Modelo de teletrabajo en la educación universitaria: Estrategias para fortalecer su implementación en la Universidad Católica de Cuenca, Ecuador / Telework model in university education: Strategies to strengthen its implementation at the Catholic University of Cuenca, Ecuador / Modelo de teletrabalho na educação universitária: Estratégias para fortalecer sua implementação na Universidad Católica de Cuenca, Equador

RESUMEN El teletrabajo se ha constituido como modelo de prestación de servicios que requiere necesariamente el uso de herramientas tecnológicas. Esta forma de desarrollar las actividades se ha expandido en el sector educativo. Desde la época de la pandemia por covid-l9 se implementó con un mayor auge en el campo universitario enfrentando grandes retos y dificultades. El objetivo fue analizar las fortalezas, oportunidades, debilidades y amenazas del teletrabajo implementado en el contexto de la educación universitaria, durante los años 2020-2021 en la Universidad Católica de Cuenca, Campus La Troncal, Ecuador En la metodología se aplicó el enfoque cualitativo de tipo descriptivo, el análisis FODA, la técnica de revisión bibliográfica, así como la interpretación y descripción a través de los grupos focales. De los resultados se desprende que, los docentes requieren capacidades y competencias específicas para desarrollar las actividades en teletrabajo. La implementación del teletrabajo en la educación universitaria presenta oportunidades significativas, pero también desafíos, que deben ser abordados con estrategias efectivas y un marco jurídico sólido para garantizar su aplicación exitosa, prevenir la vulneración derechos fundamentales y la aparición de enfermedades ocupacionales que se vinculan con esta forma de organización laboral.

ABSTRACT Teleworking has become a model of service provision that necessarily requires the use of technological tools. This way of developing activities has expanded in the educational sector Since the COVID-19 pandemic, it has implemented a greater boom in the university field facing great challenges and difficulties. The objective was to analyze the strengths, opportunities, weaknesses, and threats of telework implemented in the context of university education, during 2020-2021 at the Catholic University of Cuenca, Campus La Troncal, Ecuador In the methodology applied the qualitative approach of descriptive type, SWOT analysis, the technique of literature review, as well as the interpretation and description through focus groups. From the results, it is clear that teachers require specific skills and competencies to develop telework activities.The implementation of telework in university education presents significant opportunities, but also challenges, which must be addressed with effective strategies and a solid legal framework to ensure its successful implementation, prevent the violation of fundamental rights, and the emergence of occupational diseases that are linked to this form of labor organization.

RESUMO O teletrabalho estabeleceu-se como um modelo de prestação de serviços que requer necessariamente a utilização de ferramentas tecnológicas. Esta forma de realizar actividades expandiu-se no sector educativo. Desde a época da pandemia de covid-l9, tem sido implementado com maior intensidade no âmbito universitário, enfrentando grandes desafios e dificuldades. O objetivo foi analisar os pontos fortes, oportunidades, fraquezas e ameaças do teletrabalho implementado no contexto do ensino universitário, durante os anos 2020-2021 na Universidade Católica de Cuenca, Campus LaTroncal, Equador: A metodologia aplicada foi uma abordagem qualitativa descritiva, análise SWOT técnica de revisão da literatura, bem como interpretação e descrição através de grupos focais. Os resultados mostram claramente que os professores necessitam de aptidões e competências específicas para desenvolver actividades de teletrabalho. A implementação do teletrabalho no ensino universitário apresenta oportunidades significativas, mas também desafios, que devem ser abordados com estratégias eficazes e um quadro jurídico sólido para garantir a sua implementação bem sucedida, evitar a violação dos direitos fundamentais e o aparecimento de doenças profissionais que estão ligadas a esta forma de organização do trabalho.

Efectos de la pandemia de COVID-19 en el programa de inmunizaciones de los menores de cinco años en Ecuador / Effects of the COVID-19 pandemic on the immunization program for children under 5 years of age in Ecuador / Efeitos da pandemia de COVID-19 no programa de imunização de menores de cinco anos no Equador

