Facultad de Ciencias de la Salud y Bienestar Humano

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Universidad Indoamérica

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Risk Factors Associated with Hyporesponsiveness to Erythropoietin in Chronic Kidney Disease Patients on Hemodialysis Who Present Anemia: A Multicenter Case-Control Study
(2025)
Carlos Perez Tulcanaza
;
André Benítez-Baldassari
;
Andrea Banegas-Sarmiento
;
Sánchez Redrobán, José
Background: Anemia represents a significant complication in patients with advanced chronic kidney disease (CKD) on hemodialysis, primarily caused by reduced renal erythropoietin production. Despite erythropoiesis-stimulating agents (ESAs) being the cornerstone of treatment, hyporesponsiveness to these agents remains a clinical challenge with implications for patient outcomes. Objective: To identify and quantify risk factors associated with hyporesponsiveness to erythropoietin in patients with CKD on hemodialysis who present with anemia. Methods: This multicenter case–control study analyzed data from 784 hemodialysis patients receiving erythropoietin therapy across six dialysis centers in Ecuador between January and December 2019. Hyporesponsiveness was defined as requiring ≥ 200 IU/kg/week of erythropoietin alfa for ≥3 consecutive months to maintain target hemoglobin levels (10–12 g/dL). Demographic, clinical, and laboratory parameters were compared between hyporesponsive cases (n = 123) and responsive controls (n = 661). Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The prevalence of erythropoietin hyporesponsiveness was 15.69%. A multivariate analysis identified female sex (adjusted OR = 1.96; 95% CI: 1.20–3.20; p < 0.001), age < 50 years (adjusted OR = 4.25; 95% CI: 2.42–7.47; p < 0.001), serum albumin < 4.0 g/dL (adjusted OR = 10.53; 95% CI: 6.53–16.98; p < 0.001), ferritin ≥ 800 ng/mL (adjusted OR = 7.28; 95% CI: 4.22–12.57; p < 0.001), transferrin saturation < 20% (adjusted OR = 9.27; 95% CI: 5.47–15.69; p < 0.001), parathyroid hormone ≥ 500 pg/mL (adjusted OR = 1.89; 95% CI: 1.16–3.09; p = 0.011), and use of renin–angiotensin system blockers (adjusted OR = 2.25; 95% CI: 1.36–3.71; p = 0.002) as independent risk factors for erythropoietin hyporesponsiveness. Conclusions: Multiple demographic, clinical, and laboratory factors independently contribute to erythropoietin hyporesponsiveness in hemodialysis patients. Identification of these risk factors may guide clinicians in developing individualized treatment approaches, optimizing erythropoietin dosing, and implementing targeted interventions to improve anemia management in this vulnerable population.
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Renal Cancer with Liver Metastases
(2025)
Villavicencio Soledispa, José
;
Mónica Patricia Soto-Ayala
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Jennifer Paola Freire Timbela
;
Camila Valentina Ortiz Salazar
Kidney cancer is a disease that begins in the kidneys, two bean-shaped organs situated behind the abdominal organs, each about the size of a fist. The kidneys’ primary function is to filter excess water, salt, and waste products from the body, turning these substances into urine. Kidney cancer occurs when healthy cells in one or both kidneys start growing uncontrollably, forming a lump known as a tumor. The most common type of kidney cancer is renal cell carcinoma, which accounts for about 90% of cases. The exact cause of renal cell cancer is unknown; however, several risk factors have been identified. These include smoking, obesity, and high blood pressure. In the early stages, kidney cancer often does not present any symptoms and is usually detected incidentally during imaging tests for other complaints. As the tumor grows, symptoms may include blood in the urine, pain in the lower back, a lump in the lower back or side of the waist, unexplained weight loss, night sweats, fever, or fatigue. Cancer cells can grow into nearby areas and even spread to other parts of the body, a process known as metastasis.
