Facultad de Ciencias de la Salud y Bienestar Humano

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Universidad Indoamérica

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From remote screening to precision prevention: responsible multimodal AI for risk prediction and equitable oral healthcare
(Frontiers Media SA, 2026-07-24)
Iglesias-Pérez, Heydi Daniela
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Gallo-Sánchez, Maria Emilia
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López-Loachamin, Ariel Sebastián
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Paccha-Melgar, Daniela Alejandra
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Rivadeneira-Ahuilar, Julio Damián
Artificial intelligence (AI) applications in oral healthcare have expanded considerably over the past decade. Deep-learning systems now report diagnostic performance exceeding 0.85 sensitivity and 0.90 specificity for several image-based tasks, with the highest pooled estimates reported in AI-assisted clinical photography for oral cancer and oral potentially malignant disorder (OPMD) detection (diagnostic odds ratio 68.4; AUC 0.938). These figures, however, mask three translational gaps. First, many studies often carry high risk of bias, lack external validation, and rest on heterogeneous reference standards. Second, datasets often provide limited demographic reporting, leaving uncertainty about model performance in the populations most likely to benefit from remote screening. Third, teledentistry and mHealth tools have outpaced the regulatory, validation, and fairness-auditing, and clinical-integration frameworks required for safe deployment. Preventive value emerges most clearly when AI is embedded in multimodal systems, such as imaging, sensors, behavioural feedback, clinician support rather than evaluated as an isolated classifier. Progress will be defined less by additional accuracy gains and more by external validation in diverse populations, transparent demographic reporting, equity-focused evaluation, and integration into prevention-oriented care pathways. © 2026 Iglesias-Pérez, Gallo-Sánchez, López-Loachamin, Paccha-Melgar, Rivadeneira-Ahuilar, Luna-Ponce, Gallo-Achig, Pillajo-Villalba, Campuzano-Donoso and Reytor-González.
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Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance
(MDPI AG, 2026-05-29)
Zambrano-Villacres, Raynier
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Campuzano-Donoso, Martín
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Reytor González, Claudia
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Rossetti, Gianluca
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Cobellis, Luigi
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists have transformed obesity treatment, producing substantial weight loss during active therapy. However, real-world effectiveness may be limited by gastrointestinal adverse events, reduced dietary intake, fat-free mass loss as part of total weight reduction, and weight regain after discontinuation. Methods: This narrative review synthesizes current pharmacological, nutritional, gastrointestinal, body-composition, and implementation evidence to propose an evidence-informed nutrition-first framework for patients receiving incretin-based therapy for obesity. Results: We translate pharmacologic mechanisms into practical dietary strategies, including protein prioritization, structured meal patterns, hydration and fiber management, symptom-targeted interventions, resistance-training support, and maintenance planning. Because direct trials of structured nutrition interventions in GLP-1RA- or dual incretin-treated populations remain limited, several recommendations are extrapolated from the broader obesity, caloric restriction, body-composition, gastrointestinal, and expert-consensus literature. Conclusions: Integrating structured nutrition care into pharmacotherapy pathways may help address meal-related symptom burden, support protein and fluid adequacy, identify patients at higher nutritional or body-composition risk, and prepare patients for long-term weight-management behaviors. Embedding practical nutrition management within multidisciplinary obesity care may help translate pharmacologic efficacy into durable, patient-centered outcomes. © 2026 by the authors.
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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.
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Inflammasome–Interferon Convergence in Elite HIV Controllers and Autoimmune Diseases: A Critical Integrative Reflection
(MDPI AG, 2026-08-21)
Torres Rodriguez, Ariel Antonio
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González, Paloma
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Fors, Martha
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Trujillo Lopez, Gisselle
Background: Elite HIV controllers exhibit persistent immune activation despite sustained viral suppression, a phenomenon that challenges the traditional view of immunological equilibrium. In parallel, autoimmune diseases are characterised by chronic inflammation driven by dysregulated immune responses. Objective: This study aimed to analyse the potential pathophysiological convergence between both conditions and to identify a shared inflammatory axis with possible translational implications. Methods: A critical narrative and integrative reflection was conducted using a purposive, concept-driven selection of evidence from PubMed/MEDLINE, Scopus, and Web of Science. A total of 43 sources were included: 28 studies informing mechanistic findings (14 on elite HIV controllers and 14 on autoimmune diseases), 12 addressing modulatory strategies (pharmacological and lifestyle-based), and 3 providing contextual frameworks. Results: Both conditions demonstrate sustained activation of innate immunity, characterised by elevated pro-inflammatory cytokines (IL-1β, IL-6, TNF, type I interferons), increased inflammatory biomarkers (e.g., sCD14, IP-10), and activation of pathways such as NLRP3 inflammasome and NF-κB signalling. Collectively, these findings suggest convergence towards a potential shared inflammatory axis mediated by the inflammasome–interferon pathway, which may contribute to persistent systemic inflammation and tissue damage. Evidence from pharmacological and non-pharmacological interventions suggests that components of this axis may be susceptible to modulation. Conclusions: The observed convergence supports a conceptual model of shared innate inflammatory activation across both conditions. Rather than implying a unified therapeutic approach, the findings suggest a framework of convergent modulation targeting the inflammasome–interferon axis. This hypothesis warrants further investigation to determine its clinical and translational relevance. © 2026 by the authors.
