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Cryoagglutinin autoimmune hemolytic anemia secondary to Mycoplasma pneumoniae infection in patient with pernicious anemia: A case report
(Medwave Estudios Limitada, 2025-09-17)
Leslie Gricel Cuzco Macias
;
Ashley Carolina Cuzco Macias
;
Daniel Simancas-Racines
;
PARISE VASCO, JUAN MARCOS
This report describes the rare case of a patient with autoimmune hemolytic anemia due to cryoagglutinins secondary to Mycoplasma pneumoniae infection, coexisting with pernicious anemia. A 56-year-old man presented with a ten-day history of cough and mucocutaneous pallor. Laboratory studies revealed megaloblastic anemia with low vitamin B12 levels, positive antibodies against intrinsic factor and parietal cells, as well as hemolysis parameters and a positive direct Coombs test for complement (C3d) with cryoagglutinins active at low temperatures. M. pneumoniae infection was confirmed by indirect immunofluorescence for IgM and IgG. Intramuscular B complex supplementation and doxycycline were administered for 14 days, improving hemoglobin and other hematological parameters within four weeks. This case highlights the diagnostic complexity in patients with rare hemolytic anemias in the context of atypical infections and underscores the importance of a multidisciplinary approach for their diagnosis and appropriate treatment. The coexistence of cryoagglutinin-mediated autoimmune hemolytic anemia and pernicious anemia poses diagnostic and therapeutic challenges that are relevant to clinical practice.
Scopus© Citations 1
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Orthopedic Management of a Class III Malocclusion With Deep Anterior Crossbite and Transverse Discrepancy: A Case Report
(Wiley, 2025-10-11)
César Sebastián Arcos-López
;
Marco González
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VILLARREAL ORTEGA, BYRON MARCELO
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PARISE VASCO, JUAN MARCOS
;
Nihat Kılıç
Class III malocclusion is a dentoskeletal condition characterized by altered relationships between bones, teeth, and muscular structures. Sagittal and transversal maxillary deficiency is one of the most common patterns, negatively affecting facial esthetics and the psychosocial well‐being of the patient. This case report describes an 11‐year‐old male patient with Class III skeletal malocclusion, a deep anterior crossbite, and a transverse discrepancy. Orthodontic treatment was performed with a mini‐implant assisted rapid palatal expansion (MARPE 2S), anchored in the maxilla with two mini‐implants, combined with four additional components: two for a face mask and two for the Ertty Gap III protocol, as well as a lip bumper with flanges for 5/16 heavy intermaxillary elastics in Class III mechanics for 24 h a day, attached to a soldered lingual arch. The combination of these orthopedic devices synergistically improved expansion and anteroposterior changes, resulting in significant functional, esthetic, and psychological improvements for the patient.
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Effects of Preoperative Exercise Interventions in Patients Undergoing Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis
(MDPI AG, 2025-09-01)
SIMANCAS RACINES, DANIEL ALEJANDRO
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PARISE VASCO, JUAN MARCOS
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ANGAMARCA IGUAGO, JAIME WLADIMIR
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Ashley Carolina Cuzco Macias
;
Carlos Soria
Background: Obesity affects over one billion people globally. Bariatric surgery is the most effective long-term intervention for severe obesity. However, postoperative outcomes can vary considerably, with such factors as baseline fitness and cardiorespiratory reserve influencing surgical outcomes. This systematic review aimed to evaluate the effects of preoperative exercise or physical activity, compared to standard care or no intervention, on preoperative fitness parameters and perioperative surgical outcomes in adults with obesity undergoing metabolic and bariatric surgery. Methods: A systematic review was conducted in accordance with the recommendations of the Cochrane Handbook and the PRISMA guidelines. Randomized controlled trials, non-randomized controlled trials, and cohort studies with control groups evaluating preoperative exercise interventions were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using Cochrane tools. Meta-analyses were performed using random effects models, with standardized mean differences calculated for continuous outcomes. Evidence certainty was assessed using the GRADE approach. Results: A total of 15 studies, including 1378 participants, were identified for qualitative synthesis, with 12 contributing data for quantitative meta-analysis. Preoperative exercise interventions significantly improved six-minute walk test distance (SMD 2.01; 95% CI: 0.51 to 3.50; p = 0.009) and VO2 peak (SMD 1.02; 95% CI: 0.52 to 1.51; p < 0.0001). BMI reduction was significant (SMD −0.96; 95% CI: −1.75 to −0.16; p = 0.02), while weight change was not statistically significant (SMD −0.81; 95% CI: −1.72 to 0.09; p = 0.08). One study reported a reduction in hospital length of stay of 0.64 days (95% CI: −0.86 to −0.42; p < 0.00001). Evidence certainty was rated as very low to low across all outcomes. Conclusions: Preoperative exercise interventions have been shown to significantly improve cardiorespiratory fitness in bariatric surgery candidates, with large effect sizes for functional capacity measures. Despite the low certainty of the evidence, these findings suggest that supervised exercise programs should be incorporated into the preoperative care of bariatric surgery patients.