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Hot flashes: a potential marker of deterioration of health-related quality of life
(2026)
Juan E. Blümel
;
María S. Vallejo
;
Peter Chedraui
;
Eugenio Arteaga
;
Félix Ayala
Objective: Hot flashes are among the most common symptoms of the menopausal transition and have traditionally been considered benign and self-limiting. However, increasing evidence suggests that they may indicate broader neurovascular and inflammatory dysregulation linked to reproductive aging. The possible effect of hot flush severity on health-related quality of life (HRQoL) remains inadequately studied, particularly in Latin American populations. This study aimed to examine the association between hot flash severity and HRQoL in middle-aged women using validated tools and a large, multicenter sample. Method: A cross-sectional study was conducted between June 2024 and January 2025 in 30 healthcare centers across 12 Latin American countries. A total of 3523 women aged 40–60 years were assessed using the Menopause Rating Scale (MRS) to evaluate vasomotor symptoms and the Short Form-36 Health Survey (SF-36) to measure HRQoL. Multivariable logistic regression models were utilized to estimate the association between hot flush severity and low HRQoL, adjusting for sociodemographic, behavioral and clinical covariates. Results: Increasing severity of hot flushes was significantly associated with lower HRQoL scores across all SF-36 domains. In the logistic regression analysis, mild hot flushes (MRS item 1 score = 1) were associated with increased odds of impaired HRQoL (odds ratio [OR] 1.29; 95% confidence interval [CI]: 1.08–1.55), whereas very severe symptoms (MRS item 1 score = 4) demonstrated a substantially stronger association (OR 4.10; 95% CI: 2.93–5.74). Additional factors significantly associated with lower HRQoL included physical inactivity, the presence of comorbidities, obesity, current use of psychotropic medication, age ≥50 years and having two or more children. Conclusion: Hot flush severity is a strong and independent determinant of HRQoL in midlife women. These findings underscore the need for systematic assessment and targeted management of vasomotor symptoms in routine care, supporting the hypothesis that hot flashes may be a clinical marker of systemic aging. © 2026 International Menopause Society.
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Sleep disorders and menopausal symptoms: a Latin American perspective on postmenopausal health
(2025)
Eugenio E. Arteaga
;
Juan E. Blümel
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María S. Vallejo
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Carlos Salinas
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Konstantinos Tserotas
Objective: This cross-sectional, observational study, conducted in nine Latin American countries, aimed to examine the association between hot flashes and insomnia, and whether the severity of vasomotor symptoms (VMS) correlates with sleep disturbances. Method: The study collected sociodemographic and clinical data, and evaluated the presence of sleep disorders using Jenkin’s Sleep Scale (JSS-4) and menopausal symptoms using the Menopause Rating Scale (MRS) questionnaire. Results: The study included 1185 postmenopausal women with average age 56.9 ± 5.7 years, body mass index (BMI) of 26.5 ± 5.2 kg/m² and 8.6 ± 6.4 years since menopause. Overall, 20.6% reported sleep disturbances. Compared to those without sleep problems, affected women had longer postmenopausal duration (12 ± 9.0 vs. 10.8 ± 7.8, p < 0.03), had higher BMI (27.9 ± 5.6 vs. 26.1 ± 5.0, p < 0.001), were more often smokers and homemakers, and had more comorbidities. They were also less likely to have a partner or have used menopausal hormone therapy. Sleep disturbances increased proportionally with VMS severity (p < 0.01). In multivariate analysis, sleep disorders were associated with VMS (odds ratio [OR] 4.47), psychotropic use (OR 1.84), obesity (OR 1.45) and comorbidities (OR 1.45). Conclusion: Women with VMS were more likely to experience sleep disorders and this effect was proportional to the magnitude of the hot flashes. The study also presents several factors associated with sleep disorders in postmenopausal women that should be considered to help prevent these disturbances.
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Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment
(2026)
Sebastián Chapela
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Daniel Tettamanti Miranda
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Claudia Kecskes
Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I–III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p < 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = −13 to −15 kcal·kg−1·day−1; p < 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.
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Alcohol and Substance Use After Bariatric Surgery: Nutritional Risks and Clinical Implications in Long-Term Postoperative Care
(2026)
Martín Campuzano-Donoso
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Reytor González, Claudia
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Gerardo Sarno
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Martha Montalvan
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Luigi Barrea
Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a “reward gap” that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS.
