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Treatment of Sensitive and Resistant Tuberculous Meningitis.
Introduction: Tuberculous meningitis is caused by Koch's bacillus or Mycobacterium tuberculosis, it is caused by the passage of the blood-brain barrier of the bacterium to the brain and spinal cord, it is a disease that causes serious neurological complications consequences of late diagnosis and treatment. Objective: The main objective of the research is to define the current treatment of tuberculous meningitis. Methods: A systematic structured search was carried out with the PRISMA 2020 statement, 43 published articles on tuberculous meningitis and advances in antibiotic treatment were reviewed with information from databases such as Pubmed, Mendeley, Wiley, Web of Science, Cochrane and Google Scholar. Results: the treatment of sensitive tuberculous meningitis includes 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by a phase of isoniazid and rifampicin, with doses equal to those of pulmonary tuberculosis for 12 months, high doses of rifampicin 15, 20 and 30 mg/kg demonstrated better penetration at the level of the cerebrospinal fluid than the usual doses of the recommended standard treatment of 10 mg/kg, In patients infected with the human immunodeficiency virus, higher doses up to 35 mg/kg obtained a better minimum inhibitory concentration. Conclusions: The treatment of resistant tuberculous meningitis requires higher doses to achieve better penetration to the central nervous system. The current treatment regimen includes high doses of rifampicin, linezolid, levofloxacin or moxifloxacin orally or intravenously, which are used for multidrug-resistant germs, for a prolonged period that may include 9 to 20 months of treatment
Copyright (c) 2025 Javier Aquiles Hidalgo Acosta , Lissette Stephanie Ibarra Vélez , Natalia Andrea Campos Ordoñez, Valeria Lorena Segarra Zambrano , Manuel Ignacio Álvarez Narváez https://creativecommons.org/licenses/by/4.0
Diabetic ophthalmopathy advances in diagnosis and treatment
Introduction: diabetic retinopathy is a chronic complication of diabetes mellitus; its current management is of great importance to prevent the progression of the disease that can cause blindness and disability. Objectives: to describe current therapeutic strategies in the management of diabetic ophthalmopathy. Materials and Methods: a systematic search was carried out with the statement prism 2020 of 33 scientific medical articles, obtained from databases such as: PubMed, Scopus, Willey, Google Scholar, Scielo and Cochrane. Results: intravitreal injection of drugs in patients with diabetic macular edema is useful and superior to laser photocoagulation in diabetic macular edema to prevent vascular neoformation. Artificial intelligence has been deployed to predict and diagnose early before vision loss sets in. Observed risk factors associated with diabetic retinopathy include poisoning by some heavy metals. Conclusion: fundus with stereoscopic photography allows diagnosis by biomicroscopy to examine the retina. The image of choice is optical coherence tomography angiography, which is a test that allows the density of microscopic structures to be observed more precisely, to recognize microvascular changes. Preventive treatment of risk factors, therapeutic control of diabetes mellitus, and administration of intravitreal medications can prevent progression to blindness. The administration of fibrate can reduce the progression of the disease due to its effect on the main risk factor of diabetics, hypertriglyceridemia. Treatment with intravitreal injections of vascular anti-endothelial growth factor can delay diabetic retinopathy.
Copyright (c) 2025 Javier Aquiles Hidalgo Acosta , Ana Patricia Galeas Hernández, Estefanía Rossana Mina Mero , Miguel Ángel Carreño Álava, María Belén Cueva Pantoja https://creativecommons.org/licenses/by/4.0
Progressive Preoperative Pneumoperitoneum and Botulinum Toxin as Adjuvant Techniques in the Management of Hernias with Loss of Continent
Introduction: “Loss-of-domain” hernias are defined as those in which the hernia sac exceeds 15–20% of the abdominal cavity volume, often leading to respiratory and circulatory compromise. The Tanaka Index is commonly used for diagnosis. Management strategies include preoperative adjuvant techniques such as progressive pneumoperitoneum and botulinum toxin type A injection; both aimed at expanding abdominal capacity and reducing wall tension. Objective: To narratively review current evidence on the role of progressive preoperative pneumoperitoneum and botulinum toxin A as adjuvant strategies in the management of loss-of-domain hernias, focusing on their impact in reducing surgical complications and improving postoperative outcomes. Methods: A narrative literature review was conducted based on scientific publications retrieved from databases such as PubMed, Scielo, ScienceDirect, Web of Science, and Elsevier, prioritizing relevant information published in English and Spanish within the last five years. As this is a narrative review, no systematic protocols were applied; therefore, the results are presented in a descriptive and analytical manner. Results: The reviewed evidence shows that these techniques facilitate reintegration of abdominal contents, decrease tension during closure, and improve respiratory tolerance. Progressive pneumoperitoneum gradually enlarges abdominal volume, while botulinum toxin A induces temporary muscle relaxation, both contributing to safer surgical repair and reduced risk of complications such as abdominal compartment syndrome. Conclusions: Available literature supports the use of progressive pneumoperitoneum and botulinum toxin as effective and safe preoperative adjuncts for loss-of-domain hernias. Individualized patient selection and tailored application remain essential for optimizing outcomes
Copyright (c) 2025 Evelyn Johanna Solano Benalcázar , Jackson André Tapia Cueva, Ariana Nicole Sari Yánez , Víctor Peñafiel Gaibor https://creativecommons.org/licenses/by/4.0
Current management and advances in the treatment of Vestibular Schwannomatosis
Introduction: vestibular schwannomatosis (SV), also known as acoustic neurinoma or NF2, is a genetic mutation in the NF2 gene located on chromosome 22, characterized by loss of function of a tumor suppressor protein that has several names among them: Merlin, Neurofibromin 2 and schwannomin. It is classified as a hereditary multiple neoplasm syndrome with an incidence of 1:25,000 to 1:40,000. Objectives: to determine the current management and progress in pharmacological treatment of vestibular Schwannomatosis Methods: a systematic search was carried out with the PRISMA 2020 statement of studies or research on VS, as search words were used the terms Schwannomatosis vestibular, Schwannoma vestibular, acoustic neuroma, published in the last 5 years. For the selection, observational studies, randomized and non-randomized clinical trials, systematic reviews and meta-analyses were used; studies with missing, unavailable data were excluded. Results: gamma-ray scalpel radiosurgery is a treatment that helps stabilize tumor growth and improves hearing. Stereotactic radiosurgery for vestibular schwannoma has a high tumor control rate of 90.7%, excellent preservation of the facial nerve and low incidence of tinnitus and vertigo. Surgical management with a low failure rate can be used for tumor recurrence. Conclusions: treatment with monoclonal antibodies such as bevacizumab is a breakthrough in research, whose mechanism of action allows acting as an antiangiogenic that inhibits the vascularization of tumors by slowing their development. The main goal of treatment is to stop the growth of the tumor, which can improve symptoms such as hearing loss. Response to treatment will depend on tumor size, location and associated symptomatology. The surgical approach consists of microsurgery or stereotactic surgery with good results.
