Facultad de Ciencias de la Salud y Bienestar Humano

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Universidad Indoamérica

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Comparison of Arterial Access Sites in an Oncologic ICU: Is Brachial Artery Catheterization a Safe Alternative?
(SAGE Publications, 2026-07-21)
Unigarro, Luis
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Basantes, Emérita
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Llerena, Pablo
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Yu-Liu, Yunqi
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Palacios, Jonathan
Introduction Continuous invasive arterial blood pressure monitoring is the reference standard in the intensive care unit (ICU) for cardiovascular management. This study aimed to evaluate the safety of brachial arterial catheterization compared with radial and femoral approaches. Methods A retrospective observational study of critically ill oncologic patients admitted to the ICU of Hospital SOLCA (Quito, Ecuador) between January 2021 and December 2023 was conducted. Data were extracted from the REDCap. Continuous variables were summarized as medians (IQR) and dichotomized at the median for regression analyses. Univariable logistic regression evaluated associations between clinical variables and catheter site (radial vs brachial). Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and statistical significance was defined as p < .05. Results A total of 305 arterial catheterizations were analyzed. Radial access was most frequently used (75.59%), followed by brachial (18.78%) and femoral (3.76%). In univariable analysis, admission priority III (OR 2.57, 95% CI 1.13-5.68; p = .02) and requiring two or more catheterization attempts (OR 11.50, 95% CI 4.81-29.20; p < .001) were significantly associated with catheter site. No vascular, infectious, or neurological complications were observed. Conclusion Admission priority III and multiple attempts were significantly associated with catheter site selection. Brachial access demonstrated a safety profile comparable to radial and femoral sites, representing a valid alternative when radial cannulation is not feasible. Arterial catheterization in critically ill oncologic patients was safe, with very low complication rates. Prospective studies are warranted to confirm these findings.
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FDA safety concerns and menopausal-like symptoms in postmenopausal statin users
(Ovid Technologies (Wolters Kluwer Health), 2026-06-16)
Blümel, Juan E.
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Chedraui, Peter
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Vallejo, María S.
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Aedo, Sócrates
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Gómez-Tabares, Gustavo
Objectives: In light of US Food and Drug Administration (FDA) warnings about adverse effects of statin therapy, some of which resemble menopausal complaints, this study compared menopause-related manifestations [Menopause Rating Scale (MRS), cognitive, and musculoskeletal symptoms] between users and non-users of statins among postmenopausal women. Methods: This multinational, cross-sectional sub-analysis of the REDLINC XII study included 1,184 postmenopausal women from nine Latin American countries. Menopausal symptoms were assessed with the MRS, cognitive function with the Montreal Cognitive Assessment (MoCA), and sarcopenia risk with the SARC-F questionnaire. Multivariable logistic regression models evaluated associations between statin therapy and outcomes (menopausal symptoms, cognition, and sarcopenia risk) after adjustment for sociodemographic, lifestyle, and clinical factors Results: Of the 1,184 women, 307 (25.9%) used statins. Compared with non-users, statin users had a higher prevalence of severe menopausal symptoms (47.2% vs. 30.6%), more intense musculoskeletal symptoms (53.1% vs. 33.9%), and higher sarcopenia risk (28.7% vs. 16.5%; all P =0.0001). In multivariable logistic regression analyses, statin therapy was not associated with mild cognitive impairment defined by the MoCA global score, although exploratory analyses suggested poorer performance in delayed recall memory and visuospatial function among users. Statin therapy remained independently associated with severe menopausal symptoms [odds ratio (OR): 1.56; 95% CI: 1.17-2.10] and sarcopenia risk (OR: 1.65; 95% CI: 1.19-2.29). Conclusions: In postmenopausal women, statin therapy was not associated with mild cognitive impairment; however, statin use was linked to poorer delayed recall memory and visuospatial function and a higher burden of menopausal symptoms and sarcopenia risk. Statin-related cognitive and somatic effects may overlap with menopausal symptomatology and contribute to symptom burden during midlife.