[RESUMEN]. Objetivo. Estimar el efecto de la pandemia de COVID-19 en la provisión, la utilización, la cobertura y la oportunidad de vacunación en niños menores de 5 años. Método. Se realizó un estudio de cohorte retrospectivo con un componente cuantitativo y un componente cualitativo con dos ciclos rápidos de evaluación. En cada ciclo se aplicaron cuestionarios y entrevistas semiestructuradas a miembros del personal de salud y a madres de menores de cinco años. Los instrumentos exploraron la provisión (disponibilidad de insumos y personal) y utilización (demanda y acceso) del programa de inmunizaciones. Para estimar la cobertura de vacunación se realizó un muestreo aleatorio en menores de cinco años en cinco provincias y se analizaron registros administrativos mensuales del programa para el período 2017-2020. Resultados. Aproximadamente 50% de los informantes percibieron una reducción de personal e insumos para el programa. La demanda de atención se redujo en 26% entre el 2020 y el 2021, explicado principalmente por temor al contagio de COVID-19 en unidades de salud. El acceso a la atención del programa se vio afectado por el cambio de horario, espacios ventilados y atención virtual, que no fue bien aceptado por la población. Solo 50% de menores de 1 año tuvieron esquema completo de vacunación y la mayoría de las vacunas no se aplicaron en forma oportuna. Conclusiones. La pandemia de COVID-19 afectó de manera negativa la provisión de vacunas y la utilización del programa de inmunizaciones; en consecuencia, se intensificó la caída de la coberturas y oportunidad de la vacunación, que alcanzaron niveles subóptimos en menores de cinco años en Ecuador. Esta situación aumentó el riesgo de que los niños contraigan enfermedades prevenibles por vacunación.

[ABSTRACT]. Objective. To estimate the effect of the COVID-19 pandemic on the supply, uptake, coverage, and timeliness of vaccination in children under 5 years of age in Ecuador. Methods. Concurrent mixed-methods design with two rapid evaluation cycles. In each cycle, questionnaires and semi-structured interviews were administered to health personnel and mothers of children under 5. The instruments explored the immunization program in terms of supply (availability of material and personnel) and uptake (demand and access). To estimate vaccination coverage, we randomly sampled children under 5 in five provinces and analyzed monthly administrative program records for the period 2017-2020. Results. Approximately 50% of respondents perceived a reduction in personnel and supplies for the program. The demand for care declined 26% between 2020 and 2021, mainly due to fear of contracting COVID-19 in health facilities. Access to program services was affected by changes in schedules, ventilated spaces, and the provision of virtual care, none of which were well accepted by the population. Only 50% of children under 1 year of age completed their full vaccination schedule, and most vaccines were not administered in a timely manner. Conclusions. The COVID-19 pandemic had a negative impact on the immunization program in terms of supply and uptake. This led to a precipitous decline in the coverage and timeliness of vaccination, which have fallen to suboptimal levels in children under 5 in Ecuador. This has increased the risk of children contracting vaccine-preventable diseases.

[RESUMO]. Objetivo. Estimar o efeito da pandemia de COVID-19 sobre o fornecimento, a utilização, a cobertura e a pontualidade da vacinação em crianças menores de 5 anos. Método. Delineamento misto concomitante com dois ciclos rápidos de avaliação. Em cada ciclo, foram aplicados questionários e entrevistas semiestruturadas a membros do pessoal de saúde e às mães de crianças menores de cinco anos. Os instrumentos exploraram o fornecimento de vacinas (disponibilidade de insumos e pessoal) e a utilização (demanda e acesso) do programa de imunização. Para estimar a cobertura de vacinação, foi feita uma amostragem aleatória de menores de cinco anos em cinco províncias. Além disso, os registros administrativos mensais do programa foram analisados para o período de 2017 a 2020. Resultados. Aproximadamente 50% dos informantes perceberam uma redução na equipe e nos insumos do programa. A demanda de atenção diminuiu em 26% entre 2020 e 2021, principalmente devido ao medo de infecção pela COVID-19 nas unidades de saúde. O acesso ao atendimento do programa foi afetado por mudanças nos horários de funcionamento, espaços arejados e atendimento virtual, que não foi bem aceito pela população. Apenas 50% das crianças com menos de um ano de idade completaram o calendário de vacinação, e a maioria das vacinas não foi aplicada de forma oportuna. Conclusões. A pandemia de COVID-19 afetou negativamente o fornecimento de vacinas e a utilização do programa de imunização; como resultado, a queda na cobertura e na pontualidade da vacinação se intensificou, atingindo níveis abaixo do ideal em menores de cinco anos no Equador. Essa situação aumentou o risco de que as crianças contraiam doenças imunopreveníveis.

Impact of dengue fever on depression, anxiety, and stress symptoms in Esmeraldas Province, Ecuador: a prospective cohort study.

