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Abstract The use of bioelectrical impedance analysis (BIA) is now well established in healthcare as an essential support tool for patient management in various clinical settings. Its use in sports is rapidly expanding due to the valuable insights it offers, helping to better structure athletes’ diets and training programs, thereby optimizing their performance. In the context of sport, however, there is a consensus regarding the importance of proper interpretation of BIA-derived data, which cannot be limited to mere estimation of body composition. In this sense, therefore, the evaluation and interpretation of raw bioelectrical parameters, including resistance, reactance, and phase angle (PhA) is of relevant importance. The assessment of PhA is particularly significant in the context of sports, as it is closely linked to key factors such as muscle mass, strength, and overall muscle quality. However, the existing relationship between PhA and systemic, and loco-regional inflammation, which, in a broader sense, is the rationale behind its use for assessing and monitoring localised muscle damage. Thus, the importance of PhA monitoring during training becomes evident, as it plays a crucial role in assessing and potentially identifying functional impairments, such as overtraining syndrome, as well as muscle injury and related changes in fluid distribution, at an early stage. The aim of this review is to provide the scientific basis necessary to consider the use of whole-body PhA as an indicator of overtraining.

Abstract Background Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT). Methods Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index—BMI –, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention. Results At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = − 11.63 ± 1.76 vs − 8.95 ± 1.65 kg, p

Abstract Background Compared with conventional cigarettes, electronic cigarettes are less harmful in some studies. However, recent research may indicate the opposite. This study aimed to determine whether e-cigarette use is related to myocardial health in adults in the U.S. Methods This study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional survey of adult US residents aged 18 years or older. We examined whether e-cigarette use was related to myocardial infarction byapplying a logistic regression model to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results The final analytical sample included 198,530 adults in the U.S. Logistic regression indicated that U.S. adults who reported being former and some days of e-cigarette use had 23% and 52% greater odds of ever having an MI, respectively, than did those who reported never using e-cigarettes (OR = 1.23, 95% CI 1.08–1.40, p = 0.001; OR = 1.52, 95% CI 1.10–2.09, p = 0.010). Conclusions The results suggest that former and someday users of e-cigarettes probably have increased odds of myocardial infarction in adults in the U.S. Further research is needed, including long-term follow-up studies on e-cigarettes, since it is still unknown whether they should be discouraged.

Abstract Background Ion channels, vital transmembrane protein complexes, regulate ion movement within cells. Germline variants in channel-encoding genes lead to channelopathies. The sodium channels in cardiac cells exhibit a structure of an alpha subunit and one to two beta subunits. The alpha subunit, encoded by the SCN5A gene, comprises four domains. Case presentation A fifteen-year-old Ecuadorian female with atrial flutter and abnormal sinus rhythm with no familial history of cardiovascular disease underwent NGS with the TruSight Cardio kit (Illumina). A likely pathogenic SCN5A gene variant (NM_188056.2:c.2677 C > Tp. Arg893Cys) was identified, associated with arrhythmias, long QT, atrial fibrillation, and Brugada syndrome. Ancestral analysis revealed a predominant European component (43.9%), followed by Native American (35.7%) and African (20.4%) components. Conclusions The participant presents atrial flutter and conduction disorders, despite lacking typical cardiovascular risk factors. The proband carries a SCN5A variant that has not been previously reported in Latin America and may be associated to her phenotype. The documented arginine-to-cysteine substitution at position 893 in the protein is crucial for various cellular functions. The subject’s mixed genetic composition highlights potential genetic contributors to atrial flutter, emphasizing the need for comprehensive genetic studies, particularly in mixed populations like Ecuadorians. This case underscores the importance of genetic analysis for personalized treatment and the significance of studying diverse genetic backgrounds in understanding cardiovascular diseases.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and organ damage. Studies indicate that diet significantly influences the gut microbiota, which, in turn, affects the immune system. This article explores gut microbiota dysbiosis in SLE patients and potential mechanisms related to dietary interventions and immune function. It highlights specific dietary patterns, such as a high-fibre diet and the Mediterranean diet, that may modulate the diversity and activity of the gut microbiota. The interaction between altered microbiota and immune responses, including the regulation of inflammatory cytokines, intestinal barrier permeability, and autoantibody production is examined. This review highlights the importance of personalized dietary strategies to modulate the diversity and activity of the gut microbiota by enhancing the immune response and potentially mitigating disease progression.

The Mediterranean diet (MedDiet), originating from areas around the Mediterranean Sea, emphasises olive oil, fruits, vegetables, legumes, whole grains, and nuts while limiting red and processed meats. Studies show that higher adherence to the MedDiet reduces mortality risk by 23%. This diet contains essential nutrients and bioactive compounds important for maintaining good health. Prediabetes, characterised by impaired glucose metabolism and insulin resistance, can progress to type 2 diabetes, which increases the risk of diabetes, cardiovascular events, and mortality. Diet plays a crucial role in type 2 diabetes prevention. Healthy fats, antioxidants, high fibre, and low glycemic index foods positively affect prediabetes management by improving insulin sensitivity, regulating blood glucose, reducing inflammation, and aiding weight control. This review explores MedDiet’s molecular mechanisms and potential for prediabetes treatment and glycemic control.

Abstract The Mediterranean Diet (MD) has garnered increasing attention for its potential protective effects against gastric cancer (GC). The MD’s rich content of antioxidants, polyphenols, and other bioactive compounds contributes to its ability to modulate gene expression, inhibit tumor growth, and regulate apoptosis. Studies have shown significant reductions in inflammatory markers such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) among individuals adhering to the MD, suggesting its pivotal role in mitigating chronic inflammation-associated with cancer development. Furthermore, the MD’s anti-angiogenic properties, particularly in components like olive oil, red wine, fish, and tomatoes, offer promising avenues for reducing GC risk by inhibiting tumor angiogenesis. Additionally, the MD’s influence on intestinal microbiota composition underscores its potential in maintaining immune homeostasis and reducing systemic inflammation, factors crucial in GC prevention. Despite challenges such as variability in dietary adherence scoring systems and the need for further gender and geographical-specific studies, evidence supports the MD as a cost-effective and holistic approach to GC prevention. Emphasizing the role of nutrition in public health is a promising strategy with broad implications for global health and cancer prevention initiatives. Therefore, this review explores the multifaceted impacts of the MD on GC prevention, delving into its anti-inflammatory, anti-angiogenic, and molecular mechanisms.