Scopus© Citations 1
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Association Between Dental Caries, Dental Biofilm, and Body Mass Index in Indigenous Children from Two Regions of Ecuador: A Cross-Sectional Study
(Ovid Technologies (Wolters Kluwer Health), 2025-07)
Ana del Carmen Armas Vega
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María Cristina Rockenbach Binz Ordóñez
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Esteban Torracchi-Carrasco
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Eleonor Vélez León
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PARISE VASCO, JUAN MARCOS
Aim:To assess caries prevalence and its association with dental biofilm presence and body mass index (BMI) in children. Materials and Methods: In this cross-sectional study, 88 children aged 2–12 years were examined. The presence of dental caries was evaluated using the International Caries Detection and Assessment System (ICDAS) II criteria, with caries prevalence and index (dmft/DMFT) calculated based on established codes equivalent to World Health Organization standards (ICDAS II E-G/4–6). Dental biofilm was assessed using a standardized index, and nutritional status was determined by calculating BMI. To analyze the relationships between caries experience (dmft and DMFT) and the independent variables of weight, height, BMI, and dental biofilm index, a multiple linear regression analysis was performed using SPSS v25.0. Results: A high prevalence of dental caries was observed in the study population. For primary teeth, caries prevalence (ICDAS 2–6) ranged from 15.9% to 52.3%, with a mean of approximately two affected teeth per child. In permanent teeth, the prevalence for initial caries lesions (ICDAS II code 2) reached 75%, with an average of three affected teeth per child. A statistically significant correlation was identified between BMI, dental biofilm index, and the DMFT score. Notably, a child's weight demonstrated a moderate negative impact on their DMFT score, explaining 45% of the variance (η² = 0.45). Conclusion: The findings reveal a high burden of dental caries among children in the surveyed rural Ecuadorian communities. The significant association between a lower BMI and a higher caries index, alongside the influence of dental biofilm, underscores the intricate relationship between nutritional status, oral hygiene, and oral health. These results highlight the need for integrated public health interventions that address both malnutrition and oral hygiene to mitigate the high prevalence of dental caries in this and similar populations.
Scopus© Citations 3
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Sociodemographic and spatiotemporal distribution of tuberculosis and human immunodeficiency virus co-infection in three cantons of Guayas, Ecuador: A cross-sectional study.
(Medwave Estudios Limitada, 2025-04-16)
Ronald Cedeño Vega
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Inti Kory Quevedo
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ANGAMARCA IGUAGO, JAIME WLADIMIR
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CAGUA ORDONEZ, JAEN CARLOS
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PARISE VASCO, JUAN MARCOS
Introduction Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection are major public health problems in Latin America and Africa. The province of Guayas in Ecuador has a high proportion of cases but there is limited information on their sociodemographic characteristics and spatial distribution. The aim of this study was to analyze the sociodemographic and spatiotemporal characteristics of TB/HIV coinfection patients in three cantons of the Guayas province, Ecuador, in 2018. Methods A cross-sectional study was conducted using secondary data from the Ministry of Public Health of Ecuador. The study population was all adult patients with a diagnosis of TB/HIV co-infection residing in the three cantons of the three cantons. Data were analyzed to determine prevalence, incidence and mortality, as well as socio-demographic variables such as age, sex, educational level and housing conditions. Spatial distribution was assessed using QGIS software version 3.24 to identify high-prevalence areas. Results A total of 379 cases of TB/HIV coinfection were identified, with a predominance of males (80.74%) and a mean age of 35 years. The prevalence was 1.24 per 100 000 inhabitants, with a case fatality rate of 15.57%. Individuals below the poverty line showed a stronger association with co-infection (PR=6.773, 95% CI: 4.985 to 9.202). Spatially, cases were concentrated in socioeconomically disadvantaged municipalities of Guayaquil. Conclusions TB/HIV co-infection shows a clear association with social determinants, especially poverty and educational level. The heterogeneous spatial distribution among the three cantons and the high case fatality rate suggests the need to strengthen epidemiological surveillance and implement targeted interventions addressing social determinants in the most vulnerable areas.