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Andrographolide-Loaded Gold Carbon Quantum Dots and Their Doped Derivatives for Enhanced Hydrophilicity in a Drug Delivery System
(MDPI AG, 2026-05-24)
Pantoja-Romero, Wenndy
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Lavín Flores, Alexis
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Lozada Jerez, Jose Alejandro
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Perez-Salvá, MiaSara
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Rosa-Suárez, Fabiola
Background/Objectives: Andrographolide (ADG) is a plant-derived compound with promising anticancer properties, but its medical use is limited due to poor water solubility and low bioavailability. This study proposes developing a gold-based nanocomposite drug delivery system, using a simplified synthesis method, to improve ADG’s hydrophilicity and enhance its delivery efficiency. Methods: A one-step method was used to synthesize gold nanocomposites with carbon quantum dots (CBQDs) and doped CBQDs acting as reducing and stabilizing agents. These nanocomposites were then conjugated with ADG and thoroughly characterized using multiple structural and spectroscopic techniques such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), ultraviolet–visible spectroscopy (UV–Vis), transmission electron microscopy (TEM), Raman spectroscopy, and nuclear magnetic resonance (NMR) spectroscopy. Hydrophilicity enhancement was evaluated using NMR-based log P measurements. Biological assessment involved cell viability assays and confocal microscopy studies in PC3 prostate cancer cells, along with the morphological evaluation of human red blood cells. Results: XRD confirmed the formation of crystalline, face-centered cubic gold nanoparticles, while spectroscopic analyses verified successful nanocomposite formation and ADG conjugation. NMR results showed enhanced hydrophilicity of ADG. Biological tests demonstrated that the nanocomposites were compatible with cells. Conclusions: This study presents a straightforward strategy for synthesizing gold-based nanocomposites that enhance the hydrophilicity and delivery potential of andrographolide, supporting their applicability as nanocarrier platforms for anticancer drug delivery. © 2026 by the authors.
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Uncovering the hidden burden of congenital anomalies in Ecuador: a national integrated analysis of hospital discharges, mortality records, and live birth statistics (2012–2024)
(Springer Science and Business Media LLC, 2026-07-02)
González Andrade, Fabricio
Background: Congenital anomalies (CA), ICD-10 Q00–Q99 codes, are major causes of infant morbidity and mortality, but national assessments remain limited in countries without integrated birth defect surveillance. This study characterized hospital burden, mortality, and epidemiological patterns of CA among infants in Ecuador. Methods: A retrospective descriptive analysis of national administrative records was conducted using data from the INEC. Hospital discharge records covered 2012–2024, while mortality records and live birth statistics were incorporated according to availability. Analyses were restricted to infants under 1 year of age. Descriptive statistics, graphical assessment of temporal patterns, non-parametric comparison between periods, and correlation analyses were applied. Results: Overall, 43,134 hospital discharge events associated with CA were recorded, with a mean annual count of 3,318. Separately, in the code-level analysis of the 50 most frequent ICD-10 diagnostic codes, cardiovascular, musculoskeletal, and genitourinary categories accounted for the largest aggregated counts. Hospital discharges decreased significantly during the pandemic/post-pandemic period compared with 2012–2019 (-21.8%, p = 0.0015). Mortality indicators varied across conditions, with higher death-to-discharge ratios in selected cardiac, valve, pulmonary, and body wall anomalies. Hospital discharge rates ranged from 10.67 to 13.18 per 1,000 live births during 2021–2024. Mortality rates ranged from 1.38 to 1.47 per 1,000 live births; however, only 2021 and 2024 mortality values were observed, whereas 2022 and 2023 were interpolated. A moderate correlation was observed between hospital discharges and deaths (r ≈ 0.48). Conclusion: CA impose a substantial burden on infant health services in Ecuador. Integrating hospital discharge, mortality, and live birth data revealed complementary but non-equivalent dimensions of burden, supporting stronger surveillance, improved data linkage, and timely referral pathways for high-risk conditions. © The Author(s) 2026.
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Rethinking Tuberculosis Treatment Abandonment in Latin America: A Biopsychosocial Perspective and an Integrated Model for Continuity of Care
(MDPI AG, 2026-07-24)
Torres Rodriguez, Ariel Antonio
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González, Paloma
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Fors, Martha
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Trujillo Lopez, Gisselle
Background: Tuberculosis remains a major public health challenge in Latin America, where social inequalities, fragmented health systems, and barriers to care continue to undermine disease control. Although effective treatment is available, treatment abandonment and loss to follow-up remain persistent obstacles to successful outcomes. Methods: A structured critical analysis of the contemporary literature on tuberculosis treatment abandonment and retention in care was conducted using a narrative evidence synthesis approach. Forty scientific documents published between 2018 and 2026 were included. Of these, 23 Latin American studies informed the results synthesis, while 13 international studies supported the comparative critical reflection. Results: Findings were organised into five domains: social vulnerability, clinical complexity, health system barriers, priority populations, and protective factors and innovation. The evidence indicates that treatment abandonment is not an isolated individual behaviour, but a phenomenon associated with the convergence of social, clinical, and institutional determinants across the care trajectory. Poverty, migration, drug resistance, incarceration, weak follow-up systems, and fragmented care were repeatedly associated with discontinuity, whereas social support, active follow-up, digital tools, and economic measures were linked to improved adherence and retention in care. Conclusions: From a biopsychosocial perspective, treatment abandonment should be understood as a systemic and preventable failure across the tuberculosis care continuum. The proposed Latin American Integrated Model for Retention in Tuberculosis Care (MILERTB) offers an anticipatory, equity-oriented, and person-centred framework to strengthen retention in care and guide future implementation research. © 2026 by the authors.
