Ecuador, despite having taken aggressive and early measures to stop the progression of the pandemic (COVID-19), ended up becoming an epicenter of the pandemic in Latin America, and with the collapse of its health care system. The authors describe three patients who had confirmed COVID-19 and met the criteria for hospital admission but could not be assigned a hospital bed in a resource-limited country. The patients included a 72-year-old male, an 82-year-old female, and a 56-year-old male. They typically presented with fever, dyspnea, loss of taste and smell, diarrhea, and abdominal pain. Oxygen saturation during the initial evaluation ranged from 80-89%. Laboratory results reported lymphopenia and neutrophilia, with leukocytosis in two patients. Inflammatory markers were also elevated for all three patients. CT scan findings showed bilateral ground-glass pulmonary opacities. SARS-CoV-2 was confirmed in all three patients by real time polymerase chain reaction (RT-PCR) testing. Home-based treatment was established. At the time of writing this report, all patients remain asymptomatic and with negative COVID-19 testing. Telemedicine and home-based treatment were essential assets in the care of these severely ill patients living in a low-resource setting where not all patients who have criteria to be admitted into the hospital are able to find a place in a collapsed health care system. Cite this article as: Briones-Claudett KH, Briones-Claudett MH, Briones-Zamora KH, Briones-Márquez DC, Icaza-Freire A, Grunauer M. Telemedicine and Home-Based Treatment of COVID-19 in Resource-Limited Countries. Report of 3 Cases. Eurasian J Med 2021; 53(2): 155-7.

Background Simulation-based training plays a critical role in the acquisition of airway management skills in undergraduate medical education. Peyton’s Four-Step Approach (PFSA) and Rapid Cycle Deliberate Practice (RCDP) are two structured, evidence-based methodologies used in simulation training. While both have shown educational benefits, few studies have directly compared their effectiveness across both basic procedures, such as laryngeal mask airway (LMA) placement and endotracheal intubation (ETI), and complex procedures, such as fiberoptic intubation (FOI), especially in time-limited massed practice formats. Methods Fifty-nine third-year medical students with no prior experience in airway management participated in this simulation-based study. They were divided into two cohorts: one trained using RCDP and the other using PFSA. Each cohort received three weekly sessions focused on LMA, ETI, and FOI, respectively, with individualized hands-on training. Final evaluations were conducted using the Objective Structured Assessment of Technical Skills (OSATS) for LMA and ETI, a Global Rating Scale (GRS) for bronchoscope handling, and a 10-item checklist for FOI. Statistical analysis included t-tests, Mann-Whitney U, chi-squared or Fisher’s exact tests, and Cronbach’s alpha for instrument reliability. Results PFSA resulted in significantly higher OSATS scores for LMA placement (38.06 ± 6.67 vs. 31.93 ± 7.70, p = 0.0017), with a higher proportion of non-competent participants in the RCDP group (p = 0.009). In contrast, RCDP outperformed PFSA in ETI OSATS scores (67.00 ± 12.32 vs. 58.93 ± 11.87, p = 0.012) and in the proportion of students achieving mastery (p = 0.013). For FOI, RCDP led to significantly better results on the GRS (14.73 ± 4.65 vs. 9.66 ± 2.79, p < 0.0001) and the procedural checklist (median: 6.0, interquartile range (IQR): 5-7 vs. median: 4.0, IQR: 3-6, p = 0.0021). No participants reached mastery in FOI, but the RCDP group had significantly more moderately competent students (p = 0.0194) and fewer non-competent participants (p = 0.0003). Reliability of assessment instruments was confirmed with Cronbach’s alpha values above 0.70. Conclusion PFSA was more effective for teaching basic skills such as LMA placement, likely due to its stepwise instructional design. RCDP showed superior outcomes in ETI and FOI, supporting its use in complex procedures that benefit from iterative practice and immediate feedback. These findings highlight the importance of tailoring simulation-based training methods to the complexity of the procedure and the learners’ needs, particularly in programs with limited training time, and underscore the value of incorporating follow-up assessments to evaluate long-term retention and the durability of training effects.

Inhalation of methanol vapor is a rare but potentially life-threatening occupational hazard, particularly in environments with inadequate ventilation and safety controls. We report the case of an 18-year-old male shrimp processing worker who developed acute respiratory failure following accidental inhalation of methanol vapors mislabeled as kerosene. The patient presented with severe dyspnea, hypoxemia, metabolic acidosis, and radiographic findings of diffuse pulmonary infiltrates. He required mechanical ventilation, corticosteroids, antibiotics, and intensive supportive care. Bronchoscopy revealed erythematous bronchial mucosa with hemorrhagic stippling and was followed by bronchoalveolar lavage (BAL). Based on imaging findings, therapeutic segmental pulmonary lavage (TSPL) was performed, targeting the most affected lower lobe segments. The procedure involved instillation and aspiration of small saline aliquots to remove inflammatory debris. Following TSPL, the patient exhibited marked clinical improvement, with normalization of inflammatory markers and successful extubation within 48 hours. This case illustrates the potential value of TSPL as an adjunctive therapy in methanol-induced chemical pneumonitis. Unlike standard BAL, TSPL enables targeted clearance of toxic exudates from specific lung segments, potentially accelerating recovery in patients with localized airway injury. Given the rarity of inhalational methanol poisoning and the absence of established respiratory interventions beyond supportive care, TSPL may offer a novel approach to managing severe pulmonary complications. This experience highlights the need for heightened clinical awareness of inhalational toxic exposures and further research into therapeutic lavage techniques. Our findings suggest that TSPL could be considered in selected cases of toxic inhalation injury when conventional measures fail to produce timely improvement.

BACKGROUND Despite global vaccination efforts, COVID-19 still necessitates effective treatments for severe cases that can quickly escalate to life-threatening complications, such as acute respiratory distress syndrome (ARDS) and secondary pulmonary arterial hypertension (PAH). Here, we present the clinical journey of a 73-year-old Ecuadorian man who developed severe COVID-19 pneumonia complicated by an opportunistic Candida krusei infection and ARDS, subsequently progressing to long-term PAH, managed with bosentan, an endothelin 1 (ET-1) antagonist. CASE REPORT The patient, vaccinated with 2 doses of CoronaVac, experienced severe COVID-19 complications, including ARDS and secondary PAH, further complicated by a C. krusei infection. Despite prompt mechanical ventilation and intensive care, his condition rapidly deteriorated. Clinical evaluation confirmed COVID-19-associated ARDS, secondary PAH, and C. krusei infection through bronchoalveolar lavage. The therapeutic approach combined bosentan (125 mg twice daily) with dual antifungal therapy, leading to significant stabilization and eventual discharge. Post-discharge assessments showed persistent cardiopulmonary dysfunction, consistent with post-COVID-19 syndrome. CONCLUSIONS This case highlights critical COVID-19 complications in a vaccinated patient. While vaccination may provide substantial protection, COVID-19 pneumonia treated with corticosteroids can increase the risk of opportunistic infections like C. krusei, and ARDS can lead to pulmonary fibrosis and PAH. This case underscores the need for research on therapeutic strategies for complex COVID-19 cases and emphasizes comprehensive, personalized care for managing COVID-19 complications and sequelae.