Abstract Background The Mediterranean diet (MedDiet) is a widely studied dietary pattern reflecting the culinary traditions of Mediterranean regions. High adherence to MedDiet correlates with reduced blood pressure and lower cardiovascular disease (CVD) incidence and mortality. Furthermore, microbiota, influenced by diet, plays a crucial role in cardiovascular health, and dysbiosis in CVD patients suggests the possible beneficial effects of microbiota modulation on blood pressure. The MedDiet, rich in fiber and polyphenols, shapes a distinct microbiota, associated with higher biodiversity and positive health effects. The review aims to describe how various Mediterranean diet components impact gut microbiota, influencing blood pressure dynamics. Main body The MedDiet promotes gut health and blood pressure regulation through its various components. For instance, whole grains promote a healthy gut microbiota given that they act as substrates leading to the production of short-chain fatty acids (SCFAs) that can modulate the immune response, preserve gut barrier integrity, and regulate energy metabolism. Other components of the MedDiet, including olive oil, fuits, vegetables, red wine, fish, and lean proteins, have also been associated with blood pressure and gut microbiota regulation. Conclusion The MedDiet is a dietary approach that offers several health benefits in terms of cardiovascular disease management and its associated risk factors, including hypertension. Furthermore, the intake of MedDiet components promote a favorable gut microbiota environment, which, in turn, has been shown that aids in other physiological processes like blood pressure regulation.

Obesity and periodontitis are significant health problems with a complex bidirectional relationship. Excess body fat is linked to systemic diseases and can lead to persistent inflammation, potentially harming periodontal health. Periodontitis, a chronic inflammatory condition affecting the supporting structures of teeth, poses substantial health risks. Both conditions share pathological processes such as inflammation and oxidative stress, which aggravate health status and make treatment more challenging. Understanding this interaction is crucial for developing effective management strategies for both diseases. This study explores the multifaceted aspects of obesity and periodontitis and their reciprocal relationship.

Abstract Background Acne, a chronic inflammatory disease impacting the pilosebaceous unit, is influenced significantly by inflammation and oxidative stress, and is commonly associated with obesity. Similarly, obesity is also associated with increased inflammation and oxidation. The role of diet in acne remains inconclusive, but the very low-calorie ketogenic diet (VLCKD), known for weight loss and generating anti-inflammatory ketone bodies, presents promising potential. Despite this, the effects of VLCKD on acne remain underexplored. This study aimed to investigate the efficacy of a 45-day active phase of VLCKD in reducing the clinical severity of acne in young women with treatment-naïve moderate acne and grade I obesity. Methods Thirty-one women with treatment-naïve moderate acne, grade I obesity (BMI 30.03–34.65 kg/m2), aged 18–30 years, meeting inclusion/exclusion criteria, and consenting to adhere to VLCKD were recruited. Baseline and post-intervention assessments included anthropometric measurements, body composition, phase angle (PhA), trimethylamine N-oxide (TMAO) levels, and reactive oxygen metabolite derivatives (dROMs) as markers of inflammation, dysbiosis, and oxidative stress, respectively. A comprehensive dermatological examination, incorporating the Global Acne Grading System (GAGS) and the Dermatology Life Quality Index (DLQI), was conducted for all women. Results VLCKD resulted in general improvements in anthropometric and body composition parameters. Significantly, there were significant reductions in both the GAGS score (Δ%: − 31.46 ± 9.53, p

Obesity, a chronic global health problem, is associated with an increase in various comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, hypertension, and certain types of cancer. The increasing global prevalence of obesity requires research into new therapeutic strategies. Glucagon-like peptide-1 receptor agonists, specifically semaglutide and liraglutide, designed for type 2 diabetes mellitus treatment, have been explored as drugs for the treatment of obesity. This minireview describes the molecular mechanisms of semaglutide and liraglutide in different metabolic pathways, and its mechanism of action in processes such as appetite regulation, insulin secretion, glucose homeostasis, energy expenditure, and lipid metabolism. Finally, several clinical trial outcomes are described to show the safety and efficacy of these drugs in obesity management.

Obesity, a public health challenge, arises from a complex interplay of factors such as dietary habits and genetic predisposition. Alterations in gut microbiota, characterized by an imbalance between Firmicutes and Bacteroidetes, further exacerbate metabolic dysregulation, promoting inflammation and metabolic disturbances. Intermittent fasting (IF) emerges as a promising dietary strategy showing efficacy in weight management and favoring fat utilization. Studies have used mice as animal models to demonstrate the impact of IF on gut microbiota composition, highlighting enhanced metabolism and reduced inflammation. In humans, preliminary evidence suggests that IF promotes a healthy microbiota profile, with increased richness and abundance of beneficial bacterial strains like Lactobacillus and Akkermansia. However, further clinical trials are necessary to validate these findings and elucidate the long-term effects of IF on microbiota and obesity. Future research should focus on specific tissues and cells, the use of advanced -omics techniques, and exploring the interaction of IF with other dietary patterns, to analyze microbiota composition, gene expression, and potential synergistic effects for enhanced metabolic health. While preliminary evidence supports the potential benefits of IF in obesity management and microbiota regulation, further research with diverse populations and robust methodologies is necessary to understand its implications and optimize personalized dietary interventions. This review explores the potential impact of IF on gut microbiota and its intricate relationship with obesity. Specifically, we will focus on elucidating the underlying mechanisms through which IF affects microbiota composition, as well as its subsequent effects on obesity.

The review present data on the intricate relationship between bariatric surgery, gut microbiota, and metabolic health in obesity treatment. Bariatric surgery, is recognized as an effective intervention for managing morbid obesity, including various techniques with distinct mechanisms of action, efficacy, and safety profiles including Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), and Biliopancreatic Diversion (BPD). RYGB and SG are the most prevalent procedures globally, inducing gut microbiota changes that influence microbial diversity and abundance. Post-surgery, alterations in bacterial communities occur, such as the increased of Escherichia coli inversely correlated with fat mass and leptin levels. During digestion, microbiota produce physiologically active compounds like bile acids (Bas) and short-chain fatty acids (SCFAs). SCFAs, derived by microbial fermentation, influence appetite, energy metabolism, and obesity-related pathways. Bas, altered by surgery, modulate glucose metabolism and insulin sensitivity. Furthermore, SG and RYGB enhance incretin secretion, particularly glucagon-like peptide 1 (GLP-1). Therefore, understanding microbiota changes after bariatric surgery could be crucial for predicting metabolic outcomes and developing targeted interventions for obesity management.

