Medicine

In the area of public health, it is fundamental to understand the structure and dynamics of the Ecuadorian pharmaceutical market, its segmentation between the public and private sectors, and its relationship with supply and demand, both for generic and brand-name drugs. To achieve this, an observational descriptive study was conducted with information obtained from the available scientific, institutional, technical-administrative, and economic databases. Furthermore, the scientific information concerning the Ecuadorian and regional pharmaceutical market was reviewed through the PubMed and Ovid search engines. In Ecuador, 69.6% of dispensed drugs are brand-name and 30.4% are generics. Of all registered drugs in the country, 1,829 (13.6%) are considered over-the-counter and 11,622 (86.4%) are for sale under medical prescription. In terms of sales, 93.15% correspond to brand-name drugs and only 6.85% to generics. Ninety percent of the pharmacies are located in urban areas and only 10% ...

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Objective: Traumatic brain injury (TBI) is a public health problem worldwide. Information regarding TBI from low-and middle-income countries is scarce. The objectives of this study are to determine the incidence, mortality and geode-mographic distribution of TBI in Ecuador. Methods: A population based analytical study from 2004 to 2016 was conducted in Ecuador. Men and women with a diagnosis of TBI from all ages (0-110 years) were included. Data was obtained from official hospital-discharges records and retrieved from the National Institute of Statistics and Census (INEC) Database. We analyzed data by region, province and canton with a monthly resolution. The incidence, mortality, case fatality rates and the risk of developing TBI within the population were calculated based on the last 13 years of available data. Results: A total of 124,576 hospital admissions and 5,264 deaths due to TBI were registered in Ecuador from 2004 to 2016. The overall TBI-related hospital admission rate was 70.68 per 100,000. The sex-and age-specific rate was 90.1 per 100,000 for men and 64.1 per 100,000 for women. Mes-tizos' population has the highest adjusted incidence rate of 195.6 per 100,000, followed by the indigenous with 61.4 per 100,000 and Afro-Americans with 14.2 per 100,000. The overall annual mortality rate during the study ranged from 2.11 to 3.35 per 100,000. Case fatality rates were significantly higher in older populations, becoming fatal in up to 27% of men > 90 years/old and in 15% of women older than 90 years/old. Conclusion: This is the first recorded epidemiological study of the socio-demographic distribution of TBI in Ecuador to date. The study found that young men were almost 4 times more likely to be hospitalized due to TBI than women of this age. Fatalities due to TBI were less likely to occur among younger age groups, increasing significantly among the elderly population. The national incidence rate of TBI has been decreasing since 2011, which coincides with the introduction of stricter alcohol regulation, suggesting that this measure might have played a role in this reduction.

The progress of humanity goes hand in hand with the production of new scientific knowledge. To carry out an investigation has as its ultimate purpose to fill an information gap in the endless and dynamic universe of knowledge. It is said that unpublished information is non-existent information and this assertion is the one that provokes a frenzy within the researchers to look for opportunities to publish their results. This growing demand becomes an opportunity for those who seek to profit from the needs of teachers, researchers, students and professionals in general who try to publish their results every day.

It is currently estimated that there are more than 10,000 journals that seek to publish results in exchange for money, with a non-existent or a very brief peer review, known as predatory journals. They multiply exponentially and endanger the credibility of the science worldwide. In this brief editorial we seek to explain what predatory journals are, how to identify them and how to avoid them within the context of scientific production in the medical field.

