Population genomics of diarrheagenic Escherichia coli uncovers high connectivity between urban and rural communities in Ecuador

Human movement may be an important driver of transmission dynamics for enteric pathogens but has largely been underappreciated except for international 'travelers' diarrhea or cholera. Phylodynamic methods, which combine genomic and epidemiological data, are used to examine rates and dynamics of disease matching underlying evolutionary history and biogeographic distributions, but these methods often are not applied to enteric bacterial pathogens. We used phylodynamics to explore the phylogeographic and evolutionary patterns of diarrheagenic E. coli in northern Ecuador to investigate the role of human travel in the geographic distribution of strains across the country. Using whole genome sequences of diarrheagenic E. coli isolates, we built a core genome phylogeny, reconstructed discrete ancestral states across urban and rural sites, and estimated migration rates between E. coli populations. We found minimal structuring based on site locations, urban vs. rural locality, pathotype, or clinical status. Ancestral states of phylogenomic nodes and tips were inferred to have 51% urban ancestry and 49% rural ancestry. Lack of structuring by location or pathotype E. coli isolates imply highly connected communities and extensive sharing of genomic characteristics across isolates. Using an approximate structured coalescent model, we estimated rates of migration among circulating isolates were 6.7 times larger for urban towards rural populations compared to rural towards urban populations. This suggests increased inferred migration rates of diarrheagenic E. coli from urban populations towards rural populations. Our results indicate that investments in water and sanitation prevention in urban areas could limit the spread of enteric bacterial pathogens among rural populations.

First sequenced cases of Omicron BA.2 sublineage in Ecuador

The largest wave of infection with SARS-CoV-2 virus in Ecuador was observed in mid-December 2021 and early January 2022, driven by B.1.1.529/BA (Omicron) variant. During the second half of March, an increase in the number of daily cases was observed and coincided with the emergence of the BA.2 variant, which we describe in the present study. The first sequenced five cases of SARS-CoV-2 21L/BA.2 in Ecuador were identified using variant specific genotyping by qPCR and confirmed by whole genome sequencing (WGS). The first sequenced Ecuadorian BA.2 isolate was obtained from a person with international travel history who became symptomatic 3 days after travelling, whereas in the other cases no travel history was recorded.

Chronic Occupational Exposure to Traffic Pollution Is Associated with Increased Carotid Intima-Media Thickness in Healthy Urban Traffic Control Police

Urban traffic officers in many low- and middle-income countries are exposed to high levels of traffic-related air pollutants (TRAP) while working vehicle control on heavily congested streets. The impact of chronic TRAP exposure on the cardiovascular health, including the carotid intima-media thickness (CIMT), of this outdoor occupational group remains unclear. This cross-sectional study compared the average mean and maximum CIMT measurements of two groups of relatively young, healthy traffic police (32 ± 7 years; 77% male) in Quito, Ecuador, who were without clinical evidence of serious cardiovascular or other disease. Previously published background data on PM10 (a TRAP surrogate) indicated that street levels of the pollutant were several orders of magnitude higher at the street intersections worked by traffic police compared to those working only in an office. Accordingly, officers permanently assigned to daily traffic control duties requiring them to stand 0-3 m from heavily trafficked street intersections were assigned to the high exposure group (n = 61). The control group (n = 54) consisted of officers from the same organization who were permanently assigned to office duties inside an administration building. Mean and maximum CIMT were measured with ultrasound. General linear models were used to compare the CIMT measurements of the high exposure and control groups, adjusting for covariates. The adjusted average mean and maximum CIMT measures of the high exposure group were increased by 11.5% and 10.3%, respectively, compared to the control group (p = 0.0001). These findings suggest that chronic occupational exposure to TRAP is associated with increased CIMT in traffic police. This is important since even small increases in arterial thickening over time may promote earlier progression to clinical disease and increased premature mortality risk.

A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis-Molecular Diagnosis and Identification

Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques-antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial.

Catalogue of type specimens deposited in the Herpetology Collection of the Natural History Museum Gustavo Orcés V. at Escuela Politécnica Nacional (Ecuador)

Background

The Herpetology Collection of the Natural History Museum Gustavo Orcés V. at Escuela Politécnica Nacional (MEPN-H) in Quito maintains more than sixteen thousand curated specimens and it comprises Ecuador ´s second largest collection of herps.