Copyright (c) 2025 Javier Aquiles Hidalgo Acosta , Wagnner Ariol Intriago Zambrano , Israel Luis Villavicencio Quevedo, Evelyn Lucero Capuz Balladares , Mónica Piedad Moran Ayala https://creativecommons.org/licenses/by/4.0
Sickle Cell Disease: A Care Challenge. Narrative Review
Introduction: Sickle cell disease or sickle cell anemia (SCA) is an autosomal recessive inherited disease characterized by the production of hemoglobin S (HbS), which causes medical complications such as vaso-occlusive episodes, chronic anemia, and organ damage. This disease represents a global public health challenge requiring comprehensive medical care and effective management strategies. Objective: To analyze recent scientific literature on sickle cell disease to identify main care needs, healthcare barriers, and current debates from an integrative perspective. Method: A qualitative literature review was conducted following the PRISMA-ScR extension guidelines. Eligibility criteria included original articles and narrative reviews published between 2013 and 2023, in Spanish and English, with a clinical, epidemiological, or pathophysiological focus. The search was conducted using terms such as "sickle cell disease," "hemoglobin S," and "sickle cell disease." Five researchers participated in the selection, applying methodological quality criteria using the CAsPe tool. Results: From an initial 1,886 publications, 15 studies were selected after the screening process. The findings were organized into two thematic areas: identified care needs (pain management, crisis, preventive treatment, transfusions, and psychosocial support) and barriers to healthcare (limited access, lack of professional knowledge, socioeconomic barriers, and stigmatization). Conclusions: Sickle cell disease presents complex challenges that require a multidisciplinary approach. Significant gaps in the healthcare system were identified, especially in resource-limited countries, highlighting the need to improve professional training and the fundamental role of nursing in the comprehensive care of patients and families
Copyright (c) 2025 Alexander Casallas Vega , Juanita Parra Hernández, Eddison Ramírez Merchán , Melissa Avellaneda Gutiérrez, Jeisson Hincapié Carvajal , David Andrade Fonseca https://creativecommons.org/licenses/by/4.0
Advances in human papillomavirus infection and cervical cancer in Latin America
Introduction: Cervical cancer remains a leading cause of morbidity and mortality in women worldwide, strongly linked to persistent human papillomavirus (HPV) infection. Despite advances in vaccination, screening, and targeted therapies, disparities in access to prevention and treatment persist. Objective: To analyze recent advances in prevention, diagnosis, and treatment strategies for HPV infection and its relationship with cervical cancer. Methods: A structured narrative review was conducted to synthesize relevant scientific evidence from 80 manuscripts included. To ensure the rigorous selection of articles, we followed the PRISMA guidelines adapted to a narrative approach, searching the PubMed, Scopus, Web of Science, and Cochrane Library databases. Studies on epidemiology, pathogenesis, diagnosis, and therapies were included, in a time range from 2010 to 2024. Publications with insufficient or duplicated data were excluded. Finally, a qualitative thematic analysis was conducted, focusing on the central axes of epidemiology, pathogenesis, diagnosis, treatment, prevention, and future perspectives in HPV and cervical cancer research. Results: In Latin America, research efforts on HPV and its relationship with CCU have increased in the last two decades, mainly focusing on the identification of high-risk genotypes, the viral load in vulnerable populations, and the implementation of screening and vaccination programs, such as the nonavalent vaccine, which has significantly reduced the incidence of HPV infections and precancerous lesions. Although viral DNA detection surpasses conventional cytology in sensitivity, structural inequalities still limit access to advanced molecular diagnostic tools. As for treatment, in CCU advanced stages, multimodal treatments combining chemotherapy, radiotherapy, and immunotherapy improve survival, although access barriers remain in vulnerable communities. Conclusion: There is a technological disparity that compromises the timely detection and adequate follow-up of the population at risk of HPV infection and CCU onset. Therefore, comprehensive public health policies are essential to ensure equitable access to prevention and treatment strategies for cervical cancer, as well as to strengthen local capacity for genomic diagnosis and molecular surveillance of HPV. The implementation of screening programs based on molecular testing and educational strategies is crucial to reducing the disease burden in the region.
