Sánchez Redrobán, José
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Sánchez Redrobán, José
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Quito
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59772297900

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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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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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Neurobrucellosis manifesting as secondary hemiparkinsonism in a veterinary technician: A case report and evidence-based review

2025 , Sánchez Redrobán, José , Paola Andrea Salazar Figueroa , Maria Paula Salazar Figueroa , Hanny Alejandra Corvalan Reinthaller

Background: Neurobrucellosis is a severe complication of brucellosis, occurring in 3%–10% of systemic cases. Movement disorders, particularly parkinsonism, are rare manifestations that present significant diagnostic challenges and are often associated with occupational exposure. Case Presentation: We report the case of a 51-year-old male veterinary technician who developed progressive right hemiparkinsonism over two years, accompanied by systemic symptoms including fever, weight loss, and arthralgia. Diagnosis was established through characteristic cerebrospinal fluid (CSF) findings of lymphocytic pleocytosis, positive CSF and serum serology for Brucella, and definitive molecular confirmation with a positive CSF polymerase chain reaction (PCR) for Brucella DNA. Dopamine transporter single-photon emission computed tomography (DaT-SPECT) revealed an atypical pattern of nigrostriatal dopaminergic deficit, supporting a secondary cause. The patient was treated with a six-month, ceftriaxone-based triple-antibiotic regimen and symptomatic levodopa/carbidopa. This resulted in the resolution of systemic symptoms and significant functional recovery, with mild residual parkinsonian features at 24-month follow-up. Conclusions: This case highlights neurobrucellosis as a critical differential diagnosis for atypical parkinsonism, particularly in patients with a relevant occupational or environmental exposure history. Early diagnosis through comprehensive serological and molecular testing, followed by prompt initiation of evidence-based antibiotic protocols, can substantially improve clinical outcomes. This report underscores the imperative of stringent occupational safety measures in preventing this debilitating zoonotic infection.

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Time Series Analysis of Dengue, Zika, and Chikungunya in Ecuador: Emergence Patterns, Epidemiological Interactions, and Climate-Driven Dynamics (1988–2024)

2025 , Sánchez Redrobán, José , Carolina Álvarez Ramírez , Emilio Cevallos Carrillo , Juan Arias Salazar , César Barros Cevallos

Background: Ecuador presents a unique epidemiological laboratory for studying arboviral dynamics due to its diverse ecological zones and exposure to climatic variability. Methods: We conducted a comprehensive 36-year analysis (1988–2024) of dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) using national surveillance data from Ecuador’s Ministry of Public Health. Statistical analyses included time series decomposition, change-point detection, correlation analysis, and climate association studies. Results: Ecuador reported 387,543 arboviral cases, with dengue comprising 91.3% (353,782 cases). Dengue exhibited endemic–epidemic cycles with major peaks during El Niño events (1994: 10,247 cases; 2000: 22,937 cases; 2015: 42,483 cases; 2024: 23,156 cases through week 26). CHIKV emerged explosively in 2015 (29,124 cases, incidence 181.10 per 100,000), followed by ZIKV in 2016 (2947 cases). Both showed rapid decline post-epidemic. Severe dengue cases paradoxically decreased from 2–4% of total cases in early 2000s to <0.1% post-2016, suggesting immunological modulation. Cross-correlation analysis revealed significant associations between climatic indices and epidemic timing (r=0.67, p<0.001), particularly for the El Niño-Southern Oscillation. Conclusions: Arboviral diseases in Ecuador function as an integrated epidemiological system with evidence of viral interactions, cross-protective immunity, and strong climate forcing. These findings emphasize the need for integrated surveillance and adaptive control strategies.

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A Narrative Review of Human Papillomavirus (HPV) Vaccination in Ecuador: A Crisis of Inequity and an Evidence-Based Roadmap for Elimination

2025 , Sánchez Redrobán, José , Loaiza Martinez, Daniela , Carlos Santillan

Background: Human Papillomavirus (HPV) remains the leading cause of cervical cancer in Ecuador, which suffers from systemic programmatic failures that undermine the global elimination strategy. Crisis: Ecuador’s HPV vaccination coverage (35.6% first dose; 17.3% complete) is the lowest in Latin America, starkly contrasting with the WHO’s 90% target for cervical cancer elimination (Pan American Health Organization 2025). Structural inequities, a profound genotypic mismatch with the circulating quadrivalent vaccine (HPV 58/31/52 prevalence), and fragmented implementation perpetuate this public health crisis (Jose Ortiz Segarra et al. Infectious Disease Reports, 15(3):267–278 2023). Key Findings: Our analysis reveals that the nation’s health-center-based model fails to reach vulnerable populations, a problem exacerbated by critical cold chain deficiencies in 30% of facilities. In contrast, regional successes, such as Peru’s school-based programs (94% coverage) and Colombia’s strategic adoption of the nonavalent vaccine, offer a clear roadmap for reform (Pan American Health Organization 2025, María Ines Sarmiento-Medina et al. PLOS ONE, 19(2):e0297579 2024). Recommendations: We propose an evidence-based 5-point plan to overhaul Ecuador’s strategy: a targeted nonavalent vaccine pilot, immediate adoption of a single-dose schedule, culturally adapted self-sampling programs, phased-in gender-neutral vaccination, and urgent investment in cold chain infrastructure

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