The burden of suicide across different altitudes: 11-year geodemographic analysis conducted in 221 cantons in Ecuador ranging from 0 to 4300 m of elevation.

BACKGROUND: The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood. AIMS: This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m. METHOD: We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60-X84). RESULTS: A total of 11 280 cases of suicide were reported during 2011-2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000). CONCLUSIONS: Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.

Stroke as a rare complication of scorpion stings: A systematic review and analysis.

Approximately 1 million scorpion stings are recorded annually worldwide, resulting in 3000 deaths. Scorpion venom has various effects on the human body, with neurological complications occurring in about 2% of cases. Among these complications, stroke-whether ischemic or hemorrhagic-is particularly significant. A systematic literature review was conducted through a bibliographic search using key terms in the PubMed, Scopus, Scielo, Latin American and Caribbean Literature in Health Sciences (LILACS) and Google Schoolar databases without date restrictions. Articles related to stroke due to scorpion stings in Spanish, English, and Portuguese were included. Our protocol was registered in PROSPERO. A total of 24 articles met the inclusion criteria for this review. The primary neurological symptoms caused by scorpion stings include hemiplegia, hemiparesis, seizures, and limb weakness. Stroke should be suspected in the presence of these symptoms, as scorpion stings can lead to both hemorrhagic and ischemic strokes in both adults and pediatric populations. While stroke is a rare complication of scorpion stings, it is crucial to consider this diagnosis in patients presenting with neurological symptoms, necessitating the use of computed tomography or magnetic resonance imaging if stroke is suspected.

Flap-Free Tendon Coverage Using Autologous Fat Grafts Enhanced with Platelet-Rich Plasma and Growth Factors at a Secondary Level Hospital: A Case Report.

BACKGROUND: Autologous fat grafting, enriched with platelet-rich plasma (PRP), has been established as an effective and affordable treatment for various types of wound healing. However, its efficacy in managing wounds with tendon exposure has not been thoroughly investigated. METHODS: We report the case of a 40-year-old male who sustained a severe friction burn on his hand and forearm from a car accident, resulting in significant tissue loss and exposed extensor tendons. RESULTS: Traditional wound treatment strategies were not implemented due to specific patient circumstances. After initial surgical management failed to prevent necrosis and maintain coverage of the exposed tendons, the patient underwent a novel treatment involving autologous fat grafting combined with PRP and growth factors. The procedure was repeated twice within a month to promote granular tissue formation over that area and facilitate subsequent coverage with an epidermoreticular graft. By day 21 post-initial graft, the exposed tendons were 98% covered with granular tissue. Complete wound coverage was achieved by day 60, and by day 130 the patient had regained 90% functionality of the affected limbs. CONCLUSIONS: This case illustrates the potential of autologous fat grafting combined with PRP and growth factors as a viable, flap-free alternative for covering tendon exposures. This approach not only enhances wound healing but also supports functional recovery, underscoring the need for further research into its broader applicative potentials.

Integrity at stake: confronting "publish or perish" in the developing world and emerging economies.

The scientific community faces significant ethical challenges due to the "publish or perish" culture, particularly in developing and emerging economies. This paper explores the widespread unethical practices in scientific publishing, including the sale of authorships, the proliferation of "paper mills," and the misuse of artificial intelligence to produce fraudulent research. These practices undermine the integrity of scientific research, skew publication metrics, and distort academic rankings. This study examines various instances of academic fraud, emphasizing the impact on low-income countries, with specific cases from Latin America. Recommendations include stricter verification of authorship, disciplinary measures for scientific fraud, and policies promoting transparency and accountability in research. Addressing these challenges is crucial for maintaining the integrity and credibility of scientific endeavors globally.

Urgent Response Needed: Addressing the Dengue Crisis in the Andean and Southern Cone Latin American Regions.