Copyright (c) 2025 Jaime David Acosta España , Dámaris P Intriago Baldeón, Ricardo Tello , María Fernanda Gutierrez Bravo https://creativecommons.org/licenses/by/4.0
Relación entre dolor lumbar y rango de movilidad de la columna en personal universitario de Quito, Ecuador
Low back pain is a leading cause of disability with functional and occupational impact. This quantitative cross-sectional study evaluated the prevalence of low back pain and its relationship with lumbar mobility in the staff of Universidad Internacional SEK (UISEK), Miguel de Cervantes campus, Quito. Of the 137 employees, 71 completed the Nordic Musculoskeletal Questionnaire, and 60 underwent biomechanical lumbar flexion mobility measurements. 73% reported having experienced low back pain in the past 12 months. Regarding mobility, 53.3% had poor mobility (<40°), 43.3% normal (40–70°), and 3.3% excellent (>70°). A chi-square goodness-of-fit test was applied to compare observed versus expected values in a healthy population, and a Wilcoxon test was used to compare mobility angles between those with and without pain. A significant deviation was found (p < 0.001) in the distribution of mobility, and lower mobility in those with pain (p = 0.0009, r = 0.40). These findings support an association between low back pain and restricted mobility, possibly influenced by sedentary behavior and occupational factors.The main limitations of this study include the reduced sample size and the single-center design, which may limit the generalizability of the findings
Copyright (c) 2025 Sebastián López Cifuentes, Leandro Santiago Garrido García , Jorge Espinosa, Pedro Herrera, Jonathan Nango, Ruth Mosquera https://creativecommons.org/licenses/by/4.0
Prevalence of chronic childhood malnutrition in the community of Pasa, Tungurahua
Introduction: Chronic child malnutrition (CCM) is a global public health issue (22%) and affects the growth and development of more than 12 million children under the age of five in Latin America. According to the 2022–2023 National Child Malnutrition Survey (ENDI), the prevalence of CCM was 17.5%, reaching 27% in the province of Tungurahua, Ecuador. Objective: To determine the prevalence of chronic child malnutrition in children under five years of age and its associated factors. Methods: An observational, descriptive, and cross-sectional study was conducted in a high Andean community of Ecuador. Secondary data from a local academic project were used, collected between September 2024 and February 2025. Anthropometric, demographic, socioeconomic, and dietary variables were included. Results: In a sample of 29 indigenous children under the age of five, 27.6% were found to have CCM and 31.0% were at risk of developing it. Statistical tests showed no significant associations between nutritional status and variables such as sex, number of meals, ethnicity, or self-reported diet. Conclusions: Although the sample size was small and the results cannot be generalized to other populations, they raise concern as the prevalence found in the studied community is higher than those reported globally and in ENDI. Furthermore, the determinants of nutritional status were multifactorial
Copyright (c) 2025 Alexandra Acurio Ruiz , Ricardo Recalde Navarrete https://creativecommons.org/licenses/by/4.0
The extended classroom: the community as a pedagogical space in medical education
<pre id="tw-target-text" class="tw-data-text tw-text-large tw-ta" dir="ltr" tabindex="-1" role="text" data-placeholder="Traducción" data-ved="2ahUKEwj7_8bL6YCRAxVURjABHfqfL_4Q3ewLegQIDBAW" aria-label="Texto traducido: Medical education faces a growing challenge: training professionals capable of responding to healthcare demands in complex contexts marked by multimorbidity, inequality, and an aging population. In this scenario, the family physician emerges as a key educator, capable of transforming the community into a vibrant learning environment where students learn not only clinical practice but also social and preventive medicine.">Medical education faces a growing challenge: training professionals capable of responding to healthcare demands in complex contexts marked by multimorbidity, inequality, and an aging population. In this scenario, the family physician emerges as a key educator, capable of transforming the community into a vibrant learning environment where students learn not only clinical practice but also social and preventive medicine.
Copyright (c) 2025 Esmeralda Maricela Estrada Zamora https://creativecommons.org/licenses/by/4.0
Obesity and major adverse cardiovascular events
Introduction: Major adverse cardiovascular events are a combination of events that include acute myocardial infarction, stroke, and cardiovascular mortality. Genetic studies reveal that abdominal obesity has a detrimental effect on recovery after ischemic stroke. Heart failure precipitated by obesity causes symptoms such as fatigue, dyspnea, and functional limitation. Objectives: To determine the relationship between cardiovascular risk and obesity. Materials and methods: A systematic search was carried out with data obtained from databases such as PubMed, ELSEVIER, Wiley, WHO, SciELO with the PRISMA 2020 declaration of 39 articles or research on obesity and cardiovascular risk, for the search words obesity and cardiovascular risk were used. With articles published in the last 5 years on the research topic, observational studies, randomized and non-randomized clinical trials, systematic reviews and meta-analyses were used for selection, excluding studies with missing, unavailable data. Results: The results show that a preventive approach can be carried out with the control of variables such as systolic blood pressure at a value <120 to prevent stroke, anti-obesity drugs reduce major cardiovascular events, the administration of statins decreases mortality, the development of kidney disease increases the risk for cardiovascular complications. Conclusions: major adverse cardiovascular events involve acute heart failure associated with acute myocardial infarction, cardiac arrhythmias or unstable angina. These pathologies include the need for coronary revascularization, ischemic and hemorrhagic stroke are serious complications in which early treatment can reduce mortality, so reducing obesity is of vital importance due to its association with other risk factors modifiable.
eventos cardiovasculares adversos mayores
Copyright (c) 2025 Noemí Georgina Díaz Meneses , Moraima Elizabeth Pazmiño Iñiga , Valeria Lorena Segarra Zambrano , Sonnia Paola Díaz Cepeda , Javier Aquiles Hidalgo Acosta https://creativecommons.org/licenses/by/4.0
Introduction: Endometrial cancer (EC) is a malignancy of the inner epithelial lining of the uterus. It is considered one of the most common types of gynecological cancer in high-income countries. Its incidence is increasing worldwide, ranking it the sixth most common cancer in women, with obesity being the main risk factor. Most cases occur between the ages of 65 and 75. Objective: Describe the latest advances in endometrial cancer. Materials and methods: A review of 33 scientific articles was conducted, obtained from prestigious and internationally recognized databases such as PubMed, the New England Journal of Medicine, and international guidelines, among others. The articles were mostly from 2019 onward, in Spanish and English, and included review articles, meta-analyses, observational, descriptive, and retrospective studies, as well as author opinions on the topic of endometrial cancer and its current treatment. Results: Hysterectomy is the primary treatment, primarily in 67% of patients. Minimally invasive or robotic surgery are a current trend for the treatment of endometrial cancer. According to a study from the National Cancer Database, it would present better results compared to open surgery (p < 0.001). For advanced or recurrent EC, carboplatin AUC 5-6 plus paclitaxel 175 mg/m 2 every 21 days for six cycles should be considered first-line therapy. Conclusions: Endometrial cancer treatment depends on the stage of the histological grade and molecular subtype, the patient's age, and her reproductive desires. In early stages, total abdominal hysterectomy plus bilateral salpingo-oophorectomy is the primary treatment; in advanced stages, standard chemotherapy should be accompanied by pembrolizumab.a monoclonal antibody that binds to the PD-1 protein to help the immune system destroy cancer cells andthus improving survival.
