An On-Line Cross-Sectional Questionnaire to Assess Knowledge of COVID-19 Pandemic among Citizens Tested for the SARS-CoV-2 Virus in Quito and Ibarra, Ecuador.

Several public health measures have been implemented to contain the SARS-CoV-2 outbreak. The adherence to control measures is known to be influenced by people's knowledge, attitudes and practices with regard to the disease. This study aimed at assessing COVID-19 knowledge in individuals who were tested for the virus. An online cross-sectional survey of 32 items, adapted to the national context, was conducted among 1656 Ecuadorians. The mean knowledge score was 22.5 ± 3 out of 28, with significant differences being observed with regard to educational attainment. People with postgraduate training scored higher than those with college, secondary and elementary instruction. Indeed, multiple linear regression revealed that lower scores were associated significantly with the latter three levels of education. Interviewees were knowledgeable about the symptoms, detection, transmission and prevention of the disease. However, they were less assertive regarding the characteristics of the virus as well as the usefulness of traditional and unproven treatments. These outcomes indicated a lack of knowledge in fundamental aspects of virus biology, which may limit the effectiveness of further prevention campaigns. Conclusively, educational and communicational programs must place emphasis on explaining the basic molecular characteristics of SARS-CoV-2; such information will certainly contribute to improve the public's adherence to control measures.

A report of congenital adrenal hyperplasia due to 17α-hydroxylase deficiency in two 46,XX sisters.

Congenital adrenal hyperplasia (CAH) is a group of rare orphan disorders caused by mutations in seven different enzymes that impair cortisol biosynthesis. The 17α-hydroxylase deficiency (17OHD) is one of the less common forms of CAH, corresponding to approximately 1% of the cases, with an estimated annual incidence of 1 in 50,000 newborns. Cases description - two phenotypically female Ecuadorian sisters, both with primary amenorrhea, absence of secondary sexual characteristics, and osteoporosis. High blood pressure was present in the older sister. Hypergonadotropic hypogonadism profile was observed: decreased cortisol and dehydroepiandrosterone sulfate (DHEAS), increased adrenocorticotropic hormone (ACTH) and normal levels of 17-hydroxyprogesterone, extremely high deoxycorticosterone (DOC) levels, and a tomography showed bilateral adrenal hyperplasia in both sisters. Consanguinity was evident in their ancestors. Furthermore, in the exon 7, the variant c.1216T > C, p.Trp406Arg was detected in homozygosis in the CYP17A1 gene of both sisters. We report a homozygous missense mutation in the CYP17A1 gene causing 17OHD in two sisters from Loja, Ecuador. According to the authors, this is the first time such deficiency and mutation are described in two members of the same family in Ecuador.

The Current Genomic Landscape of Western South America: Andes, Amazonia, and Pacific Coast.

Studies of Native South American genetic diversity have helped to shed light on the peopling and differentiation of the continent, but available data are sparse for the major ecogeographic domains. These include the Pacific Coast, a potential early migration route; the Andes, home to the most expansive complex societies and to one of the most widely spoken indigenous language families of the continent (Quechua); and Amazonia, with its understudied population structure and rich cultural diversity. Here, we explore the genetic structure of 176 individuals from these three domains, genotyped with the Affymetrix Human Origins array. We infer multiple sources of ancestry within the Native American ancestry component; one with clear predominance on the Coast and in the Andes, and at least two distinct substrates in neighboring Amazonia, including a previously undetected ancestry characteristic of northern Ecuador and Colombia. Amazonian populations are also involved in recent gene-flow with each other and across ecogeographic domains, which does not accord with the traditional view of small, isolated groups. Long-distance genetic connections between speakers of the same language family suggest that indigenous languages here were spread not by cultural contact alone. Finally, Native American populations admixed with post-Columbian European and African sources at different times, with few cases of prolonged isolation. With our results we emphasize the importance of including understudied regions of the continent in high-resolution genetic studies, and we illustrate the potential of SNP chip arrays for informative regional-scale analysis.

Prevalence of methicillin-resistant Staphylococcus aureus among health care workers of intensive care units in Ecuador.