BACKGROUND: Physical symptoms of dengue have been documented extensively, but knowledge gaps on dengue-associated mental health hazards remain. We investigated the frequency of psychiatric symptoms (depression, anxiety, and stress) and neurocognitive performance during the first year after a dengue episode. METHODS: Using DASS-21 scores at 3, 6, and 12 months, we assessed depression, anxiety, and stress in anti-dengue IgM-positive adults and matched controls during the 2021 dengue season in Esmeraldas Province, Ecuador. Patients with DASS-21 scores ≤ 4 were considered normal; those with scores of 5-7, 8-10, and ≥ 11 indicated mild, moderate, and severe depression, respectively; cutoff scores for anxiety and stress were ≥ 5 and ≥ 9, respectively. We also assessed 'delayed matching to sample' (DMS) and 'spatial working memory' (SWM) using the Cambridge Neuropsychological Test Automated Battery. RESULTS: We enrolled 102 cases and 78 controls. At 3 months, 90 cases and 70 controls were available for follow-up, among these 40/90 (44.4%) cases and 12/70 (17.1%) controls had DASS-21 scores ≥ 5 (RR 2.7, 95% CI [1.5-4.7]). Dengue remained a predictor for depression after adjusting for age, sex, and COVID-19 status. We observed no difference in anxiety between the groups, but stress scores increased at month 3 (RR 1.87, 95% CI [1.01-3.4]). DASS-21 scores normalized during follow-up. DMS and SWM did not differ between groups at 3 and 6 months. At month 12, cases had lower SWM than controls did (p value < 0.001). CONCLUSIONS: Care providers should be aware of dengue-associated mood disorders and facilitate timely referral to mental health services. Future longitudinal studies are warranted to validate our observations regarding the impact of dengue on mental health and neurocognitive status in affected patients.

COVID-19 IgG seropositivity and its determinants in occupational groups of varying infection risks in two Andean cities of Ecuador before mass vaccination.

BACKGROUND: The COVID-19 pandemic has caused over 68.7 million infections and 1.35 million deaths in South America. There are limited data on SARS-CoV-2 seropositivity and its determinants from Andean countries prior to mass vaccinations against COVID-19. OBJECTIVE: To estimate SARS-CoV-2 seropositivity and its determinants before vaccination in occupational groups of adults presumed to have different levels of exposure and associations with potential symptomatology. METHODS: We measured seropositivity of anti-SARS-CoV-2 IgG antibodies in a cross-sectional study of vaccine-naïve adults aged 18 years and older, recruited within three occupational risk groups (defined as low [LR], moderate [MR], and high [HR]) between January and September 2021 in two Andean cities in Ecuador. Associations with risk factors were estimated using logistic regression. RESULTS: In a sample of 882 adults, IgG seropositivity for the three different occupational risk groups was 39.9% (CI 95% 35.3-44.6), 74.6% (CI 95% 66.4-81.4), and 39.0% (CI 95% 34.0-44.4) for the HR, MR, and LR groups, respectively. History of an illness with loss of taste and/or smell was significantly associated with seropositivity in all occupational groups, with adjusted ORs of 14.31 (95%CI, 5.83-35.12; p<0.001), 14.34 (95%CI 3.01-68.42; p<0.001), and 8.79 (95%CI 2.69-28.72; p<0.001), for the HR, MR, and LR groups, respectively; while fever was significant for the LR group with an adjusted OR of 1.24 (95%CI, 1.11-4.57; p = 0.025) and myalgia for the HR group with an adjusted OR of 2.07 (95%CI, 1.13-3.81; p = 0.019). CONCLUSION: Notable proportions of seropositivity were seen in all occupational groups between January and September 2021 prior to mass vaccination. Loss of taste and/or smell was strongly associated with presence of anti-SARS-CoV-2 IgG antibodies irrespective of presumed occupational exposure risk.

Molecular epidemiology of Mycobacterium tuberculosis in Ecuador: Recent advances and future challenges.

Tuberculosis (TB) is one of the three leading causes of death from a single infectious agent, Mycobacterium tuberculosis (MTB), together with COVID-19 and HIV/AIDS. This disease places a heavy burden on countries with low socio-economic development and aggravates existing inequalities. For the year 2021, estimations for Ecuador were 8500 TB cases, of which 370 were associated to multiple drug resistance (TB-MDR), and 1160 deaths. In the same year, Ecuador notified 5973 total cases, 401 of them were TB-MDR, pointing out an under diagnosis problem. The few molecular epidemiology studies available conclude that L4 is the most prevalent MTB lineage in Ecuador (with LAM as the main L4 sublineage), but L2-Beijing family is also present at low prevalence. Nevertheless, with less than 1 % MTB isolates genetically characterized by either MIRU-VNTR, spolygotyping or WGS to date, molecular epidemiology research must me improved to assist the TB surveillance and control program in Ecuador.

Lifestyles and academic stress among health sciences students at the National University of Chimborazo, Ecuador: a longitudinal study.