Abstract Background The terms metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) categorize subjects with obesity based on the presence or absence of cardio-metabolic risk factors. Detecting MUO phenotype is crucial due to the high risk of cardio-metabolic complications, requiring tailored and intensive follow-up. However, diagnosing MUO is time-consuming and costly. Thus, we aimed to investigate the role of Mediterranean diet (MD) in determining MHO/MUO phenotypes and whether adherence to MD could serve as an additional screening tool for MUO phenotype. Methods The study population of this cross-sectional observational study consisted of 275 subjects with obesity. We assessed their lifestyle habits (physical activity and smoking habits), anthropometric measurements (weight, height, waist circumference, body mass index), blood pressure, metabolic parameters, inflammatory marker (high sensitivity C reactive protein levels), adherence to MD (by PREvención con DIetaMEDiterránea (PREDIMED) questionnaire), and MHO/MUO phenotypes. Results The study included 275 individuals with obesity (256F/19M; 34.0 ± 10.5 years; BMI 38.3 ± 5.95 kg/m2). Among them, 114 (41.5%) exhibited MHO phenotype, while 161 (58.5%) had MUO phenotype. MHO phenotype exhibited favorable anthropometric and cardio-metabolic profiles, characterized by lower waist circumference (p

Abstract Background Numerous biomarkers have been proposed for diagnosis, therapeutic, and prognosis in sepsis. Previous evaluations of the value of biomarkers for predicting mortality due to this life-threatening condition fail to address the complexity of this condition and the risk of bias associated with prognostic studies. We evaluate the predictive performance of four of these biomarkers in the prognosis of mortality through a methodologically sound evaluation. Methods We conducted a systematic review a systematic review and meta-analysis to determine, in critically ill adults with sepsis, whether procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin (sCD14) are independent prognostic factors for mortality. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to March 2023. Only Phase-2 confirmatory prognostic factor studies among critically ill septic adults were included. Random effects meta-analyses pooled the prognostic association estimates. Results We included 60 studies (15,681 patients) with 99 biomarker assessments. Quality of the statistical analysis and reporting domains using the QUIPS tool showed high risk of bias in > 60% assessments. The biomarker measurement as a continuous variable in models adjusted by key covariates (age and severity score) for predicting mortality at 28–30 days showed a null or near to null association for basal PCT (pooled OR = 0.99, 95% CI = 0.99–1.003), CRP (OR = 1.01, 95% CI = 0.87 to 1.17), and IL-6 (OR = 1.02, 95% CI = 1.01–1.03) and sCD14 (pooled HR = 1.003, 95% CI = 1.000 to 1.006). Additional meta-analyses accounting for other prognostic covariates had similarly null findings. Conclusion Baseline, isolated measurement of PCT, CRP, IL-6, and sCD14 has not been shown to help predict mortality in critically ill patients with sepsis. The role of these biomarkers should be evaluated in new studies where the patient selection would be standardized and the measurement of biomarker results. Trial registration PROSPERO (CRD42019128790).

Introducción: Este estudio describe la incidencia de enfermedades transmitidas por vectores (ETVs) en Ecuador entre 2015 y 2019, destacando el papel de la gestión integrada de vectores. A través de un diseño ecológico de datos secundarios de vigilancia epidemiológica y registros demográficos, se identifica una tendencia disminuida en la incidencia de arbovirosis, pero con variabilidad cantonal significativa. Métodología: Con base en los datos reportados por el sistema de vigilancia epidemiológica del Ministerio de Salud Pública, registros del INEC y cartografía del Instituto Geográfico Militar, se calculó la incidencia acumulada ajustada por población y altitud, excluyendo áreas por encima de 1680 msnm para minimizar clasificaciones erróneas. Resultados: Se reportaron 113,474 casos de arbovirosis, con una reducción en la incidencia desde 464,17 casos por 100,000 habitantes en 2015 a 25,9 en 2019. La variabilidad a nivel de cantones muestra áreas con tasas persistentemente altas de infección. Conclusiones: A pesar de la disminución generalizada en la incidencia de ETVs, la variabilidad de los resultados por cantones resalta la complejidad del manejo de estas patologías y la necesidad de estrategias multidimensionales. Los futuros esfuerzos de investigación deberían centrarse en un análisis más detallado de los determinantes ambientales y sociales para mejorar las intervenciones de prevención y control, especialmente en áreas con altas tasas de infección.

Introducción: La seguridad alimentaria se alcanza cuando todas las personas en todo momento tienen acceso físico y económico a alimentos seguros, suficientes y nutritivos, siendo esta un importante determinante de bienestar y desarrollo de las poblaciones. Este estudio propone la creación de redes de investigación como propuesta para el abordaje multidimensional a la inseguridad alimentaria, enfocando en la colaboración y el desarrollo de capacidades en la región. Objetivos: Facilitar la colaboración entre instituciones académicas para compartir recursos y experiencias; Promover la investigación interdisciplinaria en aspectos clave de la seguridad alimentaria; Desarrollar capacidades y formación de recursos humanos en el campo. Métodos: se propone las siguientes fases: Fase 1: Planificación y diseño de la red, definiendo objetivos y estableciendo estructuras de gobernanza; Fase 2: Establecimiento de infraestructura de colaboración, incluyendo plataformas de comunicación y desarrollo de recursos compartidos. Fase 3: Promoción de investigación interdisciplinaria y desarrollo de capacidades mediante proyectos piloto y programas de capacitación; Fase 4: Evaluación y ajuste con sistemas de monitoreo y canales de retroalimentación. Conclusión: Las redes de académicas y de investigación pueden mejorar el bienestar y responder efectivamente a crisis alimentarias, promoviendo sistemas alimentarios sostenibles a través de la toma de decisiones basadas en evidencia. En investigación, las redes fomentan la colaboración interdisciplinaria y la innovación, permitiendo la generación de evidencia a gran escala y el desarrollo de soluciones creativas para avanzar en la investigación y mejorar la salud pública en las Américas, abordando las causas subyacentes de la inseguridad alimentaria y promoviendo el desarrollo sostenible.