New information

The Collection contains 193 type specimens: 14 holotypes, 34 paratopotypes and 145 paratypes, which correspond to 10 families, 17 genera and 32 species. The collection of type specimens is particularly important in the genera Atelopus and Pristimantis in amphibians and the genera Atractus and Enyaloides in reptiles. An assessment of the geographic distribution showed that collection sites of type specimens are clustered towards the south of Ecuador in the provinces of Zamora Chinchipe, Morona Santiago and Pastaza in the Amazon Region; and in the provinces of Carchi and Azuay in the Andes. The collection of type specimens dates from 1955 to 2013, comprising an invaluable source of historical biodiversity data.

Socioeconomic Inequalities and Factors Associated with the Use of Modern Contraceptive Methods in Women of Childbearing Age in Ecuador, 2018

The objective of this study was to determine the socioeconomic inequalities and factors associated with the use of modern contraceptive methods (MCM) in the population of sexually active women of childbearing age in Ecuador. This was an analytical observational study, based on a secondary data analysis of the 2018 National Health and Nutrition Survey (ENSANUT). Information on 19,106 sexually active, married, or cohabiting women between the ages of 15 and 49 were included. Concentration curves (CC) and Erreygers concentration indices (ECI) were calculated, taking into account the use of MCM as the dependent variable and the wealth index as the independent variable. Crude and adjusted prevalence ratios with 95% confidence intervals were calculated using generalized linear models of the Poisson family. We found that 92.8% of the women surveyed used some type of MCM in the last month. A higher educational level presented a significant pro-rich concentration in the use of MCM (EIC: 0.05; p = 0.004). On the other hand, women belonging to the age group of 20 to 29 years (ECI: -0.027; p = 0.027), women with no job (ECI: -0.025; p = 0.004), and non-indigenous women (EIC: -0.031; p < 0.001), presented a pro-poor concentration. Factors significantly associated with MCM use were age, marital status, occupation, parity, ethnicity, area of residence, and living on the coast. In Ecuador, there are socioeconomic inequalities at different levels of population subgroups in women of childbearing age. Measures to promote the use of MCM are required, focusing on groups that present inequality, taking into account the factors associated with their use.

Mastigodiaptomus galapagoensis n. sp. (Crustacea: Copepoda: Diaptomidae), a possibly extinct copepod from a crater lake of the Galápagos archipelago

Background

A new species of a Neotropical diaptomid copepod is described based on individuals recovered from a small, almost forgotten collection of unique plankton samples from El Junco, a crater lake in San Cristóbal island, Galápagos archipelago. This copepod was regularly reported (1966-2004) as an abundant zooplankter in the lake, but it was not found in subsequent plankton surveys (2007-2018), and its specific identity remained unknown. In 2020, it was declared extinct because of introduced fish predation, rotenone treatment, and other major disturbances. The taxonomic examination of these invaluable specimens allowed us to recognize them as representing an undescribed species of the freshwater diaptomid genus Mastigodiaptomus Light, 1939.

Methods

Here, we describe the new species from El Junco crater lake, located in the San Cristóbal island a part of the Galápagos archipelago, collected with plankton nets. The description is based on detailed morphology, based on SEM and light microscopy.

Results

The taxonomic examination of these invaluable specimens allowed us to recognize them as representing an undescribed species of the freshwater diaptomid genus Mastigodiaptomus Light, 1939. The new species was readily assigned to this genus and is distinguished from its known congeners by details of (1) the male right fifth leg terminal claw and aculeus, (2) spiniform processes pattern of the right geniculate antennule segments 10-16, (3) length and structure of the spiniform process of the antepenultimate segment of the male right antennule, and (4) details of the dorsal process on the female fourth pediger. This finding represents the first report of this Neotropical copepod genus outside its original biogeographic region, the third species of a diaptomid copepod reported from insular freshwater systems, the southernmost record of Mastigodiaptomus, and the only freshwater calanoid in the Galápagos. The intriguing presence of this chiefly Neotropical copepod genus here could be related either to (1) human agency linked to pirate activities, commercial travelling by Spaniard ships, whaling activities, and intense tortoise hunting in San Cristóbal island. In the past, El Junco was the only freshwater source 600 nautical miles around, or (2) zoochory of resistant dormant stages passively transported by more than 65 migrating bird species known to settle in San Cristóbal. These two hypotheses cannot be properly tested at this time, so the explanation of the presence of this copepod will remain as a new open question in the fascinating natural history of the Galápagos.