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Survival Analysis of Patients with Primary Retroperitoneal Tumors in a Specialty Hospital in Quito-Ecuador in the Period 2009-2019
(2024)
Andres Moreno Roca
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Sánchez , Xavier
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Ricardo Manosalvas
;
Luciana Armijos
;
Ruth JimboSotomayor
Purpose: Primary retroperitoneal tumors (PRT) are various heterogeneous types of neoplasms that have a frequency of less than 1%. The main factors associated with survival are time with the disease, treatment received, and recurrence. This study analyzed the clinical and pathological factors that influence the survival outcomes in patients with PRT. Methods: A retrospective cohort study and a survival analysis were conducted using the available data in the electronic clinical records of patients with a diagnosis of PRT in a specialty hospital in Quito-Ecuador between 2009 and 2019. The included patients were those coded according to the ICD-10 with the C48.0 and C48.8 code. The univariate analysis calculated frequencies, average, and dispersion measurements. Through the Kaplan-Meier method, survival time was analyzed among the different categories of included variables. These differences were shown through the log-rank test. Results: Sarcomas were the most common type of retroperitoneal tumor found. The median survival period among patients was 14 months. Several significant variables were found to be associated with lower rates of survival, including clinical stages III and IV and status of surgical resection. Conclusion: Most of the patients were detected in the late stages of the disease. This could be behind the higher mortality rate and low survival among patients. Variables such clinical stages and status of surgical resection were important risk factors for mortality and should be considered for the prognosis.
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Endometriosis as a Systemic and Complex Disease: Toward Phenotype-Based Classification and Personalized Therapy
(2026)
Simancas Racines, Daniel
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Emilia Jiménez-Flores
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Martha Montalvan
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Raquel Horowitz
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Valeria Araujo
Endometriosis is traditionally conceptualized as a pelvic lesion–centered disease; however, mounting evidence indicates it is a chronic, systemic, and multifactorial inflammatory disorder. This review examines the molecular dialog between ectopic endometrial tissue, the immune system, and peripheral organs, highlighting mechanisms that underlie disease chronicity, symptom variability, and therapeutic resistance. Ectopic endometrium exhibits distinct transcriptomic and epigenetic signatures, disrupted hormonal signaling, and a pro-inflammatory microenvironment characterized by inflammatory mediators, prostaglandins, and matrix metalloproteinases. Immune-endometrial crosstalk fosters immune evasion through altered cytokine profiles, extracellular vesicles, immune checkpoint molecules, and immunomodulatory microRNAs, enabling lesion persistence. Beyond the pelvis, systemic low-grade inflammation, circulating cytokines, and microRNAs reflect a molecular spillover that contributes to chronic pain, fatigue, hypothalamic–pituitary–adrenal axis dysregulation, and emerging gut–endometrium interactions. Furthermore, circulating biomarkers—including microRNAs, lncRNAs, extracellular vesicles, and proteomic signatures—offer potential for early diagnosis, patient stratification, and monitoring of therapeutic responses. Conventional hormonal therapies demonstrate limited efficacy, whereas novel molecular targets and delivery systems, including angiogenesis inhibitors, immune modulators, epigenetic regulators, and nanotherapeutics, show promise for precision intervention. A systems medicine framework, integrating multi-omics analyses and network-based approaches, supports reconceptualizing endometriosis as a systemic inflammatory condition with gynecologic manifestations. This perspective emphasizes the need for interdisciplinary collaboration to advance diagnostics, therapeutics, and individualized patient care, ultimately moving beyond a lesion-centered paradigm toward a molecularly informed, holistic understanding of endometriosis.
