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The Molecular Mechanisms Underlying Dercum’s Disease: Exploring the Intersection of Obesity, Pain, and Inflammation
(MDPI AG, 2025-11-18)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Emilia Jiménez Flores
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Melannie Toral-Noristz
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Campuzano Donoso Martín
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ROMAN GALEANO, NATHALY MERCEDES
Obesity is increasingly recognized not only as a metabolic disorder, but also as a state of chronic low-grade inflammation that predisposes to systemic complications. Within this context, Dercum’s disease (DD), or adiposis dolorosa, emerges as a rare yet debilitating disorder characterized by painful subcutaneous lipomas, most commonly affecting middle-aged women. Despite its clinical impact, DD remains underdiagnosed and is often misclassified as lipedema, fibromyalgia, or lipomatosis, complicating prevalence estimates and hindering the development of targeted interventions. Current evidence suggests that DD represents a distinctive model of inflammatory obesity, where adipose tissue actively contributes to pain generation rather than serving as a passive fat reservoir. Histological and molecular findings point to adipose tissue dysfunction, immune cell infiltration, and elevated secretion of pro-inflammatory adipokines, signals which appear to fuel systemic low-grade inflammation, perineural immune interactions, and nociceptor sensitization. Peripheral mechanisms further shape the clinical phenotype. While familial clustering suggests possible genetic contributions, no definitive markers have been identified, and the role of obesity-induced epigenetic modifications remains unexplored. Therapeutic strategies remain largely symptomatic, including analgesics, antidepressants, physical rehabilitation, and surgical excision of lipomas, whereas molecularly targeted and diet-based interventions are still experimental. This article discusses the pathophysiology of DD, current treatments, and future perspectives, emphasizing that advancing patient registries, omics-based analyses, and interdisciplinary clinical trials will be crucial to elucidate disease mechanisms and guide novel therapies. Improved understanding of DD may not only enhance patient care, but also provide broader insights into the interplay between obesity, inflammation, and chronic pain.
Scopus© Citations 2
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Healthcare attitudes toward depression in Latin America: a latent class analysis from Argentina, Chile, Ecuador, Peru, and Venezuela using the Spanish-validated revised depression attitude questionnaire (SR-DAQ)
(Springer Science and Business Media LLC, 2025-10-01)
Marco Faytong-Haro
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Genesis Camacho-Leon
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Robert Araujo-Contreras
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Stephanie Gallegos
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Hans Mautong
Background: Depression significantly impacts health systems worldwide, particularly in Latin America, where cultural stigmatization and misconceptions about mental health deter individuals from seeking help. Healthcare professionals’ attitudes toward depression may affect its prevention, diagnosis and treatment. Objective: To categorize Latin American healthcare professionals’ attitudes towards diagnosis and management of depression in subgroups using the Spanish-validated Revised Depression Attitude Questionnaire (SR-DAQ). Methods: A cross-sectional study surveyed 2,409 professionals using SR-DAQ from 2019 to 2022. Latent class analysis and multinomial logistic regression were used to identify attitude classes and explore demographic influences. Results: Among our sample, four attitude classes were identified: Depression Skeptics (21%), Depression Cautious (33%), Depression Neutrals (18%), and Depression Advocates (28%). Gender and medical subspecialty significantly influenced class membership, with females and mental health specialists more likely to be part of the Advocates. Conclusion: The study reveals varied attitudes towards depression among Latin American healthcare professionals, suggesting the need for tailored public health strategies to enhance effective depression care and management.