Background: The significant changes experienced by university students in their training are inherent to educational processes. Social isolation caused by the COVID-19 pandemic, online education and the reopening of higher-education institutions produced substantial variations in the lifestyle of university students in health sciences and generated academic stress and perceived stress. This study was conducted at the National University of Chimborazo (UNACH), a public institution located in Riobamba, central Ecuador, the diverse student's population provided an ideal setting for examining the interplay between academic and perceived stress, lifestyle factors, and learning modalities. The research focused on health sciences students across six academic programs. The university's geographical position and demographic characteristics offered a representative sample for investigating these factors within the context changing. Aim: To compare academic and perceived stress and university students' lifestyles at two different periods: (1) during the mandatory social confinement caused by the COVID-19 pandemic with an online learning modality (T1); (2) in the post-pandemic period with a return to face-to-face activities (T2). Design: An observational, analytical, quantitative, and longitudinal study. Participants: Students from six programs (Nursing, Physiotherapy, Clinical Laboratory, Medicine, Dentistry, and Clinical Psychology) from the Faculty of Health of the National University of Chimborazo-Ecuador (n = 2,237) participated voluntarily, the students had one mean age of M = 21.31 (SD = 2.36) at T1 and M = 22.94 (SD = 2.40) at T2. Non-probability convenience sampling was employed due to the accessibility of the student population and the importance of including the maximum number of relevant individuals within the study population. Methods: The following instruments were used: Nola Pender's Lifestyle Profile Questionnaire, Cognitive Systemic Inventory for the study of academic stress, and Cohen's Perceived Stress Scale. Results: In T1 and T2, students reported high levels of stress, and increased unhealthy lifestyle increased with the return to classrooms. Additionally, upon returning to face-to-face activities (T2), the mean score applied to the responses of Nola Pender's Lifestyle Profile Questionnaire decreased from M = 113.34 (SD = 23.02) to M = 107.2 (SD = 29.70; p < 0.001). There was significant difference (p < 0.001) in academic stress in T1 [M = 66.25 (SD = 15.66)] and T2 [M = 64.00 (SD = 17.91)]. Conclusions: Upon returning to university classrooms (T2), the number of students who reported an "unhealthy" lifestyle increased. Academic stress was high in T1 and T2 and was reported higher in online activities during social isolation.

SARS-CoV-2 infection in synanthropic rats from Guayaquil city (Ecuador) during COVID-19 pandemic: A proxy to prevent wild reservoirs in the tropics.

Human-to-animal reverse transmission of SARS-CoV-2 is a risk for new reservoirs' emergence and new variants' evolution. SARS-CoV-2 infection of synanthropic rodents in urban settings has been reported during COVID-19 in New York and Mexico cities. In this study, we addressed the potential transmission of SARS-CoV-2 to synanthropic rats in the city of Guayaquil (Ecuador) during the COVID-19 pandemic. A total number of 234 rats were collected and analyzed for SARS-CoV-2 detection by RT-qPCR. A positivity rate of 6 % (14 rats) was found, and SARS-CoV-2 infection was confirmed by Sanger sequencing of the viral genome. Our results confirm the potential risk of synanthropic rats as reservoirs for SARS-CoV-2 infection. This is worrisome for low and middle income countries like Ecuador, where pest and waste control in urban settings is challenging. Moreover, the risk of spillover to wild fauna is a concern in Guayaquil, where synanthropic fauna includes raccoons or coatis and forest patches with a wild population of felids or primates existing within the city limits. In this context, SARS-CoV-2 sentinel surveillance of synanthropic rodents could serve as a proxy for a One Health approach to prevent the emergence of new wild reservoirs.

Psycho-emotional impact of the COVID-19 pandemic on nursing professionals in Ecuador: a cross-sectional study.

AIM AND OBJECTIVES: To analyse the levels of anxiety, depression, post-traumatic stress, and burnout among nursing professionals working in the Imbabura region of Ecuador during the COVID-19 pandemic and identify the contributing socio-occupational factors. BACKGROUND: The high demand for care of COVID-19 patients led to increased work pressure on nurses, owing to increased demands for care and shortages of medical supplies and protective equipment. DESIGN: A cross-sectional study was conducted from September to December 2022 using a self-administered questionnaire addressed to nursing professionals who cared for COVID-19 patients. METHODS: The questionnaire included socio-demographic characteristics, the Spanish adaptation of Hospital Anxiety and Depression Scale (HADS-Spanish), Impact of Event Scale-Revised (IES-R) for the evaluation of post-traumatic stress disorder (PTSD), and the Spanish adaptation of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS-Spanish) for burnout assessment. Univariate and multivariate analyses were performed. RESULTS: Of the 782 participants, 88.6% had a high level of burnout (MBI-HSS-Spanish scale score > 27). Female nurses, nurses with eight-hour work shifts, and older professionals exhibited high levels of anxiety and depression. Prolonged working hours in COVID-19 patient care services were found to be a risk factor for burnout and post-traumatic stress. CONCLUSIONS: Participating nurses presented with a high level of chronic work stress and exhibited signs of anxiety and depression during the period under consideration. Providing nurses with psychological support measures and performing liaison consultations will alleviate the psychological burden on nurses. RELEVANCE TO CLINICAL PRACTICE: The study has shown that accounting for the environments where the emotional impact is greatest and how to reduce it would not only reduce anxiety, depression, and burnout in nurses but also improve the quality of care, not only in pandemic. PATIENT OR PUBLIC CONTRIBUTION: Nurses contributed to the conduct of the study by participating in the data collection via questionaries.

