BackgroundThe COVID-19 pandemic has overwhelmed health systems around the world, causing access p... more BackgroundThe COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized; and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching.MethodsThis study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center.ResultsNinety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission.ConclusionThese data show that the healthcare system did not meet the hospitalization needs of half of the patients with severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patients faced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.Disclosures All Authors: No reported disclosures.
To describe the clinical and epidemiological characteristics and diagnostic-therapeutic strategie... more To describe the clinical and epidemiological characteristics and diagnostic-therapeutic strategies associated with Histoplasma capsulatum infection at the University Hospital of Caracas. Methods: A descriptive, retrospective cohort study. We performed a data collection from medical records of patients diagnosed with Histoplasma capsulatum infection at Caracas University Hospital during the years 1999-2009. Results: Of 105 patients studied, the predominant age group was 22-46 years old, 77.1% male, 49.5% had smoking habits, 7.6% were related to construction and renovation. Fever was the most common clinical manifestation 84.8%. The diagnosis was made by serology in 56.2%, and biological samples processed in highest number were blood and bone marrow with 49.5%. The most 6 common presentation was disseminated histoplasmosis. The preferred treatment was amphotericin B and itraconazole, most patients evolved toward improvement. Conclusions: Histoplasmosis is the most common endemic opportunistic infection, especially in patients with HIV-AIDS; serology was the main diagnostic method. Treatment with amphotericin B and itraconazole was preferred, most of the patients improved. It is important to study endemic diseases in our patients, especially those with HIV-AIDS.
Se recopilan evidencias con respecto a la epidemiología de la histoplasmosis, obtenida... more Se recopilan evidencias con respecto a la epidemiología de la histoplasmosis, obtenidas durante los últimos 70 años en Venezuela, extraídas de los diferentes estudios realizados en el país, en los cuales se demuestra la existencia de esta micosis en nuestro medio. El objetivo fue estimular el interés entre nuestros médicos, por la búsqueda de esta micosis.&nbsp
Introducción: La práctica de la higiene de manospor el personal de salud es... more Introducción: La práctica de la higiene de manospor el personal de salud es un elemento esencial paraprevenir la transmisión de las infecciones asociadas a laatención sanitaria. El objetivo es evaluar el conocimiento,las prácticas y la actitud del personal de salud médicopara la higiene de las manos y las condiciones sanitariasmínimas durante la pandemia de COVID-19 en el HospitalUniversitario de Caracas, mayo 2020. Metodología:Estudio de corte transversal intrahospitalario. Población:Médicos adjuntos y residentes, y estudiantes presentesal momento de la visita al Hospital Universitario deCaracas. Instrumentos: Entrevistas, cuestionarios,inspecciones y observaciones del lavado de las manosen trabajo intrahospitalario. Análisis estadístico.Programa SPSS 21 para las estadísticas descriptivascon tablas de distribuciones de frecuencia, promedios,porcentajes, desviaciones estándar y percentiles.Pruebas de Chi2 con límites de confianza del 95 %.Resultados: 42 autocuestionarios, 32 a adjuntos yresidentes, 75,6 % jóvenes menores de 30 años y 59 %femeninos. Conocimiento suficiente 74 %, las prácticasauto reportadas el 69 % correctas, y la actitud positiva87 %. 51 áreas inspeccionadas con fallas de agua16 %, lavamanos funcionales en 28 % de los ambientes,y falta de jabón, gel alcoholado o toallas desechables.59 % de los baños para pacientes en malas condicionessanitarias. Observaciones de higiene de manos duranteel acto médico (100 momentos), solo 9 % correctos. La inspección del área de triaje de COVID-19 muestra quese cumplen con lavado de manos con gel alcoholado.La inspección del hospital (OMS) reporta 95 puntos nivelde higiene inadecuado con prácticas de HM y promocióndeficientes. Formulario inspección de la OMS ante laCOVID-19 arroja fallas en infraestructura, insumos ydisponibilidad de EPP y falta de auditorías. Discusión:El conocimiento y las prácticas en puntajes moderadosrequieren educación médica continua, y la actitud muypositiva del personal de salud permitirán mejorar lasprácticas en el lugar de trabajo, siempre que se dispongade la infraestructura, agua y jabón, y de gel alcoholadopara el cumplimiento del lavado de las manos en los 5momentos del acto médico. Conclusión: El hospitalrequiere mejoras importantes de la infraestructura y laentrega de materiales para la correcta higiene de lasmanos
Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes... more Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes a wide range of clinical manifestations; the most common is the pulmonary form. In some cases, atypical presentations are described. Case report: a 70 year old male patient, from Barinas, Venezuela, who worked in a chicken farm, with diagnosis of histoplasmosis and hemolytic anemia is described. The patient improved with antifungal treatment. Conclusions: in Venezuela, an endemic area for this mycosis, clinicians must have a high suspicion index for this disease, taking into account risk factors, such as age and epidemiology. To our knowledge, this is the third case report in the literature.
