Central University of Ecuador

This study’s objective was to evaluate the effectiveness of three different families of drugs (Empagliflozin [an SGLT-2 inhibitor], Tirzepatide [a GLP-1 receptor co-agonist], and Teneligliptin [DPP-4 inhibitor] used in the treatment of type 2 diabetes in lowering HbA1c levels in people with type 2 diabetes mellitus (T2DM). The effectiveness of different families of diabetic drugs was assessed using a meta-analytic approach. Data were gathered from a variety of research publications using ICTRP, CT.gov, and PubMed databases. The data were analyzed, and conclusions were drawn using forest plots. Teneligliptin (a DPP-4 Inhibitor) substantially lowered HbA1c levels in T2DM patients compared to other classes of T2DM drugs with a P-value of 0.0002 and 95% CI -0.63 [-0.97 to -0.30] after reviewing many pertinent articles. The pooled data analysis showed that Tirzepatide and Empagliflozin did not significantly lower HbA1c levels, with the P-value for Tirzepatide being P = 0.55 and for Empagliflozin, it was P = 0.64. According to our research, Teneligliptin may be more effective than Empagliflozin and Tirzepatide as a monotherapy for lowering HbA1c levels in T2DM patients. To corroborate these findings, further research studies are required.

Purpose This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair. Methods PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay. Results The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35–1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05–2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD − 1.05 days; 95% CI − 2.06, − 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0–80.1; p < 0.001). Conclusion The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.

We consider the integro-differential system \((\textrm{P}_m)\): where \(x\in {\mathbb {R}}^N\), \(a_k>0\), \(b_k\ge 0\), \(N\ge 2\) and \(1<p<N\), \(u_k \in \textrm{W}^{1,p}({\mathbb {R}}^{N})\), for \(k=1,\ldots ,m\). By \(\partial _{k} F(u_1,\ldots ,u_m),\) it is denoted the k-th partial generalized gradient in the sense of Clarke. The potential \(V\in \textrm{C} \left( {\mathbb {R}}^N \right) \) verifies \(\inf (V)>0\) and a coercivity property introduced by Bartsch et al. The coupling function \(F:{\mathbb {R}}^m\longrightarrow {\mathbb {R}}\) is locally Lipschitz and verifies conditions introduced by Duan and Huang. By applying tools from the non-smooth critical point theory, we prove the existence of a non-trivial mountain pass solution of \((\textrm{P}_m)\).

This article's uniqueness focuses on diagnosing Leishmaniasis, with particular attention to clinical manifestations and demographic factors when skin smear microscopy reveals a negative result and molecular tests are unavailable to the professional. The clinical case concerns an adult patient presenting a hyperkeratotic lesion in the right temporomalar region and another ulcerative lesion in the right atrial pavilion. A smear of the lesion was requested, resulting in a negative. However, two months later, new ulcerative lesions appeared, and a new smear was carried out with a positive result. Treatment with intramuscular Glucantime was started once daily for 21 days. When no improvement of ulcerated lesions in the temporomalar area and pinna was observed, the route of administration was modified by adding intralesional Glucantime, with evident improvement in the clinical state. It is relevant to consider that identifying demographic risk factors and the natural history of the lesions can be determining aspects for the diagnosis, even when the cytological study is negative. It is essential to ensure an adequate technique of taking the test to avoid false negatives and the correct administration of the chosen medication. Keywords: Leishmaniasis; cutaneous, glucantime.

