Virological evidence of the impact of non-pharmaceutical interventions against COVID-19 in Ecuador, a resource-limited setting.

Ecuador had substantial COVID-19-mortality during 2020 despite early implementation of non-pharmaceutical interventions (NPIs). Resource-limited settings like Ecuador have high proportions of informal labour which entail high human mobility, questioning efficacy of NPIs. We performed a retrospective observational study in Ecuador's national reference laboratory for viral respiratory infections during March 2020-February 2021 using stored respiratory specimens from 1950 patients, corresponding to 2.3% of all samples analysed within the Ecuadorian national surveillance system per week. During 2020, detection of SARS-CoV-2 (Pearson correlation; r = -0.74; p = 0.01) and other respiratory viruses (Pearson correlation; r = -0.68; p = 0.02) by real-time RT-PCR correlated negatively with NPIs stringency. Among respiratory viruses, adenoviruses (Fisher's exact-test; p = 0.026), parainfluenzaviruses (p = 0.04), enteroviruses (p < 0.0001) and metapneumoviruses (p < 0.0001) occurred significantly more frequently during months of absent or non-stringent NPIs (characterized by <55% stringency according to the Oxford stringency index data for Ecuador). Phylogenomic analyses of 632 newly characterized SARS-CoV-2 genomes revealed 100 near-parallel SARS-CoV-2 introductions during early 2020 in the absence of NPIs. NPI stringency correlated negatively with the number of circulating SARS-CoV-2 lineages during 2020 (r = -0.69; p = 0.02). Phylogeographic reconstructions showed differential SARS-CoV-2 dispersion patterns during 2020, with more short-distance transitions potentially associated with recreational activity during non-stringent NPIs. There were also fewer geographic transitions during strict NPIs (n = 450) than during non-stringent or absent NPIs (n = 580). Virological evidence supports that NPIs had an effect on virus spread and distribution in Ecuador, providing a template for future epidemics in resource-limited settings and contributing to a balanced assessment of societal costs entailed by strict NPIs.

Comunicación asertiva, estado nutricional y desarrollo físico en adultos mayores / Assertive Communication; Nutritional Status and Physical Development in Aged Adults

Introducción: La asertividad es una herramienta comunicacional que puede contribuir de manera positiva en que los adultos mayores interpreten correctamente la necesidad e importancia de realizar acciones que permitan mantener un adecuado desarrollo físico y estado nutricional durante la tercera edad. Objetivo: Describir cómo la implementación de la comunicación asertiva puede ayudar a la incorporación de los adultos mayores al programa de actividades físicas del adulto mayor. Métodos: Se realizó una investigación básica, no experimental y descriptiva en una población de 157 adultos mayores, de los cuales 113 formaron parte de la muestra de investigación. Se aplicó la comunicación asertiva para lograr la incorporación de estos al programa de actividades físicas del adulto mayor. Resultados: El miedo al contagio con COVID-19 fue la principal causa referida para no participar en las actividades (17,70 por ciento). Predominaron los adultos mayores con nivel de conocimiento bajo sobre la importancia de las actividades físicas en los adultos mayores. Después de aplicar la comunicación asertiva se logró que el 64,60 por ciento de los ancianos se incorporaran al programa. Conclusiones: La asertividad, con sus técnicas y acciones, facilitó la incorporación de adultos mayores al programa de actividades físicas. Su aplicación se basó en la preparación y la capacidad de negociación con las personas de la tercera edad para poder lograr su incorporación a las actividades físicas del programa del adulto mayor(AU)

