The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador’s response to the outbreak.

Background:The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. Methods:We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities.Results: A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221).We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). Conclusion:We present the first analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador's response to the outbreak.

Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 >45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration >9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19.

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Central nervous system (CNS) infections are a group of diseases, where meningitis (associated or not to neurosurgical interventions) and bacterial ventriculitis have been studied for many years in order to establish early diagnosis methods through direct therapy to reduce morbidity and mortality in this population. Analysis of the cerebrospinal fluid (CSF) is an important source of information for diagnosis of neuroinfection. Lactate concentration in the cerebrospinal fluid has a value independent of plasma because it does not cross the blood-brain barrier, therefore, constitutes the end-product of the bacterial anaerobic glycolysis being the primary source of lactate in the CSF. Therefore, it has a great tool in the diagnostic approach of bacterial meningitis, however, reference values ​​are not warranted. Objective: The authors present the latest scientific evidence on the use of lactate as a diagnostic method for two neurological pathologies with highest incidence on population, establishing a translational approach to clinical practice. Methods: A comprehensive literature review was carried out. We describe the results of a structured search based on keywords infection, meningitis, ventriculitis, bacterial, cerebrospinal fluid, and lactate, vía Medline, Scopus, WoS, EMBASE, and LATINDEX databases. Conclusion: Lactate in a CSF sample is useful to determine the bacterial etiology in patients with suspected meningitis. CSF lactate value equal or higher than 4 mmol/l could indicate bacterial meningitis about 90% of probability. Lactate value is identical in patients with ventriculitis; however, it cannot be established as neuroinfection, therefore, we should use another diagnostic method. Objective: This work will present the updated scientific evidence regarding the use of lactate as a diagnostic method for two neurological entities with high incidence in our population, establishing a translational approach to our clinical practice. Methods: A comprehensive literature review was carried out we wrote the results of a structured search with the keywords infection, meningitis, ventriculitis, bacterial, cerebrospinal fluid, and lactate, in both English and Spanish within the Medline, Scopus, WoS, EMBASE, and LATINDEX databases. Conclusion: Measuring lactate in a CSF sample is useful to determine the bacterial etiology in patients with suspected meningitis, a CSF lactate value greater than or equal to 4 mmol / l means that a patient will have bacterial meningitis with certainty greater than 90% However, the lactate value is the same in a patient with ventriculitis, it cannot be established with total certainty that it is a neuroinfection, therefore, we should use some other diagnostic method