Caracterización clínico epidemiológica de la COVID-19 en el Policlínico Ángel Machaco Ameijeiras / Clinical-Epidemiological Characterization of COVID-19 At Ángel Machaco Ameijeiras Polyclinic

Introducción: El nuevo coronavirus comenzó en Wuhan, China, a fines de 2019 y se ha diseminado con rapidez por todo el mundo. Objetivo: Caracterizar el comportamiento de la COVID-19 en el Policlínico Ángel Machaco Ameijeiras de la semana estadística 11 a la 34, 2020. Métodos: Se realizó un estudio descriptivo, de corte transversal, con el universo fueron los casos atendidos Se utilizó el Programa EPIDAT 3.1, las variables definidas permitieron la creación una base de datos en Excel. Resultados: Se confirmaron 16 casos desde el inicio de la pandemia, todos son cubanos, con una fuente de infección conocida, La tasa de incidencia acumulada es de 4,6 POR 10 000 habitantes, predominaron los pacientes asintomáticos, las edades de 21 a 39 años y de 40 a 59 años, en el consejo popular Debeche Nalón predominaron los casos en el mes de abril y reaparecieron en julio y agosto. Conclusiones: Se confirmaron un 20,2 por ciento de los casos sospechosos de COVID-19, predominaron los casos en el consejo popular Debeche Nalón y el grupo de edades de 21 a 39 años. No se evidenciaron diferencias relacionadas con el sexo. Todos los casos tenían fuente de infección conocida, sobre todo los centros de trabajo. Al momento del ingreso la mayoría era asintomático. Las infecciones respiratorias agudas se encuentran en zona de éxito durante la etapa analizada y su tendencia era descendente, así como la tendencia de la COVID-19 ligeramente ascendente(AU)

Introduction: The new coronavirus began in Wuhan, China, in late 2019 and has spread rapidly throughout the world. Objective: To characterize the behavior of COVID-19 at Ángel Machaco Ameijeiras Polyclinic from statistical week 11 to 34, 2020. Methods: A descriptive, cross-sectional study was carried out in the universe made up of the cases assisted. EPIDAT 3.1 Program was used, the defined variables allowed the creation of a database in Excel. Results: Sixteen cases have been confirmed since the beginning of the pandemic, all are Cuban, with a known source of infection. The cumulative incidence rate is 4.6 per 10,000 inhabitants, asymptomatic patients, ages 21 to 39 years and 40 to 59 years predominated. In Debeche Nalón community, cases prevailed in the month of April and reappeared in July and August. Conclusions: 20.2percent of suspected COVID-19 cases were confirmed. No differences related to sex were evident. All cases had a known source of infection, especially those in workplaces. At the time of admission, the majority were asymptomatic. Acute respiratory infections are in the success zone during the stage analyzed and their trend was downward, while the trend of COVID-19 was slightly upward(AU)

Pharmacogenetics: ethnicity, treatment and health in Latin American populations.

The Ibero-American Network of Pharmacogenetics and Pharmacogenomics (RIBEF) studies Latin American populations to benefit from the implementation of personalized medicine. Since 2006, it has studied ethnicity to apply pharmacogenetics knowledge in autochthonous populations of Latin America, considering ancestral medicine. The meeting 'Pharmacogenetics: ethnicity, Treatment and Health in Latin American Populations' was held in Mexico City, Mexico, and presented the relevance of RIBEF collaboration with Latin American researchers and the governments of Mexico, Spain and the Autonomous Community of Extremadura. The results of 17 years of uninterrupted work by RIBEF, the Declaration of Mérida/T'Hó and the call for the Dr José María Cantú Award for studies focused on the pharmacogenetics of native populations in Latin America were presented.

