Diagnóstico de situación de la inversión realizada en el sistema de salud del Instituto Ecuatoriano de Seguridad Social en el Ecuador, período 2007-2012

La presente disertación tiene por objeto hacer un análisis de la cobertura, incidencia y grado de penetración de los servicios que componen el sistema de seguridad social y de salud del Instituto Ecuatoriano de Seguridad Social. La población afiliada beneficiaria de estas prestaciones está analizada por tipo de beneficiario entre los que se destacan beneficiarios del seguro general de salud, jubilados, los hijos menores de 18 años. Además la disertación comprende un análisis de los beneficios del sistema en los que se agrupa a la población en grupos de edades para un análisis comparado de ellas dentro del período y entre períodos de tiempos. Adicionalmente, se hace un análisis del nivel de incidencia de las prestaciones sociales sobre la población afiliada indicando tasas de crecimiento, composiciones porcentuales y tendencias, así como máximos y mínimos dentro del período. Finalmente se presentan resultados, conclusiones y recomendaciones de trabajo de grado

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2