The dengue crisis in the Latin American region is currently intensifying, exacerbated by heavy rains, widespread flooding, and the onset of the El Niño-Southern Oscillation. The indirect consequences of the COVID-19 pandemic, which weakened healthcare systems, have further compounded the situation. Comparing the first 15 weeks of 2023 with the same period in 2024, we observed a significant average increase of 600% in the number of new cases. This translates to a 536% rise in the composite rate per 100,000 inhabitants across all countries. Brazil experienced a staggering surge from 1,425,000 cases in the initial 15 weeks of 2023 to 5,177,989 cases in the corresponding period of 2024. Similarly, Paraguay witnessed a notable escalation, with cases soaring from 12,497 in 2023 to more than 240,000 thus far in 2024, marking an increase of more than 1,825%. Bolivia, however, witnessed a reduction in cases, though the cause remains unclear. Urgent action is imperative to address this escalating crisis. Strengthening surveillance systems, enhancing vector control programs, and implementing effective public health campaigns are critical. Immediate and coordinated action by regional governments and health authorities is essential to mitigate the growing dengue crisis and safeguard public health in the region.

Cardioembolic stroke in Chagas disease: unraveling the underexplored connection through a systematic review.

BACKGROUND: Chagas disease (CD), triggered by the Trypanosoma cruzi parasite, is originally endemic across Latin America, affecting millions. While cardiac complications are widely recognized, the association between CD and stroke remains underexplored. This systematic review aims to elucidate the relationship between CD and stroke, highlighting the cardioembolic origins of stroke in CD patients and assessing the elevated stroke risk compared to non-infected individuals. METHODOLOGY: Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed and Scopus databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of relevant studies to understand the interplay between CD and stroke risk. RESULTS: Our analysis of 25 selected studies indicates that strokes in CD patients predominantly arise from cardioembolic sources. The data underscore a significant increase in stroke risk among individuals infected with T. cruzi compared to uninfected counterparts. Additionally, CD patients face a higher stroke and mortality risk than those with other heart failure etiologies, irrespective of disease severity. CONCLUSION: The review establishes CD as a critical contributor to stroke incidence, emphasizing the need for heightened awareness and diagnosis of CD in stroke patients, particularly in regions with high CD prevalence. Recognizing the increased stroke risk associated with T. cruzi infection is crucial for developing targeted educational and preventive strategies in endemic areas.

Fatal nephrobronchial fistula arising from xanthogranulomatous pyelonephritis: a case report.

Introduction: Nephrobronchial fistula is an exceptionally rare complication of renal infections, including the uncommon xanthogranulomatous pyelonephritis. Existing literature is limited to a few case reports, with antibiotic therapy and nephrectomy being the preferred treatments. Case: We present the case of a 63-year-old woman with a history of recurrent xanthogranulomatous pyelonephritis in her right kidney, requiring drainage through lumbotomy. She presented with a chronic dry cough and weight loss, without other noticeable symptoms. Imaging suggested a pulmonary abscess and nephrobronchial fistula. Despite antibiotic treatment and surgical intervention, her condition progressed fatally. Conclusion: Nephrobronchial fistulas are extremely complications of renal infections, often presenting with nonspecific symptoms. This case highlights their significant impact on morbidity and mortality, especially in resource-limited settings, and underscoring the urgent need for prompt diagnosis and treatment.

Direct health implications of e-cigarette use: a systematic scoping review with evidence assessment.

Background: E-cigarettes are often marketed as a less harmful alternative to traditional tobacco cigarettes. Despite their popularity, the evidence regarding their effects on human health remains unclear and is filled with complexities. Objectives: This systematic review aims to elucidate the direct effects of electronic cigarette use on human health, carefully distinguishing between the specific characteristics of the populations studied. Methodology: Adhering to the PRISMA guidelines, we conducted a comprehensive search in PubMed/Medline, Web of Science, Scopus, and Google Scholar databases without date restrictions, including articles in both Spanish and English. This approach enabled the identification and analysis of primary studies to understand the direct effect of electronic cigarettes on human health. Results: A total of 33 studies were included that evaluated cardiovascular, pulmonary, renal, weight and fertility effects. Only five studies analyzed e-cigarettes in healthy populations and seven studies compared healthy individuals against smokers. The effects evaluated on smokers or former tobacco smokers were apparently positive, however, among healthy individuals, increased heart rate, mean arterial pressure, oxidative stress, alteration of respiratory epithelial cells and increased airflow resistance were found. Conclusion: Smokers or former smokers who switch to e-cigarettes may reduce their exposure to carcinogens and lower their risk of developing severe health issues associated with conventional smoking. However, in healthy individuals who have never smoked traditional cigarettes, the use of e-cigarettes introduces several cardiovascular and respiratory adverse effects. These findings suggest that while e-cigarettes can be a strategic harm reduction tool for smokers, they are not a safe option for non-smokers.