Copyright (c) 2025 Darío Gustavo Mora Bazantes , Fernando Félix Gavilánez Ramos , Deborah Denisse Gaibor Santos , Rebeca Katherine Muzzio Mila , María Fernanda Calderón León https://creativecommons.org/licenses/by/4.0
Preoperative evaluation in adults as a source for the prevention of post-surgical complications: literature review.
rates of postoperative complications. This highlights the importance of preanesthetic assessment to identify potential risks. Worldwide, between 10% and 15% of surgeries present complications, with infections and respiratory problems being the most common. Objective: To analyze current advances and strategies in pre-surgical assessment aimed at identifying and managing risk factors, as well as their relationship with the incidence of complications. Materials and Methods: A literature search was conducted in various databases (Web of Science, PubMed, Scielo, and Elsevier), selecting studies such as randomized controlled trials, clinical practice guidelines, and literature reviews published between 2021 and 2024. Thirteen articles focusing on preoperative assessment and postoperative complications were included. Results: An estimated 313 million surgeries are performed annually, with a mortality rate of 1.34% within 30 days. Factors such as smoking, alcohol consumption, nutritional status, and comorbidities are identified during the preoperative consultation. The use of predictive scales allows for the estimation of cardiovascular and postoperative risks. Discussion and Conclusions: To reduce the reporting of surgical and post-surgical complications, risk factors such as malnutrition and other comorbidities should be considered. Although predictive scales are useful, they should not be the only tools used to assess patients. The most common complications include surgical wound infections, seromas, hematomas, and stoma complications.
Copyright (c) 2025 Evelyn Johanna Solano Benalcázar, Ariana Nicole Sari Yánez , Aisha Jahanny Ortega Moreira, Víctor Peñafiel Gaibor https://creativecommons.org/licenses/by/4.0
Types of Shock: Practical Approach in Intensive Care Unit
Introduction: Shock is a complex cardiovascular emergency, characterized by a reduction in tissue perfusion and oxygen supply below the minimum levels necessary to meet tissue requirements. Objective: To define the types of shock and establish the current management in intensive care. Methods: 55 scientific medical articles were selected, which responded with the objective and met the inclusion criteria, through a search in databases such as PUBMED, Elsevier, Wiley, journals such as NEJM, BMJ. Results: An international randomized trial (CLASSIC) demonstrated that, in septic shock, intravenous fluid restriction did not result in fewer deaths at 90 days than standard intravenous fluid therapy. Regarding the management of hemorrhage during extracorporeal life support, it is advisable to reduce heparin, until coagulation is normalized, when bleeding from the tube, selective clamping of one side of the endotracheal tube where bleeding is evident can be performed. In cases of cardiogenic shock due to thyrotoxicosis, plasmapheresis can be used to reduce thyroid hormone levels and the overload it causes to the heart. Patients with undifferentiated shock point-of-care ultrasound (POCUS) protocols have been shown to improve outcomes. In cases of anaphylactic shock, management is with epinephrine, salbutamol, corticosteroids, intravenous fluids, vasopressors, and antihistamines. Conclusions: The initial approach to the state of shock requires prioritizing actions to restore tissue perfusion, with close hemodynamic and metabolic monitoring. Diagnostic and therapeutic attitudes must be kept in mind given the seriousness of the situation, first ruling out life-threatening conditions with timely recognition and corresponding action to improve the prognosis of the critically ill patient
Copyright (c) 2025 Javier Aquiles Hidalgo Acosta, María Belén Cueva Pantoja , Kevin Fernando Gavilanes Navarrete , Alfredo Guillermo Chong Viteri https://creativecommons.org/licenses/by/4.0
Introduction: Ventilator-associated pneumonia is a healthcare-associated infection that causes increased morbidity and mortality in the intensive care unit 48 hours after endotracheal intubation and invasive mechanical ventilation. Objective: To determine the antibiotic treatment of ventilator-associated pneumonia and its current management. Methods: For the preparation of this manuscript, 37 medical articles published in the last 5 years were used, using databases PubMed, ScienceDirect, Wiley Online Library, Google Scholar, with the search words: pneumonia associated with mechanical ventilation antibiotics. Results: Ventilator-associated pneumonia occurred in the highest percentage in the groups that did not comply with the preventive measures packages. A meta-analysis revealed that VAP in a total of 84,031 participants, with the implementation of the packages of measures, reduced the episodes of VAP compared to the group that did not receive the packages of measures (OR = 0.42; 95% CI 0.33; 0.54). The initial empirical treatment with beta-lactams, fluoroquinolones or aminoglycosides is used in clinical suspicion, carbapenems or colistin are used as a second line for resistant germs, nebulized antibiotics such as amikacin, tobramycin and colistin were very useful in negativization. Conclusions: The diagnosis, treatment and prevention of VAP is relevant in the intensive care unit because it increases hospital stay, use of antibiotics, mechanical ventilation time, need for sedatives, muscle relaxants and increases mortality from multidrug-resistant germs
Copyright (c) 2025 Rebeca Tamara Cárdenas Matute, Graciela Jemima Chalco Román , Stefanny Michell Canales Vélez , Gabriela Roxana Toala Zambrano, Javier Aquiles Hidalgo Acosta https://creativecommons.org/licenses/by/4.0
Artificial intelligence, the evolution in medical diagnosis.
