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Alcohol abuse has been identified as a risk factor for contracting human immunodeficiency virus (HIV) and accelerating disease progression. Our study aims to determine alcohol consumption rates among Ecuadorian HIV positive (HIV+) patients prior to diagnosis to evaluate its impact as an independent risk factor for contracting HIV. Additionally, we will examine post-diagnosis consumption rates among the HIV+ population.We provided anonymous questionnaires to 300 HIV+ patients and 600 internal medicine patients at 3 hospitals in Quito, Ecuador. Questionnaires quantified alcohol usage prior to HIV diagnosis, at time of diagnosis, and post-diagnosis while accounting for other potential HIV risk factors. We then determined frequencies of alcohol consumption and confounding variables. Finally, we performed a multivariable logistic regression controlling for confounders to determine the statistical significance of alcohol consumption as an independent risk factor for HIV.Our results showed increased odds for contracting HIV among those who drank daily (OR 5.3, CI 2.0-14.0) and those who consumed 6 or more alcoholic beverages on days they drank (OR 5.0, CI 3.1-8.2). Through multivariable analysis, we found that abstaining from binge drinking was a protective factor with an OR 0.5 (0.3-0.96). The percentage of HIV+ patients abstaining from alcohol increased from 30% twelve months prior to diagnosis to 57% after diagnosis.Our results show that alcohol abuse significantly increases the risk of contracting HIV. We found that prior to diagnosis, HIV patients consistently drank more frequently and a greater amount than the control group. Alcohol use significantly decreased among HIV+ patients after diagnosis.

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Introduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador. Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador. Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs. Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.

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OBJECTIVES: To describe a clinical case of Klebsiella pneumoniae harboring a New Delhi metallo-ß-lactamase (NDM) plasmid in Ecuador and to present a map of reports of NDM isolates in South America. METHODS: The modified Hodge test, carbapenem inactivation method, imipenem-EDTA disk method (synergy), and Rapidec Carba NP test were used to identify antibiotic resistance mechanisms. The presence of resistance genes was explored with a conjugation assay, and molecular confirmation of NDM was performed by PCR and DNA sequencing. Plasmid characterization was conducted by PCR-based replicon typing. A literature review was performed in Google Scholar and PubMed to identify reports from South America. RESULTS: An HIV-infected patient, who had never traveled abroad, developed a bloodstream infection caused by K. pneumoniae ST147 harboring the NDM-1 resistance gene in a plasmid from the IncA/C group. Local circulation of NDM has also been described in other South American countries, in particular in Colombia and Brazil, although published scientific records were not found for other countries. CONCLUSIONS: This report presents the first evidence of autochthonous circulation of the NDM-1 resistance gene harbored by an IncA/C plasmid isolated from a K. pneumoniae ST147 in Ecuador. Efforts should be implemented to monitor and characterize the spatial and temporal distribution of NDM in Ecuador and other countries of South America.

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La enfermedad tromboembólica venosa (ETV), conformada por la trombosis venosa profunda y el tromboembolismo pulmonar, es una importante causa de morbilidad y mortalidad hospitalaria Objetivos Determinar la prevalencia de factores de riesgo para ETV en el ámbito hospitalario y la proporción de pacientes con riesgo ingresados en servicios clínicos y quirúrgicos Diseño Transversal de prevalencia Lugar y sujetos Todos los pacientes (de 18 años o más) ingresados en servicios clínicos o quirúrgicos de cinco hospitales de la ciudad de Quito durante el primer trimestre de 2008 Mediciones principales Identifcación de factores de riesgo demográfcos, clínicos y quirúrgicos mediante revisión del expediente clínico, examen físico y entrevista al paciente. Las guías de consenso internacionales se utilizaron para evaluar el riesgo de ETV Resultados Un total de 443 pacientes (edad media 50 ± 30; 54.9% masculinos) fueron estudiados. El 37.2% estuvieron ingresados en servicios clínicos y 62.8% en servicios quirúrgicos. En 396 pacientes (89.4%; IC95% =86.1% - 92.1%) se encontraron factores de riesgo para ETV. La prevalencia global de factores de riesgo fue similar entre hospitales. En los servicios clínicos y quirúrgicos la prevalencia también fue similar (88.5% vs. 89.9%; p=ns). Los factores más frecuentes fueron edad mayor de 40 años (64.1%; IC95% = 59.5% - 68.4%), cirugía mayor (28.9%; IC95% = 24.8% - 33.2%), encamamiento de cuatro o más días (24.6%; IC95% = 20.8% - 28.8%) y obesidad (23.3%; IC95% =19.5% - 27.4%). Hubo pocas diferencias en la frecuencia de los factores de riesgo entre hospitales. Los pacientes se califcaron como portadores de un riesgo leve (44.9%) moderado (37.5%), alto (12.2%) y muy alto (5.4%) para ETV. Los pacientes en los servicios clínicos tuvieron un nivel de riesgo principalmente moderado en comparación a los sujetos de servicios quirúrgicos (45.5% vs. 32.7%; p<0.01). Un riesgo muy alto solo fue encontrado en pacientes quirúrgicos. La proporción de pacientes con riesgo leve y alto fue similar entre los servicios clínicos y quirúrgicos. Conclusiones Los hallazgos de este estudio demuestran que la prevalencia de factores de riesgo para ETV es elevada en los pacientes hospitalizados en la ciudad de Quito. La identifcación temprana de estos factores junto con una estratifcación de riesgo en los pacientes, es fundamental dentro de la práctica clínica habitual, ya que permitiría emplear medidas preventivas acordes al riesgo de desarrollar ETV.

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a signifcant source of morbidity and mortality. Objective To determine the prevalence of VTE risk factors in the hospital care setting and to assess the proportion of at-risk patients in clinical and surgical wards. Design Cross sectional study Subjects and setting All hospital inpatients (aged 18 years or over) admitted to clinical or surgical wards at fve hospitals in the city of Quito-Ecuador during the frst trimester of 2008. Main measurements Demographic, clinical and surgical risk factors were collected from hospital chart review, physical examination and interview. Consensus guidelines were used to assess VTE risk. Results 443 patients (mean age 50 ± 30 years; 54.9% males) were studied; 37.2% were at clinical wards and 62.8% at surgical wards. Risk factors for VTE were identifed in 396 (89.4%; 95%CI=86.1% - 92.1%) patients. The global prevalence of risk factors was similar between hospitals. In medical and surgical wards the prevalence also was similar (88.5% vs. 89.9%; p=ns). Most common risk factors were age (40 years or over; 64.1%; 95%CI= 59.5% - 68.4%), major surgery (28.9%; 95%CI= 24.8% - 33.2%), bed rest (four days or over; 24.6%; 95%CI= 20.8% - 28.8%), and obesity (23.3%; 95%CI=19.5% - 27.4%). Few differences were found in frequency of risk factors between hospitals. Patients were judged to be at low (44.9%), moderate (37.5%), high (12.2%) and very high risk (5.4%) for VTE. Patients in clinical wards mainly had a moderate risk compared with subjects in surgical wards (45.5% vs. 32.7%; p<0.01). A very high risk was found only in surgical patients. The proportion of patients with low and high risk was similar in clinical and surgical wards. Conclusion This study showed that prevalence of VTE risk factors is high in hospital inpatients from Quito-Ecuador. An early identifcation of these factors and risk stratifcation is essential in clinical practice, in order to establish prophylactic measures in patients at risk to developing VTE.

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