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Giant uterine leiomyoma successfully managed by surgical excision: a case report
(Oxford University Press (OUP), 2026-04-01)
Llerena Freire, Luis F
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Llerena Ojeda, Cintya A
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Llerena Morales, Gloria A
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Vela Arias, Gabriela D
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Arteaga Terán, Joaury L
Giant uterine leiomyomas (>10 cm) are uncommon in the modern imaging era and may mimic ovarian malignancy due to their size and heterogeneous appearance, posing a diagnostic and therapeutic challenge. A 34-year-old nulliparous woman presented with progressive abdominal distension and pelvic pressure. Imaging revealed a 19 × 14 cm multinodular uterine mass with heterogeneous features and preserved surrounding fat planes. Given the patient’s strong desire for uterine preservation, an open abdominal myomectomy was performed. A highly vascular, multicompartmental leiomyoma arising from the uterine body was successfully enucleated with vasopressin-assisted hemostasis and meticulous multilayer myometrial reconstruction. Estimated blood loss was 1000 ml without transfusion. Histopathology confirmed a benign leiomyoma. The postoperative course was uneventful. This case highlights that, despite their size and complexity, giant multicompartmental leiomyomas can be safely managed with uterine-preserving myomectomy in carefully selected patients. Adequate preoperative assessment, intraoperative vascular control, and advanced reconstructive techniques are critical to guide surgical decision-making and optimize outcomes. © The Author(s) 2026. Published by Oxford University Press and JSCR Publishing Ltd.
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Kabisa: A Support for Teaching Decision Making in Medicine, Comparative Study
(Springer Nature Switzerland, 2026)
Sánchez Redrobán, José
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Navas, María Fernanda
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Ferrero, Federico
Decision thresholds are crucial in medicine, guiding diagnosis and treatment. This study explores the impact of Kabisa software on medical students’ clinical decision-making. Kabisa, a computer-based program, trains students in diagnostic problems in tropical and subtropical regions. Using a comparative approach with problem-based learning (PBL), this study evaluates the effectiveness of Kabisa in enhancing clinical reasoning skills. Results indicate a statistically significant improvement in diagnostic accuracy among students using Kabisa. This highlights the potential of Kabisa as a valuable tool for medical education, particularly in the context of PBL. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.
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Effective Reproduction Number (Re) Analysis of BCG Vaccination Impact on Tuberculosis Control in Ecuador: An Artificial Intelligence Approach with Sensitivity Analysis
(Springer Nature Switzerland, 2026)
Sánchez Redrobán, José
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Paredes Andrade, Adrila Nicole
Background: Tuberculosis remains a major public health challenge globally, with Ecuador reporting significant burden despite vaccination programs. The effective reproduction number provides insights into transmission dynamics under control measures. Methods: We developed a modified SVIR (Susceptible-Vaccinated-Infected-Recovered) compartmental model using Bayesian optimization to analyze BCG vaccination impact on TB transmission in Ecuador during 1995–2007. We calculated effective reproduction numbers (Re) and conducted comprehensive sensitivity analyses to quantify vaccination program effectiveness while accounting for parameter uncertainty. Results: Our analysis revealed an average effective reproduction number (Re) of 0.003 (95% CI: 0.002–0.004), indicating well-controlled transmission dynamics. The model estimated that BCG vaccination contributed to an average reduction of 54.59 cases per 100,000 population (49.65% reduction; 95% CI: 45.2–54.1%) compared to counterfactual scenarios without vaccination. Sensitivity analysis confirmed robustness of findings across parameter variations, with vaccine efficacy estimates ranging from 40–60% producing similar results. Conclusions: Ecuador’s universal BCG vaccination policy significantly contributed to TB control during the study period. However, the observed low Re values reflect the combined effect of vaccination, case detection, and treatment programs rather than vaccination alone. These findings support continued vaccination within comprehensive TB control strategies while acknowledging the need for complementary interventions. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.