Background Traditionally, X-rays have remained the standard modality for bone fracture diagnosis. However, other diagnostic modalities most notably ultrasound have emerged as a simple, radiation-safe, effective imaging tool to diagnose bone fractures. Despite the advantages, there is a prevalent scarcity of literature recognizing its significance in bone trauma management. This review investigates the effectiveness of ultrasound in the diagnosis of various bone fractures when compared to conventional radiography such as X-rays. Methodology Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science (WOS) were reviewed for observational studies and review articles from the years 2017-2022 utilizing MESH terminology in a broad term search strategy. The search returned a total of 248 articles. After removal of duplicates, abstract, and full-text screening this systematic review ultimately utilized data from 31 articles. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology (Figure 1) and were conducted during August 2022. In accordance with the guidelines for assessing the quality of included systematic reviews, we used the AMSTAR 2020, Supplemental Digital Content 2, http://links.lww.com/MS9/A241 (A Measurement Tool to Assess Systematic Reviews) tool to evaluate the methodological quality of the included studies. A data extraction form based on the Cochrane Consumers and Communication Review group’s extraction template for quality assessment and evidence synthesis was used for data extraction. The information extracted included details such as author information, database, journal details, type of study, etc. Studies included will be classified into long bones, short bones, pneumatic bones, irregular bones, ankle and knee, stress fractures, hip fractures, POCUS, and others. All included studies considered bias and ethical criteria and provided valuable evidence to answer the research question. Results The search returned a total of 248 articles, with 192 articles remaining after the removal of duplicates. Primary screening of the title and abstract articles from the database search and additional sources identified 68 relevant articles for full-text screening. This systematic review ultimately used data from 33 articles of the remaining articles we included all of them because they had more than 70% certainty, using the STROBE tool for observational articles, narrative reviews with the ENTREQ guide, and systematic reviews and meta-analyses with the PRISMA guide; however, 2 articles were excluded at the eligibility stage because of risk of bias. Conclusion This systematic review provides insightful evidence on safety and effectiveness of ultrasound in diagnosing fractures when compared to the conventional imaging modalities such as X-rays. This shall promote further large-scale, multicenter research that can eventually guide clinic practice in diagnosing and managing various bone fractures.

Background The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC. Methods The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657. Results The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four. Conclusion Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.

Urban traffic officers in many low- and middle-income countries are exposed to high levels of traffic-related air pollutants (TRAP) while working vehicle control on heavily congested streets. The impact of chronic TRAP exposure on the cardiovascular health, including the carotid intima-media thickness (CIMT), of this outdoor occupational group remains unclear. This cross-sectional study compared the average mean and maximum CIMT measurements of two groups of relatively young, healthy traffic police (32 ± 7 years; 77% male) in Quito, Ecuador, who were without clinical evidence of serious cardiovascular or other disease. Previously published background data on PM10 (a TRAP surrogate) indicated that street levels of the pollutant were several orders of magnitude higher at the street intersections worked by traffic police compared to those working only in an office. Accordingly, officers permanently assigned to daily traffic control duties requiring them to stand 0–3 m from heavily trafficked street intersections were assigned to the high exposure group (n = 61). The control group (n = 54) consisted of officers from the same organization who were permanently assigned to office duties inside an administration building. Mean and maximum CIMT were measured with ultrasound. General linear models were used to compare the CIMT measurements of the high exposure and control groups, adjusting for covariates. The adjusted average mean and maximum CIMT measures of the high exposure group were increased by 11.5% and 10.3%, respectively, compared to the control group (p = 0.0001). These findings suggest that chronic occupational exposure to TRAP is associated with increased CIMT in traffic police. This is important since even small increases in arterial thickening over time may promote earlier progression to clinical disease and increased premature mortality risk.

Salmonella Infantis and Enteritidis serovars have been reported as important causes of salmonellosis in humans worldwide. However, the virulence of these two serovars has yet to be compared. To evaluate the virulence of Salmonella Infantis (n = 23) and Salmonella Enteritidis (n = 7), we used two models: the Caco2 cells model (in vitro) and the Galleria mellonella model (in vivo). Additionally, the virulence genes of all tested strains were contrasted with phenotypic outcomes. Results showed that adhesion means were 18.2% for Salmonella Enteritidis and 38.2% for Salmonella Infantis strains. Invasion means were 77.1% for Salmonella Enteritidis and 56.2% for Salmonella Infantis strains. Significant differences were found between serovars in adherence and invasion assays. Mortality rates (58% for Salmonella Enteritidis and 62.6% for Salmonella Infantis) were not significantly different between serotypes. The distribution of virulence genes showed that genes fae (fimbrial adherence determinants) and shdA (nonfimbrial adherence determinants) were only found in Salmonella Infantis strains. On the other hand, the rck gene (invasion) and Plasmid-encoded fimbriae genes (pef A, B, C, D) were present in Salmonella Enteritidis exclusively. In conclusion, this study shows that Salmonella Enteritidis has a higher virulence potential under experimental conditions than Salmonella Infantis. However, more studies are needed to determine the risk that Salmonella Infantis could represent compared with Salmonella Enteritidis. Moreover, other in vivo models should be considered to assess the virulence of these serovars.