Alteraciones del comportamiento como contenido en la formación de estudiantes para la orientación a las familias

La formación de estudiantes para la prevención de las alteraciones del comportamiento en los niños de la primera infancia, es imprescindible porque contribuye a elevar la calidad de la atención educativa de salud y educación en ambas modalidades de atención educativa de la primera infancia. El artículo que se presenta tiene como objetivo exponer acciones dirigidas a los estudiantes en formación que los prepara para la orientación de las familias, en función de la prevención de las alteraciones del comportamientoen niños de infancia preescolar. Las acciones se aplicaron durante el periodo del 2019 al 2022 como parte de la preparación para la práctica laboral, lo que posibilitó que se elevara la calidad de la orientación familiar en función de la prevención de las alteraciones del comportamiento en los niños de infancia preescolar, en ambas modalidades de atención educativa.

The training of students for the prevention of behavioral disorders in early childhood children is essential because it contributes to raising the quality of educational health care and education in both modalities of early childhood educational care. The article that is presented aims to expose actions aimed at students in training that prepare them for the orientation of families, based on the prevention of behavioral disorders in preschool children. The actions were applied during the period from 2019 to 2022 as part of the preparation for labor practice, which made it possible to raise the quality of family guidance based on the prevention of behavioral disorders in preschool children, in both modalities of educational attention.

Maintenance of angiogenesis inhibition with aflibercept after progression to bevacizumab in metastatic colorectal cancer: real life study in the Valencian community.

INTRODUCTION: The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. PATIENTS AND METHODS: This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. RESULTS: 122 patients with a median age of 61 years were included. 89% of patients had PS 0-1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74-6.15 months) and 10.15 (95% CI 7.47-12.82 months), respectively. Disease control rate 59.8%. The most common grade 3-4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58-17.32) in patients with hypertension vs 7.78 (95% CI 5.02-10.54) in patients without hypertension (p = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. CONCLUSIONS: Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response.

Superación del médico general para la atención integral a niños con necesidades educativas especiales / Knowledge improvement of the general practitioner for comprehensive care for children with special educational needs

Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

New Variants of Pseudomonas aeruginosa High-Risk Clone ST233 Associated with an Outbreak in a Mexican Paediatric Hospital.

Recent multidrug resistance in Pseudomonas aeruginosa has favoured the adaptation and dissemination of worldwide high-risk strains. In June 2018, 15 P. aeruginosa strains isolated from patients and a contaminated multi-dose meropenem vial were characterized to assess their association to an outbreak in a Mexican paediatric hospital. The strains were characterized by antibiotic susceptibility profiling, virulence factors' production, and biofilm formation. The clonal relationship among isolates was determined with pulse-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) sequencing. Repressor genes for the MexAB-OprM efflux pump were sequenced for haplotype identification. Of the strains, 60% were profiled as extensively drug-resistant (XDR), 33% as multidrug-resistant (MDR), and 6.6% were classified as sensitive (S). All strains presented intermediate resistance to colistin, and 80% were sensitive to aztreonam. Pyoverdine was the most produced virulence factor. The PFGE technique was performed for the identification of the outbreak, revealing eight strains with the same electrophoretic pattern. ST235 and ten new sequence types (STs) were identified, all closely related to ST233. ST3241 predominated in 26.66% of the strains. Twenty-five synonymous and seventeen nonsynonymous substitutions were identified in the regulatory genes of the MexAB-OprM efflux pump, and nalC was the most variable gene. Six different haplotypes were identified. Strains from the outbreak were metallo-ß-lactamases and phylogenetically related to the high-risk clone ST233.

HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost-Utility Analysis.

Introduction: HIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy "95-95-95" which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost-utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts. Methods: For the cost-utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths. Results: Cost-benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (-$591, -$4,360) and -108 and -934 DALYs, in the case of ART and PrEP, ICER the $30,541-$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10-12 years of healthy life. Conclusion: CUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.

Pneumococcal Carriage Among Indigenous Kichwa Children From the Ecuadorian Andes After the 10-Valent Pneumococcal Vaccine Introduction.