Introduction: Artificial intelligence (AI) is considered the new promise in clinical practice, with its effectiveness in diagnosis and treatment based on predictive algorithms that may in the future reduce mortality and decrease the economic impact on society. Objectives: Describe the benefits of artificial intelligence and its applications in clinical diagnosis in medicine. Methodology: A documentary design research was carried out, descriptive and exploratory. Through the search for complete scientific articles, in databases such as SciElo, Pubmed, Google Scholar and LATINDEX, using the descriptors: artificial intelligence, diagnosis, medicine, health. Results: 31 articles were identified that have weight in the research, it is concluded that the application of AI will be the complement to medical diagnosis with relevance, effectiveness and accurate prognosis to prevent and reduce mortality from various diseases and reduce the global economic cost of health. Conclusions: It is concluded that artificial intelligence will be highly beneficial in the field of clinical diagnosis in healthcare. It will recognize pathologies in their early stages and develop them after treatment has been implemented, with application to the development of new, patient-centered treatments on an individualized basis.
Copyright (c) 2025 Carlos Antonio Escobar Suarez , Rene Marcelo Abarca Tenemasa , Mónica Ivonne López Salazar , Diana Carolina Carrazco Flores https://creativecommons.org/licenses/by/4.0
Well-being and Comprehensive Health in Young Adult University Students: Current Perspectives and Challenges.
Introduction: The well-being and holistic health of young adult university students, along with the quality of medical education in universities, are fundamental aspects for preparing professionals capable of meeting the demands of the healthcare system. Their relationship with student satisfaction not only reflects students’ perceptions of their academic experience but also serves as an indicator of educational effectiveness. This connection is transforming pedagogical models toward virtual and hybrid approaches, enhancing the quality of medical education through a sustainable development perspective. Objective: To analyze the relationship between student satisfaction and the quality of medical education at the university as a component of young adults' well-being and holistic health. The study aims to identify pedagogical, technological, and relational factors that influence this interaction, and to evaluate how educational changes derived from sustainable development have affected the perception of quality among medical students as a current trend. Materials and Methods: A systematic review of scientific literature published in the last five years was conducted. From an initial pool of 100 studies, 30 relevant articles were selected based on inclusion criteria. The analyzed studies addressed factors such as teaching quality, technological infrastructure, and pedagogical methodologies in both in-person and virtual learning environments. Results: One of the main challenges identified was that the quality of medical education at the university is the primary determinant of student satisfaction. Key contributors included teacher training, innovative strategies such as problem-based learning (PBL), and constructive feedback. Educational resources like clinical simulators significantly improved students’ perception of quality. The teacher-student relationship, grounded in empathy and support, was found to be crucial in maintaining high levels of satisfaction, positioning it as an essential component of young adults' holistic health and sustained by a framework of sustainable development. Conclusion: The well-being and holistic health of young adults face challenges related to the quality of medical education. Addressing these challenges requires a holistic approach that integrates technological innovation, such as clinical simulators and virtual reality, as well as teacher training focused on implementing strategies like PBL and constructive feedback. Additionally, on a relational level, teacher accessibility, empathy, and academic support help build student confidence and promote responsible autonomy, contributing to sustainable development as an innovative perspective.
Copyright (c) 2025 Elena Vicenta Hernández Navarro , Kevin Fabián Negrete Gordón, San Antonio Serrano Thalía Daniella, Esmeralda Maricela Estrada Zamora, Juan Pedro Vargas Naranjo https://creativecommons.org/licenses/by/4.0
Nursing interventions in cases of poisoning, literature review
Poisonings occur due to contact with a toxic substance or a non-toxic substance in large quantities, either accidentally or intentionally, causing organ damage and potentially leading to death.Objective: To analyze the frequency, risk factors, complications, therapeutic approach, and nursing interventions in poisoned patients.Methodology: This study corresponds to a bibliographic review in scientific databases such as Web of Science, Scopus, PubMed, Springer Nature, ResearchGate, Dialnet, and Scielo, as well as institutional health-related websites. A total of 56 scientific documents were used to develop this research. Results: One of the most frequently involved substances in poisonings worldwide is pesticides. Regarding risk factors, they vary depending on whether the population is pediatric, adult, or elderly, with young children being at the highest risk. Poisoning complications differ depending on the substance, including organ, nervous, and cognitive impairments, and can even be fatal. Finally, the therapeutic approach, as well as nursing interventions, is determined based on the type of poison or toxic substance. However, all aim to stabilize the patient and eliminate the toxic agent from the body, along with monitoring vital signs, blood values, neurological examinations, and other aspects.Conclusion: It is essential for nursing staff to have adequate knowledge of various toxic substances, their effects, and the appropriate therapeutic approach for each causal agent.
Copyright (c) 2025 Erika Paola Sucozhañay Pacheco , Johanna Gabriela Yanza Rodas https://creativecommons.org/licenses/by/4.0
Reflections and challenges of the graduation process in the medical degree program: Experience and perspective from university education
<pre id="tw-target-text" class="tw-data-text tw-text-large tw-ta" dir="ltr" data-placeholder="Traducción" data-ved="2ahUKEwiOy9yv58GOAxUIWDABHeWQH7YQ3ewLegQICRAW" aria-label="Texto traducido: The graduation processes in the Medical program at the Technical University of Ambato, considering the challenges and learning that this path entails for students and faculty. The graduation process represents one of the most relevant milestones in medical training, as it requires a holistic understanding of theoretical knowledge, clinical skills, and research competencies, fundamental elements for responsible professional practice. The typologies of this requirement are: a comprehensive examination and a graduation thesis, which corresponds to an original article – a systematic review and an article linked to research projects, in which various limitations have been demonstrated.">The graduation processes in the Medical program at the Technical University of Ambato, considering the challenges and learning that this path entails for students and faculty. The graduation process represents one of the most relevant milestones in medical training, as it requires a holistic understanding of theoretical knowledge, clinical skills, and research competencies, fundamental elements for responsible professional practice. The typologies of this requirement are: a comprehensive examination and a graduation thesis, which corresponds to an original article – a systematic review and an article linked to research projects, in which various limitations have been demonstrated.
