Análisis molecular de Helicobacter pylori (genes de patogenicidad) en biopsias gástricas de pacientes de la Sierra y Oriente Ecuatorianos / Molecular analysis of Helicobacter pylori (pathogenicity genes) in gastric biopsies of patients from the Ecuadorian Sierra and Oriente

Antecedentes: Helicobacter pylori es una bacteria Gram negativa, reconocida como la causa de la úlcera péptica (UP) y cáncer el gástrico (CG). Se han identificado genes de virulencia asociados con la patogenicidad del H. pylori incluyendo la isla de patogenicidad cagA y la citotoxina vacuolizante A (vacA). La frecuencia de los genes de patogenicidad se ha asociado con la localización geográfica y condiciones de vida de las personas. Pocos estudios en el Ecuador, han demostrado la relación entre los genes de patogenicidad de H. pylori y regiones geográficas de diferente altitud. Este estudio analizó los genes de patogenicidad de biopsias gástricas dos parroquias del Ecuador: una ubicada en la altura, Zumbahua (Sierra Central) y otra a nivel del mar, Shushufindi (Amazonía). Métodos: Se obtuvieron 127 muestras de biopsias gástricas embebidas en parafina de sujetos provenientes de Zumbahua (n = 90) y Shushufindi (n = 37). Mediante un análisis histopatológico se determinó la presencia de la infección y alteraciones patológicas tisulares. Se seleccionaron las muestras de los pacientes con mayor índice de infección por H. pylori (++ y +++ en el examen histopatológico) para el análisis molecular del H. pylori; se aisló su ADN y se evaluaron los genes de patogenicidad por PCR. Resultados: Se determinó la presencia de 5 casos de cáncer gástrico en la parroquia de Zumbahua, con mayor frecuencia en hombres que en mujeres. En la parroquia de Sushufindi hubo mayor prevalencia de infección por H. pylori comparada con Zumbahua. El análisis molecular de los genes de patogenicidad determinó que hubo una mayor expresión de estos en las muestras provenientes de la parroquia de Zumbahua; el 20% de las muestras amplificaron para vacAm1, 8.57% para vacAs1 y el 20% para vacAs2; mientras que para Shushufindi, únicamente el 8.0% amplificó para el gen vacAm1. Conclusiones: La prevalencia de infección por H. pylori en las muestras de las parroquias estudiadas es alta. Los genes de patogenicidad asociados con mayor virulencia provinieron de Zumbahua así como también las muestras con cáncer. Por otro lado, en las muestras de Shushufindi los genes de patogenicidad fueron menos virulentos y no hubo casos de malignidad. Es necesario establecer sistemas de tamizaje tanto para detectar cepas de H. pylori con genes de virulencia como para la detección temprana del cáncer gástrico.

Mortalidad por enfermedades cerebrovasculares en Ecuador 2001- 2015: Estudio de tendencias, aplicación del modelo de regresión joinpoint / Mortality due to cerebrovascular diseases in Ecuador 2001- 2015: a trend study, application of the joinpoint regression model

RESUMEN Objetivos: Analizar la tendencia de mortalidad por enfermedades cerebrovasculares en el Ecuador e identificar la presencia de cambios en la tendencia temporal empleando el modelo de regresión joinpoint. Materiales y métodos: Se llevó a cabo un estudio ecológico mixto. Se calcularon las tasas de mortalidad estandarizadas por edad según sexo y provincias para los últimos 15 años (2001 a 2015) en el Ecuador. Se utilizó un análisis de regresión joinpoint (puntos de cambio) para el análisis de las tendencias. Resultados: Desde 2001 hasta 2015 se registraron 48.621 defunciones por enfermedades cerebrovasculares en el Ecuador. En el análisis de regresión joinpoint, las tasas ajustadas por edad en los hombres descendieron de 71,4 a 59,5 defunciones por cada 100.000 habitantes, con un descenso anual de 1,51 % (p<0,00), en las mujeres de 61,2 a 55,5 defunciones por cada 100.000 habitantes con un descenso anual de 1,11 % (p<0,00). En las tasas de mortalidad específicas por grupo de edad, en el grupo de ≥80 años no se observó cambios estadísticamente significativos. Conclusiones: La mortalidad por enfermedades cerebrovasculares ha disminuido en el Ecuador en los últimos 15 años. Su tendencia descendente se observó en casi todos los grupos de edad.