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CBCT-guided Caldwell–Luc management of a dentigerous cyst associated with an ectopic maxillary third molar in the maxillary sinus: a case report
(Frontiers Media SA, 2026-08-04)
Llanos-Arteaga, José Luis
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Delgado-Piedra, Daniel Andrés
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Llanos-Arteaga, Luis Alberto
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Llanos-Arteaga, Anderson Daniel
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Parise Vasco, Juan Marcos
A dentigerous cyst associated with an ectopic third molar in the maxillary sinus is an extremely rare pathological entity that poses diagnostic and therapeutic challenges. We report the case of a 22-year-old woman with a four-month history of chronic nasal congestion and postnasal drip sensation, without a relevant medical history. Cone-beam computed tomography (CBCT) confirmed a cystic lesion associated with an ectopic third molar, allowing accurate three-dimensional assessment for surgical planning, with partial involvement of the left maxillary antrum. Given the size and location of the lesion, complete cystic capsule enucleation and ectopic tooth odontectomy were performed using the Caldwell–Luc approach under local anesthesia. Histopathological examination confirmed the diagnosis of a dentigerous cyst. Clinical and imaging follow-up at six months showed complete resolution of sinonasal symptoms and no evidence of recurrence. This case highlights that the Caldwell–Luc approach guided by CBCT remains a viable and effective option for treating extensive odontogenic cystic lesions involving the maxillary sinus. © 2026 Llanos-Arteaga, Delgado-Piedra, Llanos-Arteaga, Llanos-Arteaga and Parise-Vasco.
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Reconstructing severe acute respiratory infection dynamics from ICD-10 hospital discharge data: a 10-year analysis of 11.2 million discharges in Ecuador, 2014–2023
(Frontiers Media SA, 2026-07-22)
Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Fuentes-Tumbaco, Natasha Bella
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Escobar-Naranjo, Mónica
Background – In many low- and middle-income countries, surveillance of severe acute respiratory infections (SARI) relies on administrative hospital data without virological confirmation, and its ability to capture epidemic dynamics and age-specific burden remains uncertain. Methods – We analyzed 11, 232, 698 hospital discharges recorded by Ecuador's National Institute of Statistics and Censuses between 2014 and 2023, identified SARI episodes using International Classification of Diseases, 10th Revision (ICD-10) codes under broad and length-of-stay–restricted case definitions, and incorporated a neonatal component that included perinatal respiratory codes for infants younger than 1 year. Serfling harmonic regression was used to estimate seasonal baselines and excess SARI admissions at national, provincial, and age-stratified levels. Results – Administrative data identified 538, 272 SARI discharges and revealed marked heterogeneity in incidence and case fatality across provinces and age groups. A previously unrecognized shift in ICD-10 coding from respiratory to perinatal chapters produced an apparent 99% decline in infant SARI after 2014; reclassifying perinatal respiratory codes restored stable high SARI rates in infants and increased their estimated burden by nearly ten-fold. Nationally, we identified 50 epidemic weeks with 77, 352 excess SARI discharges (95% CI 70, 030–85, 982), while the COVID-19 pandemic disrupted typical seasonality, reducing admissions but increasing mortality among older adults. Conclusions – Routinely collected hospital discharge data can reconstruct SARI epidemic dynamics and geographic disparities in the absence of virological surveillance, but are highly sensitive to coding practices. Incorporating neonatal perinatal respiratory codes into SARI definitions is essential to avoid underestimating infant burden and misinforming public health priorities. Copyright © 2026 Angamarca-Iguago, Cagua-Ordónez, Parise-Vasco, Fuentes-Tumbaco, Escobar-Naranjo, Reytor-González and Simancas-Racines.
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Microtia, Hearing Disability, and Health Inequity: Socioeconomic Disparities in Rehabilitation and Specialized Care in Ecuador
(MDPI AG, 2026-07-25)
González Andrade, Fabricio
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Coello, Fausto
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Vásconez, Henry
Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. © 2026 by the authors.
