Facultad de Ciencias de la Salud y Bienestar Humano
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Inventory of instruments, medical devices, equipment and building facilities containing mercury in health facilities

2025 , Villavicencio Soledispa, José , Ortiz Salazar, Camila , Freire Timbela, Jennifer , Toaquiza Quinapallo, Mayra

The inventory of instruments, medical devices, equipment and building facilities containing mercury in health facilities was carried out on July 11, 2023 at the Riobamba Private Hospital, covering areas such as Hospitalization, Dentistry and Various Services. Devices containing mercury were identified, consisting of: 187 thermometers (oral, rectal and pediatric) with a total of 336.6 grams distributed in the hospital's rooms and warehouse, 1 laboratory thermometer with 4.4 grams in the clinical laboratory, 1 sphygmomanometer/tensiometer with 95 grams in the delivery room, and 1 gastrointestinal tube with 907 grams in the gastroenterology area. As for building equipment and facilities that contain mercury, they include: 2 in boiler indicator controls with 4,445.28 grams of mercury in the kitchen; 3 flow meters with a total of 15,000 grams distributed between the machine room and traumatology, 46 flame sensors with 138 grams, 30 pressure switches and 30 temperature switches with 345 and 165 grams of mercury, 22 inclined mercury switches with a total of 785.4 grams and 502 compact fluorescent lamps and 388 linear ones distributed in all hospital services. The waste inventory includes 187 thermometers with 1,870 grams of mercury, 1 blood pressure monitor with 95 grams, and a gastrointestinal tube with 907 grams. No esophageal dilators with mercury are reported. Dental amalgam waste contains 0.01 micrograms of mercury, with no current waste. There are 893 luminaires, lamps and fluorescent tubes with 455,430 grams of mercury. No waste from mercury switches is reported. 462 grams of liquid mercury is recorded in dentistry.

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Severe menopausal symptoms linked to cognitive impairment: an exploratory study

2024 , Calle Miñaca, Andrés , Juan E. Blümel , Peter Chedraui , María S. Vallejo , Alejandra Belardo , Maribel Dextre , Alejandra Elizalde-Cremonte , Carlos Escalante , María T. Espinoza , Gustavo Gómez-Tabares , Álvaro Monterrosa-Castro , Mónica Ñañez , Eliana Ojeda , Claudia Rey , Doris Rodríguez , Marcio A. Rodrigues , Carlos Salinas , Konstantinos Tserotas , Sócrates Aedo

Objective To evaluate the association between menopausal symptoms and cognitive decline in postmenopausal women. Methods This was a subanalysis of a cross-sectional, observational study conducted among women attending gynecological consultations across nine Latin American countries. The survey involved late postmenopausal women who were asked to complete a general questionnaire and the Menopause Rating Scale (MRS) to assess menopausal symptoms, with the Montreal Cognitive Assessment used to evaluate cognitive function as an outcome. A Montreal Cognitive Assessment score of less than 21 was used to define women with mild cognitive impairment (MCI). Results The study included 1,287 postmenopausal women with a mean age of 55.5 years and a mean body mass index of 26.3 kg/m2. On average, participants had 13.8 years of education and 2.3 ± 1.8 children, with 72.8% reporting having a partner. Additionally, 36.7% ever used menopausal hormone therapy. Regarding lifestyle factors, 50.3% engaged in a sedentary lifestyle, whereas 70.5% had never smoked. 15.3% of women had MCI exhibited significantly more intense menopausal symptoms compared with those without MCI (MRS total score 15.24 ± 12.58 vs 10.53 ± 8.84, respectively, P < 0.001). Logistic regression analysis revealed a significant association between severe menopausal symptoms (MRS total score ≥14 points) and MCI (odds ratio [OR], 1.74; 95% CI, 1.25-2.42). Conversely, a lower body mass index (OR, 0.96; 95% CI, 0.95-0.98), sexual activity (OR, 0.70; 95% CI, 0.51-0.96), physical exercise (OR, 0.55; 95% CI, 0.39-0.76), menopausal hormone therapy use (OR, 0.36; 95% CI, 0.24-0.55), and higher educational level (OR, 0.31; 95% CI, 0.21-0.46) were associated with lower odds for MCI. Conclusion Severe menopausal symptoms in postmenopausal women were associated with cognitive impairment. This study highlights the intricate interplay between hormonal, lifestyle, and sociodemographic factors and cognitive health.