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Spatial analysis of receptivity and vulnerability to arbovirosis transmission in Ecuador between 2015 and 2019: An ecological study
(Medwave Estudios Limitada, 2025-04-03)
Jaen Cagua-Ordoñez
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Inti Quevedo-Bastidas
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SIMANCAS RACINES, DANIEL ALEJANDRO
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Evelyn Frias-Toral
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PARISE VASCO, JUAN MARCOS
Introduction Arboviruses such as dengue, Zika and chikungunya represent a threat to public health in several South American countries, including Ecuador. Accurate identification of local risk areas and detection of critical transmission points are crucial for the effective planning of vector control programs, particularly in the management of the effectively planning vector control programs, particularly in managing mosquito. This study aimed to characterize the variables of receptivity and vulnerability to arboviral transmission at the cantonal level, and to identify hotspots in Ecuador between 2015 and 2019. Methods Environmental and sociodemographic data at the cantonal level were used to perform a spatial analysis, which included a spatial autocorrelation analysis to identify transmission hotspots at the parish level. GeoDa software was used to detect these hotspots. Results The provinces of Ecuador with the highest levels of receptivity and vulnerability were Manabí, Guayas, El Oro and Esmeraldas. These levels were mainly related to temperature, altitude, and limited access to clean water services. Fifty-six cantons were identified as high transmission areas. Nine parishes were classified as transmission hotspots for five consecutive years. Conclusions The spatial analysis allowed for precisely identifying the more susceptible and vulnerable areas for arbovirus transmission in Ecuador. The persistence of transmission hotspots in certain municipalities was evidenced, influenced by environmental and sociodemographic factors. This evidence is key to adapt and improve vector surveillance and control strategies in the most affected regions.
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Self-Reported Prevalence of Chronic Non-Communicable Diseases Concerning Socioeconomic and Educational Factors: Analysis of the PURE-Ecuador Cohort
(Ubiquity Press, Ltd., 2025-03-13)
FELIX GALLEGOS, CAMILO EDGAR VINICIO
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LOPEZ FLECHER, MAVEL ESTEFANIA
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Michelle Vega
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Katherine Andrango
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Selena Andrango
Background: The changing epidemiological landscape, marked by the increasing prominence of Non-Communicable Chronic Diseases (NCDs), underscores the need for studies that identify and analyze these conditions and their associated risk factors. This secondary analysis aims to describe the association between socioeconomic and educational characteristics and the prevalence of self-reported NCDs among participants in the PURE-Ecuador cohort in urban and rural populations of the Metropolitan District of Quito (MDQ), Ecuador. Methods: This secondary analysis is part of the Prospective Urban Rural Epidemiological (PURE) study. Data were collected from February to December 2018, including 2028 participants aged 35 to 70 years from different urban and rural areas of the MDQ. Data collection utilized standardized questionnaires administered in face-to-face interviews. Pearson’s chi-square tests and multivariate logistic regression were used to assess associations. Results: The self-reported prevalence of hypertension was 16.2%, rising to 32.7% in individuals over 60 years old. The prevalence of diabetes mellitus was 6.7%, coronary heart disease 1.3%, stroke 1.6%, heart failure 1.3%, COPD 0.4%, asthma 1.3%, and cancer 1.9%. Multimorbidity affected 5.9% of participants, with the highest rates in obese and older individuals (≥60 years). Adherence to medications was high for hypertension and diabetes mellitus but varied substantially between communities. Conclusions: The secondary analysis revealed significant disparities in the prevalence and management of NCDs in MDQ. The prevalence of self-reported NCDs in Quito, Ecuador, is significantly associated with age and body mass index (BMI). Older individuals, particularly those over 60 years, and obese participants demonstrated higher rates of NCDs and multimorbidity. While socioeconomic factors such as education and income showed some associations with NCD prevalence, these were less pronounced after adjusting for other variables. These findings highlight the importance of age-specific and obesity-focused interventions in addressing the burden of NCDs in this population.