Scopus© Citations 2
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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
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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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Redefining Chemoresistance: Natural Bioactives as Molecular Modulators at the Cancer–Tumor Microenvironment Interface
(MDPI AG, 2025-08-20)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Emilia Jiménez Flores
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GONZALEZ CALZADA, NATALIA
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SIMANCAS RACINES, DANIEL ALEJANDRO
Therapeutic resistance remains a critical barrier in effective cancer treatment, contributing to disease recurrence, progression, and reduced patient survival. In recent years, natural bioactive compounds have emerged as promising adjuncts in oncology due to their ability to modulate multiple biological processes involved in resistance. This review explores current evidence on the role of natural compounds in influencing cancer cell behavior and their interactions with the tumor microenvironment. By organizing these compounds into chemical families, we provide a structured overview of their potential to enhance the efficacy of standard chemotherapy and reduce resistance-related mechanisms. We also highlight innovative strategies, including combination therapies and advanced drug delivery systems, that aim to improve their clinical applicability. Overall, this work underscores the relevance of integrating natural bioactives into modern cancer therapy and calls for further translational research to bridge preclinical findings with clinical implementation.
Scopus© Citations 10
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H5N1 Avian Influenza: A Narrative Review of Scientific Advances and Global Policy Challenges
(MDPI AG, 2025-06-29)
Simancas-racines Alison
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REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Melannie Toral
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SIMANCAS RACINES, DANIEL ALEJANDRO
The H5N1 avian influenza virus continues to evolve into genetically diverse and highly pathogenic clades with increased potential for cross-species transmission. Recent scientific advances have included the development of next-generation vaccine platforms, promising antiviral compounds, and more sensitive diagnostic tools, alongside strengthened surveillance systems in both animals and humans. However, persistent structural challenges hinder global readiness. Vaccine production is heavily concentrated in high-income countries, limiting equitable access during potential pandemics. Economic and logistical barriers complicate the implementation of control strategies such as vaccination, culling, and compensation schemes. Gaps in international coordination, public communication, and standardization of protocols further exacerbate vulnerabilities. Although sustained human-to-human transmission has not been documented, the severity of confirmed infections and the rapid global spread among wildlife and domestic animals underscore the urgent need for robust preparedness. International organizations have called for comprehensive pandemic response plans, enhanced multisectoral collaboration, and investment in targeted research. Priorities include expanding surveillance to asymptomatic animal hosts, evaluating viral shedding and transmission routes, and developing strain-specific and universal vaccines. Strengthening global cooperation and public health infrastructure will be critical to mitigate the growing threat of H5N1 and reduce the risk of a future influenza pandemic.
Scopus© Citations 8
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Oesophageal adenocarcinoma, obesity, and cancer: the role of nutrition in prevention and management
(Informa UK Limited, 2025-05-29)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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SIMANCAS RACINES, DANIEL ALEJANDRO
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Emilia Jiménez Flores
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Martín Campuzano Donoso
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Angelo Michele Carella
Oesophageal adenocarcinoma (EAC) is increasingly associated with obesity, metabolic dysfunction, and genetic predispositions. This review explores how nutritional factors interact with these risk elements, emphasizing the potential of dietary strategies in EAC prevention and management. Diets such as the Mediterranean and plant-based patterns may reduce inflammation, oxidative stress, and metabolic imbalance, thereby modulating cancer risk. Nutrient-rich foods–particularly omega-3 fatty acids, cruciferous vegetables, and dietary fibre–offer additional protective effects. Personalized nutrition, tailored to individual genetic and metabolic profiles, is emerging as a promising tool in cancer prevention. Moreover, weight management strategies like caloric restriction and intermittent fasting may contribute to risk reduction. Integrating these approaches into clinical and public health practices could play a critical role in mitigating the underlying drivers of EAC. Further research is needed to strengthen dietary guidelines and advance precision nutrition for high-risk populations.
