominantly bilateral lesions, with panlobular involvement (92 %). Antibiotics, antithrombotic therapy, antivirals, steroids, and supplemental oxygen were part of the hospitalization protocol. 80 % of the patients were discharged with a satisfactory clinical evolution, only 12 % died in general, although mortality in the ICU when being in IMV was high (75 %)

Determinación de contactos cercanos con riesgo de transmisión durante las medidas de cuarentena y distanciamiento social para el Covid-19 en personal de salud / Determination of close contacts at risk of transmission during quarantine and social stating measures for Covid-19 in health personnel

El personal de salud por su ámbito laboral sanitario es de alto riesgo para la adquisición y transmisión de la infección por Covid-19. Los contactos cercanos del personal de salud fuera del ambiente hospitalario son frecuentes y variados. El objeto de la investigación es determinar la frecuencia de contactos cercanos para infecciones Covid-19 del personal de salud en su ambiente sanitario,social y familiar previo y durante la pandemia marzo y abril 2020. Métodos: Estudio de corte transversal por cuestionario auto administrado por vía digital dirigido al personal de salud. La población objeto son profesionales activos adscritos a Sociedades Científicas y la UCV. Variables demográficas: edad, sexo,año académico, cohabitante y los contactos cercanos durante traslados, actividades académicas, hospitalarias y sociales.Medidas de tendencia central y dispersión, distribuciones de frecuencia y figuras. Chi cuadrado e intervalos de confianza al 95%, medidas de correlación, comparación con t con error al fade 0,05. Resultados: 194 trabajadores de la salud completaron la encuesta, Sexo femenino 124 (63,9%), edad promedio 49,6 y mediana 53 años. La gran mayoría médicos 88,6%. Se dedican a actividades asistenciales 81%. El promedio de contactos diarios del personal de salud es 38. Los contactos intrahospitalario promedio diario son la mayoría 71%, (27,1 contactos/día). De estos con colegas 5,6, con enfermeras y paraclínicos 3,7; otro personal 4,7; pacientes y sus familiares 7,5 y 5,4. Conclusión:El personal de salud tiene un alto número de contactos cercanos diarios para la transmisión de infecciones respiratorias agudas,lo que representa un alto riesgo para adquirir y son potenciales dispersores de las infecciones a familiares y sociales(AU)

Introduction: Health workers are at high risk for the acquisition and transmission of Covid-19 infection. Close contacts of health workers outside the hospital environment are frequent and varied. The objective of the investigation is to determine the frequency of close contacts for COVID-19 infections of health workers in their previous health, social and family environment and during the pandemic. Methodology: Cross-sectional study by self-administered digital questionnaire to health workers. The target were active professionals of Scientific Societies and professionals of UCV. Demographic variables: age, gender, academic year, cohabitant and close contacts during transfers, academics, hospitals and social. Analysis of central trend and dispersion measures, presentationof data in frequency distributions and bar charts, and segment diagrams. Chi squared, confidence intervals to 95%, correlation measures, comparison with t with alpha error of 0.05 was calculated. Results: 194 health workers participants, most female 124 (63.9%), average age 49.6 and median 53 years.The majority were doctors 88.6%. 81% are dedicated to welfare activities. The average daily contact of health workers is 38people. The average daily hospital contacts are the majority 71%, average of 27.1. Average daily contacts with colleagues 5.6,with nurses and paraclinical 3.7; other personnel 4.7; patientsand their families 7.5 and 5.4. Conclusion: Health workers are highly exposed to infectious respiratory diseases due to their high frequency of close contacts in their daily routine. Therefore, Health workers are potential dispersants of infections to family members, friends and others(AU)

Epidemiology and Disease Burden of Pediatric Dengue in Venezuela.

Dengue is a mosquito-borne viral disease that has evolved from a sporadic infection to a major public health problem in the Americas, Southeast Asia and the western Pacific, and Africa. Its incidence has increased 30-fold over the past 50 years, and although the true disease burden is not well known, the annual incidence in some areas of the Americas may reach 5%-10% of all children when underreporting is considered. We recently analyzed the disease burden of dengue in Venezuela, and we found an overall decline in case numbers and mortality over the period of 1950-2011. However, there were increases in case number and mortality during epidemic years, especially among children. In this report, we focus on the most recent period of data, from 2000 to 2011, comparing pediatric and adult case numbers and mortality.

Conocimientos, prácticas y actitudes para la higiene de manos del personal médico durante la pandemia COVID-19 en el Hospital Universitario de Caracas

