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Avila RM, Camacho-Leon G, Faytong-Haro M, Merino-Alado RL, Carrillo JP, Mautong H, Simancas-Racines DA, Cherrez-Ojeda I. Case Report: Primary Cutaneous Histoplasmosis in an Immunocompetent Patient After Cosmetic Injection of Platelet-Rich Plasma Treated with Trimethoprim-Sulfamethoxazole. Am J Case Rep 2024; 25:e942660. [PMID: 38702880 PMCID: PMC11087010 DOI: 10.12659/ajcr.942660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/19/2024] [Accepted: 02/10/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Histoplasmosis is typically associated with immunocompromised individuals, but cases in immunocompetent patients are rare. Primary cutaneous histoplasmosis (PCH) is a challenging diagnosis due to its clinical polymorphism and can mimic other infectious and non-infectious diseases. Previous cases of PCH have been reported in immunocompetent patients with underlying medical conditions or trauma history. So far there have been no reports of PCH after platelet-rich plasma (PRP) application due to inadequate hygiene measures in an immunocompetent host. CASE REPORT This case report presents a rare occurrence of PCH following a cosmetic procedure (PRP injection) in an immunocompetent patient. The patient developed nodule-like lesions at the application sites, which progressed to ulceration with purulent discharge. Initially, atypical mycobacterial infection was suspected, and empirical antibiotic therapy was initiated. Complementary tests were performed, ruling out immunosuppression and systemic pathogens. The patient showed complete resolution of the lesions after one month of atypical treatment with trimethoprim-sulfamethoxazole (TMP/SMX). Pathological examination confirmed the diagnosis of PCH with intracytoplasmic inclusions of Histoplasma sp. CONCLUSIONS This case highlights the importance of considering histoplasmosis as a diagnostic possibility, especially in hyperendemic areas like Venezuela. Direct inoculation of Histoplasma sp. after aesthetic procedures without proper hygiene measures can lead to pathological lesions, even in immunocompetent individuals. TMP/SMX can be considered as an alternative treatment option in the absence of the first-line medication. Further exploration of this treatment approach may benefit patients with similar clinical conditions or when ideal treatment options are unavailable.
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Affiliation(s)
- Raquel M. Avila
- Division of Graduate Studies, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Genesis Camacho-Leon
- Division of Graduate Studies, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
- Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Rommie L. Merino-Alado
- Medical Mycology Section “Dr. Dante Borelli”, Institute of Tropical Medicine “Dr. Felix Pifano”, Central University of Venezuela, Caracas, Venezuela
| | - Jacinto Pineda Carrillo
- Medical Mycology Section “Dr. Dante Borelli”, Institute of Tropical Medicine “Dr. Felix Pifano”, Central University of Venezuela, Caracas, Venezuela
| | - Hans Mautong
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
| | - Daniel A. Simancas-Racines
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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Faytong-Haro M, Camacho-Leon G, Páez-Plúas R, Sarfraz A, Sarfraz Z, Michel J, Cherrez-Ojeda I. The influence of a quick educational video intervention on COVID-19-related knowledge in Ecuador. PLoS One 2023; 18:e0291709. [PMID: 37796963 PMCID: PMC10553301 DOI: 10.1371/journal.pone.0291709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) is a pandemic that has spread worldwide. Since its discovery, health measures have been put in place to help stop it from spreading. Proper education about COVID-19 is important because it helps people to follow health control measures and learn more about the disease. OBJECTIVE This study aimed to compare people´s knowledge of COVID-19 before and after a brief video-based educational intervention. METHODS 87 participants in Ecuador were recruited from a dataset of COVID-positive patients in Ecuador between December 2021 and February 2022. This was a cross-sectional, pre- and post-intervention study. First, COVID-19 knowledge was evaluated and then an educational intervention was provided as a video. After the intervention, the same knowledge questions were used to test the participants, and marginal homogeneity-based chi-square tests were employed for comparison. RESULTS After watching the educational video, participants knew more about the age group most likely to get the disease and their knowledge of how long it takes for Covid to spread. Their knowledge of other aspects of COVID-19 has also increased. CONCLUSION This study shows that educational intervention positively affects the knowledge of people who watch it. At the end of the study, after the intervention, the study participants knew more than they had before. This could be a useful tool for identifying possible pandemics.