BACKGROUND: We assessed nasopharyngeal pneumococcal carriage in Andean Kichwa children, the largest Amerindian indigenous population in the Ecuadorian Andes. All children in our study had been vaccinated with the 10-valent pneumococcal vaccine (PCV10). METHODS: Nasopharyngeal swabs from 63 families, 100 children <10 years old including 38 children under 5 years and 63 adult caregivers, from 5 different communities, were cultivated for Streptococcus pneumoniae and isolates were serotyped and antibiotic susceptibility testing was performed. RESULTS: Respectively, 67% of the 38 children under 5 years old, 49% of the 62 children between 6 and 10 years old and 16% of the 100 adults were colonized with S. pneumoniae. Of these, 30.9% carried a vaccine serotype, 5.4% a serotype shared by the PCV10/13-valent pneumococcal vaccine (PCV13) vaccine and 25.5% a PCV13 serotype or PCV13 vaccine-related serotype, with 19A (10.9%) and 6C (10.9%) as the most prominent. Drug susceptibility testing revealed that 46% of the S. pneumoniae strains were susceptible to 6 tested antibiotics. However, 20.3% of the strains were multidrug-resistant or extensively drug-resistant strains, including 82% of the vaccine (-related) serotype 19A and 6C strains. CONCLUSIONS: Kichwa children, vaccinated with PCV10, were highly colonized with pneumococci and should be considered a high-risk group for pneumococcal disease. Twenty-five percent of the colonizing S. pneumoniae strains were PCV13-only vaccine-targeted serotypes, and in addition to that, most were multidrug-resistant or extensively drug-resistant strains. The vaccine benefits for this population possibly will significantly increase with the introduction of PCV13.

COVID-19 en Pediatría. ¿Qué se sabe? / COVID-19 in Pediatrics. What is known about it?

Introducción: La COVID-19 es una pandemia mundial que flagela la supervivencia del hombre. Este problema sanitario estremece cada jornada los servicios de salud y genera mortalidad en casi todos los grupos de edad. Objetivo: Aportar datos sobre la COVID-19 que tribute a mejoras en el proceso de atención a niños sospechosos y enfermos con SARS-CoV-2. Material y Método: Se hizo revisión sobre la COVID-19 en Pubmed/Medline, ScienceDirecty SciELO. Se utilizó el buscador Google Académico. Se usaron las palabras coronavirus, COVID-19, y SARS-CoV-2, en idioma español e inglés. La información obtenida se clasificó según tipo fuente. Después de este proceso, se inició la redacción del artículo. Desarrollo: La mayor parte de los casos pediátricos es asintomático. Las manifestaciones clínicas comunes incluyen fiebre, tos, odinofagia y dificultad respiratoria. Aunque la presentación asintomática sigue siendo preponderante, la afectación respiratoria, digestiva, neurológica y cutánea se señala en grado variable. El hábito de fumar, y otras condiciones individuales se relacionan con la evolución de la enfermedad. Las pruebas de laboratorio describen leucopenia; sobre todo, en formas graves. La elevación de la procalcitonina y la proteína C reactiva orientan a sobreinfección bacteriana, y es justificación para usar antibióticos. La radiografía de tórax habitualmente es normal, pero puede revelar infiltrados en forma de parches en pacientes con afectación parenquimatosa. La evolución es favorable, y la mortalidad baja. Conclusiones: La COVID-19 en niños tiene presentación heterogénea. Por lo general, es asintomática, aunque puede tener afectación en sistemas y aparatos. Evoluciona hacia la recuperación total en 3-4 semanas(AU)

Introduction: COVID-19 is a global pandemic that threats the survival of man. This health problem shakes health services every day and generates mortality in almost all age groups. Objective: To provide data on COVID-19 that contribute to improve quality of the care process in children with suspected SARS-CoV-2 or with the infection. Material and Methods: A review of COVID-19 was carried out in Pubmed/Medline, Science Direct and SciELO. Google Scholar search engine was used. The words coronavirus, COVID-19, and SARS-CoV-2 in Spanish and English were used. The information obtained was classified according to the type of source. After this process, the drafting of the article began. Development: Most pediatric cases are asymptomatic. Common clinical manifestations include fever, cough, odynophagia, and respiratory difficulty. Although asymptomatic presentation remains to be predominant, respiratory, digestive, neurological and cutaneous involvement is noted in varying degrees. Smoking and other individual conditions are related to the evolution of the disease. Laboratory tests describe leukopenia, above all, in serious ways. Elevation of procalcitonin and C-reactive protein suggest bacterial overinfection, justifying the prescription of antibiotics. Chest X-ray is usually normal, but it may reveal patchy infiltrates in patients with parenchymal involvement. The evolution is favorable and the mortality is low. Conclusions: COVID-19 in children has a heterogeneous presentation. It is usually asymptomatic, although it may affect systems and organs. It evolves towards recovering in 3-4 weeks(AU)

"Cancer is in style": lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador.

Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America.Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques.Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets.Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America.

Control of Methicillin-Resistant Staphylococcus aureus Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C.

Methicillin-resistant Staphylococcus aureus (MRSA) is considered an opportunistic pathogen in humans and is mainly associated with healthcare-associated infections (HCAIs). This bacterium colonizes the skin and mucous membranes of healthy people and causes frequent hospital outbreaks. The aim of this study was to perform molecular typing of the staphylococcal cassette chromosome mec (SCCmec) and agr loci as wells as to establish the pulsotypes and clonal complexes (CCs) for MRSA and methicillin-sensitive S. aureus (MSSA) outbreaks associated with the operating room (OR) at a pediatric hospital. Twenty-five clinical strains of S. aureus (19 MRSA and 6 MSSA strains) were recovered from the outbreak (patients, anesthesia equipment, and nasopharyngeal exudates from external service anesthesia technicians). These clinical S. aureus strains were mainly resistant to benzylpenicillin (100%) and erythromycin (84%) and were susceptible to vancomycin and nitrofurantoin. The SCCmec type II was amplified in 84% of the S. aureus strains, and the most frequent type of the agr locus was agrII, which was amplified in 72% of the strains; however, the agrI and agrIII genes were mainly detected in MSSA strains. A pulsed-field gel electrophoresis (PFGE) analysis grouped the 25 strains into 16 pulsotypes (P), the most frequent of which was P1, including 10 MRSA strains related to the anesthesia equipment, external service anesthesia technicians, and hospitalized patients. Multilocus sequence typing (MLST) identified 15 sequence types (STs) distributed in nine CCs. The most prevalent ST was ST1011, belonging to CC5, which was associated with the SCCmec type II and agrII type. We postulate that the external service anesthesia technicians were MRSA carriers and that these strains were indirectly transmitted from the contaminated anesthesia equipment that was inappropriately disinfected. Finally, the MRSA outbreak was controlled when the anesthesia equipment disinfection was improved and hand hygiene was reinforced.

HIV/AIDS-related Knowledge and Behavior among School-attending Afro-Descendant Youths in Ecuador.

BACKGROUND OR OBJECTIVES: HIV/AIDS transmission in Ecuador is considered a concentrated epidemic; therefore, there are some studies on high risk groups but there is limited published data regarding the HIV/AIDS risk factors among adolescents of African descent. In this study, we sought to explore the determinants of HIV/AIDS-related knowledge and behavior among afro-descendant youths attending schools in the city of Esmeraldas, Ecuador. METHODS: A cross-sectional survey among school-attending youths was conducted in Esmeraldas, Ecuador in 2010. Our target population was afro-descendant youths attending the last two years of high school. Thirty public high schools enrolling students in junior and senior years were identified. Outcome data were analyzed in the form of three composite variables. A multivariate linear regression model was built for each outcome. RESULTS: A total of 213 school-attending afro-descendant youths aged 14 to 21 years old were enrolled in this study. Gender distribution was almost equal with a 1:1.17 male to female ratio. Overall, students in this population scored well in comprehensive knowledge of HIV with 88% having medium or higher knowledge. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Knowledge of HIV and its determinants was medium to high, but knowledge of sexually transmitted diseases was low among afro-descendant Ecuadorian adolescents in our study. Results of this study might be instrumental in facilitating decision-making processes related to the planning, implementation, and evaluation of HIV/AIDS prevention and control strategies in this specific population.

Current Situation of the Presence of Dirofilaria immitis in Dogs and Humans in Bucaramanga, Colombia.