Assessment of the COVID-19 pandemic progression in Ecuador through seroprevalence analysis of anti-SARS-CoV-2 IgG/IgM antibodies in blood donors.

Introduction: Coronavirus Disease 2019 (COVID-19) is a severe respiratory illness caused by the RNA virus SARS-CoV-2. Globally, there have been over 759.4 million cases and 6.74 million deaths, while Ecuador has reported more than 1.06 million cases and 35.9 thousand deaths. To describe the COVID-19 pandemic impact and the vaccinations effectiveness in a low-income country like Ecuador, we aim to assess the seroprevalence of IgG and IgM antibodies against SARS-CoV-2 in a sample from healthy blood donors at the Cruz Roja Ecuatoriana. Methods: The present seroprevalence study used a lateral flow immunoassay (LFIA) to detect anti-SARS-CoV-2 IgG and IgM antibodies in months with the highest confirmed case rates (May 2020; January, April 2021; January, February, June, July 2022) and months with the highest vaccination rates (May, June, July, August, December 2021) in Quito, Ecuador. The IgG and IgM seroprevalence were also assessed based on sex, age range, blood type and RhD antigen type. The sample size was 8,159, and sampling was performed based on the availability of each blood type. Results: The results showed an overall IgG and IgM seroprevalence of 47.76% and 3.44%, respectively. There were no differences in IgG and IgM seroprevalences between blood groups and sex, whereas statistical differences were found based on months, age range groups, and RhD antigen type. For instance, the highest IgG seroprevalence was observed in February 2022 and within the 17-26 years age range group, while the highest IgM seroprevalence was in April 2021 and within the 47-56 years age range group. Lastly, only IgG seroprevalence was higher in RhD+ individuals while IgM seroprevalence was similar across RhD types. Discussion: This project contributes to limited data on IgG and IgM antibodies against SARS-CoV-2 in Ecuador. It suggests that herd immunity may have been achieved in the last evaluated months, and highlights a potential link between the RhD antigen type and COVID-19 susceptibility. These findings have implications for public health strategies and vaccine distribution not only in Ecuador but also in regions with similar characteristics.

May Measurement Month 2021: an analysis of blood pressure screening results from Ecuador.

Arterial hypertension is a growing burden worldwide, leading to over 10.8 million deaths each year. Before the outbreak of the COVID-19 pandemic, cardiovascular diseases were the main cause of death in Ecuador. Hypertension is the main risk factor for the major cause of death, coronary and cerebrovascular disease. The 2021 May Measurement Month Campaign (MMM21) is a global initiative by the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to provide a temporary solution for opportunistic screening until more systematic approaches can be established. A cross-sectional survey was carried out in May 2021 across 22 health centres in Ecuador. The average age of participants was 44.7 ± 15.8 years. Blood pressure measurement, the definition of hypertension (mean of the 2nd and 3rd BP measurements ≥ 140/90 mmHg or on medication for high BP), and statistical analysis followed the standard MMM protocol. In total, 1326 volunteers participated in MMM21. After multiple imputation of missing BP readings, 423 (31.9%) had hypertension. Of those, 70.5% were receiving antihypertensive medication. Of individuals receiving antihypertensive medication, 50.0% had uncontrolled BP. Overall, of 423 participants with hypertension, only 35.2% had their BP controlled (<140/90 mmHg). MMM21 demonstrated a high prevalence of hypertension in Ecuador during the COVID-19 pandemic. It was the largest BP screening campaign done in Ecuador thus far. The high percentage of persons untreated or with uncontrolled hypertension while on pharmacologic treatment suggests that appropriate screening can help to identify a significant number of people with elevated BP and those inadequately treated. These data should attract the attention of doctors and health care providers in Ecuador.

COVID-19: Medical education from the point of view of medical students using the participatory Delphi method.

BACKGROUND: The COVID-19 pandemic has prompted a transformation of medical training. Although there were obvious medical education and social interaction challenges, e-learning presented some advantages, which may have generated medical curricula innovation and adjustments to novel technological methodologies. This study aims to generate consensuses among medical students regarding medical education provided during the pandemic in the resource-limited context of a Global South university. METHODS: The implementation of a participatory Delphi method included a recruitment campaign, training, constitution of Delphi panels and questions, and development of the Delphi exercises. Students from the second to the sixth year of medicine of a university in Quito, Ecuador, constituted two Delphi panels, developed questions about the education received during the pandemic, and answered them over 3.5 rounds. FINDINGS: Twenty-two medical students participated in the Delphi exercises about their perception of medical education during the COVID-19 pandemic. The analysis consisted of a total of 22 Delphi questions divided into five distinct categories: adaptations and innovations, curriculum and assessment changes, virtual clinical practice, time management, and mental health. The authors established high, medium, and low consensuses for analysis. CONCLUSIONS: Consensuses were reached based on students' academic year and focused on the changes in lecture delivery, the usage of new technologies, patient care skills, the impact of the educational routine, and the mental health of the COVID-19 pandemic. The way the pandemic affected medical education in the Global South set the stage for the need for a comprehensive review of tools, skills, and curricula for students from culturally diverse backgrounds. This study offers a highly replicable methodology to generate consensuses and introduce students to academic research.