Professional sociology in Ecuador started with the first chair in sociology in 1915. This led to a series of foundational texts during the 1920s and 30s that sought to define what sociology is while applying it to core aspects of Ecuadorian society. While this time was – in the Global North- marked by a growing centralization on the theories of Durkheim and Weber, the Ecuadorian sociologists preferred other thinkers in order to understand society. The result was a mixture of different theories that were not always clearly articulated but did sustain the first relatively coherent sociological readings of Ecuadorian society. This text will shed light on how the first professional sociology in Ecuador used the classics of sociology in a particular way to build local sociology. The focus will be on the four most relevant sociological thinkers of the first half of the twentieth century, Agustín Cueva Sáenz, Ángel Modesto Paredes, Víctor Gabriel Garcés, and Luis Bossano. They worked with Tarde, Worms, Durkheim, and some German, US-American, and Latin American authors. The creation of the first School for Sociology in the 1960s meant a break from this tradition that has not been reflected adequately until today.

Introducción: el sistema gastrointestinal, más lejos de su clásico rol en la alimentación e inmunidad, cumple también funciones endocrinas mediante la secreción de hormonas que participan en la homeostasis. Objetivo: exponer las generalidades del rol neuroendocrino del sistema gastrointestinal y su impacto en la homeostasis. Métodos: revisión narrativa de la literatura que incluyó 46 artículos seleccionados en base a su disponibilidad abierta y ser publicados en inglés y español. Conclusiones: el estudio de las hormonas gastrointestinales permite el desarrollo de nuevas tecnologías diagnósticas y dianas de tratamiento en el contexto de distintas patologías. Conocer el rol de estas hormonas, desde el prisma de las ciencias biomédicas, podría aportar en el tratamiento de patologías como diabetes, obesidad y síndrome metabólico.

El efecto solvatocrómico es la modificación del espectro de absorción de un soluto al variar el solvente. El presente trabajo evaluó las características solvatocrómicas de Malvidina-3-glucósido clorhidrato. El método para obtener longitudes de onda máxima fue por barridos espectrales. En estándar primario CAS No 7228-78.6, la variación fue determinada en mezclas binarias de etanol-agua: 40,55 y 70%v/v. El efecto solvatocrómico al modificar el pH del solvente (agua) fue evaluado en colorante natural y estabilizado. Los resultados indican que los enlaces hidrógeno intermoleculares entre Malvidina-3-glucósido y las mezclas binarias de etanol-agua son responsables de los cambios solvatocrómicos: 565,2586 ± 3.2784nm, 472,5498 ± 2.5128nm y 457,3589 ± 6.2586nm, producidos por las combinaciones analizadas. Al estabilizar antocianinas en una matriz quelante los cambios solvatocrómicos producidos al variar el pH del solvente agua, son no significativos en comparación con el colorante natural sin estabilizar.