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HIV Disease hospitalizations and factors associated with in‐hospital mortality in Ecuador: A nationwide analysis from 2015 to 2023

2025 , German Josuet Lapo‐Talledo , Ángel Luis Zamora Cevallos , Carlos Rafael Arteaga Reyes , Sánchez Redrobán, José , Jhon Ernesto Delgado Pinargote , Ángela María Espinoza Guevara , Edgar Antonio Menéndez Cuadros

Human immunodeficiency virus (HIV) remains a significant public health concern worldwide, contributing to notable rates of hospitalization and mortality. This study aimed to analyse HIV disease hospitalization trends and factors associated with in‐hospital mortality in Ecuador during 2015–2023. Methods Official national hospital discharge data were used. Hospitalization and in‐hospital mortality rates were calculated. Multivariable logistic regression was performed to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to identify factors associated with in‐hospital mortality. Results: Totally 28 408 HIV disease hospitalizations were analysed; the majority were males 61.19% (n = 17 383). Average hospitalization rate was 18.48 per 100 000 inhabitants. In‐hospital deaths accounted for 11.31% (n = 3214). Older age (≥40 years) was significantly associated with a higher likelihood of death, particularly in 60–69 years (aOR 1.78, 95% CI 1.49–2.13) and ≥70 years (aOR 1.79, 95% CI 1.36–2.34). Patients with HIV‐related Pneumocystis jirovecii pneumonia (aOR 2.74, 95% CI 2.28–3.29) and multiple malignant neoplasms (aOR 4.30, 95% CI 1.66–11.15) had the highest mortality likelihood. Although a declining trend in mortality rates was observed throughout 2015–2023, there was an increase in mortality probabilities in 2021 which may be linked to healthcare disruptions during the COVID‐19 pandemic, while subsequent decline in 2022 and 2023 suggests improvements in HIV care access.ConclusionsWhile HIV‐related hospitalizations and mortality have declined in Ecuador, older patients and those with severe opportunistic infections or malignancies remain at higher risk. These findings underscore the need for early diagnosis, enhanced management of HIV‐related complications and sustained antiretroviral therapy (ART) coverage, particularly during public health crises.

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Effect of Ph on the Physicochemical Properties of a Cassava Peel Starch Biopolymer

2025 , Anchundia, Lisbeth , Jadán Piedra, Felipe , Macías Alcívar, José , Sánchez Mendoza, Virginia , Giler Intriago, Sonia

Background/Aims: This study investigates how pH levels affect the characteristics of biopolymer films manufactured from cassava peel starch. Cassava peel starch‘s abundance and biodegradability make it a promising candidate for sustainable packaging. The study seeks to improve film qualities such as thickness, density, moisture content, solubility, and optical properties by altering pH levels. Understanding these effects is critical for increasing the acceptability of cassava peel starch biopolymers in a variety of industrial applications, notably environmentally friendly packaging solutions. Methods: Starch extracted from cassava peel was used to produce films using the casting method at specified pH levels. The films were evaluated for thickness and density using classical methods. Moisture content was determined following the AOAC 930.15 (2000) protocol. Color analysis was conducted using the CIELab color space technique. Water solubility and solubility in acidic (HCl) and alkaline (NaOH) solutions were assessed through chemical solubility tests performed by gravimetry. Results: The study investigated how pH impacts biopolymer films manufactured from cassava peel starch. The film thickness varied greatly across pH levels, with pH 10.5 creating the thickest films (0.158 ± 0.012 mm) and pH 6.5 providing the thinnest (0.118 ± 0.015 mm). Density varied slightly, from 1.393 ± 0.122 g/cc to 1.551 ± 0.153 g/cc. Moisture content fluctuated significantly, affecting biodegradability. Color study indicated pH-dependent variations in transparency and opacity, with higher pH values resulting in larger color deviations (∆E). Water solubility remained constant, but NaOH solubility dropped with increasing pH, peaking at pH 7.5 (23.44 ± 2.82%). Conclusion: This work investigates the use of cassava peel starch for biopolymer synthesis at controlled pH levels. The findings demonstrate the material‘s practicality and provide critical insights for enhancing film qualities, particularly in a variety of industrial applications and environmentally friendly packaging solutions.