Post-COVID conditions response: a collaborative approach to -establishing multidisciplinary clinics in Ecuador.

INTRODUCTION: Worldwide, 3.7% (144.7 million) of people diagnosed with COVID-19 developed Post-COVID Conditions (PCC). Therefore, creating and implementing multidisciplinary rehabilitation clinics is important to address the needs of patients and improve overall recovery. This study was made possible with support from the United States Agency for International Development funded RISE program, under the terms of the cooperative agreement 7200AA19CA00003. METHODS: This case study was conducted in Ecuador and describes the creation and implementation of 21 PCC rehabilitation clinics in primary healthcare centers and secondary level hospitals in 7 provinces across the country. Data was gathered for the identification of partnering health facilities and needs, for the evaluation of knowledge enhancement in health professionals after a specific training program, and for the measurement of key performance indicators. This article emphasizes the organization, educational strategies, and implementation of rehabilitation programs tailored specifically for the management of Post-COVID Conditions in Ecuador. RESULTS: The implementation of PCC rehabilitation clinics involved a collaborative effort between the Ministry of Public Health (MOPH), the private sector and a non-governmental organization (Jhpiego). Twenty-one health facilities from the primary and secondary level of care were selected, and PCC rehabilitation implemented in 7 provinces of Ecuador. Additionally, 133 health providers were trained and a total of 13,846 patients treated, among whom 859 had a diagnosis of PCC. Medical doctors outperformed nurses in both pre- and post-tests scores. However, all healthcare professionals demonstrated comparable improvement in knowledge acquisition. Rehabilitation manuals were developed and adopted by the MOPH, rehabilitation equipment was donated and a mobile application, "RESPIRA", was developed and disseminated free of charge. CONCLUSION: The establishment of PCC rehabilitation clinics in Ecuador was successful in identifying patients in need of early rehabilitation. The insights of this study can serve as a guide for the development of similar initiatives in other countries. Tailored courses are essential to address disparities and ensure comprehensive skill development and promote equitable healthcare delivery.

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ±â€…13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

Analysis of the Spread and Evolution of COVID-19 Mutations in Ecuador Using Open Data.

Currently, the analyses of and prediction using COVID-19-related data extracted from patient information repositories compiled by hospitals and health organizations are of paramount importance. These efforts significantly contribute to vaccine development and the formulation of contingency techniques, providing essential tools to prevent resurgence and to effectively manage the spread of the disease. In this context, the present research focuses on analyzing the biological information of the SARS-CoV-2 viral gene sequences and the clinical data of COVID-19-affected patients using publicly accessible data from Ecuador. This involves considering variables such as age, gender, and geographical location to understand the evolution of mutations and their distributions across Ecuadorian provinces. The Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology is applied for data analysis. Various data preprocessing and statistical analysis techniques are employed, including Pearson correlation, the chi-square test, and analysis of variance (ANOVA). Statistical diagrams and charts are used to facilitate a better visualization of the results. The results illuminate the genetic diversity of the virus and its correlation with clinical variables, offering a comprehensive understanding of the dynamics of COVID-19 spread in Ecuador. Critical variables influencing population vulnerability are highlighted, and the findings underscore the significance of mutation monitoring and indicate a need for global expansion of the research area.

COVID-19 in a common woolly monkey (Lagothrix lagothricha): First evidence of fatal outcome in a nonhuman primate after natural SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization in March 2020. Since then, viral spread from humans to animals has occurred worldwide. Nonhuman primates (NHPs) have been found to be susceptible to reverse-zoonosis transmission of SARS-CoV-2, but initial research suggested that platyrrhine primates are less susceptible than catarrhine primates. Here we report the natural SARS-CoV-2 infection of a common woolly monkey (Lagothrix lagothricha) from a wildlife rehabilitation center in Ecuador. The course of the disease, the eventual death of the specimen, and the pathological findings are described. Our results show the susceptibility of a new platyrrhine species to SARS-CoV-2 and provide evidence for the first time of a COVID-19-associated death in a naturally infected NHP. The putative route of transmission from humans, and implications for captive NHPs management, are also discussed. Given that common woolly monkeys are at risk of extinction in Ecuador, further understanding of the potential threat of SARS-CoV-2 to their health should be a conservation priority. A One Health approach is the best way to protect NHPs from a new virus in the same way that we would protect the human population.