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Affiliation(s)
- Marco Faytong-Haro
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
- Ecuadorian Development Research Lab, Daule, Guayas, Ecuador
- Sociology and Demography Department, The Pennsylvania State University, State College, PA, University Park, United States of America
| | - Genesis Camacho-Leon
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL, United States of America
| | - Roberto Páez-Plúas
- Ecuadorian Development Research Lab, Daule, Guayas, Ecuador
- Francisco de Quito (USFQ), Universidad San, Quito, Ecuador
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Jack Michel
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL, United States of America
| | - Ivan Cherrez-Ojeda
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
- Respiralab Research Center, Guayaquil, Ecuador
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Banga A, Mautong H, Alamoudi R, Faisal UH, Bhatt G, Amal T, Mendiratta A, Bollu B, Kutikuppala LVS, Lee J, Simadibrata DM, Huespe I, Khalid A, Rais MA, Adhikari R, Lakhani A, Garg P, Pattnaik H, Gandhi R, Pandit R, Ahmad F, Camacho-Leon G, Ciza N P, Barrios N, Meza K, Okonkwo S, Dhabuliwo A, Hamza H, Nemat A, Essar MY, Kampa A, Qasba RK, Sharma P, Dutt T, Vekaria P, Bansal V, Nawaz FA, Surani S, Kashyap R. ViSHWaS: Violence Study of Healthcare Workers and Systems-a global survey. BMJ Glob Health 2023; 8:e013101. [PMID: 37696546 PMCID: PMC10496720 DOI: 10.1136/bmjgh-2023-013101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education. METHODS The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms. RESULTS A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance. CONCLUSION This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.
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Affiliation(s)
- Akshat Banga
- Department of Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - Hans Mautong
- Department of Medicine, Universidad de Especialidades Espíritu Santo, Samborondon, Ecuador
| | - Razan Alamoudi
- Department of Pharmaceutical Services, King Fahd Armed Forces Hospital, Jeddah, Makkah, Saudi Arabia
| | - Umme Habiba Faisal
- Department of Urology, All India Institute of Medical Sciences, Kalyani, India
| | - Gaurang Bhatt
- Department of Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Tanya Amal
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ayushi Mendiratta
- Department of Internal medicine, Parkview Medical Center, Pueblo, Colorado, USA
| | - Bhaswanth Bollu
- Department of General medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - L V Simhachalam Kutikuppala
- Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation Hospital, Amalapuram, Andhra Pradesh, India
| | - Joanna Lee
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
| | - Daniel Martin Simadibrata
- Department of Medicine, Universitas Indonesia, Depok, Indonesia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ivan Huespe
- Department of Intensive Care Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Aisha Khalid
- Department of Gastroenterology, Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ramesh Adhikari
- Department of Internal medicine, Franciscan Health Lafayette East, Lafayette, Indiana, USA
| | - Alisha Lakhani
- Department of Internal medicine, Shantabaa Medical College and General Hospital, Amreli, Gujarat, India
| | - Piyush Garg
- Department of Cardiology, Medanta The Medicity, Gurgaon, Haryana, India
| | - Harsha Pattnaik
- Department of Undergraduate Medicine, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Raghu Gandhi
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ramesh Pandit
- Department of Internal medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Faizan Ahmad
- Public Health Reference Laboratory Department, Khyber Medical University, Peshawar, Pakistan
| | - Genesis Camacho-Leon
- Division de estúdios para graduados, Universidad del Zulia, Maracaibo, Venezuela
| | - Pierre Ciza N
- Department of Psychiatry, Kampala International University, Kampala, Uganda
| | - Nimsi Barrios
- Department of Medicine, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Kelly Meza
- Department of Internal medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Susan Okonkwo
- Department of Family Health, Society for Family Health Nigeria, Abuja, Nigeria
| | - Amuza Dhabuliwo
- Department of Pediatrics, Kawempe National Refferal hospital, Kampala, Uganda
| | - Hafeez Hamza