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A comprehensive framework for integrating modern educational technologies with problem-based learning in medical education

2025 , Sánchez Redrobán, José , Monserrat Vanessa Romero-Duran

Problem-Based Learning (PBL) has evolved from its traditional roots into a sophisticated pedagogical approach enhanced by advanced digital technologies, including artificial intelligence as a subset of these digital innovations. This comprehensive framework provides medical educators with evidence-based guidance for implementing technology-enhanced PBL methodology, incorporating both traditional principles and modern technological tools. We synthesize current literature from 2019 to 2025, analyzing research findings to create actionable recommendations for educators seeking to implement or improve their PBL programs. Recent studies demonstrate significant improvements through technology integration: 34% enhancement in diagnostic accuracy (Yang et al. in J Pharm Educ Pract 12:112–120, 2024), 28% better knowledge retention (Yan et al. in BMC Med Educ 23:456, 2023), and 42% increase in student engagement (Matsuda and Izumi in Med Educ Online 29:2345, 678, 2024). The integration of virtual patients, simulation-based learning, and adaptive systems shows promising results in enhancing traditional PBL methodologies while maintaining core pedagogical principles. Our proposed framework addresses implementation planning, role definitions, assessment strategies, and quality assurance mechanisms that medical educators can immediately apply across diverse cultural and institutional contexts. © The Author(s) 2025.

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Association between type of menopause and mild cognitive impairment: The REDLINC XII study

2024 , María T. Espinoza , Juan E. Blümel , Peter Chedraui , María S. Vallejo , Mónica Ñañez , Eliana Ojeda , Claudia Rey , Doris Rodríguez , Marcio A. Rodrigues , Carlos Salinas , Konstantinos Tserotas , Calle Miñaca, Andrés , Maribel Dextre , Alejandra Elizalde , Carlos Escalante , Gustavo Gómez-Tabares , Álvaro Monterrosa-Castro

Objective: To evaluate the association between type of menopause (spontaneous or surgical) and mild cognitive impairment (MCI). Study design: This study was a cross-sectional, observational, and sub-analytical investigation conducted within gynecological consultations across nine Latin American countries. Method: We assessed sociodemographic, clinical, and anthropometric data, family history of dementia, and the presence of MCI using the Montreal Cognitive Assessment (MoCA) tool. Results: The study involved 1185 postmenopausal women with a mean age of 55.3 years and a body mass index of 26.4 kg/m2. They had an average of 13.3 years of education, and 37 % were homemakers. Three hundred ninety-nine experienced menopause before 40, including 136 with surgical menopause (bilateral oophorectomy). Out of the 786 women who experienced menopause at 40 or more years, 110 did so due to bilateral oophorectomy. There were no differences in MoCA scores among women who experienced menopause before or after the age of 40. However, lower MoCA scores were observed in women with surgical menopause than in those with spontaneous menopause (23.8 ± 4.9 vs. 25.0 ± 4.3 points, respectively, p < 0.001). Our logistic regression model with clustering of patients within countries found a significant association between MCI and surgical menopause (OR 1.47, 95 % CI: 1.01–2.16), use (ever) of menopausal hormone therapy (OR 0.33, 95 % CI: 0.21–0.50), and having >12 years of education (OR 0.21, 95 % CI: 0.14–0.30). Conclusion: When comparing women who experience spontaneous menopause over the age of 40 with those who undergo it before this age, there was no observed increased risk of developing MCI, while those with surgical menopause, independent of age, are more prone to cognitive decline. Women who have ever used menopausal hormone therapy have a lower MCI risk. Further research is warranted to delve deeper into this topic.

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Unraveling the association between obesity and climacteric symptoms: a generalized structural equation modeling approach

2025 , Sócrates Aedo , Juan Enrique Blümel , María Soledad Vallejo , Claudia Rey , Marcio Alexandre Rodrigues , Doris Rodríguez-Vidal , Carlos Salinas , Konstantinos Tserotas , Calle Miñaca, Andrés , Maribel Dextre , Alejandra Elizalde , Carlos Escalante , María Teresa Espinoza , Gustavo Gómez-Tabares , Álvaro Monterrosa-Castro , Eliana Ojeda , Mónica Ñañez

Objective: To assess the direct and indirect associations between obesity and the severity of menopausal symptoms in postmenopausal women, considering related conditions such as chronic diseases and physical activity. Methods: This observational subanalysis utilized data from the REDLINC XII multinational study, which included 722 postmenopausal women aged 70 or younger from 9 Latin American countries. Menopausal symptoms were measured using the Menopause Rating Scale (MRS). Clinical, behavioral, and sociodemographic data were obtained through physician-administered surveys. Generalized Structural Equation Modeling was employed to examine the direct and indirect relationships between obesity, chronic cardiovascular and respiratory diseases, chronic hypertension, diabetes mellitus, and physical activity, and MRS scores. Odds ratios (ORs) were calculated to enhance interpretability. Results: A total of 722 participants were included. Obesity was directly associated with higher MRS scores (OR = 1.75). In addition, obesity exhibited indirect associations with MRS scores, with an odds ratio of 19.07, through chronic arterial hypertension, diabetes mellitus, physical inactivity, and chronic cardiovascular or respiratory diseases. The total association between obesity and MRS scores was reflected in an OR of 33.45. Furthermore, physical inactivity and the use of antidepressants were associated with greater symptom severity, whereas higher educational attainment, regular physical activity, and menopausal hormone therapy were associated with lower MRS scores. Conclusions: Obesity is strongly associated with more severe menopausal symptoms, both directly and through related chronic conditions and behavioral factors. Longitudinal studies are needed to establish temporal and causal inferences.