Se ha observado un incremento de las infecciones causadas por Histoplasma capsulatum, particularm... more Se ha observado un incremento de las infecciones causadas por Histoplasma capsulatum, particularmente en pacientes inmunocomprometidos. El objetivo del estudio fue determinar las caracteristicas de la histoplasmosis en pacientes con leucemias y linfomas del Hospital Universitario de Caracas, Clinica Atias y Hospital Miguel Perez Carreno, cuyo diagnostico etiologico fue realizado en la Seccion de Micologia Medica del Instituto de Medicina Tropical, UCV, en los ultimos siete anos. Se diagnosticaron 30 pacientes con histoplasmosis, 25 fueron adultos y 5 pediatricos. El 83% provenia de la Gran Caracas. 2 estaban embarazadas. El 46% tenian leucemia mieloide aguda, 20% leucemia linfoide aguda, 23% linfomas. En 83% de los casos el diagnostico se hizo durante la neutropenia febril y la enfermedad de base no estaba en remision. Los pacientes se encontraban en tratamiento segun la enfermedad de base, de acuerdo con los protocolos establecidos por los servicios de hemato-oncologia de los respe...
Se presenta una actualizacion de las enfermedades emergentes yreemergentes que mas han dado probl... more Se presenta una actualizacion de las enfermedades emergentes yreemergentes que mas han dado problemas en los ultimos anos, zika,malaria y chagas. Zika es una arbovirosis emergente que ha sufrido ungran subregistro, en parte causado por el hecho de que la mayoria delas infecciones son asintomaticas o subclinicas, y por otra parte, dadopor la limitacion del laboratorio del Instituto Nacional de Higiene paraprocesar las muestras para PCR, solo procesando las de pacientes concomplicaciones y embarazadas. Malaria es una enfermedad reemergenteque tan solo en lo que va de 2016 ha sido reportado en 130.000pacientes. Tambien es notorio que se han presentado casos en sitiosen los cuales no se habian reportado antes, tales como las costas de losestados Vargas y Miranda. Se anade a esta situacion la dificultad paraconseguir el tratamiento antimalarico, el cual solamente se encuentra enalgunos establecimientos del Ministerio del Poder Popular para la Salud(MPPS). Tanto zika como malaria tienen e...
The coronavirus disease 2019 (COVID‐19) pandemic has particularly affected countries with weakene... more The coronavirus disease 2019 (COVID‐19) pandemic has particularly affected countries with weakened health services in Latin America, where proper patient management could be a critical step to address the epidemic. In this study, we aimed to characterize and identify which epidemiological, clinical, and paraclinical risk factors defined COVID‐19 infection from the first confirmed cases through the first epidemic wave in Venezuela. A retrospective analysis of consecutive suspected cases of COVID‐19 admitted to a sentinel hospital was carried out, including 576 patient cases subsequently confirmed for severe acute respiratory syndrome coronavirus 2 infection. Of these, 162 (28.1%) patients met the definition criteria for severe/critical disease, and 414 (71.2%) were classified as mild/moderate disease. The mean age was 47 (SD 16) years, the majority of which were men (59.5%), and the most frequent comorbidity was arterial hypertension (23.3%). The most common symptoms included fever (...
Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects peopl... more Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. his...