Scopus© Citations 3
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Preventing and Managing Pre- and Postoperative Micronutrient Deficiencies: A Vital Component of Long-Term Success in Bariatric Surgery
(MDPI AG, 2025-02-20)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Evelyn Frias-Toral
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NUÑEZ VASQUEZ, CRISTINA ELIZABETH
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PARISE VASCO, JUAN MARCOS
;
Raynier Zambrano-Villacres
Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes.
Scopus© Citations 43
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Distribution of malignant neoplasms of the oral cavity in Ecuador: an epidemiological study from 2015 to 2019
(Medwave Estudios Limitada, 2025-04-01)
Karina Lalangui
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QUENTIN, EMMANUELLE
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PARISE VASCO, JUAN MARCOS
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REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Evelyn Frías-Toral
Introduction Malignant neoplasms of the oral cavity represent a public health problem worldwide with an increasing incidence, especially in young populations. In Ecuador, the epidemiology of these conditions has been little studied, limiting timely diagnosis and management. The study aims to identify the distribution of hospitalizations and deaths from oral cavity malignant neoplasms in Ecuador during the pre-pandemic years, from 2015 to 2019, describing spatiotemporal patterns by province, gender, and age. Methods An observational and descriptive study was conducted using the database of hospitalizations and deaths of the National Institute of Statistics and Census of Ecuador. Variables such as age, gender, province, and location of the neoplasms were analyzed, and frequencies, proportions, and crude rates were calculated. Results Between 2015 and 2019, 4444 hospitalizations and 726 deaths were reported, with a notable increase in 2019. Males predominated in all the studied years. Malignant neoplasms of unspecified sites and other sites of the tongue had the highest frequency of cases and deaths. Geographically, the provinces of Loja, El Oro, Cañar, Carchi, and Bolivar had the highest rates. Conclusions The study shows an increase in hospitalizations and deaths due to malignant neoplasms of the oral cavity between 2015 and 2019, highlighting the urgency of implementing public health strategies aimed at prevention, early detection, and timely treatment of this disease.
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Experiencias y desafíos de la Comisión nacional asesora de eventos supuestamente atribuibles a la vacunación o inmunización graves de Ecuador, 2020-2023
(Pan American Health Organization, 2024-12-16)
SIMANCAS RACINES, DANIEL ALEJANDRO
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PARISE VASCO, JUAN MARCOS
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Sebastián Baldeón-Espinosa
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Rosa R. Aguinaga
;
Gabriela Vinueza-Valencia
Objective. To describe the experiences of the National Advisory Commission on Serious Events Supposedly Attributable to Vaccination or Immunization (ESAVI) implemented in Ecuador for the period 2020-2023. Method. A report analyzing the implementation, operations, and results of the National Advisory Commission on Serious ESAVI in Ecuador was prepared. A quantitative analysis of vaccination records was carried out, as well as a qualitative analysis based on expert interviews, reflecting the direct experiences and operational challenges faced by the members of the Commission. Results. Implementation of the Commission has allowed for the systematic recording and analysis of serious ESAVIs. Of 256 reported cases, 139 were analyzed: 59% were considered coincident events; 16.6%, unclassifiable; 6.5%, indeterminate; 5%, stress-related; 3.6% as events related to a programmatic error; and 9.4% as vaccine-related, which included allergic reactions, Guillain-Barré syndrome, and thrombosis, among others. The experts highlighted the need to improve staff training and technology infrastructure, and noted that the Commission played a crucial role in monitoring vaccine safety, as well as in increasing public confidence in vaccination processes. Conclusions. The National Advisory Commission has played an essential role in vaccine safety surveillance in Ecuador by ensuring reporting, causality analysis, and investigation of serious ESAVIs. Challenges were identified and will need to be addressed to maintain public trust in immunization programs.
Scopus© Citations 1

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