Delayed acquisition of airway commensals in antibiotic naïve children and its relationship with wheezing in rural Ecuador

Introduction

The hygiene hypothesis identified a relationship between living in rural areas and acquiring protective environmental factors against the development of asthma and atopy. In our previous study, we found a correlation between particular bacterial species and early-onset wheezing in infants from the rural tropics of Ecuador who were corticosteroid-naïve and had limited antibiotic exposure. We now describe a longitudinal study of infants conducted to determine the age-related changes of the microbiome and its relationship with wheezing.

Methods

We performed an amplicon sequencing of the 16S rRNA bacterial gene from the oropharyngeal samples obtained from 110 infants who had a history of recurrent episodic wheezing sampled at different ages (7, 12, and 24 months) and compared it to the sequencing of the oropharyngeal samples from 150 healthy infants sampled at the same time points. Bioinformatic analyses were conducted using QIIME and R.

Results

As expected, the microbiota diversity consistently increased as the infants grew older. Considering age-based microbiota changes, we found that infants with wheeze had significantly lower species richness than the healthy infants at 7 months, but not at 12 or 24 months. Most of the core and accessory organisms increased in abundance and prevalence with age, except for a few which decreased. At 7 months of age, infants with wheeze had notably higher levels of a single Streptococcus operational taxonomic unit and core microbiota member than controls.

Conclusions

In a cohort with limited antibiotic and corticosteroid use, a progressively more complex and diverse respiratory microbial community develops with age. The respiratory microbiota in early life is altered in infants with wheeze, but this does not hold true in older infants.

Food exchange list based on macronutrients: adapted for the Ecuadorian population

Background

Food exchange lists allow health professionals to generate healthy eating plans adapted to individual or population needs. The objective of this study was to develop the first food exchange list based on the macronutrients and energy provided by the various food groups of the Ecuadorian diet.

Methods

The list of Ecuadorian food exchanges was constructed by going through the following phases: (1) Selection of household measurements; (2) Selection of tables and databases of the nutritional composition of food items; (3) Definition of food groups and quantities; (4) Determination of the average energy and macronutrient values of each group; and (5) Photographic record. For the definition of food quantities, statistical criteria were applied according to a standard deviation of ±2SD; thus, for carbohydrates: ±5 g, total fat: ±2 g, and protein: ±3 g. To ensure the inclusion of the food items in the groups, a coefficient of variation of less than 30% and a Z value of ±2 were also considered.

Results

The list of food exchanges is presented with eight general groups according to the predominant nutrient (carbohydrates, proteins, or fats), and, where necessary, subgroups are included according to the second predominant nutrient. The list includes 404 food items with their photographic record, represented by their net weights and corresponding household measurement. All food items met the statistical criteria that help to reduce the variability of the nutritional composition of the food items in each group.

Conclusion

This is the first list of Ecuadorian food exchanges based on statistical criteria. It represents a novel tool for public health professionals as well as researchers. Resulting healthier eating plans may improve daily dietetic practice, facilitate better clinical trial designs and help establish guidelines according to Ecuador's cultural and dietary patterns. The described methodology can further be used to develop other food exchanges lists for patients with specific nutritional requirements.

Three new species of the Neotropical genus Smilidarnis Andrade (Hemiptera, Membracidae)

Smilidarnisduocornussp. nov., S.erwinisp. nov., and S.robustussp. nov. are described, illustrated, and included in a key to the five species here recognized in Smilidarnis. One member of this genus, from Ecuador (new country record for genus), is S.erwini, which differs from its congeners in having distinct coloration and being of intermediate size in terms of overall body length and the relative length of the lateral apical spines. Smilidarnisrobustus (from Peru) and S.duocornus (from Brazil) differ from the other species of Smilidarnis in having the pronotum bearing a pair of suprahumeral spines.

Case report: First report on human infection by tick-borne Babesia bigemina in the Amazon region of Ecuador

Babesiosis is a protozoan disease acquired by the bite of different species of ticks. More than 100 Babesia spp. infect wild and domestic animals worldwide, but only a few have been documented to infect humans. Generally, babesiosis is asymptomatic in immunocompetent persons; however, in immunocompromised can be life-threatening. A 13-year-old boy from the Amazon region presented with a 3-month evolution of fever, chills, general malaise, and arthralgia accompanied by anemia and jaundice. In the last 4 years was diagnosed with chronic kidney failure. By nested-PCR using 18S RNA ribosomal gene as target and DNA sequencing, the phylogenetic analysis showed Babesia bigemina as the causative agent in the blood. Treatment with oral quinine plus clindamycin for six continuous weeks was effective with no relapse occurring during 12 months of follow-up. This is the second human case in Ecuador but the first caused by the zoonotic B. bigemina which confirms the existence of active transmission that should alert public health decision-making authorities on the emergence of this zoonosis and the need for research to determine strategies to reduce tick exposure.