Introduction: Assertiveness is a communicational tool that can contribute positively to aged adults' correct interpretation of the need and importance of performing actions that allow them to maintain adequate physical development and nutritional status during older age. Objective: To describe how the implementation of assertive communication can help the incorporation of aged adults to the physical activity program for the elderly. Methods: A basic, nonexperimental and descriptive research was conducted with a population of 157 aged adults, of which 113 were part of the research sample. Assertive communication was applied to achieve their incorporation into the physical activity program for the elderly. Results: Fear of infection with COVID-19 was the main reported cause for not participating in the activities (17.70 percent). Aged adults with a low level of knowledge about the importance of physical activities for the elderly predominated. After applying assertive communication, 64.60 percent of the older adults could become part of the program. Conclusions: Assertiveness, with its techniques and actions, facilitated the incorporation of aged adults to the physical activities program. Its application was based on the preparation and the ability to negotiate with older adults in order to achieve their incorporation to the physical activities of the program for the elderly(AU)

Orientación nutricional y práctica de actividades físicas en pacientes con enfermedades reumáticas / Nutritional guidance and physical activity practice in patients with rheumatic diseases

RESUMEN Las enfermedades reumáticas son un grupo de afecciones que generan una gran variedad de manifestaciones clínicas y complicaciones secundarias a la actividad clínica de la enfermedad. Entre los factores que pueden ayudar en el control de la actividad clínica destacan la adherencia farmacológica, el estado nutricional y la práctica de actividades físicas. La presente investigación tuvo como objetivo dar a conocer las ventajas que ofrecen la orientación nutricional y la práctica sistemática de actividades físicas en pacientes con enfermedades reumáticas, así como la forma adecuada de brindar consejo en ambas esferas. El reporte aporta los elementos metodológicos y pedagógicos que se deben cumplir en la orientación nutricional y de actividades físicas a los pacientes. Se concluye que la orientación nutricional y la práctica de actividades físicas es parte indispensable de los esquemas terapéuticos de los pacientes con enfermedades reumáticas. Constituye un elemento fundamental para lograr el control de la actividad clínica de estas, así como del mejoramiento articular. Se exponen las recomendaciones generales y los elementos metodológicos que se debe seguir para brindar consejo nutricional y asesoría en actividades físicas encaminadas a su incorporación en el quehacer médico diario.

ABSTRACT Rheumatic diseases are a group of conditions that generate a wide variety of clinical manifestations and complications secondary to the clinical activity of the disease. Among the factors that are described can help in the control of clinical activity, drug adherence, nutritional status and the practice of physical activities stand out. The objective of this research was to present the advantages offered by nutritional counseling and the systematic practice of physical activities in patients with rheumatic diseases, as well as the appropriate way to provide advice in both spheres. The report provides the methodological and pedagogical elements that must be met in the nutritional and physical activity orientation of patients. It is concluded that nutritional guidance and the practice of physical activities is an indispensable part of the therapeutic schemes of patients with rheumatic diseases. It is a fundamental element to achieve control of the clinical activity of RD, as well as joint improvement. The general recommendations and the methodological elements that must be followed to provide nutritional advice and advice on physical activities aimed at their incorporation in the daily medical work are exposed.

Calidad de la dieta de los estudiantes de educación básica media de la Unidad Educativa ¨Sicapa¨. Chimborazo 2019 / Quality of the diet of middle school students of the Educational Unit "SICALPA". Chimborazo 2019

Introducción: La adolescencia es considerada una etapa de transición que implica una serie de cambios entre los que destacan la ganancia de peso y estatura y la maduración psicológica. Estos procesos demandan una gran cantidad de nutrientes que se adquieren a través de la dieta. Objetivo: Determinar la influencia del nivel socio-económico en la calidad de la dieta de los adolescentes que asisten a la Unidad Educativa Sicalpa. Metodología: Se realizó una investigación descriptiva, de corte transversal. La muestra incluyó 82 estudiantes. Se utilizó una escala propuesta por el Instituto Nacional de Estadísticas y Censos (INEC) para medir el nivel socio-económico que va de alto (A) a bajo (D). La calidad de la dieta se midió a través del cuestionario de frecuencia de consumo de alimentos (IASE). Se utilizó la correlación de Pearson para determinar la asociación entre el nivel socio-económico y calidad de la dieta. Resultados: La edad promedio del grupo estudiado fue 15.32 años, la mayor parte de adolescentes (41.46%) tuvieron entre 14 y 16 años y fueron de sexo masculino (59.76%). La mayor parte de adolescentes (74.39%) necesitaron realizar cambios en su dieta. En su mayoría los adolescentes pertenecieron al grupo de nivel socio-económico C- (64.63 %). La prueba de correlación de Pearson entre condiciones socio-económicas y calidad de la dieta mostró un resultado de 0.68. Conclusiones: Existió correlación positiva considerable entre las condiciones socio-económicas y la calidad de la dieta de los adolescentes de la Unidad Educativa Sicalpa.