La reciente decisión de la Corte Constitucional de Ecuador de legalizar la eutanasia marca un hito histórico, posicionando al país como el segundo en América Latina, después de Colombia, en reconocer este derecho. Este avance se produjo a raíz del caso de Paola Roldán, diagnosticada con esclerosis lateral amiotrófica (ELA), y destaca por considerar la criminalización de la eutanasia como inconstitucional, liberando de responsabilidad penal a los médicos que la practiquen. La sentencia exige la elaboración de una ley específica que regule los procedimientos eutanásicos, otorgando un plazo máximo de 12 meses a la Asamblea Nacional para su aprobación y dos meses al Ministerio de Salud para desarrollar un reglamento. La mirada global sobre la eutanasia revela una diversidad de prácticas y legislaciones. Países como Bélgica, Colombia, Países Bajos, España, Canadá, Australia, Nueva Zelanda, y Luxemburgo tienen en común la necesidad de solicitudes formales y evaluaciones médicas rigurosas que confirmen la incurabilidad y el sufrimiento insoportable del paciente. Además, se requieren informes médicos detallados, consentimiento informado, y, en algunos casos, la aprobación de comités multidisciplinarios. Esta comprensión global enfatiza la importancia de un marco legal cuidadosamente estructurado en Ecuador para garantizar que el derecho a morir con dignidad sea accesible, respetuoso y éticamente fundamentado.

Objetivo: Evaluar críticamente la calidad metodológica de la Guía de Práctica Clínica para malaria de la Organización Mundial de la Salud. Metodología: Tres revisores de forma independiente utilizaron el instrumento AGREE II para evaluar la calidad metodológica de la Guía de Práctica Clínica para malaria. Las calificaciones fueron recogidas y analizadas en una matriz de EXCEL. Se utilizó el coeficiente de concordancia de Fleiss Kappa para determinar la medida de acuerdo entre los evaluadores. Resultados: La Guía de Práctica Clínica (GPC) destacó en claridad, objetivos, y participación de los implicados, pero identificó áreas de mejora en rigor de elaboración y aplicabilidad. Con puntuaciones altas en la mayoría de los dominios y una buena gestión de la independencia editorial, se recomienda su uso a pesar de los desafíos en implementación práctica. Conclusiones: La evaluación AGREE II de la Guía de la OMS para malaria 2022 destaca su calidad y claridad, pero señala áreas de mejora en metodología y aplicabilidad. Subraya la necesidad de adaptación local y colaboración para actualizar continuamente las recomendaciones.

Objectives: The purpose of this study is to describe the genetic variants present in the Ecuadorian population and the incidence and mortality patterns of thyroid cancer in Ecuador from 2016 to 2021. Methods: The present research constitutes a nationwide cross-sectional study encompassing all reported cases of thyroid cancer (C-73) in Ecuador from 2016 to 2021. Incidence rates were calculated based on the annual population at risk, considering factors such as ethnicity, sex, age group, and the geographic location of the incidence. All data was collected from the Hospital Discharge Statistics and the Statistical Registry of General Deaths Databases. Results: Between 2016 and 2021, a total of 20,297 hospital admissions and 921 deaths attributed to thyroid cancer were reported in Ecuador. The incidence of thyroid cancer remained relatively stable from 2016 to 2019. However, there was a notable decrease in 2020, followed by an increase in 2021. Notably, thyroid cancer prevalence rates were found to be higher in highlands regions. Moreover, two genetic variants, the BRAFV600E and KITL678F, have been identified in the Ecuadorian population. It is noteworthy that women exhibited a higher susceptibility to thyroid cancer, being five times more likely than men to develop this condition. Conclusion: Ecuador exhibits one of the highest global incidences of thyroid cancer. Consequently, describing the genetic variants and epidemiological characteristics of thyroid cancer is imperative for enhancing healthcare access and formulating evidence-based public health policies. This research contributes towards a comprehensive understanding of thyroid cancer in the Ecuadorian context, aiming to improve targeted interventions and health outcomes.

Introducción: Las neoplasias malignas de los órganos digestivos representan un desafío significativo para la salud pública a nivel mundial. En el contexto de Ecuador, la falta de estudios actualizados que proporcionen datos sobre la distribución de estas neoplasias en la población es evidente. Objetivo: El propósito de esta investigación es analizar la distribución de los casos hospitalarios y las defunciones generales relacionadas con neoplasias malignas de órganos digestivos (CIE-10: C15-C26) durante los años pandémicos (2020-2022) en Ecuador. Métodos: Se llevó a cabo un estudio ecológico utilizando la base de datos de egresos hospitalarios del Instituto Nacional de Estadísticas y Censos del Ecuador (INEC). Se procedió a unir las bases anuales por la cuestión de registros extratemporáneos y la extracción de datos se realizó en función de las fechas de ingreso de los pacientes. El análisis estadístico se efectuó utilizando el software RStudio. Las variables consideradas fueron el sexo, la edad y el tipo de cáncer. Resultados: Se registró una media anual de 11,537 casos hospitalarios y 4,528 defunciones relacionadas. El grupo de 60-69 años representó el 29% de los egresos hospitalarios, mientras que el grupo de 70-79 años constituyó el 27% de las defunciones. Las tasas más altas de morbilidad y mortalidad se observaron en las provincias de la sierra y la costa. Conclusiones: Los hallazgos revelan una distribución de neoplasias malignas de órganos digestivos que varía en función del sexo, edad y provincias de Ecuador. Estos resultados enfatizan la importancia de implementar medidas específicas de prevención y concienciación dirigidas a las áreas y grupos más afectados.

Introducción: La Vigilancia Basada en Eventos a nivel comunitario es una herramienta clave en países de bajos y medianos ingresos para monitorear y responder a amenazas de salud pública. A pesar de su potencial para mejorar la salud comunitaria, existen interrogantes sobre su impacto real. Metodología: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual se mantenida mediante el cribado de múltiples fuentes de información, incluyendo PUBMED-MEDLINE, EMBASE, COCHRANE, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, se valoraron las revisiones encontradas utilizando la lista de verificación de evaluación crítica de Joanna Briggs Institute para revisiones sistemáticas, posteriormente se realizó y se preparó una matriz de resumen de los hallazgos encontrados. Resultados: Se identificaron cinco revisiones sistemáticas que aportan datos primarios sobre el impacto de la Vigilancia Basada en Eventos a nivel comunitario. Conclusiones: Los hallazgos sugieren que esta modalidad de vigilancia proporciona información valiosa que puede fortalecer la función de alerta temprana de los sistemas nacionales de vigilancia, podría influir positivamente en la salud comunitaria, pero se necesita más evidencia para confirmar su impacto definitivo.