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Artificial intelligence in physical examination teaching in Latin America: a critical narrative review and conceptual model proposal
(Frontiers Media SA, 2026-04-13)
Torres Rodriguez, Ariel Antonio
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González, Paloma
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Fors, Martha
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Trujillo Lopez, Gisselle
Artificial intelligence (AI) is reshaping medical education, particularly in the teaching of physical examination and the development of clinical judgement in digitally mediated contexts. This study presents a critical narrative review examining the ethical, pedagogical, and humanistic implications of AI integration into physical examination training in Latin America. A structured search of literature published between 2018 and 2025 was conducted across PubMed, Scopus, Web of Science, SciELO, and Google Scholar. Thirty-one peer-reviewed studies and three institutional documents met predefined relevance criteria and were analyzed through thematic synthesis. Four thematic domains emerged: (1) AI-assisted clinical simulation and automated feedback, (2) curricular integration and institutional implementation strategies, (3) governance and ethical supervision frameworks, and (4) emerging challenges related to digital literacy, technological dependence, and preservation of clinical judgement. Evidence suggests that AI enhances procedural precision and formative feedback; however, its educational value remains complementary and dependent on structured human-in-the-loop supervision. Based on these findings, the Modelo Educativo Digital basado en Inteligencia Artificial (or Medical Education with Artificial Intelligence) (MED-IA) conceptual model is proposed, framing clinical competence development across three interconnected levels: technical execution, experiential patient interaction, and reflective judgement. The model integrates technological mediation with ethical oversight and humanistic formation. These findings highlight the need for transparent governance frameworks, teacher digital literacy, and context-sensitive institutional policies to ensure responsible AI implementation in Latin American medical education. Copyright © 2026 Torres, González, Fors and Trujillo.
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Predictors of in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Ecuador
(Springer Science and Business Media LLC, 2026-06-16)
Noboa-Salgado, Mariana
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González Andrade, Fabricio
Background: Neonatal mortality remains a major challenge in low- and middle-income countries, where locally derived evidence from neonatal intensive care units is limited. We aimed to identify factors associated with in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Quito, Ecuador, and to evaluate an internally validated mortality prediction model. Methods: We conducted a retrospective cohort study of inborn neonates aged ≤ 28 days admitted to the NICU of Isidro Ayora Gynecology and Obstetrics Hospital from January 1 to December 31, 2022. Maternal, perinatal, neonatal, early clinical severity, laboratory, respiratory support, clinical course, and resource utilization variables were extracted from medical records. The primary outcome was in-hospital mortality. Bivariate analyses and multivariable logistic regression were performed. Model performance was assessed using discrimination, calibration, bootstrap internal validation, and decision curve analysis. Results: Among 220 critically ill neonates, 87 (39.5%) died. Small-for-gestational-age status was independently associated with mortality after adjustment for birth weight category, gestational age, sex, congenital malformations, and antenatal corticosteroid exposure (adjusted OR, 2.57; 95% CI, 1.29–5.14; P=.01). Birth weight < 1400 g was associated with greater clinical severity and resource use but not independently with mortality. Early hemodynamic instability, metabolic acidosis, higher lactate, higher FiO₂, thrombocytopenia, and higher oxygenation index were more frequent among non-survivors. The final model showed good discrimination (apparent AUC, 0.870; optimism-corrected AUC, 0.854) and acceptable calibration. Among survivors, each additional day of invasive mechanical ventilation was associated with longer NICU stay. Conclusion: In this tertiary Ecuadorian NICU cohort, small-for-gestational-age status was independently associated with mortality. These findings support fetal growth assessment, early severity evaluation, and locally validated neonatal risk stratification. © The Author(s) 2026.
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Evidence-based evaluation of MARPE versus SARPE in cases of maxillary transverse deficiency: overview of reviews and GRADE assessment
(Informa UK Limited, 2026-06-04)
Carvajal-Álvarez, Mishell
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Echeverría-Carrera, Cynthia
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Villareal-Ortega, Byron
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Parise Vasco, Juan Marcos
Purpose: To synthesize the comparative effects of mini-implant assisted rapid palatal expansion (MARPE) and surgically assisted rapid palatal expansion (SARPE) on upper airway, skeletal, and dentoalveolar dimensions in patients with maxillary transverse deficiency, and to assess certainty of evidence for each outcome using GRADE approach. Materials and methods: A hybrid evidence synthesis was undertaken, combining a FRISBEE-based overview of systematic reviews with a de novo random-effects meta-analysis of primary studies identified from those reviews. Analyses were done in RevMan Web, and certainty of evidence was assessed with GRADEpro. Prespecified outcomes were anterior nasal width, posterior nasal width, upper first molar inter-cusp distance, posterior maxillary basal width, and posterior nasal floor width. Results: Two systematic reviews comprising three primary studies (84 participants) were included. Certainty of evidence was very low for all outcomes according to GRADE. Although point estimates showed numerical differences between techniques, with trends favouring MARPE for posterior nasal width and posterior nasal floor width and SARPE for upper first molar inter-cusp distance, these findings were highly uncertain and did not support reliable comparative inferences. No definitive conclusions could be drawn from the available evidence. Conclusions: MARPE and SARPE seem to produce measurable skeletal and nasal dimensional changes, but the available evidence is of very low certainty and does not include functional respiratory outcomes. Current data are more consistent with possible clinical equivalence than with superiority of either technique. High-quality randomized trials incorporating functional respiratory outcomes and stratification by age and skeletal maturity are needed. © 2026 Japanese Orthodontic Society. Published by Informa UK Limited, trading as Taylor & Francis Group.

Facultad de Ciencias de la Salud y Bienestar Humano

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