Evaluación de la calidad de guías de práctica clínica para el tratamiento de adultos con COVID-19 leve o moderada, utilizando la herramienta AGREE II / Assessment of the quality of clinical practice guidelines on the treatment of adults with mild or moderate COVID-19, using the AGREE II tool

INTRODUCCIÓN: Varias guías de práctica clínica para el tratamiento de la COVID-19 se han desarrollado durante los dos últimos años de pandemia, sin embargo, su calidad metodológica es poco clara. OBJETIVO: Realizar una evaluación sistemática de la calidad de las guías de práctica clínica publicadas entre 2021 y octubre de 2022 para el tratamiento de la COVID-19, utilizando la herramienta AGREE II, e identificar las recomendaciones formuladas en dichas guías. JUSTIFICACIÓN: Durante la pandemia, surgieron múltiples guías, pero la claridad so-bre su calidad metodológica fue limitada. MÉTODOS: Se realizó una búsqueda sistemática de guías de práctica clínica sobre el tratamiento para la COVID-19 leve o moderada utilizando metabuscadores como Epistemonikos y Trip Database, y sitios web de organizaciones de sa-lud. Las guías seleccionadas fueron evaluadas con el instrumento AGREE II. RESULTADOS: Se evaluaron 11 GPC, presentando altas puntuaciones en los dominios de alcance y propósito (98,74 %), participación de los implicados (97,22 %), rigor en la elaboración (92 %), claridad de presentación (100 %), aplicabilidad (85,61 %), e independencia editorial (100 %). Aunque la ca-lidad general de las guías fue alta, se identificó la necesidad de mejorar en los aspectos de rigor en la elaboración y aplicabilidad de las recomendaciones. CONCLUSIONES: Encontramos que la calidad de las guías de práctica clínica evaluadas, en su mayoría es alta y, por lo tanto, son recomendables, aunque reconocemos la necesidad de mejorar la descripción de los dominios de rigor en la elaboración y aplicabilidad de las recomendaciones.

INTRODUCTION: Several clinical practice guidelines for the management of COVID-19 have been developed during the last two years of the pandemic, but their methodological quality is unclear. OBJECTIVE: To systematically assess the quality of clinical practice guidelines for the treatment of COVID-19 published between 2021 and October 2022 using the AGREE II tool, and to identify the recommendations made in these guidelines. JUSTIFICATION: During the pandemic, many guidelines were published, but clarity about their methodological quality was limited. METHODS: A systematic search for clinical practice guidelines on the management of mild-to-moderate COVID-19 was performed using meta-search engines such as Epistemoni-kos and Trip Database, as well as health organization websites. The selected guidelines were appraised using the AGREE II instrument. RESULTS: Eleven clinical practice guidelines (CPGs) were evaluated, showing high scores in the domains of scope and purpose (98.74%), stakehol-der involvement (97.22%), rigor of development (92%), clarity of presentation (100%), applica-bility (85.61%), and editorial independence (100%). Although the overall quality of the guidelines was high, there was identified a need for improvement in the areas of rigor of development and applicability of the recommendations. CONCLUSIONS: We found that the quality of the evalua-ted clinical practice guidelines is predominantly high, and therefore, they are recommendable. However, we recognize the need to improve the descriptions of the domains of rigor of develop-ment and applicability of the recommendations,

Detection of thermotolerant coliforms and SARS-CoV-2 RNA in sewage and recreational waters in the Ecuadorian coast: A call for improving water quality regulation.

Wastewater surveillance represents an alternative approach to regulating contamination and the early detection of infectious agents and outbreaks of diseases of public health importance. This study evaluated domestic wastewater effects on recreational waters in estuarine and seawater bodies in Guayas and Santa Elena provinces in Ecuador, South America. Fecal indicator bacteria (thermotolerant coliforms) served as key indicators for evaluation. Physical, chemical, and microbiological quality markers following the Ecuadorian environmental quality standard and the discharge of effluents to the water resource were analyzed. Samples were collected from 44 coastal sites and 2 oxidation lagoons during the dry and rainy seasons of 2020 and 2021, respectively. SARS-CoV-2 RNA was detected in samples with higher E. coli concentrations using reverse transcription quantitative PCR to detect the genes N and ORF1ab. All samples analyzed for SARS-CoV-2 showed Ct ˂ 40 for at least one gene. Four samples showed at least 20 genome copies of gene N per reaction. These were at an artisanal fishing port, an estuarine area (Palmar), a recreational bay, and an oxidation lagoon. A moderate correlation was found between SARS-CoV-2 RNA, thermotolerant coliform and E. coli (p-value ≤ 0.0037), and a strong and positive correlation between thermotolerant coliform and E. coli. (p-value ≤ 0.00001), highlighting the utility of these established parameters as a proxy of the virus. Significant differences were found in the concentrations of thermotolerant coliforms between seasons (p-value = 0.016) and sites (p-value = 0.005). The highest levels of coliforms were found in the dry season (63000 MPN/100 mL) in Anconcito and during the rainy season (14000 MPN/100 mL) at Esterillo in Playas County. It is recommended that the decentralized autonomous governments of the surveyed provinces in Ecuador implement urgent corrective actions and establish medium-term mechanisms to minimize a potential contamination route. Additional parameters must be included in the monitoring, such as Enterococcus and intestinal parasites, due to their public health implications. In the oxidation lagoons, maintenance actions must be carried out, including the dissolution of sediments, an increase in water retention times, and in situ treatment of the sludge, to improve the system's performance.