Copyright (c) 2025 Alexandra del Rocío Laguapillo Vergara https://creativecommons.org/licenses/by/4.0
The role of primary health care in palliative care: a case of Creutzfeldt-Jakob disease in Ecuador
Introduction: Creutzfeldt-Jakob disease is a rare neurodegenerative disease caused by an abnormal isoform of the prion protein. Its rapid progression and high mortality profoundly impact on the quality of life of patients and their families, necessitating an integrated palliative approach. Objective: To describe the role of primary health care in providing palliative care to a patient with Creutzfeldt-Jakob disease, highlighting its importance in comprehensive management, family support, and improving quality of life in the context of neurodegenerative diseases. Case presentation: A 66-year-old woman with eight months of progressive asthenia, memory loss, severe cognitive impairment with disorientation, apraxia, and total dependence in basic activities. The patient received home palliative care by the primary care team until her death. Discussion: The poor prognosis and lack of curative treatment for Creutzfeldt-Jakob disease require a palliative approach from primary health care for continuous support for the patient and their family until the end of life. Conclusion: Creutzfeldt-Jakob disease, although rare, requires a comprehensive approach that provides continuous support for the patient and their family, from diagnosis to bereavement support. Its rapid progression underscores the importance of early detection, interdisciplinary management, and timely implementation of palliative care, given the lack of curative treatment
Jacqueline Elizabeth Cevallos Salazar Jacqueline Elizabeth Cevallos Salazar
Copyright (c) 2025 Irving Israel Buitrón Nieto, Alexandro Vinicio Cruz Mariño, Raúl Ruiz de Zarate Del Cueto, Andrea Valeria Araujo Lascano, Jacqueline Elizabeth Cevallos Salazar Jacqueline Elizabeth Cevallos Salazar https://creativecommons.org/licenses/by/4.0
Resistencia antimicrobiana en infecciones hospitalarias en América Latina: revisión bibliográfica
Introduction: Antimicrobial resistance (AMR) in nosocomial infections is a growing public health challenge in Latin America, limiting therapeutic options and increasing hospital-related mortality. Objectives: To examine the prevalence of multidrug-resistant hospital infections, identify dominant bacterial resistance mechanisms, and assess current control strategies in Latin American healthcare systems. Methods: A narrative review was conducted using literature published between 2019 and 2024 from PubMed, Scopus, and SciELO. Observational studies, systematic reviews, and regional surveillance reports were included. Results: The prevalence of infections caused by multidrug-resistant bacteria ranged from 25% to 56%, exceeding 60% in intensive care units. The most frequently reported pathogens were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Common resistance mechanisms included ESBL production, carbapenemases (KPC, NDM, OXA), and efflux pumps. Considerable disparities were identified between countries in terms of diagnostic capacity, surveillance systems, and antibiotic regulation. Conclusions: AMR in Latin American hospital settings is a multifactorial issue requiring coordinated regional responses. Strengthening epidemiological surveillance, expanding access to molecular diagnostics, promoting antimicrobial stewardship, and developing comprehensive public health policies are essential to contain the spread of resistance.
Copyright (c) 2025 Christian García Suárez, Lissett Delgado Díaz , Estephania Chinchilima Sánchez https://creativecommons.org/licenses/by/4.0
Application of hydrocolloid patches in patients hospitalized in the icu as a strategy for the prevention of pressure ulcers
The use of hydrocolloid patches is recommended to prevent pressure ulcers in critically ill patients. Objective: To analyze the scientific evidence on the application of hydrocolloid patches in patients in the ICU as a prevention strategy against the formation of pressure ulcers. Materials and methods: Descriptive qualitative systematic review in which articles published in prestigious journals were analyzed, performing a search based on a PICO question in the PubMed, Scielo, and Trip Database databases with a maximum age of 10 years. Results: Seven articles were evaluated, all of which were quantitative with different designs; 42.8% of them were randomized clinical trials, 28.6% were systematic reviews, 14.3% prospective observational and the other 14.3% descriptive observational. 72% of the reviewed studies indicated that the hydrocolloid patch fulfills its function in the prevention of pressure ulcers, however the cost it represents is higher than other dressings. Conclusions: Hydrocolloid patches are an ideal option to prevent pressure injuries in patients hospitalized in the ICU
Copyright (c) 2025 Anthony Steeven Vilca Ruiz, Darwin Javier Ramos Cevallos, Yorgi Alejandro Ramirez Godoy, Stephany Mishell Chimbo Soriano https://creativecommons.org/licenses/by/4.0
Vertical Transmission of Sexually Transmitted Infections: HIV, Syphilis, and Hepatitis B
Sexually transmitted infections (STIs) constitute a global public health problem, with a significant impact on pregnant women due to the risk of vertical transmission to the fetus. The transmission of STIs such as HIV, syphilis, and hepatitis B can occur at various stages of pregnancy, childbirth, and lactation, affecting neonatal health. This literature review aims to analyze STIs with the highest risk of vertical transmission and their complications in newborns. A systematic search was conducted in indexed scientific databases, including Scielo, Scopus, and PubMed, selecting studies published between 2019 and 2023. Findings indicate that untreated syphilis can lead to miscarriages and congenital malformations, while HIV, without antiretroviral therapy, has a transmission rate of 25%-40%, which decreases to less than 2% with treatment. Hepatitis B, with a 90% transmission rate in mothers with positive HBeAg, can be prevented with immunoglobulin and neonatal vaccination. Strategies such as early diagnosis, effective prenatal care, and timely treatment have significantly reduced the vertical transmission of these infections. However, it remains necessary to strengthen prevention programs and improve access to treatment to minimize risks to maternal and infant health.