ABSTRACT Objective: To analyze the mortality trend for cerebrovascular diseases in Ecuador and to identify the presence of changes in the temporal trend using the joinpoint regression model. Materials and Methods: A mixed ecological study was carried out. Standardized mortality rates for the last 15 years (2001 to 2015) in Ecuador were calculated and stratified by age, sex, and provinces. A joinpoint regression analysis was used for analysis of trends. Results: From 2001 to 2015, there were 48,621 deaths from cerebrovascular diseases in Ecuador. In the joinpoint regression analysis, age-adjusted rates in men declined from 71.4 to 59.5 deaths per 100,000 population, with an annual decline of 1.51% (p <0.05) in females from 61.2 to 55.5 deaths per 100,000 population, with an annual decrease of 1.11% (p <0.05). In the analysis by provinces, Sucumbíos presented a growing trend of 3.17% per year (p <0.05). Conclusions: Mortality from cerebrovascular disease has declined in Ecuador in the last 15 years. The downward trend was observed in almost all age demographics.

Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study.

BACKGROUND: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. OBJECTIVE: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. METHODS: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. RESULTS: Of the total, 43.2% (216/500) of participants reported that they had access to the Internet, and 25.4% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5%, 145/218) and short message service (SMS) text messaging (61.0%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0%, 157/218) followed by SMS (63.8%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. CONCLUSIONS: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries.

[Does Ecuadorians with asthma has preferences in the use of information and communication technologies? Pilot study]. / ¿Los ecuatorianos con asma tienen preferencias en el uso de tecnologías de la información y comunicación? Estudio piloto.

BACKGROUND: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs) it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient. OBJECTIVE: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma. METHODS: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients. RESULTS: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4), the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 %) and internet access (62.7 %). The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and email (p <0.05). CONCLUSION: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

Antecedentes: La comunicación inadecuada entre los pacientes y sus médicos puede interferir directamente con el control del asma. En los últimos años, el uso de tecnologías de la información y comunicación se ha incrementado en Latinoamérica y parece ser un recurso útil para mejorar la comunicación, adherencia y control del paciente con asma. Objetivo: evaluar la frecuencia y patrones de preferencia de las tecnologías de comunicación e información en pacientes ecuatorianos con asma bronquial. Métodos: estudio transversal en el que se utilizó la versión en español del cuestionario Michigan. La edad y el nivel educacional fueron categorizados en tres grupos. Se utilizó regresión logística entre los grupos respecto a la frecuencia de uso e interés en buscar y recibir información relacionada con el asma, según la edad y nivel educativo. Resultados: en nuestro estudio participaron 222 pacientes. La edad media fue de 45.6 ± 17.4 años y el sexo más común fue el femenino, con 89.25 %. Casi todos los pacientes tenían teléfono celular (87.5 %) y acceso a internet (62.7 %). Las tres tecnologías de la información y comunicación con mayor probabilidad de ser usadas con fines de buscar o recibir información acerca de la enfermedad fueron WhatsApp, Facebook y correo electrónico (p < 0.05). Conclusión: el correo electrónico y los mensajes de texto fueron preferidos por los pacientes, sin embargo, WhatsApp y Facebook pueden ser apropiados para ciertos grupos, especialmente para los jóvenes. La selección de TIC adecuadas para la comunicación médico-paciente podría mejorar la adherencia y el control de los pacientes con asma.

Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia.

BACKGROUND: Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the bloodstream, that may occur in patients with acute and chronic leukemia. OBJECTIVES: To assess the clinical effectiveness and safety of any pharmacological intervention for treating DIC in acute or chronic leukemia. SEARCH STRATEGY: The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 12), MEDLINE (1950 to 28 October 2010), EMBASE (1980 to 10 October 2010), LILACS (1982 to 19 August 2010) and African Index Medicus (1993 to 19 August 2010). There was no language restriction. We sought additional randomized controlled trials (RCTs) from the World Health Organization (WHO) Clinical Trials Registry Platform and by using the reference lists of primary studies found. SELECTION CRITERIA: RCTs assessing the effectiveness of interventions for treating disseminated intravascular coagulation (DIC) in patients with acute and chronic leukemia. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: Four RCTs (126 participants) met the inclusion criteria. These trials evaluated the human activated protein C, recombinant human soluble thrombomodulin, tranexamic acid and dermatan sulphate. Included RCTs reported data on mortality and bleeding. The included RCTs were classified as: 1) including patients with or without leukemia, and 2) only including patients with leukemia. However, data were not reported for the leukemia subgroup. We were not able to pool results from studies due to the inconsistency in the measurement and reporting of mortality and bleeding data. The included studies were at high risk of bias. AUTHORS' CONCLUSIONS: We found four RCTs which reported mortality and bleeding data. It is not possible to determine whether human activated protein C, recombinant human soluble thrombomodulin, tranexamic acid and dermatan sulphate are effective or harmful for patients presenting with DIC related to acute or chronic leukemia. The effects of these interventions need to be tested in sufficiently powered RCTs. Outcome measures should include in-hospital mortality from any cause, overall mortality, incidence of resolution of respiratory failure, renal failure, shock and safety. The definition of bleeding should be standardized in these patients.