The cardiopulmonary dirofilariosis caused by Dirofilaria immitis, is a vector-borne infection, which can be transmitted to humans. The main hosts are both domestic and wild canids. This species mainly occurs in tropical and subtropical climates, and temperature and humidity are the main factors that favor the presence and proliferation of culicid mosquitoes as vectors of the disease. There are few reports of cardiopulmonary dirofilariosis in dogs and humans in Colombia, a region with favorable climatic conditions which favors the presence of mosquitoes that act as vectors of the disease. Therefore, this study aimed to examine its current prevalence in dogs and the risk of human exposure to the disease in Bucaramanga, one of the most populated areas in Colombia located at the center of the country. Furthermore, its demographic and environmental characteristics could be useful as a study model for other similar locations and neighboring countries. Serum samples from 351 dogs and 506 humans from the Bucaramanga Metropolitan area were analyzed. All dog samples were analyzed by Knott's technique and tested with a commercial immunochromatographic to detect the presence of circulating antigens of D. immitis. Human samples were analyzed using a non-commercial ELISA test kit to detect IgG against the somatic antigens of adult D. immitis and Wolbachia. Positive results were further confirmed using western blot analysis. Thirty-eight dogs tested positive with a overall prevalence of 10.82%. Of these dogs, 18 showed D. immitis microfilariae, being 5.12% of the total population. The overall seroprevalence in humans was 6.71%; seroprevalence was significantly higher in individuals aged 16-34 years-old and in women than in men. To our knowledge, this study describes seropositivity to D. immitis for the first time in a Colombian human population located in the same area as that of dogs infected with D. immitis, which represents a potential threat to public health. In humans, age and gender can be considered risk factors for exposure to D. immitis.

Calidad percibida del control de la diabetes en indígenas chontales / Perceived quality of diabetes control in chontal indigenous people / Percepção da qualidade do controle do diabetes em povos indígenas chontal / Perception de la qualité du contrôle du diabètedans la populationautochtone chontal

Resumen Objetivo Interpretar la percepción de pacientes indígenas chontales sobre su enfermedad y la calidad en el control de la diabetes tipo 2 en el estado mexicano de Tabasco. Materiales y métodos Se realizó investigación cualitativa en tres unidades médicas que dan atención a población indígena chontal. Participaron 44 personas con diabetes tipo 2 en cuatro grupos focales. Se emplearon guías de entrevista y dinámica de grupos. Para el análisis de los datos se empleó el software MAXQDA 2018. Se integraron los discursos más representativos, estos fueron documentados, organizados, categorizados y codificados. Resultados Los discursos de los indígenas chontales revelan que los problemas que perciben para lograr la calidad en el controlde su enfermedad son: su situación económica precaria, desigualdad y rezago para recibir atención médica, el escaso apoyo de la familia, la hegemonía del médico en la atención, la violencia doméstica en el caso de las mujeres, la necesidad de ser tratados como personasy no como una enfermedad, la manera como descifran su enfermedad, basada en mitos y creencias erróneas. Conclusiones Los resultados de este estudio muestran que la cosmovisión de las personas para comprender la diabetes que padecen ylograr su control metabólico, es clave para los servicios de salud en la mejora de la calidad.

Abstract Objective To interpret the perception of indigenous chontal patients about their disease and the quality in the control of type 2 diabetes in the Mexican state of Tabasco. Materials and methods Qualitative research was conducted in three medical units that provide attention to the indigenous Chontal population. 44 people with type 2 diabetes participated in four focus groups. Interview guides and group dynamics were used. For the analysis of the data, the MAXQDA 2018 software was used. The most representative speeches were integrated, these were documented, organized, categorized and codified. Results The speeches of the Chontal Indians reveal that the problems they perceive to achieve quality in the control of their disease are: their precarious economic situation, inequality and lag to receive medical care, poor family support, doctor's hegemony in care, domestic violence in the case of women, the need to be treated as people and not as a disease, the way they decipher their disease, based on myths and mistaken beliefs. Conclusions The results of this study show that the worldview of people to understand the diabetes they suffer and achieve their metabolic control, is key for health services in improving quality.