Prevalence of Listeria monocytogenes in RTE Meat Products of Quevedo (Ecuador)

Listeria monocytogenes is a foodborne pathogen that causes listeriosis and can be a problem in areas where meat products are sold at unregulated storage temperatures. In this work, the prevalence of L. monocytogenes was determined in the five most widely traded meat products in the province of Quevedo (Ecuador): bacon, "chorizo paisa", grilled hamburger meat, mortadella, and salami. A total of 1000 samples of these products were analyzed in two seasons of the year (dry season/rainy season). All L. monocytogenes isolates were confirmed by PCR with primers designed for the iap gene. Furthermore, the positive samples were quantified for L. monocytogenes. Of the 1000 meat products analyzed, 163 were positive for L. monocytogenes (16.3%). The prevalence of L. monocytogenes in the two seasons in different meat products was as follows: 22.5% in mortadella, 19% in hamburger meat, 15% in bacon, 14.5% in chorizo paisa and 10.5% in salami. In addition, the concentration of L. monocytogenes in most of the positive samples was in the range of 4-6 log CFU/g or even higher. The results show the need for improvements in the hygienic measures and meat storage temperatures in Quevedo (Ecuador) to avoid risks of foodborne listeriosis.

Genetic diversity and natural selection of Plasmodium vivax reticulocyte invasion genes in Ecuador

BACKGROUND

Knowledge of the diversity of invasion ligands in malaria parasites in endemic regions is essential to understand how natural selection influences genetic diversity of these ligands and their feasibility as possible targets for future vaccine development. In this study the diversity of four genes for merozoite invasion ligands was studied in Ecuadorian isolates of Plasmodium vivax.

METHODS

Eighty-eight samples from P. vivax infected individuals from the Coast and Amazon region of Ecuador were obtained between 2012 and 2015. The merozoite invasion genes pvmsp-1-19, pvdbpII, pvrbp1a-2 and pvama1 were amplified, sequenced, and compared to the Sal-1 strain. Polymorphisms were mapped and genetic relationships between haplotypes were determined.

RESULTS

Only one nonsynonymous polymorphism was detected in pvmsp-1-19, while 44 nonsynonymous polymorphisms were detected in pvdbpII, 56 in pvrbp1a-2 and 33 in pvama1. While haplotypes appeared to be more related within each area of study and there was less relationship between parasites of the coastal and Amazon regions of the country, diversification processes were observed in the two Amazon regions. The highest haplotypic diversity for most genes occurred in the East Amazon of the country. The high diversity observed in Ecuadorian samples is closer to Brazilian and Venezuelan isolates, but lower than reported in other endemic regions. In addition, departure from neutrality was observed in Ecuadorian pvama1. Polymorphisms for pvdbpII and pvama1 were associated to B-cell epitopes.

CONCLUSIONS

pvdbpII and pvama1 genetic diversity found in Ecuadorian P. vivax was very similar to that encountered in other malaria endemic countries with varying transmission levels and segregated by geographic region. The highest diversity of P. vivax invasion genes in Ecuador was found in the Amazonian region. Although selection appeared to have small effect on pvdbpII and pvrbp1a-2, pvama1 was influenced by significant balancing selection.

Advance Care Planning in Ecuador

Advance Care Planning is a process by which a patient's health care preferences are established in advance in the event that he or she become temporarily or constantly unable to make decisions for themselves in the future. It is also applied early in emergencies, in intensive care treatment, and after surgery where one's ability to decide is reduced. In Ecuador there is currently no legislation on this subject, however, the National Health Bioethics Commission validated and published the document "Advance Living Will" and as an important advance issued a favorable criterion before the National Assembly for it to be incorporated into the Organic Health Code, the concept, regulations, and the text of Vital Advance Will. Instead of, its use is currently not in force. However, the compliance criteria have been established in the Palliative Care Standard since 2015, but are not yet implemented. There are few studies that demonstrate its application in the country, so it is important to know the cultural and social characteristics of both health professionals and patients, which limit its application.