Introducción: Ecuador es el décimo país con la tasa de embarazo adolescente más alta en Latinoamérica, este es un problema que tiene consecuencias sociales y económicas. Objetivo: El objetivo de este estudio es describir los factores asociados al embarazo adolescente en Ecuador utilizando los datos del ENSANUT 2018, y analizar el rol del primer nivel de salud en la atención a este grupo vulnerable. Metodología: Se utilizó los datos de la Encuesta Nacional de Salud y Nutrición (ENSANUT) 2018. El diseño del estudio es descriptivo analítico para el análisis de variables como: edad, nivel educativo, región y área de residencia, conocimiento y uso de métodos anticonceptivos. Resultados: Los hallazgos revelan que la edad, el nivel educativo y la región de residencia son condiciones significativas en la prevalencia del embarazo adolescente. Se observa una correlación entre el nivel educativo y la posibilidad de embarazo en adolescentes. Conclusión: El estudio describe los factores asociados al embarazo adolescente en Ecuador, identifica algunas barreras de acceso al sistema de salud, y concluye enfatizando la necesidad de políticas públicas eficientes y estrategias orientadas a mejorar el acceso a la educación y servicios de salud sexual, y reproductiva para adolescentes, con el objetivo de reducir las tasas de embarazo adolescente y mejorar su calidad de vida en Ecuador.

Contar con datos oportunos, eficientes, y sistemas de información resilientes en el ámbito de la salud es fundamental para el monitoreo en tiempo real de eventos críticos que impactan la vigilancia epidemiológica y la salud pública. Este artículo se enfoca en mostrar una metodología para la optimización del funcionamiento de los motores de bases de datos de los sistemas de información del Ministerio de Salud Pública del Ecuador enfocado en enfermedades arbovirales y malaria, con el propósito de mejorar la capacidad de detección temprana, el análisis oportuno y la respuesta efectiva ante eventos de importancia epidemiológica.

El objetivo de este trabajo es describir la necesidad de asistencia sanitaria que pudiese requerir un enfermo terminal para alcanzar una muerte digna que alivie sus dolencias. Cuando un paciente ha desarrollado una enfermedad crónica grave, incurable y que, en etapa avanzada se describe como discapacitante e imposibilitante porque provoca dependencia total para realizar actividades cotidianas y un sufrimiento físico y/o psíquico intolerable, es fundamental cuestionarnos el rol de la sociedad y del sistema sanitario para garantizar vida digna incluso al final de los días. Describimos como ejemplo a la esclerosis lateral amiotrófica, una enfermedad que compromete las neuronas del cerebro y de la médula espinal. Se considera una de las enfermedades motoneuronales más catastróficas que afecta a dos de cada 100 mil personas en el planeta, según datos de la Organización Mundial de la Salud. Por otro lado, analizamos a la eutanasia como una alternativa al cumplimiento de los derechos del paciente. La palabra eutanasia proviene de las voces griegas eu = bueno y thanatos = muerte, "Buena muerte". Este término a evolucionado y actualmente hace referencia al acto de acabar con la vida de otra persona a petición suya, con el fin de minimizar el sufrimiento. Se comenta el caso mediático de Paola Roldan, una mujer valiente de 42 años con esclerosis lateral amiotrófica. Su condición ha sido catalogada como; crónica grave, incurable, discapacitante e imposibilitante porque provoca dependencia total para realizar actividades cotidianas. Según las normativas aprobadas en otros países donde se ha legalizado la eutanasia, Paola podría solicitar ayuda sanitaria para una muerte digna y estaría totalmente justificado dada su condición clínica incurable y con un pronóstico desfavorable. Es indispensable para la salud pública motivar la creación de políticas que permitan respetar el derecho individual de las personas para decidir sobre su muerte.

Gestational diabetes mellitus is a condition marked by raised blood sugar levels and insulin resistance that usually occurs during the second or third trimester of pregnancy. According to the World Health Organization, hyperglycemia affects 16.9% of pregnancies worldwide. Dietary changes are the primarily alternative treatment for gestational diabetes mellitus. This paper aims to perform an exhaustive overview of the interaction between diet, gene expression, and the metabolic pathways related to insulin resistance. The intake of foods rich in carbohydrates can influence the gene expression of glycolysis, as well as foods rich in fat, can disrupt the beta-oxidation and ketogenesis pathways. Furthermore, vitamins and minerals are related to inflammatory processes regulated by the TLR4/NF-κB and one carbon metabolic pathways. We indicate that diet regulated gene expression of PPARα, NOS, CREB3L3, IRS, and CPT I, altering cellular physiological mechanisms and thus increasing or decreasing the risk of gestational diabetes. The alteration of gene expression can cause inflammation, inhibition of fatty acid transport, or on the contrary help in the modulation of ketogenesis, improve insulin sensitivity, attenuate the effects of glucotoxicity, and others. Therefore, it is critical to comprehend the metabolic changes of pregnant women with gestational diabetes mellitus, to determine nutrients that help in the prevention and treatment of insulin resistance and its long-term consequences.

A medida que los países se industrializan, la tasa de urbanización tiende a acelerarse. Se estima que para el año 2030, el 60 % de la población mundial vivirá en áreas urbanas, lugares donde se concentran factores sociales como la pobreza, la desigualdad, la migración, asentamientos humanos ilegales y la degradación ambiental, los cuales obstaculizan el desarrollo sostenible y contribuyen a una mayor transmisión de enfermedades infecciosas. A lo largo de este artículo, discutiremos la relevancia de una planificación y la implementación de políticas urbanas adecuadas para el control de enfermedades infecciosas, como el dengue, la leishmaniasis y el COVID-19, las que han afectado especialmente a aquellas personas que habitan en asentamientos informales o en zonas urbanas no planificadas. Mediante una extensa revisión de literatura demostraremos que la planificación y las políticas urbanas desempeñan un papel importante en la prevención de enfermedades y en la creación de entornos de vida saludable, mientras que la falta de estas puede ampliar los riesgos para la salud de las personas. Las experiencias de Brasil y los datos epidemiológicos en Ecuador en cuanto al dengue y la leishmaniasis demuestran el impacto que la urbanización no planificada y las inequidades no resueltas pueden tener en la salud pública. Cabe destacar que la salud ocupa un lugar imprescindible en las interrelaciones de las ciudades y comunidades sostenibles. Por ello es esencial contar con un equipo interdisciplinario que involucre a urbanistas, arquitectos, constructores y profesionales en la salud pública para trabajar en ...