Resumo Objetivo Interpretar a percepção dos pacientes indígenas chontales sobre sua doença e a qualidade no controle da diabetes tipo 2 no estado mexicano de Tabasco. Materiais e métodos Pesquisa qualitativa realizada em três unidades médicas que atendem a população indígena Chontal. Participaram 44 pessoas com diabetes tipo 2 divididas em quatro grupos focais. Foram utilizados guias de entrevista e dinâmica de grupo. Para a análise dos dados foi utilizado o software MAXQDA 2018. Os discursos mais representativos foram integrados, sendo documentados, organizados, categorizados e codificados. Resultados Os discursos dos índios chontales revelam que os problemas que eles percebem para obter a qualidade no controle de sua doença são: situação econômica precária; desigualdade e atraso na atenção médica; apoio familiar insuficiente; hegemonia médica no cuidado; violência doméstica no caso das mulheres; a necessidade de serem tratados como pessoas e não como um doente; e a maneira como decifram sua doença com base em mitos e crenças equivocadas. Conclusões Os resultados deste estudo mostram que a visão de mundo das pessoas para entender a sua diabetes e alcançar seu controle metabólico é fundamental para os serviços de saúde na melhoria de sua qualidade.

Résumé Objectif Interpréter la perception de patients autochtones chontal de leur maladie et de la qualité du contrôle du diabète de type 2 dans l'État mexicain de Tabasco. Matériels et méthodes Une recherche qualitative a été menée dans trois unités médicales qui fournissent des soins à la population autochtone chontal. 44 personnes atteintes de diabète de type 2 ont participé à quatre groupes de discussion. Des guides d'entretien et des dynamiques de groupe ont été utilisés. L'analyse des données a été réalisée avec le logiciel MAXQDA 2018. Les discours les plus représentatifs ont été intégrés, documentés, organisés, catégorisés et codés. Résultats Les discours des autochtones chontal révèlent que les problèmes qu'ils perçoivent pour atteindre la qualité dans le contrôle de leur maladie sont les suivants : leur situation économique précaire, l'inégalité et le retard social dans l'accès aux services médicaux, le faible soutien de la famille, l'hégémonie du médecin, la violence domestique dans le cas des femmes, le besoin d'être traité comme des personne et non comme une maladie, leur façon d'interpréter leur maladie sur la base de mythes et de croyances erronées. Conclusions Les résultats de cette étude montrent que la cosmovision des personnes en relation à leur compréhension du diabète dont elles souffrent et à leur possibilité de parvenir à contrôler leur métabolisme est essentielle pour l'amélioration de la qualité des services de santé.

Depression is associated with efavirenz-containing treatments in newly antiretroviral therapy initiated HIV patients in Ecuador.

BACKGROUND: It is well known that people living with HIV (PLWH) is in higher risk for the development of depression and it has also been suggested that the use of efavirenz into the antiretroviral regimens increases even that risk. OBJECTIVE: To evaluate the effect of efavirenz-containing antiretroviral regimens on the development of depression in newly ART initiated HIV patients in Ecuador. METHODS: In a prospective cohort study from June 2016 to May 2017, all newly HIV diagnosed patients at the HIV/AIDS Unit of the Hospital Eugenio Espejo in Quito, Ecuador were evaluated using the Hamilton Rating Scale for Depression followed by a second assessment 8-12 weeks after antiretroviral therapy containing efavirenz was initiated. RESULTS: A total of 79 patients, mainly males younger than 35 years were studied. Majority of them were on TDF/FTC/EFV. Initial score in Hamilton Rating Scale revealed that less than 30% had no depression symptoms while almost 40% had mild depression. However, in the second assessment, 22.6% of the subjects had a score in the Hamilton Rating Scale compatible with severe or very severe depression (RR 1.58, 95% CI 1.09 to 2.28; p = 0.05). CONCLUSION: In our cohort study, depression was much higher in patients on Efavirenz-containing treatments. Therefore, assessment for depression must be essential as part of follow-up in these patients.