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Predicting University Students’ Lifestyle Quality (CEVJU) Using Socio-Demographic and Contextual Factors: A Machine Learning Approach for Personalized HCI Interventions
(Springer Nature Switzerland, 2026)
Esparza Yánez, Wilmer
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Iñiguez Jiménez, Samuel Olegario
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Vinueza Fernández, Israel Santiago
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Espinosa Pinos, Carlos Alberto
The transition to university life is a critical period for health-behavior adoption. This study evaluates the predictive capacity of five low-effort socio-demographic and contextual variables age, sex, ethnicity, parish type, and the Multidimensional Poverty Index (MPI) for classifying lifestyle risk using the University Student Lifestyle Questionnaire (CEVJU) in 370 Ecuadorian undergraduates. A Random Forest model (10-fold × 3-repeat CV) achieved AUC-ROC = 0.560 and accuracy of 71.8% against a No-Information Rate of 68.9% (+2.9 pp). Parish type was the strongest predictor, followed by age and MPI. The central finding is diagnostic: static socio-contextual variables alone have limited predictive power, motivating a tiered personalization framework for proactive HCI systems that progressively incorporates real-time behavioral signals. This framework constitutes the primary HCI contribution. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.
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Political stability, health system resilience, and macroeconomic shocks as factors associated with malaria control outcomes: a comparative analysis of Ecuador and Venezuela (2000–2023)
(Springer Science and Business Media LLC, 2026-06-20)
Sánchez Redrobán, José
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Mideros Mora, Maria Cristina
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Jaramillo Pérez, Melissa
Background: The post-2000 period in South America presents a striking divergence in malaria epidemiology: Ecuador achieved a >99% reduction in malaria incidence approaching elimination, while Venezuela experienced one of the most severe resurgences in modern public health history. We examined the association between governance factors, health policies, intersectoral coordination, and malaria control outcomes by comparing the national experiences of Ecuador and Venezuela. Methods: We conducted a comparative ecological study using epidemiological data from WHO World Malaria Reports and PAHO updates (2000–2023), integrated with political stability indices, health expenditure data, GDP per capita, poverty rates, and crude-oil price series from World Bank and CFR databases. A joinpoint (segmented) regression model was applied to each country’s log-transformed malaria incidence time series to identify statistically significant inflection points and estimate annual percentage change (APC) per segment. A multi-dimensional framework assessed governance, health-system capacity, surveillance infrastructure, intersectoral coordination, and community engagement. We also examined systemic fragility through concurrent infectious disease trends (diphtheria, measles, tuberculosis) in Venezuela. Use of AI language models is declared in the Methods. Results: Ecuador reduced cases from 106,641 (2001) to 757 (2023), a 99.3% reduction. The joinpoint model identified two significant inflection points (2008, 2014) delineating three phases of declining trend (APC: -34.2%, -12.5%, -1.2%). Venezuela experienced a 1,217% increase from 35,500 (2000) to a peak of 527,627 (2018); a single joinpoint at 2014 marked a shift from non-significant endemic transmission (APC: +2.8%, p=0.12) to explosive resurgence (APC: +84.6%, p<0.001), temporally coinciding with the global crude-oil price collapse and ensuing fiscal contraction. Post-2018 case declines in Venezuela are accompanied by concurrent surveillance collapse, mass emigration, and reduced care-seeking, suggesting underreporting rather than epidemiological improvement. Pearson correlations with malaria incidence were observed for political stability index (r=-0.85), health expenditure (% GDP, r=-0.78), poverty rate (r=+0.82), and crude-oil price (r=-0.89) in Venezuela. These correlations should be interpreted with caution given potential confounding and collinearity among indicators. Comparison across five governance-resilience domains using PAHO/WHO operational criteria shows systematic differences between countries. Resurgence of diphtheria (>1,600 cases), measles (>7,300 cases), and tuberculosis (near-doubling of incidence) in Venezuela occurred concurrently with the malaria resurgence. Conclusions: Health-system resilience and governance quality appear to be associated with the relationship between macroeconomic shocks and epidemiological outcomes. The strong collinearity between political stability and commodity-price cycles in Venezuela precludes definitive attribution to either factor independently. Technical interventions may be insufficient without stable governance, protected financing, and institutional continuity. Recommendations aligned with the PAHO malaria elimination framework are provided. © The Author(s) 2026.

Facultad de Ciencias de la Salud y Bienestar Humano

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