Bonner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction: Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993. Currently, there are two four-year EM residency programs and an estimated 300 residency-trained emergency physicians countrywide. This study describes the current challenges in EM in Ecuador. Methods: We conducted 25 semi-structured, in-person interviews with residency-trained emergency physicians, general practitioners, public health specialists, prehospital personnel, and physicians from other specialties. The interviewer asked about challenges in the areas of emergency care, working conditions of emergency physicians, EM residency education, EM leadership, and prehospital care. We analyzed data for challenges and registered the number of interviewees who mentioned each challenge. Results: Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil (20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians; six (24%) residency-trained physicians from other specialties working in or closely associated with the emergency department (ED); one (4%) general practitioner working in the ED; one (4%) specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for better medico-legal protection, lack of EM residencies outside of Quito, and desire for more bedside teaching were the challenges mentioned with the highest frequency (each 44%). The next most frequently mentioned challenges (each 38%) were the need for better access to ultrasound equipment and the low presence of EM outside the capital city. Other challenges mentioned included the low demand for emergency physicians in private institutions, the lack of differential pay for night and weekends, need for more training in administration and leadership, need for a more effective EM national society, and lack of resources and experience in EM research. Conclusion: Emergency medicine has a three-decade history in Ecuador, reaching important milestones such as the establishment of two EM residencies and a national EM society. Challenges remain in medical care, working conditions, residency education, leadership, and prehospital care. Stronger collaboration and advocacy among emergency physicians can help strengthen the specialty and improve emergency care. [

Introduction Sexually transmitted infections are commonly tested for in the emergency department (ED), but diagnostic test results are often unavailable during the clinical encounter. Methods We retrospectively reviewed health records of 3,132 men ≥18 years that had an emergency department visit in northeast Ohio between April 18, 2014 and March 7, 2017. All subjects underwent testing for Neisseria gonorrhoeae and Chlamydia trachomatis. Independent t-tests and chi-square analyses were performed as well as multivariable regression analysis. Results On univariable analysis, men with N gonorrhoeae and/or C trachomatis, compared with uninfected men, were younger (25.9 vs 32.4 years), more likely to be of Black race (91.7% vs 85.6%), less likely to be married (3.7% vs 10.2%), less likely to arrive to the ED by ambulance or police (1.7% vs 4.1%), and more likely to be diagnosed with a urinary tract infection (8.3% vs 3.7%), to be treated for gonorrhea and chlamydia in the ED (84.6% vs 54.9%), and to have higher emergency severity index (ESI) scores (3.8 vs 3.6) (P ≤ .03 for all). On urinalysis, men infected with N gonorrhoeae and/or C trachomatis had significantly more white blood cells (55.1 vs 20.9); more mucus (1.3 vs 1.2); higher leukocyte esterase (1.5 vs .4); fewer squamous epithelial cells (.6 vs 1.4); higher urobilinogen (1.1 vs .8); higher bilirubin (.09 vs .05); and more protein (.4 vs .3) (P ≤ .04). Conclusions Demographic and urinalysis findings can be associated with an increased odds of men being infected with N gonorrhoeae and/or C trachomatis.

Introduction Vaginal infections are common in the emergency department (ED) but the frequency of vaginal coinfections identified on wet preparation is unknown. Methods The study examined a data set of 75,000 ED patient encounters between April 18, 2014, and March 7, 2017, who had received testing for gonorrhea, chlamydia, or trichomonas or had received a urinalysis and urine culture during the ED encounter. From this data set we reviewed 16,484 patient encounters where a vaginal wet preparation was performed on women age 18 years and older. Findings from the vaginal wet preparation and ED discharge diagnoses were examined to evaluate the frequency of vaginal coinfections with vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis. Results Among the women who had wet preparations, 4,124 patient encounters (25.0%) had a diagnosis of bacterial vaginosis, 625 (3.8%) had a diagnosis of vulvovaginal candidiasis, and 1,802 (10.9%) were infected with Trichomonas vaginalis. Twenty encounters (0.1%) had a diagnosis of vulvovaginal candidiasis and trichomoniasis; 150 (0.9%), bacterial vaginosis and trichomoniasis; 136 (0.8%), vulvovaginal candidiasis and bacterial vaginosis; and 10 (0.1%), trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. On vaginal wet preparation, the mean white blood cell count was 13.0 per high-power field. Clue cells were found in 6,988 wet preparations (42.4%); 1,065 wet preparations (6.5%) had yeast and 1,377 (8.4%) had T. vaginalis. T. vaginalis was identified in 2.5% (266/10,542) of urinalyses and 8.4% (406/4,821) of nucleic acid amplification tests. Conclusions Vaginal coinfections were uncommon among women receiving a vaginal wet preparation in the emergency department. The most common vaginal coinfection was bacterial vaginosis and trichomonas.