Single nucleotide variants in the CCL2, OAS1 and DPP9 genes and their association with the severity of COVID-19 in an Ecuadorian population.

COVID-19 has a broad clinical spectrum, ranging from asymptomatic-mild form to severe phenotype. The severity of COVID-19 is a complex trait influenced by various genetic and environmental factors. Ethnic differences have been observed in relation to COVID-19 severity during the pandemic. It is currently unknown whether genetic variations may contribute to the increased risk of severity observed in Latin-American individuals The aim of this study is to investigate the potential correlation between gene variants at CCL2, OAS1, and DPP9 genes and the severity of COVID-19 in a population from Quito, Ecuador. This observational case-control study was conducted at the Carrera de Biologia from the Universidad Central del Ecuador and the Hospital Quito Sur of the Instituto Ecuatoriano de Seguridad Social (Quito-SUR-IESS), Quito, Ecuador. Genotyping for gene variants at rs1024611 (A>G), rs10774671 (A>G), and rs10406145 (G>C) of CCL2, OAS1, and DPP9 genes was performed on 100 COVID-19 patients (43 with severe form and 57 asymptomatic-mild) using RFLP-PCR. The genotype distribution of all SNVs throughout the entire sample of 100 individuals showed Hardy Weinberg equilibrium (P=0.53, 0.35, and 0.4 for CCL2, OAS1, and DPP9, respectively). The HWE test did not find any statistically significant difference in genotype distribution between the study and control groups for any of the three SNVs. The multivariable logistic regression analysis showed that individuals with the GG of the CCL2 rs1024611 gene variant had an increased association with the severe COVID-19 phenotype in a recessive model (P = 0.0003, OR = 6.43, 95% CI 2.19-18.89) and for the OAS1 rs10774671 gene variant, the log-additive model showed a significant association with the severe phenotype of COVID-19 (P=0.0084, OR=3.85, 95% CI 1.33-11.12). Analysis of haplotype frequencies revealed that the coexistence of GAG at CCL2, OAS1, and DPP9 variants, respectively, in the same individual increased the presence of the severe COVID-19 phenotype (OR=2.273, 95% CI: 1.271-4.068, P=0.005305). The findings of the current study suggests that the ethnic background affects the allele and genotype frequencies of genes associated with the severity of COVID-19. The experience with COVID-19 has provided an opportunity to identify an ethnicity-based approach to recognize genetically high-risk individuals in different populations for emerging diseases.

Evaluating low and high vitamin D levels in Ecuadorian cities from 2018 to 2022: interrupted time series and a cross-sectional study.

OBJECTIVES: To identify differences in the mean vitamin D concentrations in samples obtained from a private laboratory in Quito and to explore their relationship with the pre-pandemic and pandemic periods spanning from 2018 to 2022. DESIGN: A combination of an interrupted time series design and a retrospective cross-sectional approach. SETTING AND PARTICIPANTS: The study involved 9285 participants who had their 25-hydroxyvitamin D (25(OH)D) levels tested at a well-known private laboratory in Quito, Ecuador, from 2018 to 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: The 25(OH)D levels were analysed and assessed for correlations with age, and the year the measurements were taken. RESULTS: The mean 25(OH)D level was 27.53 ng/mL (± 14.11). Approximately 68.8% of participants had serum 25(OH)D levels of less than 30 ng/mL, and 0.6% showed potential harm from excess 25(OH)D, with levels over 100 ng/mL. The analysis indicated a significant monthly increase of 0.133 units in 25(OH)D levels (p=0.006). However, the period after March 2020, compared with before, saw a non-significant decrease of 1.605 units in mean 25(OH)D levels (p=0.477). CONCLUSIONS: The study's findings indicate a significant prevalence of 25(OH)D deficiency, underscoring the necessity for preventative measures. However, the increasing trend in high 25(OH)D levels is concerning, emphasising the importance of prudent vitamin D supplement prescriptions and public education against self-medication. For efficient resource allocation and targeting of those with higher risks, it may be advantageous to concentrate vitamin D testing on specific population groups.

Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022.

OBJECTIVE: This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. METHODS: This study included 31,616 dengue hospitalizations in Ecuador during 2015-2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. RESULTS: During 2015-2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015-2017 and 31.73% annual increase during 2017-2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015-2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. CONCLUSIONS: It was observed as an important accomplishment in Ecuador's ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.