- Department of Pharmacy, Girne American University, Girne, Cyprus
| | - Arash Nemat
- Microbiology Department, Kabul University of Medical Sciences Abu Ali Ibn Sina, Kabul, Afghanistan
| | | | - Anne Kampa
- Department of Development, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakhtan K Qasba
- Department of Medicine, Green Life Medical College and Hospital, Dhanmondi, Bangladesh
| | - Pranjal Sharma
- Department of Nephrology, MercyOne Clinton, Clinton, Iowa, USA
| | - Taru Dutt
- Department of Psychiatry, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Pratikkumar Vekaria
- Department of Internal medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Internal Medicine, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Vikas Bansal
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Faisal A Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Al Aweer, Dubai, UAE
| | - Salim Surani
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pulmonary, and Critical Care & Sleep Medicine, Texas A&M University, College Station, Texas, USA
| | - Rahul Kashyap
- Department of Gastroenterology, Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts, USA
- Department of Research, WellSpan Health, York, Pennsylvania, USA
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Camacho-Leon G, Faytong-Haro M, Carrera K, De la Hoz I, Araujo-Contreras R, Roa K, Mautong H, Cardozo J, Briceño M, Cherrez-Ojeda I. Attitudes towards depression of Argentinian, Chilean, and Venezuelan healthcare professionals using the Spanish validated version of the revised depression attitude questionnaire (SR-DAQ). SSM Popul Health 2022; 19:101180. [PMID: 35968042 PMCID: PMC9365952 DOI: 10.1016/j.ssmph.2022.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/26/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background The beliefs and attitudes of physicians toward depression may predict whether they are supportive or avoidant of patients diagnosed with this condition. Describing the attitudes toward depression of Argentinian, Chilean, and Venezuelan healthcare professionals could be a valuable tool for understanding the Latin American perspective on depression recognition, management, and prevention. Materials and methods A cross-sectional study was conducted among healthcare professionals in Argentina, Chile, and Venezuela using the Spanish validated version of the revised depression attitude questionnaire (R-DAQ). The questionnaire was collected online from August to November 2021, in a quota-based sample of 1759 health professionals (the final analytical sample is 1234). Descriptive data analyses were performed using STATA version 16 statistical software. Results Depression was considered a disease that anyone could suffer by 90% of the respondents. However, 70% of professionals answered that they feel more comfortable dealing with physical illness than mental illness. Furthermore, the findings show that a quarter of the participants in the study believed that either medical treatment (28.6%) or psychosocial approach (<20%) were ineffective tools for people suffering from depression. Findings also show that depression is seen as a more natural part of life by Argentinian professionals and men. Finally, psychologists and psychiatrists are most likely to treat depression as any other physical disease. Medical providers who routinely perform surgeries are not as likely to know how to treat depression or consider it an actual disease. Conclusions Healthcare professionals in Argentina, Chile, and Venezuela have varying attitudes toward depression. While they recognize depression as a disease on the same level as other physical diseases, most do not know how to treat it. The findings point to the need for these countries to promote the training of healthcare workers in areas such as depression diagnosis, treatment, and social interventions. Physicians' attitudes toward patients who exhibit signs and symptoms of depression can impact the disease's outcomes. This study offers a basis for understanding Latin American physicians' expertise and confidence in depression care. Our data revealed that less than half of respondents in all three countries received depression management training. Our findings show that less than half of respondents believe they are prepared to assess depression in patients. This study emphasizes the need of training and preparing healthcare personnel to have improved attitudes toward depression.
