First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador.

Background: COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported. Methodology: A genotyping analysis and two different types of whole genome sequencing were performed (Illumina MiniSeq and ONT MinION). When examining the phylogenetic analysis in NextClade and Pangolin webservers, and considering the genotyping findings, conflicting results were obtained. Results: The raw data of the sequencing was analyzed, and nucleotide variants were identified between different reads of the virus genome. B.1 and P.1 lineages were identified within the same sample. Conclusions: We concluded that this is a co-infection case with two SARS-CoV-2 lineages, the first one reported in Ecuador.

Development of Films, Based on Oxidized Ipomea Batatas Starch, with Protein Encapsulation / Desarrollo de Películas, Basadas en Almidón Oxidado de Ipomea Batatas, con Encapsulación de Proteínas

ABSTRACT Dialdehyde starches (DAS) have been used as biomaterials due to their biocompatibility and biodegradability; nonetheless, sweet potato (Ipomea batatas L.) starch has not been researched. Films based on sweet potato DAS, mixed with native starch (NS), poly-vinyl alcohol (PVA) and glycerin have been developed with protein encapsulation, using central composite design (CCD) and response surface methodology (RSM). Input variables were oxidation degree, NS concentration and polymeric mixture volume, while output variables were film's thickness, equilibrium swelling and BSA (Bovine serum albumin) release. DAS was obtained through hydrogen peroxide (H2O2) oxidation, and the oxidation degree is referred to as H2O2 concentration. Films presented rough surfaces, and formulations containing 10% H2O2 DAS presented micropores. Water uptake was greater with higher DAS content. Film thickness depended on the volume of the polymeric suspension and influenced swelling capacity. According to RSM, the optimal formulation was DAS with 5% H2O2 and 35% NS. These results demonstrate that oxidized sweet potato starch has potential for protein encapsulation and delivery.

RESUMEN Almidones dialdehído (DAS) se han utilizado como biomateriales por su biocompatibilidad y biodegradabilidad; sin embargo, el almidón de camote (Ipomea batatas L.) no ha sido investigado. Se han desarrollado películas de DAS de camote, con almidón nativo (NS), alcohol polivinílico (PVA) y glicerina con encapsulación de proteínas, utilizando un diseño central compuesto (CCD) y metodología de superficie de respuesta (RSM). Las variables de entrada fueron: grado de oxidación, concentración de NS y volumen de la mezcla polimérica, mientras que las variables de salida fueron: espesor de la película, hinchamiento y liberación de BSA (Albúmina de Suero Bovino) en equilibrio. DAS se obtuvo mediante oxidación con peróxido de hidrógeno (H2O2), y el grado de oxidación se define como concentración de H2O2. Las películas presentaron superficies rugosas y las formulaciones con 10% H2O2 DAS presentaron microporos. La absorción de agua fue mayor con mayor contenido de DAS. El espesor de la película dependió del volumen de la mezcla polimérica e influyó en la capacidad de hinchamiento. Según RSM, la formulación óptima fue DAS con 5% H2O2 y 35% NS. Estos resultados demuestran que el almidón de camote oxidado tiene potencial para aplicaciones en la encapsulación y liberación de proteínas.

Awareness of obstetric warning signs in Ecuador: a cross-sectional study.

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.

Natural disaster management: experience of an academic institution after a 7.8 magnitude earthquake in Ecuador.

OBJECTIVES: This case study describes the implementation of an academic institution's disaster management plan. STUDY DESIGN: Case study. METHODS: USFQ's Medical School developed a six-phase disaster relief plan consisting of: induction, establishing a base camp, crisis management and mental health aid, creation of multidisciplinary teams and multi-agency teams, and reconstruction. Each phase uses a community-oriented approach to foster survivor autonomy and recovery. RESULTS: Our methodology facilitated the successful implementation of multidisciplinary interventions to manage the earthquake's aftermath on the personal, community and regional levels, treated and prevented psychological and physical morbidity among survivors and promoted healthy living conditions and independence. CONCLUSIONS: A multidisciplinary response team that addresses medical needs, mental health, education, food, nutrition and sanitation is highly effective in contributing to timely, effective relief efforts. The short- and long-term solutions we describe could be applicable to other academic centres' interventions in future disaster scenarios around the world.

Different low constant flows can equally determine the lower inflection point in acute respiratory distress syndrome patients.

Among the possible techniques to obtain the pressure-volume (P x V) curve at the bedside the low constant flow (CF) is the easiest and quickest one. However, the best value for CF to perform a good semi-static P x V curve is still to be determined. The purpose of this study was to evaluate the influence of 4 different CFs (1, 2, 5, and 10 L/min) on determination of lower inflection point of the P x V curve (L-Pflex) and upper inflection point of the P x V curve (U-Pflex) on the maximum slope and on the inspiratory work of breathing (up to volume of 1.35 L; inspiratory work L/cm H2O), comparing the volume estimated from the CF with the measured volume obtained by the respiratory inductive plethysmograph. The design was a prospective study, and the setting was an adult medical intensive care unit of a university hospital. There were 7 acute respiratory distress syndrome (ARDS) patients, less than 5 days of installation, after the standardization of lung volume history received sequentially from 4 different low inspiratory CFs in 2 trials. The P x V curve lasted from 73 +/- 1.6 s (1 L/min) to 8.8 +/- 0.69 s (10 L/min). The L-Pflex differed in the 2 performed trials (p = 0.04). There was no difference of L-Pflex among the 4 CFs comparing the 3 methods (p = 0.072) used for its calculation as well as comparing the estimated and the measured volume (p = 0.456). The maximum slope decreased significantly while increasing the flow from 1 to 10 L/min just in the estimated volume (p = 0.03). The inspiratory work did not increase with the increment of the flow either in the estimated volume (p = 0.217) or in the measured volume (p = 0.149). The U-Pflex differed among the trials (p = 0.003) and the methods used for its calculation (p < 0.01). Constant flows from 1 to 10 L/min can equally determine L-Pflex in ARDS patients and is an easy and quick way to obtain the L-Pflex in order to optimize positive end expiratory pressure (PEEP) in ARDS patients.