Treatment Eligibility and Therapeutic Responses of an Ecuadorian Population at High Cardiovascular Risk Based on the ATP III Guidelines

Abstract Background The Adult Treatment Panel III (ATPIII) guidelines aim to reduce cardiovascular morbidity and mortality. In Ecuador, 20% of people have high LDL cholesterol levels, and 39% have high triglyceride levels. Objective To analyze lipid-lowering regimens in Ecuadorian patients and determine the achievement rate of the ATPIII goals for lipid profile. Methods Using a retrospective analysis, 385 subjects older than 30 years, who received pharmacological treatment for dyslipidemia for at least three months was randomly selected from institutions at two large cities in Ecuador. Data were collected from patients' medical records and analyzed by chi-square test or paired t-test; p-values less than 0.05 were considered significant. Results Baseline total cholesterol values were above 200 mg/dL in 75% of subjects, LDL-c values above 129 mg/dL in 83% of subjects and triglycerides values above 150 mg/dL in 79% of subjects. Most (n = 253, 95.8%) patients at very high cardiovascular risk were taking statins, 50% of them atorvastatin. Considering the ATPIII guidelines' goals, only 24 subjects (19%) at high CV risk achieved an LDL-c < 100 mg/dl, while a significantly lower percentage (p = 0.04) of patients at very high risk reached an LDL-c < 70mg/dl (11%; n = 30). Conclusion These data indicate a low rate of compliance with the ATPIII guidelines, independent of the medication used or duration of the treatment. This may be attributed to the prescription of low doses of medication and a therapy targeting isolated lipid fractions rather than a complete lipid profile. (Int J Cardiovasc Sci. 2020; 33(4):371-376)

Guía de prácticas para enfermería en la atención a los cuidadores de pacientes con demencia / A Nursing Practice Guide for Attending Caregivers of Dementia Patients

Introducción: A partir de las necesidades de enfermería es posible realizar el trabajo comunitario con pautas a seguir de manera organizada, teniendo en cuenta que estén vinculadas con la promoción de salud. Objetivo: Diseñar una guía de prácticas para Enfermería en la atención al cuidador de pacientes con demencia. Métodos: Investigación de desarrollo tecnológico, se trabajó con un universo de 80 cuidadores principales y cinco enfermeras del departamento de Salud Mental del municipio de Marianao, La Habana, en el período del 2016-2017, se utilizaron como técnicas la revisión documental, encuestas, la escala de Zarit y consulta a expertos. Resultados: Los cuidadores fueron mayoritariamente los hijos, del sexo femenino, amas de casas, con nivel de escolaridad universitario y todos habían experimentado ansiedad y depresión. Las tres primeras necesidades humanas de enfermería afectadas fueron: la comunicación, el autocuidado, el sueño y el descanso, más de la mitad presentaron sobrecarga intensa. Se identificó que el personal de enfermería requiere conocimientos para la atención al cuidador, lo que justificó la elaboración de la guía. Conclusiones: Se reconoció una sobrecarga intensa y necesidades de enfermería afectadas descritas por Virginia Henderson en los cuidadores principales, lo que permite realizar acciones de promoción de salud y prevención de enfermedades a través de la guía de prácticas para enfermería, que se sometió a validación por expertos(AU)

Introduction: Based on nursing needs, community work can be carried out following organized guidelines, taking into account that they are associated to health promotion. Objective: To design a nursing practice guide for attending the caregivers of dementia patients. Methods: In this technological development research, we worked with a population of 80 main caregivers and five nurses from the Mental Health department of Marianao Municipality, Havana, in the period 2016-2017. Document review and the survey were used as techniques, together with the Zarit scale and consults to experts. Results: The caregivers were mainly the children, belonged to the female sex, were housewives, with university education, and all had experienced anxiety and depression. The first three human nursing needs affected were communication, self-care, sleep, and rest, more than half the group presented intense overburden. The nursing staff was identified to requires knowledge for attending the caregiver, which justified the guide preparation. Conclusions: Intense overburden and affected nursing needs were observed, as described by Virginia Henderson for the main caregivers, which allows health promotion and disease prevention actions to be carried out through the nursing practice guide, which was validated by experts(AU)

Prevalence of canine and human dirofilariosis in Puebla, Mexico.

