Paradigms about the COVID-19 pandemic: knowledge, attitudes and practices from medical students.

BACKGROUND: As the disease caused by the novel coronavirus has spread globally, there has been significant economic instability in the healthcare systems. This reality was especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors has led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation of final-year medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent requirement that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes, and practices of Ecuadorian final-year medical students that could potentially guide the design of better medical education curricula regarding COVID-19. METHODS: This was a cross-sectional 33-item online survey conducted between April 6 to April 2020 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final-year medical students. It was sent by email, Facebook, and WhatsApp. RESULTS: A total of 309 students responded to the survey. Out of which 88% of students scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 and volunteering during the outbreak in Ecuador (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment. The latter finding was significantly associated with negative attitudes. CONCLUSIONS: Although a large number of students displayed negative attitudes, the non-depreciable percentage of students who were willing to volunteer and the coexisting high level of knowledge displayed by students, suggests that Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Not having personal protective equipment was significantly associated to negative attitudes. Providing the necessary tools and creating a national curriculum may be one of the most effective ways to ensure all students are trained, whilst simultaneously focusing on the students' most pressing concerns. With this additional training, negative attitudes will improve and students will be better qualified.

[Depression and anxiety among medical students in virtual education during COVID-19 pandemic]. / Depresión y ansiedad en estudiantes de medicina en la educación virtual durante la pandemia por COVID-19.

Background: The lockdown derived from the declaration of a pandemic due to SARS-CoV-2 in March 2020 by the World Health Organization altered daily activities, including the academic ones, which were adapted to virtuality. In Ecuador, the new modality of study had an increase in the use of electronic devices that triggered new problems. Objective: To stablish the prevalence of depression and anxiety among medical students from the Universidad Central del Ecuador (Central University of Ecuador) in virtual education during the COVID-19 pandemic. Material and methods: Cross-sectional analytic study conducted between June and July of 2021 in students from first to tenth semester during virtual education. All studied subjects were evaluated using an electronic survey, depression and anxiety variables were assessed with the BDI-II and GAD-7 scales, respectively. In addition, sociodemographic data were collected, including the family APGAR. A response rate of 63.3% (1528 students) was obtained. Results: Overall prevalence of depression was 37.8% and the prevalence of anxiety 30.3%. Lower-years students were the most affected by these pathologies. The protective factors found were physical activity and psychological support in religion, whereas the main risk factors found were a dysfunctional family, lack of an exclusive study space and low academic performance. Furthermore, the frequency of depression and anxiety was significantly higher in women. Conclusion: The virtual modality showed a high prevalence of depression and anxiety in medical students.

Introducción: el confinamiento derivado de la declaración de pandemia por SARS-CoV-2 en marzo de 2020 por la Organización Mundial de la Salud alteró las actividades diarias, incluidas las académicas, que se adaptaron a la virtualidad. En Ecuador, la nueva modalidad de estudio tuvo un aumento del uso de dispositivos electrónicos que desencadenó nuevos problemas. Objetivo: determinar la prevalencia de depresión y ansiedad en estudiantes de medicina de la Universidad Central del Ecuador en el ciclo de educación virtual durante la pandemia por COVID-19. Material y métodos: estudio analítico transversal realizado entre junio y julio de 2021 en estudiantes de medicina de primero a décimo semestre durante la educación virtual. Por medio de una encuesta electrónica enviada a todos los sujetos de estudio, se evaluaron las variables depresión y ansiedad mediante las escalas BDI-II y GAD-7 respectivamente. Además, se recopilaron datos sociodemográficos, incluido el APGAR familiar. Se obtuvo una tasa de respuesta del 63.3% (1528 estudiantes). Resultados: la prevalencia de depresión fue de 37.8% y la de ansiedad 30.3%. Los estudiantes de años inferiores fueron los más afectados. Los factores protectores fueron la actividad física y el apoyo psicológico en la religión, mientras que los factores de riesgo fueron tener una familia disfuncional, la ausencia de un espacio exclusivo de estudio y un bajo rendimiento académico. Asimismo, la frecuencia de depresión y ansiedad fue significativamente superior en mujeres. Conclusión: durante la modalidad virtual se observó una alta prevalencia de sintomatología de depresión y ansiedad en estudiantes de medicina.