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Physical activity as an alternative or adjunct to menopausal hormone therapy for symptom management in women with primary ovarian insufficiency

2026 , Félix Ayala , Juan E. Blümel , María S. Vallejo , Peter Chedraui , Hugo Gutiérrez-Crespo , Marcela López , Juan Matzumura-Kasana , Paolo Meza , Álvaro Monterrosa-Castro , Mónica Ñañez , Eliana Ojeda , Claudia Rey , Ana Lucia Ribeiro Valadares , Doris Rodríguez-Vidal , Marcio A.H. Rodrigues , Javier Saavedra , Carlos Salinas , Lida Sosa , Konstantinos Tserotas , Margot Acuña-San Martín , Marcela S. Aguirre , Eugenio Arteaga , Ascanio Bencosme , Calle Miñaca, Andrés , Lucia Costa-Paiva , Maribel Dextre , Karen Díaz , Alejandra Elizalde-Cremonte , Santiago Elizalde-Cremonte , Carlos Escalante , María T. Espinoza , Ircania García , Gustavo Gómez-Tabares

Background: Physical activity alleviates menopausal symptoms in women whose menopause occurs after the age of 45; however, its effect in primary ovarian insufficiency, which occurs before the age of 40, remains unknown. Objective: To examine the association between physical activity, menopausal symptoms, and the use of menopausal hormone therapy in women with primary ovarian insufficiency. Methods: We analysed data from 4708 participants from two studies conducted in 12 Latin American countries. After applying eligibility criteria, 564 women with primary ovarian insufficiency (351 idiopathic and 213 surgical) were included. Menopausal symptoms were assessed using a validated scale, and severe symptoms were defined according to established cut-offs. Physical activity was classified according to international recommendations for moderate-intensity activity. Logistic regression models were adjusted for sociodemographic, clinical, and lifestyle variables. Results: The prevalence of severe menopausal symptoms was 39.2%, with no significant difference between idiopathic and surgical primary ovarian insufficiency. Women with severe symptoms were less likely to meet recommended levels of physical activity or to be current users of menopausal hormone therapy. In adjusted models, regular physical activity (OR 0.65; 95% CI 0.45–0.94) and current use of menopausal hormone therapy (OR 0.27; 0.17–0.42) were associated with a lower likelihood of severe symptoms, whereas obesity and use of psychotropic medication were associated with a higher likelihood. Conclusions: Women with primary ovarian insufficiency who engage in regular physical activity or currently use menopausal hormone therapy report less severe menopausal symptoms. Regular exercise may be an important non-hormonal option for women who cannot or prefer not to use hormone therapy. © 2026 Elsevier B.V.

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Body Composition Evaluation using Bioelectrical Impedance and its Impact on Academic Performance of Nursing Students

2023 , Romero Riaño, Paola , Camaño Carball, Lilian , Yánez-Rueda H. , Buele, Jorge

In the past, nutritional assessment relied on manual measurements that did not allow for the differentiation of body composition components. With technological advancements, the introduction of bioelectrical impedance has provided a more specific approach to obtaining results. This study aims to utilize this innovative method to assess the connection between body composition and academic performance in nursing students. The research focused on a representative sample of 89 participants, utilizing bioelectrical impedance to measure the primary bioelements of the human body. Strong and significant correlations were observed between height and weight, height and muscle mass, and muscle mass and weight. A moderate correlation was found between weight and fat, as well as significant weak correlations between age and fat, and between fat and body mass index. Additionally, a significant weak negative correlation was observed between height and fat. Of the participants, 42.2% of women and 48% of men were classified as overweight. However, the statistical analysis did not reveal significant correlations between academic performance and variables such as weight, muscle mass, fat, and body mass index. Based on this information, it was concluded that most students had a body mass index within the normal range, and no direct relationship between body composition and academic performance was identified. Continuous monitoring of overweight students using this technology is recommended to promote healthy nutritional practices. © 2023 IEEE.

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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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