The objective of this work was to determine the risk of exposure to Dirofilaria immitis in the stray dog population and people living in the metropolitan area of Puebla City, Mexico, using serologic methods. A total of 283 blood salmples were collected from dogs and 254 salmples from people. The canine samples were analyzed using a commercial kit to detect D. immitis antigens and the Knott test to detect microfilariae. Human samples were analyzed by ELISAs to detect antibodies against D. immitis and Wolbachia anti-WSP, as well as Western blot to identify specific bands of the parasite in the adult antigenic extract of D. immitis. Positive results were represented on a GIS map that included layers with geoenvironmental information relevant to parasite transmission in the study area. The prevalence of D. immitis in the canine stray population was 2.12 %, with positive cases found in individuals aged 1-10 years. Human seroprevalence was established at 5.11 %, with women and men similarly affected. By age, a significantly higher seroprevalence was observed in younger individuals (<18 years) than in the rest of the population. The geolocation of the results showed that positive cases were found in the environment (within 2 km) of potentially favorable areas for mosquito breeding. The importance of human influence in the creation and maintenance of favorable conditions for the transmission of canine and human dirofilariosis within an urban area is highlighted, both by the lack of environmental sanitation and by the absence of measures to limit or eliminate the canine reservoir population.

Molecular Epidemiology, Antibiotic Resistance, and Virulence Traits of Stenotrophomonas maltophilia Strains Associated With an Outbreak in a Mexican Tertiary Care Hospital.

Stenotrophomonas maltophilia, an emerging opportunistic pathogen, is widely distributed in the environment the resistance mechanisms, and virulence factors of this bacterium facilitate its dissemination in hospitals. This study aimed to characterize the molecular epidemiology of S. maltophilia strains associated with an outbreak in the Children's Hospital of México Federico Gómez (HIMFG). Twenty-one clinical S. maltophilia strains were recovered from cultures of blood and urine samples from 10 pediatric patients at the emergency department, and nine environmental S. maltophilia strains recovered from faucets in the same area were also included. Two of the 10 patients were related with health care-associated infections (HCAIs), and the other eight patients (8/10) were infected with environmental S. maltophilia strains. The outbreak was controlled by monthly disinfection of the faucets in the emergency department. Typing using pulsed-field gel electrophoresis (PFGE) showed a 52% genetic diversity with seven pulsotypes denoted P1-P7 among all S. maltophilia strains. Three pulsotypes (P2, P3, and P7) were identified among both the clinical and environmental S. maltophilia strains and associated with two type sequences (STs), namely, ST304 and ST24. Moreover, 80% (24/30) of the strains exhibited resistance mainly to tetracycline, 76.66% (23/30) to trimethoprim-sulfamethoxazole, and 23.33% (7/30) to the extended-spectrum ß-lactamase (ESBL) phenotype. The main resistance genes identified by multiplex PCR were sul1 in 100% (30/30), qnr in 86.66% (26/30), and intl1 in 80% (24/30) of the samples, respectively. Furthermore, the pilU, hlylII, and rmlA genes were identified in 96.6% (29/30), 90% (27/30), and 83.33% (25/30) of the samples, respectively. Additionally, 76.66% (23/30) of the S. maltophilia strains exhibited high swimming motility, 46.66% (14/30) showed moderate biofilm formation capacity, 43.33% (13/30) displayed moderate twitching motility, and 20% (6/30) exhibited high adherence. The clinical S. maltophilia strains isolated from blood most strongly adhered to HTB-9 cells. In conclusion, the molecular epidemiology and some of the features such as resistance, and virulence genes associated with colonization patterns are pathogenic attributes that can promote S. maltophilia dissemination, persistence, and facilitate the outbreak that occurred in the HIMFG. This study supports the need for faucet disinfection as a control strategy for clinical outbreaks.