Antihipertensivos de primera línea para el manejo de las crisis hipertensivas en el embarazo / First line antihypertensive for crisis management hypertensive in pregnancy

Los transtornos hipertensivos del embarazo representan una importante carga de morbilidad, discapacidad y muerte en la población obstétrica a lo largo del mundo. En América Latina, una cuarta parte de las defunciones maternas se asocian a estas causas [1]. En el Ecuador, a pesar de los múltiples esfuerzos realizados, se reporta que la razón de mortalidad materna se encuentra por encima del promedio regional, en el periodo 1990-2010 [2]. Los últimos datos publicados por el Instituto Nacional de Estadísticas y Censos, sitúan a la razón de muerte materna en un valor de 49.16 por cada 100000 nacidos vivos. En este escenario, para el año 2014, los transtornos hipertensivos en el Ecuador ocupan el segundo y tercer lugar de las principales causas de muerte materna

The hypertensive disorders of pregnancy represent an important burden of morbidity, disability and death in the obstetric population throughout the world. In Latin America, a quarter of the Maternal deaths are associated with these causes [1]. In Ecuador, a Despite the many efforts made, it is reported that the reason for Maternal mortality is above the regional average, in the period 1990-2010 [2]. The latest data published by the Institute National Statistics and Census, place the maternal death ratio at a value of 49.16 per 100,000 live births. In this stage, for 2014, hypertensive disorders in Ecuador occupy the second and third place of the main causes of maternal death

Amitriptilina para el tratamiento de la neuropatía diabética periférica dolorosa / Amitriptyline for the treatment of painful peripheral diabetic neuropathy

La prevalencia de neuropatía periférica dolorosa en pacientes diabéticos es de aproximadamente 16%. Esta condición clínica afecta de manera importante la calidad de vida de los pacientes. Además, se conoce que la adherencia de los pacientes es menor para fármacos que alivian el dolor, en relación a antidiabéticos orales. Los factores más relevantes para esto son el costo de los medicamentos, el potencial benefcio que se podría obtener con su administración y estados emocionales como la depresión, este último asociado también al no consumo de antidiabéticos orales [1, 2]. Las alternativas farmacológicas de primera línea contra el dolor de la neuropatía diabética periférica incluyen los antidepresivos tricíclicos (como amitriptilina), inhibidores selectivos de la recaptación de serotonina y noradrenalina (duloxetina) y los anticonvulsivantes gabapentina y pregabalina [1]. De estos fármacos, la amitriptilina ha sido una alternativa tradicional y los otros son opciones más modernas. En este contexto, se formuló en formato PICO (paciente ­ intervención ­ comparación ­ resultados) la siguiente pregunta: ¿En pacientes con neuropatía diabética periférica dolorosa, el uso de amitriptilina en relación con gabapentina, pregabalina y duloxetina; controla adecuadamente el dolor?

The prevalence of painful peripheral neuropathy in diabetic patients is of approximately 16%. This clinical condition significantly affects the quality of life of patients. In addition, it is known that adhesion of patients is less for drugs that relieve pain, in relation to oral antidiabetics The most relevant factors for this are the cost of medications, the potential benefit that could be obtained with its administration and emotional states such as depression, the latter associated also to the non-consumption of oral antidiabetics. The first line pharmacological alternatives against the pain of neuropathy Peripheral diabetics include tricyclic antidepressants (such as amitriptyline), selective serotonin and norepinephrine reuptake inhibitors (duloxetine) and Gabapentin and pregabalin anticonvulsants. Of these drugs, amitriptyline It has been a traditional alternative and the others are more modern options. In this context, the following question was asked in PICO format (patient - intervention - comparison - results): In patients with painful peripheral diabetic neuropathy, the use of amitriptyline in relation to gabapentin, pregabalin and duloxetine; properly control pain?