In this study, we assessed the relationship between tubers quality of three varieties (INIAP Libertad, INIAP Josefina and Diacol Capiro) of Ecuador highland early of potato and two formulations of edaphic fertilizer sources. Leaf chlorophyll content (LCC) was evaluated with Chlorophyll Meter SPAD-502Plus. Samples were taken at different heights in three phenological stages: vegetative grow, flowering–formation of tubers and ripening-thickening. Several responses were found in the three potato varieties. Correlation between SPAD value and weight of tubers (W), dry matter (DM), specific gravity (SG) and good chips (GC) were significantly correlated with potato leaves chlorophyll content. For Libertad variety and formulation (KNO3 + NH4H2PO4 + KCl), at vegetative grow in upper strata of plant, the optimal mathematic function for SPAD value andW, DM, SG and GC were: y = 0.262x (R = 0.9938), y = 42.948e (R = 0.5240), y = 10x (R = 0.3277) and y = 10x (R = 0.8681); at plant flowering-formation of tuber stage, the optimal function models were: y = 10 x (R = 0.8553), y = 28.789 e (R = 0.9103), y = 10 x(R = 0.7543) and y = 0.468x + 64.361 (R = 0.9935); at plant ripening-thickening, the optimal function models were: y = 0.664 e (R = 0.7924), y = 29.370 e (R = 0.9572), y = 10 x (R = 0.8247) and y = 0.576x + 62.675 (R = 0.9690), respectively. Our results showed that the use of SPAD-520PLUS proved to be a rapid method for the determination of LCC, being an effective tool for estimating potato tuber quality.

Purpose The purpose of this study was to highlight the clinical and molecular features of 13 Raoultella ornithinolytica strains isolated from clinical environments in Ecuador, and to perform comparative genomics with previously published genomes of Raoultella spp. As Raoultella is primarily found in environmental, clinical settings, we focused our work on identifying mechanisms of resistance that can provide this bacterium an advantage to establish and persist in hospital environments. Methods We analyzed 13 strains of Raoultella ornithinolytica isolated from patients with healthcare associated infections (HAI) in three hospitals in Quito and one in Santo Domingo de Los Tsáchilas, Ecuador, between November 2017 and April 2018. These isolates were subjected to phenotypic antimicrobial susceptibility testing, end-point polymerase chain reaction (PCR) to detect the presence of carbapenemases and whole-genome sequencing. Results Polymerase chain reaction revealed that seven isolates were positive isolates for bla OXA–48 and one for bla KPC–2 gene. Of the seven strains that presented the bla OXA–48 gene, six harbored it on an IncFII plasmid, one was inserted into the bacterial chromosome. The bla KPC gene was detected in an IncM2/IncR plasmid. From the bioinformatics analysis, nine genomes had the gene bla OXA–48 , originating from Ecuador. Moreover, all R. ornithinolytica strains contained the ORN-1 gene, which confers resistance for β-lactams, such as penicillins and cephalosporins. Comparative genome analysis of the strains showed that the pangenome of R. ornithinolytica is considered an open pangenome, with 27.77% of core genes, which could be explained by the fact that the antibiotic resistance genes in the ancestral reconstruction are relatively new, suggesting that this genome is constantly incorporating new genes. Conclusion These results reveal the genome plasticity of R. ornithinolytica , particularly in acquiring antibiotic-resistance genes. The genomic surveillance and infectious control of these uncommon species are important since they may contribute to the burden of antimicrobial resistance and human health.

Human cysticercosis, caused by the parasitic infection of Taenia Solium , is an important challenge for public health in Ecuador and other countries where poor sanitary conditions are a key factor for its appearance. In this series of cases, we publish the imaging findings corresponding to three patients treated in 2022 at the Center of Medical Specialties “Comité del Pueblo” Quito - Ecuador, in which, through radiographic images, multiple radiodense lesions were found in different anatomical regions which follow the typical pattern of distribution parallel to the muscular tissues of the affected region, generating the radiological sign known as “rice grain calcifications”, which corresponds to the presence of Disseminated Cysticercosis (DCC)in the muscular tissue of the host.