Obesity is a chronic disease characterized by abnormal or excessive fat accumulation that could impact an individual’s health; moreover, the World Health Organization (WHO) has declared obesity a global epidemic since 1997. In Latin America, in 2016, reports indicated that 24.2% of the adult population was obese. The environmental factor or specific behaviors like dietary intake or physical activity have a vital role in the development of a condition like obesity, but the interaction of genes could contribute to that predisposition. Hence, it is vital to understand the relationship between genes and disease. Indeed, genetics in nutrition studies the genetic variations and their effect on dietary response; while genomics in nutrition studies the role of nutrients in gene expression. The present review represents a compendium of the dietary behaviors in the Latin American environment and the interactions of genes with their single nucleotide polymorphisms (SNPs) associated with obesity, including the risk allele frequencies in the Latin American population. Additionally, a bibliographical selection of several studies has been included; these studies examined the impact that dietary patterns in Latin American environments have on the expression of numerous genes involved in obesity-associated metabolic pathways.

Studies in human microbiota dysbiosis have shown that short-chain fatty acids (SCFAs) like propionate, acetate, and particularly butyrate, positively affect energy homeostasis, behavior, and inflammation. This positive effect can be demonstrated in the reduction of butyrate-producing bacteria observed in the gut microbiota of individuals with type 2 diabetes (T2DM) and other energy-associated metabolic alterations. Butyrate is the major end product of dietary fiber bacterial fermentation in the large intestine and serves as the primary energy source for colonocytes. In addition, it plays a key role in reducing glycemia and improving body weight control and insulin sensitivity. The major mechanisms involved in butyrate regulation include key signaling pathways such as AMPK, p38, HDAC inhibition, and cAMP production/signaling. Treatment strategies using butyrate aim to increase its intestine levels, bioavailability, and improvement in delivery either through direct supplementation or by increasing dietary fiber in the diet, which ultimately generates a higher production of butyrate in the gut. In the final part of this review, we present a summary of the most relevant studies currently being carried out in humans.

Avian influenza (AI) is a contagious disease among the poultry population with high avian mortality, which generates significant economic losses and elevated costs for disease control and outbreak eradication. AI is caused by an RNA virus part of the Orthomyxoviridae family; however, only Influenzavirus A is capable of infecting birds. AI pathogenicity is based on the lethality, signs, and molecular characteristics of the virus. Low pathogenic avian influenza (LPAI) virus has a low mortality rate and ability to infect, whereas the highly pathogenic avian influenza (HPAI) virus can cross respiratory and intestinal barriers, diffuse to the blood, damage all tissues of the bird, and has a high mortality rate. Nowadays, avian influenza is a global public health concern due to its zoonotic potential. Wild waterfowl is the natural reservoir of AI viruses, and the oral–fecal path is the main transmission route between birds. Similarly, transmission to other species generally occurs after virus circulation in densely populated infected avian species, indicating that AI viruses can adapt to promote the spread. Moreover, HPAI is a notifiable animal disease; therefore, all countries must report infections to the health authorities. Regarding laboratory diagnoses, the presence of influenza virus type A can be identified by agar gel immunodiffusion (AGID), enzyme immunoassay (EIA), immunofluorescence assays, and enzyme-linked immunoadsorption assay (ELISAs). Furthermore, reverse transcription polymerase chain reaction is used for viral RNA detection and is considered the gold standard for the management of suspect and confirmed cases of AI. If there is suspicion of a case, epidemiological surveillance protocols must be initiated until a definitive diagnosis is obtained. Moreover, if there is a confirmed case, containment actions should be prompt and strict precautions must be taken when handling infected poultry cases or infected materials. The containment measures for confirmed cases include the sanitary slaughter of infected poultry using methods such as environment saturation with CO2, carbon dioxide foam, and cervical dislocation. For disposal, burial, and incineration, protocols should be followed. Lastly, disinfection of affected poultry farms must be carried out. The present review aims to provide an overview of the avian influenza virus, strategies for its management, the challenges an outbreak can generate, and recommendations for informed decision making.

Abstract Background Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps. Methods We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios. Results A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores. Conclusions Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.

Con una población mundial que anhela regresar a la “normalidad” anterior a la pandemia Covid-19, el discurso político se ha centrado en encontrar ese porcentaje mágico de población a vacunar necesaria para alcanzar la tan esperada “inmunidad de rebaño” que permitiría a groso modo quitar las restricciones establecidas. Pero esta decisión no tiene base científica sólida debido a que la aparición de nuevas variantes aumenta la capacidad y velocidad de contagio del virus y amenaza la efectividad de las vacunas cambiando las reglas establecidas y los cálculos más optimistas. Por tanto, se va tornando utópica la posibilidad de derrotar al SARSCOV2 en el corto plazo y solamente a través de las vacunas. Es indispensable cambiar el mensaje negacionista y de relajación de un posible fin de la pandemia en pocos días por uno dirigido a mantener las medidas de prevención como la mascarilla, distancia y lavado de manos, vacunación masiva refuerzos, vigilancia epidemiológica, análisis genómico del virus, que son pilares fundamentales para combatir adecuadamente esta guerra sanitaria que no da tregua y sobre la que aún tendremos mucho que hablar.

Objetivo: Los pacientes con lupus eritematoso sistémico (LES) tienen mayor riesgo cardiovascular (RCV), esto combinado con los factores de riesgo del síndrome metabólico (SM) aumenta la probabilidad de eventos y patologías cardiacas. El presente estudio tiene como objetivo determinar la frecuencia de los factores del SM en una población de pacientes con LES. Materiales y métodos: Se realizó un estudio descriptivo, transversal, observacional, en 132 pacientes con diagnóstico de LES del servicio de Medicina Interna del Hospital Eugenio Espejo, entre los meses de enero a mayo del año 2018, mediante la revisión de historias clínicas y entrevistas personales. Resultados: Se estableció una prevalencia de SM del 30 %, del cual 83.5 % fueron menores de 40 años, el 84.7 % presentaron sobrepeso u obesidad. Conclusiones: Los pacientes con LES presentan un estado proinflamatorio y aterogénico, que se traduce en un riesgo aumentado de desarrollar enfermedades cardiovasculares y por tanto mayor incidencia de los factores de riesgo asociados al síndrome metabólico y por tanto una inminente morbimortalidad temprana. Se considera vital tomar acciones preventivas y terapéuticas en este grupo poblacional.

