Facultad de Ciencias de la Salud y Bienestar Humano

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Universidad Indoamérica

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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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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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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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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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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.

Facultad de Ciencias de la Salud y Bienestar Humano

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