Introducción: se examina la violencia en sus diversas formas y las causas que la impulsan, con énfasis en la violencia intrafamiliar, como una manifestación de las relaciones de poder entre hombres y mujeres, que a menudo se naturaliza en la sociedad y no distingue edad, etnia, condición social o identidad de género. Para proteger a las víctimas de la violencia, se han desarrollado herramientas legales a nivel nacional e internacional, y se mencionan las leyes de Ecuador que abordan la violencia contra las mujeres y el femicidio. Objetivos: Establecer criterios para determinar si la boleta de auxilio debe mantenerse o ser revocada después de terminada una investigación de violencia intrafamiliar. Metodología: El estudio se basa en un enfoque cualitativo y utiliza métodos de investigación documental para analizar la boleta de auxilio frente a la violencia intrafamiliar en Ecuador. Se examinan las disposiciones legales, los tratados y trabajos científicos relevantes, así como los principios y criterios aplicados en la protección contra la violencia intrafamiliar. La investigación documental proporciona información valiosa y diversa para respaldar el análisis. Resultados: se destaca que la violencia intrafamiliar conlleva altos costos sociales, económicos y personales para la víctima y la familia, y puede generar enfermedades físicas, mentales e incluso la muerte. Los índices de violencia intrafamiliar en Ecuador han ido en aumento, y la boleta de auxilio se ha convertido en una herramienta importante para proteger a las personas en riesgo de sufrir agresiones. Se ha desarrollado una investigación doctrinaria documental, estadística, legal y jurisprudencial, todo con el fin de cumplir con el objetivo general de establecer criterios para determinar si la boleta de auxilio debe mantenerse o ser revocada después de terminada una investigación de violencia intrafamiliar. Conclusiones: se concluye que el Estado debe garantizar la protección de las personas en riesgo de violencia, y el planteamiento de medidas de protección como una forma de prevenir futuros actos de violencia. Área de estudio general: Derecho. Área de estudio específica: Derecho de familia / Derecho penal.

A review of: Pioneras de la Arquitectura Ecuatoriana, virtual exhibition at https://www. pionerasarquitecturaec.com/exposición-virtual, launched 20 November, 2020, curated by María José Freire and Verónica Rosero. The review examines the Ecuadorian exhibition, which recovers memories that have long remained in the personal and intimate sphere and exposes them to the social sphere, a fundamentally political act.

Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Methods Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. Results Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. Conclusion This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.

A multiplex PCR system (m-PCR) has been developed to accurately differentiate the five most important pathogenic Prototheca species, including the three species associated with infection in dairy cattle (P. ciferrii, P. blaschkeae, and P. bovis) and the two species associated with human infections (P. wickerhamii and P. cutis). The method is low-cost since it employs a simple “heat-shock” method in a TE buffer for DNA extraction. Furthermore, it requires only primers, a Taq polymerase, an agarose gel, and a molecular weight marker for identification. The method was based on published Prototheca cytochrome B sequences and was evaluated using reference strains from each of the five Prototheca species. The validity of the method was confirmed by identifying 50 strains isolated from milk samples. The specificity was tested in silico and with experimental PCR trials, showing no cross-reactions with other Prototheca species, as well as with bacteria, fungi, cows, algae, animals, or humans. The method could detect mixed infections involving two or three Prototheca species, providing a rapid test that delivers results within three hours.

Diarrheal diseases are a leading cause of mortality and morbidity in low- and middle-income countries. Diarrhea is associated with a wide array of etiological agents including bacterial, viral, and parasitic enteropathogens. Previous studies have captured between- but not within-country heterogeneities in enteropathogen prevalence and severity. We conducted a case-control study of diarrhea to understand how rates and outcomes of infection with diarrheagenic pathotypes of Escherichia coli vary across an urban–rural gradient in four sites in Ecuador. We found variability by site in enteropathogen prevalence and infection outcomes. Any pathogenic E. coli infection, coinfections, diffuse adherent E. coli (DAEC), enteroinvasive E. coli (EIEC), and rotavirus were significantly associated with acute diarrhea. DAEC was the most common pathotype overall and was more frequently associated with disease in urban areas. Enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC) were more common in rural areas. ETEC was only associated with diarrhea in one site. Phylogenetic analysis revealed that associations with disease were not driven by any single clonal complex. Higher levels of antibiotic resistance were detected in rural areas. Enteropathogen prevalence, virulence, and antibiotic resistance patterns vary substantially by site within Ecuador. The variations in E. coli pathotype prevalence and virulence in this study have important implications for control strategies by context and demonstrate the importance of capturing within-country differences in enteropathogen disease dynamics.