INTRODUCTION: Colonization of health care workers with methicillin-resistant Staphylococcus aureus (MRSA) has been an important route of dispersion and infection of MRSA and has been implicated in epidemic outbreaks. The objective of the present study was to assess prevalence of MRSA colonization in the anterior nares of health care personnel at the intensive care unit (ICUs) of three hospital facilities in Quito, Ecuador. METHODOLOGY: The prevalence of MRSA in specimens from all ICU health care workers of three hospitals was measured by using a real-time PCR assay and CHROMagar MRSA. RESULTS: The prevalence of MRSA among the three health care facilities was 2.4%. CONCLUSION: The prevalence of MRSA colonization was relatively low compared to other studies and showed no differences between hospital facilities.

Prevalence of common hemoglobin variants in an afro-descendent Ecuadorian population.

BACKGROUND: Hemoglobinopathies are among the most studied and frequent pathologies. These genetic disorders are considered a very important health care threat in many tropical countries. Ecuador is a tropical Latin-American country with an important presence of afro-descendants (7.2%). Afro-descendants are among the ethnic groups with higher frequency of hemoglobinopathies reported. Ambuqui is a region within the Imbabura province with an important presence of afro-descendants (>50%). The present study analyzed the frequency of the most common hemoglobin variants in an asymptomatic afro-descendent population using capillary electrophoresis. FINDINGS: From 114 individuals, 25 (22%) reported a hemoglobin variant. All individuals that presented hemoglobin variants were heterozygotes (asymptomatic). Hemoglobin S (sickle cell trait) was the most frequent variant found (14%), followed by hemoglobin E (4.4%), Fetal (2.6%) and C (1%). CONCLUSION: Prevalence of hemoglobin S was consistent with populations from other countries, but it was lower than other Ecuadorian afro-descendent populations. Frequency of hemoglobin C was lower than other afro-descendent populations. This data suggests the possibility of gene flow from Native American individuals to the Ambuqui population there by lowering the frequency of their hemoglobin variants compared with other afro-descendant populations. Evaluating the frequency of hemoglobinopathies in Ecuadorian populations is essential. Despite the high frequency of these disorders, very few health care facilities implement hemoglobinopathies tests as a routine practice.

Terapia biológica en el tratamiento de las enfermedades reumáticas / Biological therapy in the treatment of rheumatic diseases

El desarrollo de la terapia biológica en el tratamiento de las enfermedades reumáticas ha progresado rápidamente en los últimos años, especialmente aquellos dirigidos contra citocinas, que juegan un papel importante tanto en la iniciación como en el mantenimiento de la inflamación, El presente es una revisión de los agentes bloqueadores de citocinas, utilizados en la practica clínica reumatológica.

The development of biological therapy in the treatment of rheumatic diseases has progressed rapidly in recent years, especially those directed against cytokines, which play an important role in both initiation and maintenance of inflammation. This is a review of cytokine blocking agents used in rheumatology clinical practice.

Pericarditis tuberculosa; Presentación de casos y revisión de la literatura / Tuberculous pericarditis; Case presentation and literature review

La infección por Mycobacterium tuberculosis, es un diagnóstico de exclusión que siempre debe estar presente en todos los casos de derrame pericárdico agudo y crónico, más aún en nuestro país donde la prevalencia de tuberculosis es cada vez más alta. El diagnóstico precoz y el inicio del tratamiento influyen directamente en la sobrevida del paciente y su mortalidad. Aquí presentamos 4 pacientes con diagnóstico de pericarditis tuberculosa quienes tuvieron diferente evolución y grados variables de derrame.

Mycobacterium tuberculosis infection is a diagnosis of exclusion that must always be present in all cases of acute and chronic pericardial effusion, even more so in our country where the prevalence of tuberculosis is increasingly high. Early diagnosis and initiation of treatment directly influence patient survival and mortality. Here we present 4 patients with a diagnosis of tuberculous pericarditis who had different evolution and variable degrees of effusion.

Tuberculosis mamaria un problema que continua: presentación de dos casos / mamaria Tuberculosis a continuous problem that: presentation of two cases

La tuberculosis es un problema de salud pública a nivel mundial. La localización extrapulmonar a nivel mamario es rara y sin manifestaciones sistémicas. Clínicamente es indistinguible de las neoplasias de la glándula, esto dificulta el diagnóstico y retarda el incio del tratamiento. Presentamos dos casos de tuberculosis mamaria, además se revisa la literatura sobre el tema e insistimos sobre el problema diagnóstico.

