Increased Cardiovascular Mortality in Ecuador during COVID-19 Pandemic.

Before the COVID-19 pandemic, chronic noncommunicable diseases (NCDs), represented a high burden for low and middle-income countries. Patients with NCDs are at higher risk of COVID-19 and suffer worse clinical outcomes. We present mortality trends for myocardial infarction (AMI), stroke, hypertension (HT), and type-2 diabetes mellitus (T2DM) from 2005 to 2021 in Ecuador. The greatest increase in mortality observed in the pandemic was in AMI, T2DM, and HT. Factors related to COVID-19, health services, and patients with NCDs could contribute to these important increases in mortality.

Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C). METHODS: One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission. RESULTS: Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities. CONCLUSIONS: Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.

Misleading Advertising of Health-Related Products in Ecuador during the COVID-19 Pandemic.

Background Media coverage of the COVID-19 pandemic increased tuning ratings during this time. The aim of this study was to identify misleading advertising of health-related products on Ecuadorian television during the COVID-19 pandemic. Methods Television channels were monitored for 111 h in the months of June and October 2020. Verbal, nonverbal and context content were analyzed from each advertising spot according to ethical standards for the promotion of products for human health Results A total of 667 spots were analyzed. Most, 90%, involved misleading advertising of health-related products. Products for gastrointestinal conditions were the most publicized (17.8%) during the period analyzed. Newscasts most often advertised products intended to improve sexual potency (22.9%) and to a lesser degree those intended to prevent and treat respiratory problems (1.8%); this relationship was reversed when compared to general programming (p < 0.05). Conclusions Most of the health-related products advertised on Ecuadorian television are advertised misleadingly, with news programs having the highest number of such advertisements per hour of programming.

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.

Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.

A bibliometric analysis of COVID-19 research in Latin America and the Caribbean

Introduction: Latin America and the Caribbean (LAC) is one of the regions most affected by the COVID-19 pandemic. Yet, there is scarce literature addressing the research strategies developed in LAC to face COVID-19. Objective: To quantify and assess the production of scientific publications about COVID-19 in 32 countries of LAC between January 1 and July 31,2020. Materials and methods: Bibliometric study. Scientific papers on COVID-19 conducted in LAC or reporting data pertaining to LAC and published between January 1 to July 31, 2020 were searched in the Scopus, PubMed and LILACS databases. A subgroup analysis including only original research articles was performed to determine the contribution of LAC countries to research in COVID-19, and standardization measures (# of articles per 1 million people) were applied to compare the country-specific production of this type of articles. Results: A total of 1291 publications were retrieved. Overall, most of them were non-original research articles (81.72%), and the countries with the highest scientific production were Brazil (43.91%) and Mexico (9.14%). However, after applying the standardization measures, Chile was the country with the highest production of original articles (0.58 per 1 million inhabitants). Regarding original studies (n=236), cross-sectional design was the most common (25.84%). Diagnosis and treatment of the disease was the main research focus (n=354;27.42%). In the subgroup analysis (n=236), however, epidemiology and surveillance were the most prevalent research focus (n=57;24.15%). Conclusions: During the study period, non-original research articles were predominant in the scientific production of the LAC region, and, among original articles, interventional studies were scarce, while cross-sectional predominated. Further research with a better quality of evidence should be performed in these countries to contribute to the making of health policies aimed at easing the burden of COVID-19 in the region and to be prepared for other pandemics to come. Alternate abstract: Introducción. Latino América y el Caribe (LAC) es una de las regiones más afectadas por la pandemia por COVID-19. Sin embargo, hay poca literatura sobre las estrategias de investigación desarrolladas en la región para confrontar la COVID-19. Objetivo. Cuantificar y evaluar la producción de publicaciones científicas sobre COVID-19 en 32 países de LAC entre 1 de enero y el 31 de julio del 2020. Materiales y métodos. Estudio bibliométrico. Se realizó una búsqueda de artículos científicos sobre COVID-19 realizados en LAC o con datos de LAC y publicados entre enero 1 y julio 31 de 2020 en Scopus, PubMed y LILACS. Se realizó un análisis de subgrupos en el que se incluyeron solo artículos de investigación original para determinar la contribución de los países de la región a la investigación en COVID-19;además se utilizaron medidas de estandarización (# artículos por millón de habitantes) para comparar la producción de este tipo de artículos por país. Resultados. Se identificaron 1,291 artículos. La mayoría no eran investigaciones originales (81,72%), y los países con más producción fueron Brasil (43,91%) y México (9,14%). Sin embargo, luego de aplicar las medidas de estandarización, Chile fue el país con mayor producción de artículos originales (0.58 por millón de habitantes). Respecto a los artículos originales (n=236), el tipo de diseño de estudio más común fue el transversal (25,84%). El diagnóstico y tratamiento de COVID-19 fue el tema más investigado (n=354, 27,42%), pero en el análisis de subgrupo (n=236), el enfoque de investigación más frecuente fue epidemiologia y vigilancia (n=57;24,15%). Conclusiones. En el periodo de estudio, los artículos no originales predominaron en la producción científica de LAC, y, entre las investigaciones originales, los estudios intervencionales escasearon, mientras que los transversales predominaron. Se requiere realizar más investigación con una mejor calidad de evidencia en los países de la región para contribuir en la formulación de políticas de salud dirigidas a aliviar la carga de la COVID-19 en la región y para prepararse para futuras pandemias.

The Impact of Strengthening Study Habits for Medical Students During COVID-19 Academic Transition: a Mixed-Methods Study.

PURPOSE: Assess the impact of learner-specific interventions on third-year medical students to cope with quarantine distance learning due to the COVID-19 pandemic. METHODS: We conducted a nested cross-sectional and mixed-methods study in a sample of 81 third-year medical students. Two face-to-face interventions were designed and conducted to offer tools to improve study habits, time management, and prioritizing skills. A nine-item structured questionnaire was administered. Descriptive statistics was performed for the quantitative section and thematic analysis for the qualitative section. RESULTS: Of the study population, 74.1% (60/81) completed the online questionnaire, 65.4% were female, and the mean age of the sample was 21.4±1.2 years old. Overall, ~50% of participants affirmed that the workshops were useful to improve time management, organize tasks and adapt to the new study modality imposed by the COVID-19 pandemic. More than 60% of the students found the application of the provided tools during the interventions (SMART and COMPASS) useful to determine personal values and set a proper mindset for coping with distance learning. Further, 93.3% of the respondents applied the SMART strategy learned to set goals at least once during the confinement time. These findings were also seen in the thematic analysis. CONCLUSIONS: Overall, most of the students found the workshops useful and were able to practice what they had learned during this pandemic lockdown. Medical schools and higher education institutions should evaluate the possibility of formally including study habit preparation for undergraduates' students in order to provide resilience and successful academic adaptation during an ever-changing world.