De novo appearance of cerebral microbleeds in community-dwelling older adults. Neuroimaging and clinical correlates

BACKGROUND AND PURPOSE

Prospective studies on cerebral microbleeds (CMB) have departed from individuals who already have CMB at baseline. Therefore, main outcomes have usually been the composite of new lesions appearing on the follow-up among patients who already had CMB together with those who de novo developed CMB. Using the Atahualpa Project Cohort, we aimed to assess correlates of incident CMB in community-dwelling older adults free of CMB at baseline.

METHODS

Atahualpa residents aged ≥ 60 years received baseline clinical interviews and a brain MRI. Those who were free of CMB at baseline and received follow-up brain MRI at the end of the study were included. Multivariate logistic and Poisson regression models were fitted to assess the association and the incidence rate ratio (IRR) of incident CMB according to clinical and neuroimaging variables.

RESULTS

The mean age of 241 study participants was 65.6 ± 6.1 years (57% women). After 6.5 years of follow-up, 25 subjects (10.4%) developed incident CMB. A total of 37 CMB were noticed in these 25 patients. A parsimonious logistic regression model demonstrated an association between the Edmonton Frail Scale (EFS) and incident CMB (p = .043). Multivariate logistic regression models showed an association between WMH progression and incident CMB (p = .011). Using Poisson regression models, the IRR for WMH progression at follow-up was increased in subjects with incident CMB (p = .029).

CONCLUSIONS

Study results show a significant relationship between the EFS, WMH progression, and incident CMB. This knowledge will allow the implementation of preventive policies to reduce incident CMB and its consequences.

Association of household food insecurity with developmental delay in preschool children: 2018 Ecuadorian Nutrition and Health National Survey

We investigated the association of household food insecurity (HFI) with developmental delays in 36-59-month-old preschool children (n 7005) using cross-sectional data from the 2018 Ecuadorian National Health and Nutrition Survey. HFI was assessed with the Food Insecurity Experience Scale and developmental delays with the Early Childhood Development Index. Log-binomial regression models estimated the association of HFI with global (overall) developmental delay (GDD) and delays in four individual developmental domains, adjusting for covariates. Nearly half of the children lived in households with marginal (24⋅5 %) or moderate-severe HFI (21⋅7 %). Eighteen percent were identified with GDD. Delays in the individual domains of literacy-numeracy, social-emotional, physical and cognitive development were identified for 64, 21⋅5, 3⋅3 and 3⋅1 %, respectively. GDD was more likely among preschool children from households with marginal (aPR = 1⋅29; 95 % C.I. = 1⋅10, 1⋅49) and moderate-severe HFI (aPR = 1⋅30; 95 % C.I. = 1⋅11, 1⋅51). Social-emotional development delays were also more likely among those from households with marginal (aPR = 1⋅36; 95 % C.I. = 1⋅19, 1⋅56) and moderate-severe HFI (aPR = 1⋅33; 95 % C.I. = 1⋅15, 1⋅54) different from the other three domains. Several other potentially modifiable risk (violent discipline, maternal depressive symptoms) and protective factors (adequate child stimulation, higher maternal education, handwashing with soap/detergent) were also independently associated with GDD and/or literacy-numeracy and cognitive delays. Our findings suggest that HFI is an independent risk factor for GDD and social-emotional developmental delays in Ecuadorian preschoolers. They underscore the importance of strengthening and expanding poverty reduction, food security and early childhood development policies and interventions to improve the opportunities for children to achieve their full developmental potential.

Richer than Gold: the fungal biodiversity of Reserva Los Cedros, a threatened Andean cloud forest

BACKGROUND

Globally, many undescribed fungal taxa reside in the hyperdiverse, yet undersampled, tropics. These species are under increasing threat from habitat destruction by expanding extractive industry, in addition to global climate change and other threats. Reserva Los Cedros is a primary cloud forest reserve of ~ 5256 ha, and is among the last unlogged watersheds on the western slope of the Ecuadorian Andes. No major fungal survey has been done there, presenting an opportunity to document fungi in primary forest in an underrepresented habitat and location. Above-ground surveys from 2008 to 2019 resulted in 1760 vouchered collections, cataloged and deposited at QCNE in Ecuador, mostly Agaricales sensu lato and Xylariales. We document diversity using a combination of ITS barcode sequencing and digital photography, and share the information via public repositories (GenBank & iNaturalist).

RESULTS

Preliminary identifications indicate the presence of at least 727 unique fungal species within the Reserve, representing 4 phyla, 17 classes, 40 orders, 101 families, and 229 genera. Two taxa at Los Cedros have recently been recommended to the IUCN Fungal Red List Initiative (Thamnomyces chocöensis Læssøe and "Lactocollybia" aurantiaca Singer), and we add occurrence data for two others already under consideration (Hygrocybe aphylla Læssøe & Boertm. and Lamelloporus americanus Ryvarden).

