David Gaus

Emergency Department of a Rural Hospital in Ecuador

Introduction There is a paucity of data studying patients and complaints presenting to emergency departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%), fever (15.1%) and trauma (10.8%). Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%), upper extremity radiograph (9.4%), and electrocardiogram (9.0%). There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion Analysis of patients presenting to a rural ED in Ecuador contributes to the global study of acute care in the developing world and also provides a self-analysis identifying disease patterns of the area, training topics for residents, areas for introducing protocols, and information to help planning for rural EDs in low- and middle-income countries.

Quantifying the reduction in nonmedical costs after the introduction of a rural county hospital in Ecuador

OBJECTIVE This study attempts to quantify the impact of the introduction of local second-level health services on nonmedical costs (NMCs) for residents of the rural Ecuadorian county of La Maná. METHODS NMCs for patients accessing second-level health care were assessed by using a quasi-experimental pre- and postintervention study design. In 2007, before local second-level health care services existed, and then in 2008, after the introduction of second-level health care services in the form of a county hospital, 508 patients from the county who sought second-level health care were interviewed. RESULTS Mean NMCs per patient per illness episode were US

Influenza lectura crítica

93.58 before the county hospital opened and US

Attempted isolation of Blastomyces dermatitidis from rectal cultures of beaver (Castor canadensis) from north central Wisconsin.

12.62 after it opened. This difference was largely due to reductions in transport costs (US

HIPOTIROIDISMO Y BOCIO

50.01 vs. US

FIEBRE EN NIÑOS

4.28) and food costs (US

El abordaje integral e intercultural del paciente

25.38 vs. US

MRSA infected wounds in a community hospital in rural tropical Ecuador

7.28) (P < 0.001 for each category). CONCLUSIONS NMCs can be decreased sevenfold with the introduction of a county hospital in a rural province previously lacking second-level health care. Introduction of rural second-level health care reduces financial barriers and thus may increase access to these health services for poorer patients in rural communities.

Caso Clínico: Parálisis del VI par craneal asociado con Infección con Chikungunya

Influenza, es una epidemia recurrente en el mundo desde hace varios siglos, a pesar de los esfuerzos medicos cada cierto tiempo se producen epidemias y es un motivo de consulta frecuente en el servicio de Emergencia y Consulta Externa produciendo varias muertes al ano en todos los paises del planeta. El conocimiento que tenemos alrededor de esta enfermedad es el que se publica en los paises del primer mundo, no contamos con investigaciones grandes en Latinoamerica y este conocimiento nunca es adecuadamente contextualizado. El objetivo es realizar una revision bibliografica sobre el tema y contextualizar este conocimiento para los paises tropicales. METODO Usamos el metodo de lectura critica es la lectura realizada de un modo analitico. Esto significa que ademas de comprender los que se dice en un texto determinado, se intenta analizar lo expresado para verificar sus aciertos, sus errores y los modos en que se presenta la informacion. Se buscar tener una vision propia de los hechos presentados, intentando corroborar lo que se afirma con otras fuentes.