Debido a la emergencia sanitaria global causada por la pandemia del COVID-19, tanto la comunidad científica como organizaciones públicas y privadas, juntaron recursos para el desarrollo de vacunas contra la COVID-19. Normalmente, el proceso de creación y aprobación de una vacuna suele tardar varios años, por lo que, organizaciones internacionales como la FDA han otorgado una Autorización por Uso de Emergencia (EUA) para poder agilizar su distribución. El proceso de creación de una vacuna tiene la fase preclínica y las fases clínicas, en las cuales, se analizan su seguridad, eficacia e inmunogenicidad. Sin embargo, no es suficiente la manufactura de la vacuna, sino también garantizar el monitoreo en su seguridad (pos-aprobación) , distribución global y una apropiada divulgación científica a cerca de la misma. Para una apropiada campaña de vacunación , es importante determinar las limitaciones socio-económicas y demográficas de cada país, al igual que los problemas de inequidad en la distribución de vacunas globalmente. Esta revisión, resume la literatura existente acerca de la seguridad de las vacunas que actualmente se suministran en el Ecuador, además, busca informar a los lectores sobre la elaboración de las vacunas y de los retos que enfrenta la inmunización contra el COVID-19

El diagnóstico de COVID-19 en niños es un reto clínico especialmente para los médicos generales pues su prevalencia es menor en la infancia, la sintomatología es diversa y varía según la edad. Los niños pueden ser asintomáticos, presentar sintomatología leve o incluso llegar a tener cuadros graves como el Síndrome Inflamatorio Multisistémico. El propósito de este artículo de revisión es presentar la información científica más importante sobre seroprevalencia, cuadro clínico y factores de riesgo asociados a esta enfermedad infecciosa en la infancia con el fin de aportar al diagnóstico y manejo oportunos.

El 11 de marzo del 2020 la OMS declaró pandemia de COVID-19, causada por el virus SARS-CoV-2. Como resultado, varios países implementaron medidas para evitar la propagación del virus, dentro de las cuales el cierre de los centros escolares fue una decisión común implementada a nivel mundial. La información sobre esta medida es conflictiva, varios estudios reportan que los niños tienen baja participación en la cadena de transmisión mientras que otros reportan que son vehículos de transmisión por su alta carga viral y tendencia a no ser detectados por radares epidemiológicos. Existe un impacto psicológico y social en los niños frente al cierre de escuelas, sin embargo, este factor no debe ser el único determinante en la decisión de reaperturar centros escolares. El gobierno de cada país debe medir su capacidad de control epidemiológico y de respuesta ante posibles brotes y sopesarla contra los efectos que el cierre escolar tiene en sus niños para empezar a considerar la reapertura de escuelas. Con este fin organismos internaciones proponen un listado de recomendaciones para ayudar a los países que decidan reaperturar escuelas a hacerlo tan seguro como sea posible.

Background Testing used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the control of the disease. We collated, delineated and appraised current worldwide recommendations about the role and applications of tests to control SARS-CoV-2/COVID-19.Methods We searched for documents providing recommendations for COVID-19 testing in PubMed, EMBASE, LILACS, the Coronavirus Open Access Project living evidence database and relevant websites such as TRIP database, ECRI Guidelines Trust, the GIN database, from inception to 21 September 2020. Two reviewers applied the eligibility criteria to potentially relevant citations without language or geographical restrictions. We extracted data in duplicate, including assessment of methodological quality using the Appraisal of Guidelines for Research and Evaluation-II tool.Results We included 47 relevant documents and 327 recommendations about testing. Regarding the quality of the documents, we found that the domains with the lowest scores were ‘Editorial independence’ (Median=4%) and ‘Applicability’ (Median=6%). Only six documents obtained at least 50% score for the ‘Rigour of development’ domain. An important number of recommendations focused on the diagnosis of suspected cases (48%) and deisolation measures (11%). The most frequently recommended test was the reverse transcription-PCR (RT-PCR) assay (87 recommendations) and the chest CT (38 recommendations). There were 22 areas of agreement among guidance developers, including the use of RT-PCR for SARS-Cov-2 confirmation, the limited role of bronchoscopy, the use chest CT and chest X-rays for grading severity and the co-assessment for other respiratory pathogens.Conclusion This first scoping review of recommendations for COVID-19 testing showed many limitations in the methodological quality of included guidance documents that could affect the confidence of clinicians in their implementation. Future guidance documents should incorporate a minimum set of key methodological characteristics to enhance their applicability for decision making.

La pandemia de COVID-19 sigue azotando al mundo, cada vez es más común escuchar casos de pacientes que vuelven a contagiarse o tienen recaídas. La causa de muchos de estos casos no es segura pero la información disponible apunta a que al menos una porción es debido a reinfección de SARS-CoV-2. Varios casos de reinfección confirmada mediante análisis genéticos demuestran que la reinfección de SARS-CoV-2 es posible, aunque por el momento es un fenómeno poco documentado, con menos de 30 reportes de casos genéticamente confirmados. A futuro las autoridades sanitarias deben tomar en cuenta la posibilidad de este evento para la toma de decisiones respecto a vacunas y políticas de prevención, mitigación y contención del virus.

La pandemia de COVID-19 causada por la transmisión del virus SARS-CoV-2 ha generado un gran impacto sanitario y socioeconómico de difícil solución ya que hasta el momento no existe un tratamiento o vacuna aprobado para combatirla. De esta manera, las medidas para controlar la transmisión de SARS-CoV-2 se han limitado al distanciamiento social, uso de tapa bocas y a la vigilancia epidemiológica a través de la implementación de pruebas diagnósticas en la población. Estas pruebas son útiles para conocer sobre la transmisión del virus, para poder aislar a los infectados, rastrear a los sospechosos, y de esta manera, obtener datos precisos sobre el número de casos de COVID-19. El uso de distintas pruebas influye en la toma de decisiones clínicas y de políticas públicas, por lo que el objetivo de este artículo es realizar una revisión de la literatura sobre las pruebas de diagnóstico para SARS-CoV-2, considerando, además, las recomendaciones otorgadas por diversas guías de práctica clínica que han sido desarrolladas durante el tiempo de pandemia.

Objective: The aim of this study is two fold. First, it describes the temporal trends of malignant melanoma mortality from 2000 to 2016 in Ecuador. Second, it analyzes the spatial clusters of high mortality rates due to malignant melanoma in the country, from 2011 to 2016. Methods: This is an ecological study; we included all death certificates of malignant melanoma from the National Institute of Statistics and Census database in Ecuador from 2000 to 2016. We calculated crude mortality rates and age-standardized mortality rates, all rates are expressed as deaths per 100,000 population. In order to assess the trend of malignant melanoma rates, we obtained average annual percent changes through Joinpoint regression analysis. Spatial scan statistics were used to identify high-risk clusters and the spatial autocorrelation was evaluated through a global Moran index. Results: In Ecuador, between 2000 and 2016, malignant melanoma caused a total of 958 deaths. Crude mortality rates increased significantly (annual percent change = 4.8%; 95% confidence interval: 2.6–7.0), the age-standardized mortality rate also increased (annual percent change: 2.9%; 95% confidence interval: 0.5–5.4). The most likely cluster included 19 cantons and the second most likely cluster included 10 cantons, located in the Highlands region. The Global Moran I index for the study period shows a positive spatial autocorrelation (0.32; p = 0.001). Conclusion: Mortality due to malignant melanoma in Ecuador significantly increased over the 17-year study period; the spatial analysis and spatial autocorrelation indicates the presence of high-risk occurrence clusters in the Highlands region of the country.