BackgroundThe COVID-19 pandemic has overwhelmed health systems around the world, causing access p... more BackgroundThe COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized; and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching.MethodsThis study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center.ResultsNinety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission.ConclusionThese data show that the healthcare system did not meet the hospitalization needs of half of the patients with severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patients faced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.Disclosures All Authors: No reported disclosures.
To describe the clinical and epidemiological characteristics and diagnostic-therapeutic strategie... more To describe the clinical and epidemiological characteristics and diagnostic-therapeutic strategies associated with Histoplasma capsulatum infection at the University Hospital of Caracas. Methods: A descriptive, retrospective cohort study. We performed a data collection from medical records of patients diagnosed with Histoplasma capsulatum infection at Caracas University Hospital during the years 1999-2009. Results: Of 105 patients studied, the predominant age group was 22-46 years old, 77.1% male, 49.5% had smoking habits, 7.6% were related to construction and renovation. Fever was the most common clinical manifestation 84.8%. The diagnosis was made by serology in 56.2%, and biological samples processed in highest number were blood and bone marrow with 49.5%. The most 6 common presentation was disseminated histoplasmosis. The preferred treatment was amphotericin B and itraconazole, most patients evolved toward improvement. Conclusions: Histoplasmosis is the most common endemic opportunistic infection, especially in patients with HIV-AIDS; serology was the main diagnostic method. Treatment with amphotericin B and itraconazole was preferred, most of the patients improved. It is important to study endemic diseases in our patients, especially those with HIV-AIDS.
Se recopilan evidencias con respecto a la epidemiología de la histoplasmosis, obtenida... more Se recopilan evidencias con respecto a la epidemiología de la histoplasmosis, obtenidas durante los últimos 70 años en Venezuela, extraídas de los diferentes estudios realizados en el país, en los cuales se demuestra la existencia de esta micosis en nuestro medio. El objetivo fue estimular el interés entre nuestros médicos, por la búsqueda de esta micosis.&nbsp
Introducción: La práctica de la higiene de manospor el personal de salud es... more Introducción: La práctica de la higiene de manospor el personal de salud es un elemento esencial paraprevenir la transmisión de las infecciones asociadas a laatención sanitaria. El objetivo es evaluar el conocimiento,las prácticas y la actitud del personal de salud médicopara la higiene de las manos y las condiciones sanitariasmínimas durante la pandemia de COVID-19 en el HospitalUniversitario de Caracas, mayo 2020. Metodología:Estudio de corte transversal intrahospitalario. Población:Médicos adjuntos y residentes, y estudiantes presentesal momento de la visita al Hospital Universitario deCaracas. Instrumentos: Entrevistas, cuestionarios,inspecciones y observaciones del lavado de las manosen trabajo intrahospitalario. Análisis estadístico.Programa SPSS 21 para las estadísticas descriptivascon tablas de distribuciones de frecuencia, promedios,porcentajes, desviaciones estándar y percentiles.Pruebas de Chi2 con límites de confianza del 95 %.Resultados: 42 autocuestionarios, 32 a adjuntos yresidentes, 75,6 % jóvenes menores de 30 años y 59 %femeninos. Conocimiento suficiente 74 %, las prácticasauto reportadas el 69 % correctas, y la actitud positiva87 %. 51 áreas inspeccionadas con fallas de agua16 %, lavamanos funcionales en 28 % de los ambientes,y falta de jabón, gel alcoholado o toallas desechables.59 % de los baños para pacientes en malas condicionessanitarias. Observaciones de higiene de manos duranteel acto médico (100 momentos), solo 9 % correctos. La inspección del área de triaje de COVID-19 muestra quese cumplen con lavado de manos con gel alcoholado.La inspección del hospital (OMS) reporta 95 puntos nivelde higiene inadecuado con prácticas de HM y promocióndeficientes. Formulario inspección de la OMS ante laCOVID-19 arroja fallas en infraestructura, insumos ydisponibilidad de EPP y falta de auditorías. Discusión:El conocimiento y las prácticas en puntajes moderadosrequieren educación médica continua, y la actitud muypositiva del personal de salud permitirán mejorar lasprácticas en el lugar de trabajo, siempre que se dispongade la infraestructura, agua y jabón, y de gel alcoholadopara el cumplimiento del lavado de las manos en los 5momentos del acto médico. Conclusión: El hospitalrequiere mejoras importantes de la infraestructura y laentrega de materiales para la correcta higiene de lasmanos
Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes... more Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes a wide range of clinical manifestations; the most common is the pulmonary form. In some cases, atypical presentations are described. Case report: a 70 year old male patient, from Barinas, Venezuela, who worked in a chicken farm, with diagnosis of histoplasmosis and hemolytic anemia is described. The patient improved with antifungal treatment. Conclusions: in Venezuela, an endemic area for this mycosis, clinicians must have a high suspicion index for this disease, taking into account risk factors, such as age and epidemiology. To our knowledge, this is the third case report in the literature.