CONCLUSIONS

Plants and animals are known to exhibit exceptionally high diversity and endemism in the Chocó bioregion, as the fungi do as well. Our collections contribute to understanding this important driver of biodiversity in the Neotropics, as well as illustrating the importance and utility of such data to conservation efforts.

RESUMEN

Antecedentes: A nivel mundial muchos taxones fúngicos no descritos residen en los trópicos hiper diversos aunque continúan submuestreados. Estas especies están cada vez más amenazadas por la destrucción del hábitat debido a la expansión de la industria extractivista además del cambio climático global y otras amenazas. Los Cedros es una reserva de bosque nublado primario de ~ 5256 ha y se encuentra entre las últimas cuencas hidrográficas no explotadas en la vertiente occidental de los Andes ecuatorianos. Nunca antes se ha realizado un estudio de diversidad micológica en el sitio, lo que significa una oportunidad para documentar hongos en el bosque primario, en hábitat y ubicación subrepresentatadas. El presente estudio recopila información entre el 2008 y 2019 muestreando material sobre todos los sustratos, reportando 1760 colecciones catalogadas y depositadas en el Fungario del QCNE de Ecuador, en su mayoría Agaricales sensu lato y Xylariales; además se documenta la diversidad mediante secuenciación de códigos de barras ITS y fotografía digital, la información está disponible en repositorios públicos digitales (GenBank e iNaturalist).

RESULTADOS

La identificación preliminar indica la presencia de al menos 727 especies únicas de hongos dentro de la Reserva, que representan 4 filos, 17 clases, 40 órdenes, 101 familias y 229 géneros. Recientemente dos taxones en Los Cedros se recomendaron a la Iniciativa de Lista Roja de Hongos de la UICN (Thamnomyces chocöensis Læssøe y "Lactocollybia" aurantiaca Singer) y agregamos datos de presencia de otros dos que ya estaban bajo consideración (Hygrocybe aphylla Læssøe & Boertm. y Lamelloporus americanus Ryvarden).

CONCLUSIONES

Se sabe que plantas y animales exhiben una diversidad y endemismo excepcionalmente altos en la bioregión del Chocó y los hongos no son la excepción. Nuestras colecciones contribuyen a comprender este importante promotor de la biodiversidad en el Neotrópico además de ilustrar la importancia y utilidad de dichos datos para los esfuerzos de conservación.

Prevalence and gender disparities of type 2 diabetes mellitus and obesity in Esmeraldas, Ecuador: a population-based survey in a hard-to-reach setting

BACKGROUND

Type 2 Diabetes (T2DM) prevalence is increasing in low- and middle-income countries along with high levels of obesity which vary according to socioeconomic and contextual characteristics. We aim to estimate the prevalence of T2DM and obesity in men and women in a hard-to-reach rural area in northern Ecuador considering socio-demographic characteristics.

METHODS

Cross-sectional descriptive study based on a population-based survey in the Eloy Alfaro health district of Esmeraldas between October 2020 and January 2022. We collected sociodemographic information and risk factors for non-communicable diseases with an adapted version of the STEPS survey, performed oral glucose tolerance tests, biochemistry and took physical measurements. We estimated the prevalence of T2DM, obesity, and calculated Odds Ratios (OR) with confidence intervals by logistic regression in Stata v.15.

RESULTS

The overall prevalence of T2DM was 6.8% (CI95%: 4.9-8.7), markedly higher among women compared to men (10.4%, CI95% 7.3-13.4%, compared 2.0%, CI95% 0.4-3.7% respectively). The risk of having T2DM in women was 5 times higher than in men adjusting for age, ethnicity, employment, household earnings and obesity (OR: 5.03; 95%CI: 1.68-15.01). Regarding age, the risk of T2DM increased by 6% per year (adjusted OR: 1.06; 95%CI: 1.03-1.08). Obesity prevalence was 30.8% (CI95%: 27.3-34.3), in women was nearly three times higher than in men (43.2% CI95%: 38.2-48.2, compared to 14.7% prevalence, CI95%: 10.6-18.8). Indigenous women had a lower prevalence of obesity compared with the Afro-Ecuadorian women (OR: 0.05; 95%CI: 0.02-0.18) after adjusting for age, employment status, household earnings and setting.