Prevalencia de IGG e IGM para citomegalovirus en las madres y recién nacidos del Hospital Gineco Obstétrico Isidro Ayora / PreValencia of IGG and IGM for citomegalovirus in the mothers and new born of the Hospital Obstetrical Gineco Isidro Ayora

La infección congénita por citomegalovirus (CMV) puede producir malformaciones neonatales: después de la introducción de la vacuna contra rubéola, es la principal causa de pérdida auditiva neurosensorial, problemas de aprendizaje y retardo mental. Se requiere ayuda complementaria para su diagnóstico, ya que el 90 por ciento de los recién nacidos infectados son asintomáticos al nacimiento. Es un estudio transversal, descriptivo, realizado en 81 madres y sus recién nacidos aleatoriamente escogidos, en el Hospital Gineco Obstétrico Isidro Ayora de Quito, cuyo objetivo fue conocer la seroprevalencia del citomegalovirus en mujeres postparto y sus recién nacidos y la relación con la edad materna. Se procesarn 324 pruebas...

The epidemiology of cutaneour leishmaniasis / The epidemiology of cutaneous leishmaniasis

An epidemiologic survey was conducted in an area of sutrolical rainforest in Northwest Ecuador with followin objectives; (1) to determine the prevalencie of cutaneous leishmaniasis (CL), (2) to identify the leishmania species cusing human disease, (3) to investigate the major CL clinical manifestations, (4) to study cellular and humoral inmune response indicators, and (5) to identify risk factors associated with the disease, Half of the 466 subjects had laboratory and clinical evidencie of either current (14 for cent) or piror disease (33 for cent). Subjects with c urrent disease had an average of 2.6+-1.9 lesions with a mean size of 8.4 +-19.4 cms. The parasite species isolated from subject lesions were: Leismania guyanesis (63 for cent. L. panamensis (33 for cent) and L. brazilensis (4 for cent). Subjects with CL exhibited the highest serum IgG an IgM concentrations (p<0.0001). Lesion number (t=2.9, p=0.007) and size (t=3.8, p=0.0004) was predictive or serum IgG levels. The Montenegro skin test induration size was correlated positively with ulcer number (t=2.2, p=0.038). Age<5 yrs (AOR=1.5, 95 for cent C.I.=0.48-2.35), adult male gender (AOR=2.8.95 for centC.I.=1.1-7.8), and wood and/or cane exterior house walls (AOR=1.8,95 for cent CI=1.4-2.5) were associated with an increased for CL. In contrast, electric home lighting was associated with decreased risk (AOR=0.7, 95 for cent CI=0.4-2.3). The results suggest that it may be possible to modify a portion of the risk for CL by making changes in the housing evironment which may help to reduce the amount of contact with the vector...

Ethnomedical Knewledge, Attitudes, and treatment practices related to cutaneous leishmaniasis in an endemic Ecuadorian population

La leishmaniasis cutanea (LC) es una zoonosis que representa un problema de salud publica en el Ecuador, al igual que en la mayoría de países latinoamericanos. Sin embargo, existe poca información sobre los conocimientos etnomedicos y prácticas terapéuticas en esta enfermedad. Se realizaron dos estudios en los que se investigó el uso de los tratamientos para la LC en una área endémica de Ecuador. alrededor del 80 por ciento de los adultos mencionaron al menos un tipo de tratamiento tradicional o convencional para la LC. De los 175+ métodos terapéuticos especificados, una tercera parte correspondió al uso tópico de hierbas, leche o resina de árboles, frutas, u otras plantas autoctonas. Los otros métodos incluyen antibióticos, varios ácidos, productos químicos, polvos, pomadas, lacas, productos derivados del petróleo, agua u objetos calientes y varios productos animales. Menos del 25 por ciento mencionó al Glucantimer, el tratamiento convencional que se usa actualmente en LC. La mayoría de estos métodos son probablemente inocuos; sin embargo, algunos de ellos como ácidos, agentes cáusticos y metales calientes incrementan la lesión y dan como resultado cicatrices más grandes y profundas en relación a la que causa la ulcera de la LC. En forma adicional, la aplicación de sustancias como el cloro, gasolina, mercurio y plomo en las úlceras abiertas pueden ser carciongénicas o causar defectos en los fetos de mujeres em barazadas. Es importante considerar que varios de estos métodos tradicionales pueden tener valor terapéutico, entre los que se pueden mencionar el agua caliente y las plantas que contienen alcaloides, terpenos y otros componenetes naturales con actividad antiprotozoaria; por consiguiente, su valor potencial debe ser investigado como alternativas terapéuticas en la LC.