Se ha observado un incremento de las infecciones causadas por Histoplasma capsulatum, particularm... more Se ha observado un incremento de las infecciones causadas por Histoplasma capsulatum, particularmente en pacientes inmunocomprometidos. El objetivo del estudio fue determinar las caracteristicas de la histoplasmosis en pacientes con leucemias y linfomas del Hospital Universitario de Caracas, Clinica Atias y Hospital Miguel Perez Carreno, cuyo diagnostico etiologico fue realizado en la Seccion de Micologia Medica del Instituto de Medicina Tropical, UCV, en los ultimos siete anos. Se diagnosticaron 30 pacientes con histoplasmosis, 25 fueron adultos y 5 pediatricos. El 83% provenia de la Gran Caracas. 2 estaban embarazadas. El 46% tenian leucemia mieloide aguda, 20% leucemia linfoide aguda, 23% linfomas. En 83% de los casos el diagnostico se hizo durante la neutropenia febril y la enfermedad de base no estaba en remision. Los pacientes se encontraban en tratamiento segun la enfermedad de base, de acuerdo con los protocolos establecidos por los servicios de hemato-oncologia de los respe...
Se presenta una actualizacion de las enfermedades emergentes yreemergentes que mas han dado probl... more Se presenta una actualizacion de las enfermedades emergentes yreemergentes que mas han dado problemas en los ultimos anos, zika,malaria y chagas. Zika es una arbovirosis emergente que ha sufrido ungran subregistro, en parte causado por el hecho de que la mayoria delas infecciones son asintomaticas o subclinicas, y por otra parte, dadopor la limitacion del laboratorio del Instituto Nacional de Higiene paraprocesar las muestras para PCR, solo procesando las de pacientes concomplicaciones y embarazadas. Malaria es una enfermedad reemergenteque tan solo en lo que va de 2016 ha sido reportado en 130.000pacientes. Tambien es notorio que se han presentado casos en sitiosen los cuales no se habian reportado antes, tales como las costas de losestados Vargas y Miranda. Se anade a esta situacion la dificultad paraconseguir el tratamiento antimalarico, el cual solamente se encuentra enalgunos establecimientos del Ministerio del Poder Popular para la Salud(MPPS). Tanto zika como malaria tienen e...
The coronavirus disease 2019 (COVID‐19) pandemic has particularly affected countries with weakene... more The coronavirus disease 2019 (COVID‐19) pandemic has particularly affected countries with weakened health services in Latin America, where proper patient management could be a critical step to address the epidemic. In this study, we aimed to characterize and identify which epidemiological, clinical, and paraclinical risk factors defined COVID‐19 infection from the first confirmed cases through the first epidemic wave in Venezuela. A retrospective analysis of consecutive suspected cases of COVID‐19 admitted to a sentinel hospital was carried out, including 576 patient cases subsequently confirmed for severe acute respiratory syndrome coronavirus 2 infection. Of these, 162 (28.1%) patients met the definition criteria for severe/critical disease, and 414 (71.2%) were classified as mild/moderate disease. The mean age was 47 (SD 16) years, the majority of which were men (59.5%), and the most frequent comorbidity was arterial hypertension (23.3%). The most common symptoms included fever (...
Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects peopl... more Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. his...
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Papers by Maria Eugenia Landaeta