CONCLUSION

We found alarming differences between the prevalence of T2DM and obesity in women and men that may be explained by gender roles, exacerbated in the rural context. Health promotion measures with a gender perspective should be adapted according to the characteristics of isolated rural contexts.

New Primers for Detection and Differentiation between Leishmania viannia and L. leishmania Subgenera by Polymerase Chain Reaction

Background

Leishmania is the parasitic protozoan responsible for leishmaniases, a disease that can cause a range of cutaneous, mucosal, and visceral infections. Two subgenera L. Viannia and L. Leishmania are known to infect humans in the tropics and subtropics of the Americas. The aim of the present study was to develop a new pair of primers for the two subgenera and test in clinical samples.

Methods

We designed two new pairs of primers for a PCR method from two conserved genes, cysteine proteinase B (cpb) and N-acetylglucosamine-6-phosfate deacetylase-like protein (nagA), as specific markers for those two respective subgenera. Primers were tested with 16 microscopical positive clinical samples from the Amazon region of Ecuador obtained in 2010-2020 period.

Results

The cpb presented a band of 172 bp and the nagA a band of 300 bp, thus clearly differentiating L. viannia from L. leishmania. Additionally, primers identified and differentiated the clinical samples in the two subgenera.

Conclusion

The new primers targeting different two genes and standardized in a PCR assay could identified and differentiated Leishmania parasites at subgenus level. This protocol could be used for Leishmania genus identification and diagnosis at the subgenus level and for determining the parasite's geographical distribution where different Leishmania subgenera are found in the same area.

Molecular identification of Trypanosoma theileri (Laveran, 1902) in cattle from two slaughterhouses in Ecuador and its relation with other haemotropic agents

Trypanosoma theileri is a worldwide distributed haemoparasite that has been reported throughout the American continent in various species, including bovines, buffaloes and bats. In bovines, high incidence of T. theileri can be harmful when associated with other infections or under stress situations. There is little information on this hemoflagellate in Ecuador, which prompted the study and molecular identification of the trypanosomes collected in two slaughtering centers. Between February and April 2021, a total of 218 samples of bovine blood were collected in abattoirs located in the Andean region of Quito (n = 83) and in the coastal region, in Santo Domingo (n = 135). Quito public Slaughterhouse is the biggest in Ecuador, and for that, they receive animals from all country; on the other hand, Santo Domingo's Slaughterhouse is a small one where mainly females from the region are sacrificed and some males. The samples were evaluated using two molecular tests, the PCR cathepsin L-like (CatL) specific for T. theileri and for the positive samples, a Nested PCR that targets the ITS of the 18S gene. The corresponding PCR products were sequenced, analyzed by BLAST/NCBI and the sequences were used to build a concatenated phylogenetic tree, using the MEGA XI software. Overall, 34 out of the 218 samples, (15.6%) were positive to T. theileri by PCR CatL, resulting from 20/83 (24.1%) positives from the Quito abattoir and 14/135 (10.4%) from the Santo Domingo slaughterhouse. These prevalence rates were found to be significantly different (p = 0.006). According to the phylogenetic tree based on the CatL and ITS concatenated sequences (n = 13), the two novel Equatorial T. theileri isolates, ThI (n = 7) and ThII (n = 6) are closely related and associated to the IC, IB and IIB genotypes, present in Brazil, Venezuela and Colombia. Thirty-one out of the thirty-four T. theileri-positive bovines were co-infected with other haemotropic pathogens, Anaplasma marginale Babesia spp and T. vivax. This coinfection could be responsible for additional pathologies and harmful effects on the affected cattle. This study presents the molecular identification and genotypification of T. theileri isolated from cattle in Ecuador through the analysis of CAtL and ITS sequences, and the high frequency of coinfection of this hemoflagellate with other blood haemotropic organisms.

First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis

Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus.

INTRODUCTION

In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis.

METHODS

A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis.

RESULTS

The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis.

CONCLUSION

This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.