Copyright (c) 2025 Verónica del Pilar Gavilanes Fray , Fausto Mauricio Tamayo Vásquez , Joseline Stefanie Bustamante Silva, Andrea Eizabeth Vilaruel Quishpe https://creativecommons.org/licenses/by/4.0
Complications and mortality of neuroinfection. A systematic review
Introduction: Neuroinfection is a serious cause of neurological disease, epidemiologically it is estimated that it affects 2.5 million people in the world, at any age, with greater prevalence in regions that lack vaccination programs, such as the African continent specifically in the area called meningitis belt, where there is a high prevalence of the disease. since it is considered a health problem of great relevance worldwide. Objectives: to conduct a systematic review on complications and mortality in neuroinfection. Materials and methods: Databases such as PubMed, Wiley, SciELO, BMC, Europe PMC, Latindex, Google Scholar were searched. Observational studies, multicenter studies, randomized trials, systemic reviews, and meta-analyses were included with the research topic with a total of 50 articles. Results: According to a meta-analysis of 157 656 published cases of bacterial meningitis, the highest case fatality rate was presented by meningitis caused by Listeria monocytogenes with 27%, pneumococci 24%, meningococci 9% and H. influenzae 11%, whereas, the immunization of individuals with risk factors or areas against invasive meningococcal disease caused by Neisseria meningitidis of groups A, C, Y, W and X is a priority. A retrospective study carried out at the Eugenio Espejo Hospital in Quito revealed that 58 patients with HIV and neuroinfection accounted for 13.27% of admissions, the clinical manifestations were characterized by altered state of consciousness in 25.86%, seizures in 20.7%, headache in 15.5%, neurological focality in 39.7% of cases. Conclusions: Neuroinfection is a common pathological state in patients with risk factors or exposed to risk areas where preventive immunization is deficient and represent susceptible populations that can generate infection in the brain, presenting high morbidity and mortality and important neurological sequelae. In our country, the largest number of patients with neuroinfection is expressed by patients suffering from the human immunodeficiency virus
Copyright (c) 2025 Javier Aquiles Hidalgo Acosta, Romina Ivanna Mendoza Granda, Israel Luis Villavicencio Quevedo, Urvina Muñoz Jefferson Vicente , Wagnner Ariol Intriago Zambrano https://creativecommons.org/licenses/by/4.0
Evidence-Based Medicine (EBM): A Systematic Review
Background: Evidence-Based Medicine (EBM) is a process that integrates the best available scientific evidence with the clinical practice of healthcare professionals. The implementation and application of EBA must establish appropriate guidelines to ensure the optimal functioning. Objective: To evaluate the existing scientific information regarding the application and impact of Evidence-Based Medicine (EBM) as a decision-making methodology among medical professionals in undergraduate and postgraduate settings. Methods: A systematic review was carried out using the PRISMA methodology. A search of articles was conducted using various health-related databases, based on defined inclusion and exclusion criteria. Results: A total of 120 articles related to EBM were identified, of which 10 were duplicates. Of the remaining articles, 48 explained that decisions were made under pressure from superiors, and 36 met the inclusion criteria. Conclusion: These findings highlight the importance of applying EBM in clinical practice and its role as a critical factor in undergraduate and postgraduate education
Copyright (c) 2025 Gustavo Rafael Galarza Ortiz , Harold Hernando Hermoza Ruiz , Lidia Tatiana Pozo Pozo, Elías David Dávila Alcocer https://creativecommons.org/licenses/by/4.0
Situs inversus totalis, unusual image finding: clinical report
Introduction: Situs inversus totalis is a rare congenital anomaly characterized by a mirror-image of the normal position of both the abdominal and thoracic organs. Frequency of situs inversus is 1:10,000, with male predominance 1.5:1. Advanced imaging modalities can be used to evaluate fine anatomical details, which is of vital importance for interventional radiology and surgery. Objective: To describe the importance of ultrasound in the diagnosis of situs inversus totalis in a case with acute appendicitis. Materials and methods: A retrospective descriptive study was conducted, in a case of situs inversus totalis with acute appendicitis. Informed consent was obtained from the patient's legal tutor. Data were collected from the patient's medical history during their hospital stay and collected using Google Sheets. A bibliographic search was conducted using PubMed, MEDSCAPE, Elsevier, and Google Scholar databases, including the keywords "ultrasound" AND "situs inversus" OR "situs inversus vicerum" AND "appendicitis." Results: We describe a clinical case of a 12-year-old male patient with abdominal pain of 24 hours of evolution is described. It worsens and is located in the left hemiabdomen. Abdominal ultrasound is performed and findings compatible with situs inversus totalis and acute appendicitis are shown. Conclusions: The proper use of ultrasound plays an important role in the diagnosis of surgical emergencies in the pediatric population, and is especially useful in patients with anatomical variants or genetic malformations. It is a cost-effective tool with high sensitivity and specificity, for the diagnosis of important diseases in this population.
Copyright (c) 2025 Gabriela Andrade Navas , Fabián Andrade Navas , Alejandro Martínez Pérez https://creativecommons.org/licenses/by/4.0
Clinical case report: Acute appendicitis due to appendicular endometriosis.