Objetivo: Describir la frecuencia, magnitud y tratamiento de los diversos tipos de melanoma diagnosticados en el Hospital de Especialidades Carlos Andrade Marín (HECAM) de la ciudad de Quito. Métodos: Se realizó un estudio transversal de los pacientes que acudieron a la clínica de Melanoma del servicio de Dermatología del HECAM, durante los años 2013 a 2018. Se tomó en cuenta a todos los pacientes con histopatología diagnóstica de cualquier tipo de melanoma maligno y que tuvieron tratamiento y seguimiento. Se clasificó a los pacientes según el estadiaje clínico y patológico después de la biopsia y se obtuvieron datos sobre su tratamiento y pronóstico. Resultados: Durante un período de cinco años aproximadamente se obtuvieron datos de 77 sujetos con diagnóstico de melanoma maligno, no existieron diferencias en la presentación por sexo (hombres 49,3% frente a mujeres 50,7%), y edad (hombres 68,5 años frente a mujeres 65,7 años). El tipo de melanoma maligno más frecuente en mujeres fue el melanoma maligno de extensión superficial (58,9%) y en hombres el melanoma invasor (42,1%), el tratamiento más frecuente fue la escisión y cierre directo en los casos menos severos, mientras que en estadiajes severos fue la escisión seguida de injerto. Conclusiones: El melanoma maligno es un tipo de cáncer que en nuestro medio afecta por igual a hombres y mujeres, sin embargo, en el Ecuador parece ser que se manifiesta con mayor severidad en los hombres. Las características clínicas de este tipo de patología retrasan el diagnóstico, por lo que es necesario educar a la población para la detección temprana de lesiones sospechosas de melanoma maligno.

Las guías de práctica clínica (GPC) son documentos que incluyen recomendaciones basadas en la evidencia científica para la toma de decisiones clínicas; al mismo tiempo, pueden desempeñar un papel importante en la elaboración de políticas de salud. Por lo tanto, es crucial que se evalúe críticamente su calidad y aplicabilidad en diversos contextos, para lo cual se ha desarrollado la herramienta AGREE II. Este artículo tiene como objetivo dar a conocer el desarrollo, la aplicación y la evaluación de la calidad de las guías de práctica clínica, de manera que se pueda realizar una lectura crítica de las mismas.

Cochrane is an international collaboration whose mission is to promote evidence-based decision-making on health. This is done by conducting high-quality, relevant and accessible systematic reviews, as well as through other forms of summarized scientific evidence. Knowledge translation promotes the real use of scientific knowledge and Cochrane has been developing various projects within this theme. One of those projects includes a collaboration with Wikipedia to improve the quality of information provided in the medical articles published in this digital encyclopaedia. This article summarizes the main characteristics of these initiatives.

BackgroundA false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19.MethodsWe searched MEDLINE, EMBASE, LILACS, as well as COVID-19 repositories, including the EPPI-Centre living systematic map of evidence about COVID-19 and the Coronavirus Open Access Project living evidence database. Two authors independently screened and selected studies according to the eligibility criteria and collected data from the included studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the proportion of false-negative test results using a multilevel mixed-effect logistic regression model. The certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. All information in this article is current up to July 17, 2020.ResultsWe included 34 studies enrolling 12,057 COVID-19 confirmed cases. All studies were affected by several risks of bias and applicability concerns. The pooled estimate of false-negative proportion was highly affected by unexplained heterogeneity (tau-squared = 1.39; 90% prediction interval from 0.02 to 0.54). The certainty of the evidence was judged as very low due to the risk of bias, indirectness, and inconsistency issues.ConclusionsThere is substantial and largely unexplained heterogeneity in the proportion of false-negative RT-PCR results. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 54% of COVID-19 patients may have an initial false-negative RT-PCR (very low certainty of evidence).Systematic review registrationProtocol available on the OSF website: https://tinyurl.com/vvbgqya.

INTRODUCTION Dental caries have been conventionally managed by non-selective removal of carious tissue (total complete removal); however, the adverse effects of this procedure have promoted the use of conservative caries removal techniques (selective removal), but there is still controversy regarding its effectiveness. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including seven studies overall, of which all were randomized trials. We concluded that selective caries removal may decrease the need for root canal treatment and the risk of pulp exposure in teeth with deep caries, but the certainty of the evidence is low. It is not clear whether the selective removal of caries reduces the risk of appearance of signs and symptoms of pulp disease and the risk of restorations failure, as the certainty of the evidence is very low.

ObjectivesThe aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis.MethodsWe conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed.ResultsAmong all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers.ConclusionsUnderstanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.

Abstract Background We aimed to assess recent Latin American medical school graduates’ knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians. Methods Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates’ data with data collected in 2010–2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly. Results Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p

La edición genómica en células germinales es una técnica de ingeniería genética en la que el ADN es insertado, eliminado o reemplazado en el genoma de los gametos o células precursoras. En noviembre de 2018, el investigador chino He Jiankui, anunciaba junto con sus colegas la "creación" de los primeros bebés genéticamente modificados del mundo a través del sistema CRISPR-Cas9, las gemelas Lulu y Nana. Estas declaraciones generaron diferentes reacciones en la comunidad científica, así como preguntas sobre los dilemas bioéticos que envuelven este tipo de procedimientos. El objetivo del presente artículo es analizar los consensos nacionales e internacionales relacionados con los aspectos bioéticos en la investigación de edición genómica en humanos.

En los últimos años los nacimientos por cesárea se han incrementado de manera global, incluso en ausencia de indicaciones terapéuticas claras. Este aumento se debe a un sin número de circunstancias entre las que se destacan el mayor acceso a intervenciones en salud, el nivel de educación o cultural de las madres y mayores réditos económicos al personal sanitario. El profesional de la salud que decide realizar una intervención por petición de la paciente se debe enfrentar a varias consideraciones éticas y de juicio clínico, social y económico.