Scopus© Citations 12
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Innovation and bioethics in surgery: Redefining boundaries for a safe and human-centered future
(Medwave Estudios Limitada, 2025-03-06)
Evelyn Frias-Toral
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Alex Enrique Vásconez García
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Melannie Toral-Noristz
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Martín Campuzano-Donoso
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ZAMBRANO ESPINOSA, ANA KARINA
Since surgery is a complex procedure due to multiple factors, it is more difficult to rigorously evaluate innovative processes in this field than clinical trials of new drugs. Being able to carry out an adequate study design with all its corresponding implications, achieving high-quality standards for these studies, ensuring respect for patients' rights, and verifying that their principles of beneficence, minimization of the risk of harm, justice and autonomy are a challenge for many researchers and professionals involved in the surgical process. Hence, it is advantageous to have guides that guarantee the methodological quality of research on innovative surgical procedures and that these guides include the ethical aspects involved in each of their stages. This review aims to make a historical overview of what has been published on the ethical approach to surgical innovation. In addition, the ethical aspects of the stages of the IDEAL framework for surgical innovation will be explained.
Scopus© Citations 1
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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
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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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Preoperative Nutrition in Bariatric Surgery: A Narrative Review on Enhancing Surgical Success and Patient Outcomes
(MDPI AG, 2025-02-02)
SIMANCAS RACINES, DANIEL ALEJANDRO
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Evelyn Frias Toral
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Martín Campuzano-Donoso
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RAMOS SARMIENTO, DANIEL ALEXANDER
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Raynier Zambrano-Villacres
Bariatric surgery has become the preferred treatment for individuals with morbid obesity. Nutrition is key in optimizing surgical outcomes by reducing risks and enhancing recovery. Preoperative strategies, such as reducing body fat, decreasing liver size, and improving metabolic profiles, have been shown to facilitate safer surgical procedures with fewer complications. This narrative review aims to provide an analysis of the fundamental role of preoperative nutritional management in improving bariatric surgery outcomes, emphasizing the importance of addressing specific nutritional challenges to enhance surgical safety, recovery, and overall health. Preoperative nutritional interventions focus on correcting comorbidities and nutritional deficiencies, particularly hypovitaminosis and micronutrient imbalances, through a multidisciplinary approach involving nutritionists and other healthcare professionals. These interventions not only prepare patients for the physiological demands of surgery but also initiate a period of adaptation to new dietary habits, aiming to improve long-term compliance and mitigate risks such as postoperative weight regain and dumping syndrome. Adopting dietary changes, such as very low-calorie or ketogenic diets 6–12 weeks before surgery, enhances adherence to postoperative restrictions and overall surgical success. Future research should focus on developing comprehensive guidelines for preoperative nutritional care to improve patient outcomes globally.
Scopus© Citations 22
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Association between type of health insurance and dental visits among Ecuadorian older population: evidence from a cross-sectional study
(Springer Science and Business Media LLC, 2025-01-08)
Marite Falquez
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Adriana Canessa Rojas
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Antonio Lanata-Flores
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Freddy Espinoza-Carrasco
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Ivan Cherrez-Ojeda
Background: Dental services are often overlooked within healthcare systems, despite their critical role in overall health. Socioeconomic barriers and disparities in insurance coverage frequently limit access to oral care, particularly among vulnerable populations like older adults. Objective: To examine the impact of different health insurance types on the frequency of dental consultations among Ecuadorian senior citizens, aiming to highlight gaps in access to care. Methods: Using the 2009 National Survey of Health, Well-being, and Aging (SABE), which aims to determine the health and living conditions of older individuals, this study analyzed the health insurance status and dental service visits of 4,565 older adults in Ecuador. Binary logistic regression was employed to explore the association between insurance type and dental-care utilization. Results: In the sample, 76.50% of older adults had not visited a dentist in the past year. Insurance breakdown revealed 17.04% with general IESS, 9.59% with rural IESS, 2.23% with private insurance, 1.86% with ISSFA/ISSPOL, 1.86% with municipal insurance, and 69.66% were uninsured. Individuals with private insurance or ISSFA/ISSPOL insurance were 32% and 91% more likely, respectively, to seek oral care compared to those without these respective insurances. Conversely, uninsured individuals were 43% less likely to seek dental care than those with any type of insurance. Conclusion: Health insurance significantly influences the frequency of dental consultations among Ecuadorian seniors, highlighting the need for policy interventions to ensure equitable access to oral care.

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