Background: Biomedical and ethnographic studies among indigenous people are common practice in health and geographical research. Prior health research misconduct has been documented, particularly when obtaining genetic material. The objective of this study was to crossmatch previously published data with the perceptions of the Waorani peoples about the trading of their genetic material and other biological samples. Methods: We conducted a mixed methods study design using a tailored 15-item questionnaire in 72 participants and in-depth interviews in 55 participants belonging to 20 Waorani communities about their experiences and perceptions of participating in biomedical research projects. Additionally, we conducted a systematic review of the literature in order to crossmatch the published results of studies stating the approval of an ethics committee and individual consent within their work. Results: A total of 40 men (60%) and 32 women (40%), with a mean age of 57 ± 15 years agreed to be interviewed for inclusion. Five main categories around the violation of good clinical practices were identified, concerning the obtention of blood samples from a recently contacted Waorani native community within the Amazonian region of Ecuador. These themes are related to the lack of adequate communication between community members and researchers as well as the voluntariness to participate in health research. Additionally, over 40 years, a total of 38 manuscripts related to the use of biological samples in Waorani indigenous people were published. The majority of the studies (68%) did not state within their article obtaining research ethics board approval, and 71% did not report obtaining the informed consent of the participants prior to the execution of the project. Conclusion: Clinical Research on the Waorani community in the Ecuadorian Amazon basin has been performed on several occasions. Unfortunately, the majority of these projects did not follow the appropriate ethical and professional standards in either reporting the results or fulfilling them. The results of our investigation suggest that biological material, including genetic material, has been used by researchers globally, with some omitting the minimum information required to guarantee transparency and good clinical practices. We highlight the importance of stating ethics within research to avoid breaches in research transparency.

Resumen Tras el diagnóstico de la primera persona infectada con el coronavirus SARS-CoV-2 este ha llegado a expandirse por todo el mundo, ocasionando una pandemia y poniendo en alerta a los sistemas de salud. Actualmente, la evidencia indica que los efectos de este coronavirus en humanos no siempre se limitan al tracto respiratorio, pueden invadir el sistema nervioso central ocasionado dolor de cabeza, convulsiones y alteraciones de conciencia. Por esta razón, se recomienda pensar en una infección con SARS-CoV-2 como un diagnóstico diferencial en pacientes que presentan manifestaciones neurológicas. Palabras clave: SARS-CoV-2, neuroinvasión, neurotropismo. Abstract Since the diagnosis of the first person infected with SARS-Cov-2, it has quickly spread throughout the world causing a pandemic and putting healthcare systems on maximal alert. Currently, evidence indicates that SARS-Cov-2 infection is not a disease limited to the respiratory system but it can also affect the central nervous system, causing anosmia, headache, seizures , stroke and altered mental status. For this reason, it is important to be aware of the neurological complications associated SARS-CoV-2 infection. Instroducción A lo largo de la historia humana, las enfermedades han interferido no solo como un determinante del número de personas en el planeta, sino que también han afectado la cultura y la forma de socializar. Los mayores asesinos de la historia son las bacterias y los virus responsables de millones de muertes en todo el mundo. 1 Algunas de las pandemias más devastadoras incluyen la muerte negra, la viruela, el cólera, el SIDA, la enfermedad de tipo influenza y las últimas tres enfermedades zoonóticas similares a la gripe del coronavirus, incluido el síndrome respira-torio agudo severo (SARS), el síndrome respiratorio del Medio Oriente (MERS) 2 y finalmente, las enfermedades por coronavirus descritas en 2019 (COVID-19) 3 La cla-sificación actual de los coronavirus reconoce 49 especies en 27 subgéneros que pertenecen a la familia Coronavi-ridae, de estos, tres pueden causar enfermedades tanto en animales como en humanos. 4 El sistema respiratorio es el más afectado por esta enfermedad, sin embargo, hay cre-ciente evidencia de que el sistema nervioso central (SNC) también puede verse afectado. El presente estudio pre-tende recopilar la literatura más relevante sobre cómo la infección por SARS-CoV-2 puede conducir al desarrollo de complicaciones neurológicas. Para esto se inicia con una descripción de la enfermedad, se continúa explicando la evidencia existente sobre la afectación en el sistema nervioso, los mecanismos por los cuales el coronavirus (CoV) puede afectar el sistema nervioso y finalmente se

