Technological Improvements in Low- and Middle-Income Countries (LMICs): A Review of the Literature and the "Sociedad de Lucha Contra el Cáncer" (SOLCA) Institutional Experience in Neuro-Radiosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

OBJECTIVE: Neurosurgery is a medical field that requires specialized professionals and equipment, 2 important but scarce resources in low- and middle-income countries. Our goal was to report our experience with the replacement and implementation of linear accelerators with radiosurgery capabilities at "Sociedad de Lucha Contra el Cáncer" (SOLCA) Hospital in Quito, Ecuador, and give some recommendations for future technological replacements (TRs). METHODS: Two surveys were performed in SOLCA's radiosurgery department, one before the TR was finalized and one after, consisting of an open and multiple-choice questionnaire. Questions focused on the performance of the new equipment, perceptions regarding the training, and the influence of the pandemic on the whole process. In addition, we share our experience regarding the difficulties and benefits of TR at SOLCA. RESULTS: The most-reported limitation was lack of training (48%). By the time of the second survey, 95.2% of the staff had already treated patients or planned a radiosurgical procedure; 42.9% considered training to have been adequate, and 76.2% felt that the pandemic hindered the training process. Currently, 33 radiosurgeries have been done (26 for the central nervous system and 7 stereotactic radiation body therapies). CONCLUSIONS: The TR in SOLCA had similarities with other experiences in low- and middle-income countries, but the pandemic brought additional limitations, mainly complicating the staff training. Nevertheless, those limitations can be resolved with a structured training program and international collaboration. Overall, the benefits obtained from a TR result in exponentially better medical care and accessibility to novel treatments.

Management of an Unusual Metastasis of Cervical Cancer in the Adrenal Bed With Stereotactic Ablative Body Radiation Therapy.

Uterine cervical carcinoma is an important type of cancer among Ecuadorian women, especially in adult women. Survival rates have improved with the development of radiotherapy, surgical techniques, and chemotherapy. However, recurrence and/or metastasis are not unusual phenomena. Frequent sites of metastasis are the lungs, regional lymph nodes, and bones. Atypical locations can also occur on solid organs, such as adrenal glands. Treatment for the rare complication that is adrenal metastasis is individualized, it can include surgical resection, chemotherapy, local ablation, or different types of radiotherapy. We aimed to report a case of an Ecuadorian woman from Quito city with a diagnosis of cervical carcinoma diagnosed in 2009, treated surgically and with adjuvant chemotherapy. Her progression was monitored with medical controls with no recurrence until 2018, when she relapsed with a metastatic invasion of the pelvic ganglia and the surroundings of the abdominal aorta, with a histopathologic diagnosis of adenocarcinoma. She was then treated with chemotherapy and radiotherapy until June 2019. In 2020, she went through a splenectomy and left adrenalectomy to treat vascular thrombosis. In 2021, 37 x 15 mm mass was discovered in the surgical bed of the previously removed adrenal gland. It was treated as an oligometastatic carcinoma with stereotactic body radiotherapy (SBRT) by a linear accelerator.

Prevalencia y factores asociados de las infecciones asociadas a la atención de la salud en el servicio de pediatría y unidad de cuidados intensivos pediátricos del Hospital Vicente Corral Moscoso / Prevalence and associated factors of health care-associated infections in the pediatric service and pediatric intensive care unit of the Vicente Corral Moscoso Hospital

Introducción: Las Infecciones asociadas a la atención de la salud (IAAS) son procesos infecciosos transmisibles que se presentan después de 48 horas de hospitalización sin estar presentes en el momento de ingreso. El objetivo del presente estudio fue establecer la prevalencia y sus factores asociados. Métodos: El presente estudio de tipo transversal y analítico se realizó en el área de Pediatría y Unidad de Cuidados Intensivos Pediátricos del Hospital Vicente Corral Moscoso de Cuenca, Ecuador en el período Mayo 2018-Octubre 2019. Se incluyeron con una muestra probabilística niños de 29 días de edad hasta menores de 16 años. Las variables observadas fueron la presencia de IAAS, edad, estado nutricional, diagnóstico de ingreso, días de hospitalización, uso de ventilación mecánica, uso de catéteres, sitio de internación, germen aislado y resistencia antibiótica. Se utiliza estadística descriptiva y razón de prevalencia (RP). Resultados: Fueron 385 casos, 212 hombres (55.1%). La edad más prevalente: lactantes 31.4%. La prevalencia de IAAS fue del 13.5% (IC95% 13.33-13.68%). La principal IAAS fue la sepsis (40.4%), seguida por la neumonía (36.5%). La edad <24 meses RP 2.55 (IC95% 1.5-4.2, P<0.001), Desnutrición RP 4.07 (IC95% 2.5-6.6, P=<0.001), hospitalización >14 días RP 32.0 (IC95% 16.6-61.6 P<0.001), uso de catéter venoso central RP 16.6 (IC95% 8.7-32.2, P<0.001). Conclusiones: Existe una prevalencia de IASS mayor al 10% y se asocia con factores que condiciona mayor permanencia hospitalaria, desnutrición y uso de dispositivos invasivos.

Introduction: Infections associated with health care (HAI) are communicable infectious processes that occur after 48 hours of hospitalization without being present at the time of admission. The objective of the present study was to establish the prevalence and its associated factors. Methods: The present cross-sectional and analytical study was carried out in the area of Pediatrics and the Pediatric Intensive Care Unit of the Vicente Corral Moscoso Hospital in Cuenca, Ecuador in the period May 2018-October 2019. Children of 29 days of age to under 16 years were included with a probabilistic sample. The variables observed were the presence of HAI, age, nutritional status, admission diagnosis, days of hospitalization, use of mechanical ventilation, use of catheters, hospitalization site, isolated germ, and antibiotic resistance. Descriptive statistics and prevalence ratio (PR) are used. Results: There were 385 cases, 212 men (55.1%). The most prevalent age: infants 31.4%. The prevalence of HAI was 13.5% (95% CI 13.33-13.68%). The main HAI was sepsis (40.4%), followed by pneumonia (36.5%). Age <24 months PR 2.55 (95% CI 1.5-4.2, P <0.001), Malnutrition PR 4.07 (95% CI 2.5-6.6, P = <0.001), hospitalization> 14 days PR 32.0 (95% CI 16.6-61.6 P <0.001), so from central venous catheter RP 16.6 (95% CI 8.7-32.2, P <0.001). Conclusions: There is a prevalence of IASS greater than 10% and it is associated with factors that condition longer hospital stays, malnutrition and the use of invasive devices.

Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys.

OBJECTIVES: Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening. METHODS: Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios. RESULTS: 64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy. CONCLUSIONS: Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.