Enseñanza del Yoga como técnica para disminuir los niveles de estrés en estudiantes de pregrado de la facultad de Salud Pública / Teaching of Yoga as a technique to reduce stress levels in undergraduate students of the Faculty of Public Health

Cursar una carrera universitaria implica una serie de esfuerzos físicos y mentales para los estudiantes de este nivel educacional. Las actividades evaluativas parciales y semestrales hacen que los estudiantes estén sometidos a niveles de estrés que en muchas ocasiones sobrepasen las capacidades adaptivas de los individuos generando así manifestaciones clínicas que disminuyen su capacidad intelectual y por ende su aprovechamiento académico. De este concepto se deriva la importancia de minimizar los niveles de estrás en estudiantes universitarios para mantener el correcto equilibrio biopsicosocial. El yoga es una técnica de relajación milenaria que se ha utilizado con buenos resultados para minimizar niveles de estrés en distintos grupos poblacionales; su enseñanza e implementación en estudiantes universitarios constituye una alternativa viable que puede representar a corto plazo disminución del estrés y maximizar el rendimiento académico de los estudiantes(AU)

To pursue a university career involves a series of physical and mental efforts for students of this educational level. The partial and semester evaluation activities mean that students are subject to stress levels that in many cases exceed the adaptive capacities of individuals, thus generating clinical manifestations that diminish their intellectual capacity and therefore their academic performance. From this concept derives the importance of minimizing the levels of stress in university students to maintain the correct biopsychosocial balance. Yoga is a thousand-year-old relaxation technique that has been used with good results to minimize levels of stress in different population groups; Its teaching and implementation in university students is a viable alternative that can represent short-term stress reduction and maximize the academic performance of students(AU)

An unusual neck tumor in a young pregnant woman: challenge diagnosis and response to treatment.

We report the case of a 19-year-old woman 33 weeks pregnant who presented a painful mass of progressive growth in the neck, having also dysphonia and dyspnea. Physical examination revealed a primary laryngeal tumor. A neuroendocrine small-cell carcinoma was diagnosed after histopathology, immunohistochemistry and genetic studies. Chemo-radiotherapy with a cisplatin-etoposide schedule was administered. Despite obtaining a complete response, the patient relapsed and finally survived 35 months with successive cisplatin-based treatments. Small-cell neuroendocrine carcinoma of the larynx is an uncommon entity, differential diagnosis can be problematic and treatment is challenging.

Left ventricular apical diseases.

There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

Kawasaki disease: a review with emphasis on cardiovascular complications.

Kawasaki disease (KD) is an acute systemic vasculitis that is currently the leading cause of acquired heart disease in childhood in the United States. Cardiovascular complications are the major cause of morbidity, are responsible for virtually all deaths from KD and should be evaluated as soon as possible after the acute phase to establish the baseline status, in order to predict disease progression and determine adequate treatment. In selected patients, electrocardiography (ECG)-gated cardiac computed tomography (CT) and magnetic resonance (MR) imaging are valuable non-invasive techniques that can be used to help diagnose the cardiovascular complications associated with KD. In this article, we review the epidemiology, aetiology and pathogenesis, histopathology, clinical features, cardiovascular complications and imaging, focusing on the role of cardiac CT and MR on the initial assessment and follow-up of the cardiovascular complications of KD.