Resumen El accidente cerebrovascular (ACV)-también conocido como stroke-es una de las principales causas de muerte a nivel mundial. Numerosos y tradicionales factores de riesgo han sido asociados con un incremento en la prevalencia e incidencia del ACV; tal es el caso de la hipertensión arterial esencial, el tabaquismo, la obesidad o la diabetes mellitus. A su vez, existen factores de riesgo menormente asociados con dicha incidencia o prevalencia, llamados factores de riesgo no tradicionales, entre los cuales podemos nombrar al consumo de cocaína, consumo excesivo de alcohol, presencia del síndrome de inmuno-deficiencia adquirida (SIDA), deficiencia de vitamina D o deficiencia de proteína C. La relación entre la exposición a la hipoxia hipobárica hallada en las grandes alturas y su papel sobre la etiología del ACV, no ha sido claramente establecida. El propósito de esta revisión es establecer si la hipoxia hipobárica (HH) tiene algún efecto sobre la incidencia y el desarrollo del ACV entre los residentes o visitantes expuestos a las grandes alturas. Esta es una revisión de la evidencia disponible sobre los datos epidemiológicos y los factores de riesgo asociados con la enfermedad cerebrovascular entre las poblaciones situadas a grandes alturas. Basado en la evidencia científica disponible y en los factores de riesgo encontrados en estas circunstancias, el investigador concluye que vivir a grandes alturas y estar expuesto a un grado significativo de HH, se asocia con un incremento en el riesgo de presentar un ACV, especialmente el de tipo isquémico. Los pocos estudios epidemiológicos disponibles muestran que los índices de prevalencia del ACV parecen ser mayores entre pobladores y residentes de las grandes alturas, y parece predisponer a personas jóvenes por lo demás sanas a desarrollar un ACV. El grado de HH y la altura, en la cual el ACV parece ser más frecuente, es difícil de establecer, pero se puede concluir que la HH tiene que ser lo suficientemente significativa para inducir aclimatación, y por ende policitemia y niveles elevados de hematócrito, dos de los factores de riesgo más fuertemente asociados con incremento en la prevalencia del ACV en las alturas. Palabras clave: Grandes alturas, Stroke, Policitemia, Hematócrito, Hipoxia hipobárica (HH), Enfermedad aguda de montaña (EAM), Accidente cerebrovascular de tipo isquémico, Pre-condicionamiento a la hipoxia, Adaptación, Aclimatación, Metros sobre el nivel del mar (msnm). Abstract Despite our understanding about cerebrovascular accident, also known as stroke, its risk factors, treatment and prevention, it remains the leading cause of death of both men and women worldwide.