A report on SARS-CoV-2 first wave in Ecuador: drug consumption dynamics

Introduction: The first COVID-19 wave in Ecuador started in March 2020 and extended until November. Several types of drugs have been proposed as a potential treatment during this period, and some affected people have self-medicated. Method: A retrospective study was conducted with 10,175 individuals who underwent RT-PCR tests for SARS-CoV-2 from July to November 2020. We compared the number of positive and negative cases in Ecuador with symptoms and drug consumption. The Chi-square test of independence compared clinical and demographic data and PCR test results. Odds ratios analyzed drug consumption dynamics. Results: Of 10,175 cases, 570 were positive for COVID-19, while 9,605 were negative. In positive cases, there was no association between the RT-PCR result and sex, age, or comorbidities. When considering demographic data, Cotopaxi and Napo had the highest rates of positive cases (25.7% and 18.8%, respectively). Manabí, Santa Elena, and Guayas regions had fewer than 10% positive cases. The Drug consumption dynamic analysis showed that negative COVID-19 cases presented higher drug consumption than positive cases. In both groups, the most consumed medication was acetaminophen. Acetaminophen and Antihistamines had higher odds of consumption in positive PCR cases than in negative. Symptoms like fever and cough were more related to positive RT-PCR results. Conclusion: The first COVID-19 wave in Ecuador has affected the provinces differently. At a national level, the consumption of drugs has been highly associated with self-medication.

Leishmania species and clinical characteristics of Pacific and Amazon cutaneous leishmaniasis in Ecuador and determinants of health-seeking delay: a cross-sectional study

BACKGROUND

Cutaneous Leishmaniasis (CL) affects up to 5.000 people in Ecuador each year. L. guyanensis and L. braziliensis are the most common of the eight CL-causing Leishmania species. Earlier CL research concentrated on the easily accessible Pacific region. This study aims to describe the Leishmania species in Pacific and Amazon ecoregions, to analyze regional differences in CL patient clinical presentation, and to identify determinants of health-seeking delay.

METHODS

All cases in this cross-sectional study were diagnosed using smear slide microscopy, PCR, or both. Cytochrome B gene sequencing was used to identify the causative Leishmania species in qPCR-positive samples.

RESULTS

This study included 245 patients, with 154 (63%) infected in the Pacific region and 91 (37%) infected in the Amazon. Causative Leishmania species were identified in 135 patients (73% of qPCR positives). L. guyanensis was identified in 76% (102/135) of the samples and L. braziliensis in 19% (26/135). The Pacific region had a low prevalence of 6% (5/89) of L. braziliensis. For the first time, we report L. guyanensis from the central Amazon, L. braziliensis from the northern Pacific, and L. lainsoni from both the central Amazon and northern Pacific. Amazon cases had a longer median health-seeking delay in months (2.0, IQR 3.0) than Pacific cases (1.0, IQR 1.5). Prolonged health-seeking delay was associated with older age, Amerindian ethnicity, infection at lower altitudes, non-ulcerative lesions, and lesions on the lower limbs.

CONCLUSIONS

In the Pacific region, health-seeking delay is relatively short and L. braziliensis prevalence remains low. Limited access to health care and stigma might explain the prolonged health-seeking delay in the Amazon. We recommend larger studies on the distribution of Leishmania species in Amazon CL cases and additional regional research into diagnostic test accuracy. Furthermore, the determinants of health-seeking delay in Ecuador should be investigated further.

The mediating role of emotions in offline and online political participation: A post-social outbreak study in Ecuador and Chile

Introduction

In 2019, there was a period of social outbreaks in several Latin American countries, which share a background of social inequality, distrust in authorities, a crisis of representativeness, and discontent towards social and economic policies. In October 2019, in Ecuador and Chile, participation in these protests was characterized by street protests and broad political participation in social networks and alternative media, which were followed or interrupted by the COVID-19 pandemic. These facts have been deeply researched, addressing causal and structural factors of the phenomenon, the alternatives of political participation, and the role of emotions as determinants of action in these contexts. The objective of this study is to explore offline and online political participation (Facebook) after the social outbreak of 2019 in both countries, based on political interest, and how emotions intervene, especially negative ones, in a context of high demobilization.

Methods

A descriptive, correlational ex post facto and cross-sectional methodology was used, with the participation of 367 people, 210 from Ecuador (57.2%) and 157 from Chile (42.8%), aged between 17 and 48 years (M = 22.13, SD = 3.73). The measurement was carried out from 2020 to 2021.

Results

A mediation analysis showed that people who are more interested in politics are more likely to experience anger and anxiety with the political and economic situation, which motivates conventional political participation (Model 1). In Model 2 people who showed greater concern about the political and economic impacts of the COVID-19 pandemic and together with anger, favor online political participation, especially local support.

Discussion

These results suggest the influence of emotions on political participation, which occurs when there is an increase in social discontent due to government policies adopted during the pandemic and which represents a continuity of the discontent that was expressed in the October 2019 social outbreak.