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Affiliation(s)
- Genesis Camacho-Leon
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia. Maracaibo, 4001, Venezuela.,Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL, USA
| | - Marco Faytong-Haro
- Ecuadorian Development Research Lab, Daule, 090656, Ecuador.,Sociology and Demography Department, The Pennsylvania State University, University Park, PA, USA
| | | | - Ivonne De la Hoz
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia. Maracaibo, 4001, Venezuela
| | | | - Karelis Roa
- Médicos Unidos Por Venezuela, Caracas, 1080, Venezuela
| | - Hans Mautong
- Universidad de Especialidades Espíritu Santo, Samborondón, 0901952, Ecuador.,Respiralab Research Group, Guayaquil, 090501, Ecuador
| | | | | | - Ivan Cherrez-Ojeda
- Universidad de Especialidades Espíritu Santo, Samborondón, 0901952, Ecuador.,Respiralab Research Group, Guayaquil, 090501, Ecuador
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Sarfraz A, Sarfraz Z, Camacho-Leon G, Alvarado-Villa GE, Andrade-Molina DM, Fernandez-Cadena JC, Agolli A, Yukselen Z, Felix M, Gallardo Bastidas JC, Espinoza-Fuentes F, Michel J, Cherrez-Ojeda I. Impact of biosecurity measures, social pressure and bullying on attitudes, perceptions, and job satisfaction levels among healthcare workers during the COVID-19 pandemic: a cross-sectional survey. BMJ Open 2022; 12:e056952. [PMID: 35879003 PMCID: PMC9327436 DOI: 10.1136/bmjopen-2021-056952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The extent and nature of social pressure and bullying towards healthcare workers (HCWs) during the COVID-19 remains unclear. The following study identifies the effect of social pressure and bullying directed towards HCWs when using biosecurity measures during the COVID-19 pandemic; further, the impact on perceptions, attitudes and job satisfaction level is also explored. METHODOLOGY We conducted a cross-sectional survey-based study among 684 Ecuadorian HCWs. The survey consisted of 38 questions related to the frequency, attitudes, and perceptions of biosecurity measures during the COVID-19 pandemic. Exploratory factor analysis was performed to assess the validity of the questionnaire. Associations between variables were analysed using χ2 and Fisher's exact test. Using SPSS V.25, qualitative and quantitative data were analysed. RESULTS Of the 684 participants, 175 (25.59%) experienced or felt bullying or social pressure during the COVID-19 pandemic associated with the use of biosecurity measures. Of these, 40.6% believed it was due to an imbalance of power in the workplace. The perception that HCWs wearing personal protective equipment resulting in bullying was noted in 12% of the respondents. Job satisfaction was positive among 73% of the respondents. Gender (female) and type of institution (public) were noted to contribute towards job satisfaction and bullying experiences. CONCLUSION Exposure to social bullying and pressure due to the use of biosecurity measures during the COVID-19 pandemic may result in reduced job satisfaction and thoughts about quitting work.
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Affiliation(s)
- Azza Sarfraz
- Research and Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
- Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zouina Sarfraz
- Research and Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
- Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
| | | | | | | | | | - Arjola Agolli
- Research and Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
| | - Zeynep Yukselen
- Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
- Department of Medicine, New York City Health + Hospitals/Lincoln, Bronx, New York, New York, USA
| | | | | | - Jack Michel
- Research and Academic Affairs, Larkin Community Hospital, South Miami, FL, USA
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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Camacho-Leon G, Faytong-Haro M, Carrera K, Molero M, Melean F, Reyes Y, Mautong H, De La Hoz I, Cherrez-Ojeda I. A Narrative Review of Telemedicine in Latin America during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:1361. [PMID: 35893183 PMCID: PMC9330433 DOI: 10.3390/healthcare10081361] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic greatly impacted traditional health structures, posing new challenges in an unprecedented health crisis. Telemedicine services were implemented in countries with robust digital platforms to reduce hospital attendance while continuing to provide medical care. This study aims to determine how telemedicine services have been used as a tool to ensure the right to health in Latin America during the pandemic. MATERIALS AND METHODS We conducted a narrative review in which words such as telemedicine, COVID-19, Latin America, access, and right to health, were searched on scientific medical datasets such as PubMed and SciELO. Additionally, we reviewed legislation in the Latin American health domain regarding the administration and transmission of digital data. RESULTS AND CONCLUSIONS Several countries have used telemedicine to reduce the saturation of healthcare systems and increase patient access. Issues such as broadband access for low-income populations and adequate legal regulations for transmitting and storing confidential data must be addressed to improve telemedicine use in Latin America.
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Affiliation(s)
- Genesis Camacho-Leon
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela; (G.C.-L.); (I.D.L.H.)
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Marco Faytong-Haro
- Sociology and Demography Department, The Pennsylvania State University, University Park, PA 16802, USA
- Ecuadorian Development Research Lab, Daule, Guayas 090656, Ecuador
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
| | - Keila Carrera
- Gastroenterology, Universidad de Oriente, El Tigre, Anzoátegui 6050, Venezuela;
| | - Marlyn Molero
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Franhe Melean
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Yuliana Reyes
- Médicos Unidos Por Venezuela, Caracas, Distrito Capital 1000, Venezuela; (M.M.); (F.M.); (Y.R.)
| | - Hans Mautong
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
| | - Ivonne De La Hoz
- División de Estudios para Graduados, Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela; (G.C.-L.); (I.D.L.H.)
| | - Ivan Cherrez-Ojeda
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón, Guayas 0901952, Ecuador;
- Respiralab Research Group, Guayaquil, Guayas 090512, Ecuador
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