La pandemia de la COVID-19 ha golpeado fuerte-mente al Ecuador, no solo en lo sanitario, sino en lo social, lo económico y lo político. Las estadísticas oficiales (que distan mucho de la realidad) han expuesto, a través de las autoridades de gobierno, que más de 85.000 personas se han infectado a nivel nacional matando a más de 9.000 residentes de nuestro país. Los entendidos sobre este tema, los familiares de los fallecidos y los propios afectados saben que este número dista mucho de la realidad. Con los análisis moleculares de acceso limitado, costosos y escasos es imposible hacer política pública. En vista de que la toma de decisiones requiere datos de alta calidad y ante la dificultad de acceder a los mismos, han aparecido múltiples fuentes de información y percep-ciones sobre el comportamiento de la pandemia en el país que no necesariamente se ajustan a los datos oficiales. Desde periodistas, economistas y demás académicos incluyendo obviamente a los que hacemos salud, nos hemos sumado al análisis multilateral de datos con el fin de brindar información digerible a las personas que no manejan números o términos de difícil comprensión. Los elementos típicos para rastrear una pandemia en cualquier país son las curvas de contagio y de mortalidad, pero la diferencia en los resultados entre el gobierno, las unidades académicas y los expertos ha despertado un intenso debate, especialmente en redes sociales. La importancia de acceder a esta información radica en que se confunde por mensajes opuestos. Así, muchas personas dejan de prestar atención a los informes. Esta (des)información puede acarrear falsa sensación de segu-ridad, prácticas inapropiadas y aumento de contagios en nuestro país. Para tratar de combatir estas aberraciones en los datos, fuentes locales como El Universo o internacionales COVID19 has hit Ecuador drastically. In fact, until today around 75.000 confirmed cases and almost 9.000 deaths because of the virus has been showed by Official Statistics in the country. Good decisions can be made having data of high quality, but the national public health system was not able to provide such as input. Because of this, multiple sources of information and insights about the behavior of the pandemic in the country has appeared. From journalists and economists to health experts, all have published graphics and statistics that show how bad was managed the sanitary crisis in Ecuador. The typical elements to track a pandemic in any country are contagious and mortality curves but the difference in the results across the government, academic units and experts has woke up an intense debate. As information was not accurate , many people left to pay attention and as a result it might be seen that this disinformation contributed to the increase of contagious in our country. The crisis has been hard for many countries but international media like The Economist 1 and Financial Times 2 in United Kingdom developed an easy method to track the evolution of pandemics in any country. The developed method was named Excess death tracker and in a big effort of these organizations, teams of data experts and journalists collected data about historic deaths in almost all countries across the globe. The essence behind the developed technique is simple. If no COVID19 crisis were present, the trend in deaths would be similar to past years. As a result, comparing the actual deaths against the historic average at time levels of months or weeks could produce an estimation of the normal behavior of deaths in each country. Subtracting those mean values from real death values gives the gold standard of excess deaths.

Introduction: The exponential growth of SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on most health systems around the world. The complications derived from the novel coronavirus disease (COVID-19) vary due to comorbidities, sex and age, with more than 50% of the patients requiring some level of intensive care developing acute respiratory distress syndrome (ARDS). The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological, and radiological presentation as well as the current treatment strategies. Areas covered: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The new treatment strategies are updated, and the analysis of the physiopathology is included in this review. Expert opinion: ARDS is one of the most frequent complications in patients with COVID-19. Information regarding the etiology and physiopathology are still unfolding and for the prevention and amelioration, good clinical management, adequate ventilatory support and the use of systemic corticoids seem to be the most efficient way to reduce mortality and to reduce hospital lengths. ARTICLE HISTORY

Background: Biomedical and ethnographic studies among indigenous people are common practice in health and geographical research. Prior health research misconduct has been documented, particularly when obtaining genetic material. The objective of this study was to crossmatch previously published data with the perceptions of the Waorani peoples about the trading of their genetic material and other biological samples. Methods: We conducted a mixed methods study design using a tailored 15-item questionnaire in 72 participants and in-depth interviews in 55 participants belonging to 20 Waorani communities about their experiences and perceptions of participating in biomedical research projects. Additionally, we conducted a systematic review of the literature in order to crossmatch the published results of studies stating the approval of an ethics committee and individual consent within their work. Results: A total of 40 men (60%) and 32 women (40%), with a mean age of 57 ± 15 years agreed to be interviewed for inclusion. Five main categories around the violation of good clinical practices were identified, concerning the obtention of blood samples from a recently contacted Waorani native community within the Amazonian region of Ecuador. These themes are related to the lack of adequate communication between community members and researchers as well as the voluntariness to participate in health research. Additionally, over 40 years, a total of 38 manuscripts related to the use of biological samples in Waorani indigenous people were published. The majority of the studies (68%) did not state within their article obtaining research ethics board approval, and 71% did not report obtaining the informed consent of the participants prior to the execution of the project. Conclusion: Clinical Research on the Waorani community in the Ecuadorian Amazon basin has been performed on several occasions. Unfortunately, the majority of these projects did not follow the appropriate ethical and professional standards in either reporting the results or fulfilling them. The results of our investigation suggest that biological material, including genetic material, has been used by researchers globally, with some omitting the minimum information required to guarantee transparency and good clinical practices. We highlight the importance of stating ethics within research to avoid breaches in research transparency.