Appendiceal Endometriosis is a rare condition that occurs in women of reproductive age. It can present as an acute inflammatory abdomen, where the expertise of the healthcare professional and the performance of a thorough physical examination play a crucial role in determining whether surgical intervention is necessary. This article reports a case of acute appendicitis due to appendiceal endometriosis with a subhepatic location of the vermiform appendix. Objective: To describe a clinical case of appendiceal endometriosis in a patient presenting with an acute appendicitis-like clinical picture, with an unusual location, along with its management, clinical evolution, and the identification of the most appropriate surgical technique. Materials and Methods: This is a descriptive retrospective case report. Informed consent was obtained from the patient for the review of her medical records and imaging studies, which contributed to the development of this investigation. Bibliographic references published up to August 2024 were included. Results: We report the case of a 30-year-old female patient who presented to the emergency department with a clinical picture initially compatible with Pelvic Inflammatory Disease, which did not respond to medical treatment. Due to the persistence of an acute inflammatory abdomen, a diagnostic laparoscopy was performed, revealing a Grade I appendix located in the subhepatic region. Conclusion: Appendiceal endometriosis is caused by subserosal or subperitoneal invasion. Its prevalence ranges from 0.05% to 1.69%, making it a rare entity. Even more uncommon is the subhepatic location of the cecum and appendix, with an incidence of 0.09 per 100,000 population. Subhepatic appendicitis is difficult to diagnose, as it may mimic hepatobiliary diseases, making the decision for surgical intervention challenging. The surgeon’s experience and training, along with preoperative imaging and careful planning, are fundamental pillars for the successful evaluation and surgical management of this condition
Copyright (c) 2025 David Aulestia, Edwin Alarcón, Steven Alarcón , Evelyn Salguero, Jenifer Salguero https://creativecommons.org/licenses/by/4.0
The Da Vinci robot in surgery: a systematic literature review
Introduction: The Da Vinci robot has revolutionized modern surgery by enabling highly precise, minimally invasive procedures in various medical specialties such as urology, oncology, gynecology, and digestive surgery. This article analyzes recent literature on its use, efficacy, safety, and limitations in terms of accessibility and costs. Objective: To analyze the Da Vinci robot in surgery. Methods: A systematic literature review was conducted according to the PRISMA2020 guideline, in databases such as Scopus and PubMed, considering original articles published between 2020 and 2024. Thirty open-access, full-text studies in Spanish and English were included, excluding review articles, theses, and duplicates. The information collected was organized into analysis tables under the criteria of four PICO questions to facilitate the interpretation of the results. Results: Among the main findings were: the Da Vinci robot has been successfully applied in nephrectomies, prostatectomies, hysterectomies, and tumor resections; a significant reduction in postoperative pain and hospitalization time has been reported; and acquisition and maintenance costs are the main limitation to its accessibility in developing countries. Conclusions: Da Vinci robot-assisted surgery is an effective tool in modern medical practice. Its precision and reduced postoperative impact make it a preferred option in many procedures, although its high cost remains a challenge for its widespread adoption. Further research into its cost-benefit ratio and strategies to improve its global accessibility is recommended
Copyright (c) 2025 Juan Patricio Sigüenza Orellana, Mateo Nicolás Guerrón Chamba, Jandry Leomar Contento Carranza, Carlos Mateo Castillo Jara, Alex Humberto Castillo Valarezo https://creativecommons.org/licenses/by/4.0
Forensic Archaeology in Ecuador: An Interdisciplinary Approach to the Localization and Analysis of Human Remains
This study proposes integrating archaeological practices into Ecuadorian forensic investigations, specifically in the search, recovery, and analysis of skeletal remains through interdisciplinary work. A methodological framework is designed based on a qualitative approach of an exploratory and descriptive nature, through a thorough review of materials related to the topic. The study assesses the feasibility of implementing these practices within the National Police, considering the challenges and potential benefits of their application in forensic work. Additionally, guidelines are developed for training forensic personnel, aiming to form interdisciplinary teams capable of applying these methodologies in both field and laboratory settings. The study concludes that integrating archaeology into forensic investigations can enhance the accuracy, efficiency, and depth of criminal investigations, providing clearer answers in cases of disappearances and unsolved crimes
Copyright (c) 2025 Ricardo Alejandro Benítez Álvarez, Jefferson Manuel Cazorla Velasco https://creativecommons.org/licenses/by/4.0
The Transformative Potential of Generative Artificial Intelligence in Clinical Medicine: Promises and Ethical Challenges
Generative artificial intelligence (GAI), characterized by its ability to create original content by learning complex patterns from large data sets, is emerging as a disruptive tool in clinical medicine. Unlike traditional AI models focused on prediction or classification, GAI—particularly large language models (LLMs)—enables the generation of text, images, audio, and other types of data with unprecedented sophistication. This capability has opened a broad spectrum of applications ranging from diagnostics and personalized treatment to drug development optimization and enhanced doctor–patient communicatio
Copyright (c) 2025 Ricardo Xavier Proaño https://creativecommons.org/licenses/by/4.0
Dengue in Ecuador: its relationship with climate change and the dynamics of Aedes aegypti.
Introduction: Dengue is the most common vector-borne disease in Ecuador, especially in tropical areas. Climate change and environmental conditions have favored its spread to new regions, including higher altitudes. This represents a challenge for disease surveillance and control in the country. Methodology: A review and analysis of scientific literature addressing the impact of dengue in Ecuador was conducted, with an emphasis on its relationship with climate change and the environmental conditions that favor its spread. Results: In Ecuador, 27,838 cases of dengue were reported in 2023, increasing to 61,352 in 2024 and 15,814 cases in 2025. The most affected provinces are in tropical areas such as Guayas, Napo, and Manabí; however, a notable increase has been seen in Andean provinces such as Loja, Pichincha, and Bolívar. Discussion: The analysis reveals that the behavior of Aedes aegypti and the transmission dynamics of dengue are closely linked to environmental variables such as increased temperature, humidity, and rainfall. These conditions have allowed the colonization of previously non-endemic areas, such as regions of the Ecuadorian Sierra. Furthermore, extreme weather events, such as El Niño, accelerate its life cycle, favoring a higher incidence. Conclusions: It is concluded that climate change, combined with unfavorable socio-environmental factors, has intensified the presence of dengue in the country. Integrated environmental surveillance and health control strategies are required to contain its spread and reduce its impact on public health
Copyright (c) 2025 María Paz Calle Tello, Claudia Gabriela Clavijo Rosales, Rosa Daniela Pineda Baculima https://creativecommons.org/licenses/by/4.0