Introducción: La práctica de la higiene de manos por el personal de salud es un elemento esencial para prevenir la transmisión de las infecciones asociadas a la atención sanitaria. El objetivo es evaluar el conocimiento, las prácticas y la actitud del personal de salud médico para la higiene de las manos y las condiciones sanitarias mínimas durante la pandemia de COVID-19 en el Hospital Universitario de Caracas, mayo 2020. Metodología: Estudio de corte transversal intrahospitalario. Población: Médicos adjuntos y residentes, y estudiantes presentes al momento de la visita al Hospital Universitario de Caracas. Instrumentos: Entrevistas, cuestionarios, inspecciones y observaciones del lavado de las manos en trabajo intrahospitalario. Análisis estadístico. Programa SPSS 21 para las estadísticas descriptivas con tablas de distribuciones de frecuencia, promedios, porcentajes, desviaciones estándar y percentiles. Pruebas de Chi2 con límites de confianza del 95 %. Resultados: 42 autocuestionarios, 32 a adjuntos y residentes, 75,6 % jóvenes menores de 30 años y 59 % femeninos. Conocimiento suficiente 74 %, las prácticas auto reportadas el 69 % correctas, y la actitud positiva 87 %. 51 áreas inspeccionadas con fallas de agua 16 %, lavamanos funcionales en 28 % de los ambientes, y falta de jabón, gel alcoholado o toallas desechables. 59 % de los baños para pacientes en malas condiciones sanitarias. Observaciones de higiene de manos durante el acto médico (100 momentos), solo 9 % correctos. La inspección del área de triaje de COVID-19 muestra que se cumplen con lavado de manos con gel alcoholado. La inspección del hospital (OMS) reporta 95 puntos nivel de higiene inadecuado con prácticas de HM y promoción deficientes. Formulario inspección de la OMS ante la COVID-19 arroja fallas en infraestructura, insumos y disponibilidad de EPP y falta de auditorías. Discusión: El conocimiento y las prácticas en puntajes moderados requieren educación médica continua, y la actitud muy positiva del personal de salud permitirán mejorar las prácticas en el lugar de trabajo, siempre que se disponga de la infraestructura, agua y jabón, y de gel alcoholado para el cumplimiento del lavado de las manos en los 5 momentos del acto médico. Conclusión: El hospital requiere mejoras importantes de la infraestructura y la entrega de materiales para la correcta higiene de las manos.

Background: The practice of correct hand hygiene by health workers is a key element in the prevention of health care associated infections. The aim of the study is to assess the knowledge, practice and attitudes of the medical staff on hand hygiene and the minimum sanitary conditions during the COVID-19 pandemic at the Hospital Universitario de Caracas during May 2020. Methods: Transversal study based at the Hospital. Population: medical staff, residents, and medical students present when the inspection team visited the Hospital Universitario de Caracas. Instruments: interviews, questionnaires, inspection and observation of the hand hygiene process during hospital work. Statistical analysis: SPSS 21 software for the descriptive statistics, with frequency distribution tables average, percentage, standard deviation and percentiles. Chi2 test with 95 % confidence limits. Results: 42 self-administered questionnaires, 32 to medical staff and residents, 75,6 % were less than 30 years old and 59 % were female. 74 % had sufficient knowledge, correct self reported practice 69 %, positive attitude 87 %. 51 inspected areas, water failure 16 %, working sinks in 28 % of the areas, lack of soap, alcoholic gel or paper towels. 59 % of patient toilet facilities in bad sanitary conditions. Observations of hand hygiene procedures during medical work (100 moments) were only 9 % correct. Inspection of the COVID-19 triage area showed proper alcoholic gel hand hygiene. Hospital inspection (WHO) reported 95 inadequate hygiene points with deficient hand hygiene and promotion. WHO COVID-19 Inspection Form showed infrastructure failures, lack of supplies and availability of PPE and lack of audits. Discussion: Knowledge and practice had moderate scores which require intervention on the continuous medical education. The staff's positive attitude will allow improvement of practices at the workplace whenever infrastructure and supplies are available, especially soap and water or alcoholic gel, for the 5 moment hand hygiene protocol compliance. Conclusion: The hospital requires important infrastructure and supplies improvements for this purpose.

Diabetes Care in Venezuela.

BACKGROUND: The incidence of type 2 diabetes (T2D) and its economic burden have increased in Venezuela, posing difficult challenges in a country already in great turmoil. OBJECTIVES: The aim of this study was to review the prevalence, causes, prevention, management, health policies, and challenges for successful management of diabetes and its complications in Venezuela. METHODS: A comprehensive literature review spanning 1960 to 2015 was performed. Literature not indexed also was reviewed. The weighted prevalence of diabetes and prediabetes was estimated from published regional and subnational population-based studies. Diabetes care strategies were analyzed. FINDINGS: In Venezuela, the weighted prevalence of diabetes was 7.7% and prediabetes was 11.2%. Diabetes was the fifth leading cause of death (7.1%) in 2012 with the mortality rate increasing 7% per year from 1990 to 2012. In 2012, cardiovascular disease and diabetes together were the leading cause of disability-adjusted life years.T2D drivers are genetic, epigenetic, and lifestyle, including unhealthy dietary patterns and physical inactivity. Obesity, insulin resistance, and metabolic syndrome are present at lower cutoffs for body mass index, homeostatic model assessment, and visceral or ectopic fat, respectively. Institutional programs for early detection and/or prevention of T2D have not been established. Most patients with diabetes (∼87%) are cared for in public facilities in a fragmented health system. Local clinical practice guidelines are available, but implementation is suboptimal and supporting information is limited. CONCLUSIONS: Strategies to improve diabetes care in Venezuela include enhancing resources, reducing costs, improving education, implementing screening (using Latin America Finnish Diabetes Risk Score), promoting diabetes care units, avoiding insulin levels as diagnostic tool, correct use of oral glucose tolerance testing and metformin as first-line T2D treatment, and reducing health system fragmentation. Use of the Venezuelan adaptation of the transcultural Diabetes Nutrition Algorithm for lifestyle recommendations and the Latin American Diabetes Association guidelines for pharmacologic interventions can assist primary care physicians in diabetes management.