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Molecular Bases of Myopathies and Their Impact on Clinical Practice: Advances and Future Perspectives
(2026)
Martín Campuzano-Donoso
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Reytor González, Claudia
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Melannie Toral-Noristz
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Yamilia González
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Simancas Racines, Daniel
Myopathies represent a highly heterogeneous group of primary muscle disorders, traditionally classified based on clinical presentation and histopathological findings. Recent breakthroughs in molecular genetics, immunology, and pathophysiology have revolutionized the understanding, diagnosis, and management of these conditions. Both inherited and acquired forms of myopathy, including structural, metabolic, inflammatory, endocrine, and mitochondrial subtypes, are now recognized to arise from diverse pathogenic mechanisms such as impaired calcium handling, mitochondrial dysfunction, chronic inflammation, altered metabolism, and defective muscle regeneration. The advent of next-generation sequencing technologies has enabled more precise diagnosis of genetic forms, while the discovery of novel molecular biomarkers and immunological signatures offers promising avenues for disease monitoring and stratification across the broader spectrum. Importantly, molecular and mechanistic insights have redefined clinical classifications, allowing for better prognostic predictions and patient-tailored therapeutic approaches. Innovative treatments, including gene therapy, antisense oligonucleotide therapies, immune-modulating agents, metabolic support strategies, and targeted pharmacological interventions, are progressively translating molecular knowledge into clinical applications. However, technical limitations, biological variability, and ethical considerations continue to pose significant challenges to the implementation of precision medicine in myopathies. In this narrative review, we comprehensively discuss the latest molecular findings, their integration into clinical practice, and the emerging therapeutic strategies based on these discoveries. We also highlight current limitations and propose future research directions aimed at bridging the gap between molecular insights and effective, equitable patient care.
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Maternal and neonatal outcomes among adolescent mothers in a high-risk NICU population in Ecuador
(2026)
Mónica Sánchez-Moreira
;
González Andrade, Fabricio
Background: Adolescent pregnancy remains a public health concern in Ecuador, particularly among socially vulnerable populations. Evidence from high-risk neonatal settings suggests that adverse neonatal outcomes associated with adolescent pregnancy may be strongly influenced by structural and healthcare-related factors rather than maternal age alone. However, data from neonatal intensive care units (NICUs) in low- and middle-income countries remain limited. Objective: To compare maternal characteristics, obstetric practices, and neonatal outcomes between adolescent and adult mothers in a high-risk NICU population in Ecuador, stratified by term (37–41 weeks) and preterm (< 37 weeks) births, and to identify clinical predictors of neonatal distress. Methods: A cross-sectional observational study was conducted using medical records from the Neonatal Intensive Care Unit of Pablo Arturo Suárez General Hospital (Quito, Ecuador) between 2018 and 2021. The study included 288 neonates admitted with prenatal, perinatal, or postnatal risk factors for pulmonary hypertension. Four groups were analyzed: term and preterm neonates born to adolescent mothers and to adult mothers (n = 72 per group). Neonatal distress was operationally defined by adverse early clinical indicators, including low APGAR score, low birth weight for gestational age, and the presence and severity of pulmonary hypertension. Multivariate ordinal logistic regression models were used to identify predictors of neonatal distress. Results: Adolescent mothers had significantly lower educational attainment, lower socioeconomic status, and fewer prenatal care visits compared with adult mothers (p < 0.001). Cesarean section rates were markedly higher among preterm adolescent pregnancies (91.7% vs. 25.0% in adults). Neonatal outcomes differed across groups: among term births, only 26.4% of infants born to adolescent mothers had normal APGAR scores compared with 75.0% among adults (p < 0.001), and low birth weight was more frequent (65.3% vs. 25.0%). In multivariate analyses, low birth weight and moderate-to-severe pulmonary hypertension were the strongest independent predictors of neonatal distress, whereas maternal age showed no direct effect after adjustment. Conclusions: In this high-risk NICU population, adolescent mothers experienced greater socioeconomic disadvantage, inadequate prenatal care, and higher rates of obstetric intervention, which were associated with poorer neonatal indicators. Adverse outcomes were primarily driven by clinical and structural factors—particularly low birth weight and pulmonary hypertension—rather than maternal age itself. These findings highlight the need for targeted improvements in prenatal care and social support for adolescent mothers within high-risk clinical settings. © The Author(s) 2026.
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Facultad de Ciencias de la Salud y Bienestar Humano

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