Infection by COVID-19, being a respiratory disease caused by SARS-CoV-2, can predispose to arterial and venous thrombotic disease, in response to excessive inflammation, platelet activation, endothelial dysfunction, and venous stasis. During the COVID-19 pandemic period, the technological and resource availability for the care of these patients with thrombotic disease is critical, marking a factor of morbidity and poor prognosis in these cases. We describe a case of priapism in a patient with COVID-19, during the course of systemic inflammatory response syndrome and respiratory distress syndrome with a procoagulant state, seeking to relate the pathophysiological factors of ischemic priapism in patients with infection with SARS-Cov-2

Background: South America has low research productivity. The lack of a structured research curriculum is one of the barriers to conducting research.Objective: To report our experience adapting an active learning-based research methods curriculum to improve research productivity at a university in Ecuador.Design: We used a mixed-method approach to test the adaptation of the research curriculum at Universidad Catolica Santiago de Guayaquil. The curriculum uses a flipped classroom and active learning approach to teach research methods. When adapted, it was longitudinal and had 16-hour programme of in-person teaching and a six-month follow-up online component. Learners were organized in theme groups according to interest, and each group had a faculty leader. Our primary outcome was research productivity, which was measured by the succesful presentation of the research project at a national meeting, or publication in a peer-review journal. Our secondary outcomes were knowledge and perceived competence before and after course completion. We conducted qualitative interviews of faculty members and students to evaluate themes related to participation in research.Results: Fifty university students and 10 faculty members attended the course. We had a total of 15 groups. Both knowledge and perceived competence increased by 17 and 18 percentage points, respectively. The presentation or publication rate for the entire group was 50%. The qualitative analysis showed that a lack of research culture and curriculum were common barriers to research.Conclusions: A US-based curriculum can be successfully adapted in low-middle income countries. A research curriculum aids in achieving pre-determined milestones.Abbreviations: UCSG: Universidad Catolica Santiago de Guayaquil; UM: University of Miami

Objectives. To evaluate the impact of the April 2016 7.8-magnitude earthquake in Ecuador on the incidence of Zika virus (ZIKV) cases.Methods. We used the national public health surveillance system for reportable transmissible conditions and included suspected and laboratory-confirmed ZIKV cases. We compared the number of cases before and after the earthquake in areas closer to and farther from the epicenter.Results. From January to July 2016, 2234 patients suspected of having ZIKV infection were reported in both affected and control areas. A total of 1110 patients had a reverse transcription-polymerase chain reaction assay, and 159 were positive for ZIKV. The cumulative incidence of ZIKV in the affected area was 11.1 per 100 000 after the earthquake. The odds ratio of having ZIKV infection in those living in the affected area was 8.0 (95% CI = 4.4, 14.6; P < .01) compared with the control area and adjusted for age, gender, province population, and number of government health care facilities. METHODSWe included all confirmed ZIKV cases in areas affected by the earthquake and in control areas that are similar in elevation, average temperature, proximity to the coast, and population size. We also included suspected ZIKV cases to evaluate the geographic relationship between these cases and those confirmed by laboratory.The epicenter of the 2016 earthquake was 17 miles south-southeast of Muisne, Esmeraldas, in the northeastern part of the country. The Manabí and Esmeraldas provinces had the most earthquake-related damage, with 705 and 420 destroyed buildings, respectively.7 Before the earthquake, Manabí had 199 health centers and 15 hospitals. After the earthquake, 7 hospitals had major damage and were inoperative. 8,9Almost all earthquake-related deaths in Ecuador were reported in Manabí; the earthquake affected larger urban centers in Manabí than in Esmeraldas, Guayas, and Los Ríos. Definitions of EarthquakeAffected AreasWe defined the earthquake-affected area as the province of Manabí, which is 30 miles south of the epicenter. The rationale for using only this province was that the roads to Esmeraldas province and the health care facilities most proximal to the epicenter were completely destroyed, 10,11 preventing the collection of any confirmatory samples, whereas several facilities in nearby Manabí remained partially operational and accessible by car. Manabí has larger urban areas and more health care facilities and transportation infrastructure than Esmeraldas. To better evaluate the relationship between earthquake-related damage and ZIKV incidence, we also collected data at the county Correspondence should be sent to Denisse C. Pareja, MD, MSPH, Department of Veterans Affairs, Bruce W. Carter VA Medical Center, 1201 NW 16th Street, 207G, Miami, FL 33125-1693 (denpareja@gmail.com). Reprints can be ordered at http://www. ajph.org by clicking the "Reprints" link.