Background: Preoperative nutritional interventions, including low-calorie diets (LCDs) and very low-calorie diets (VLCDs), are commonly implemented in metabolic and bariatric surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative dietary interventions in patients undergoing bariatric surgery, with primary outcomes including perioperative complications, operative time, and length of hospital stay. Methods: A systematic review and meta-analysis were conducted, including studies that compared LCD and VLCD with regular diets in adults undergoing bariatric surgery. The primary outcomes assessed were perioperative complications, operative time, and length of hospital stay. Random- and fixed effects models were used for quantitative synthesis. Risk of bias was evaluated using the Cochrane Risk of Bias tool and ROBINS-I, while the certainty of evidence was assessed using the GRADE approach. Results: Eight trials comprising 1197 patients were included in the meta-analysis. VLCDs were associated with a significant reduction in perioperative complications (OR 0.59; 95% CI: 0.37–0.94; p = 0.03), whereas LCDs showed no significant effect on complications (OR 1.64; 95% CI: 0.71–3.78; p = 0.25). No significant reduction in operative time was observed (MD −2.64 min; 95% CI: −6.01 to 0.73; p = 0.12). Hospital stay was slightly reduced (MD −0.17 days; p = 0.0001), though the clinical significance remains uncertain. The certainty of evidence was low, primarily due to the risk of bias and small sample sizes. Conclusions: VLCDs may lower the risk of perioperative complications, while LCDs do not appear to provide this benefit. However, the evidence is limited by methodological heterogeneity and low certainty. Further high-quality studies are needed to establish optimal preoperative nutritional protocols.

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.

Natural products have emerged as promising multi-target agents for addressing the complex biology of gastric cancer, a malignancy characterized by marked molecular heterogeneity, late clinical presentation, and frequent resistance to systemic therapies. This narrative synthesis integrates primarily preclinical evidence, with emerging clinical data, on how naturally derived compounds modulate three central molecular processes that drive gastric tumor progression and therapeutic failure: evasion of programmed cell death, persistent tumor-promoting inflammation, and chemoresistance. Compounds such as curcumin, resveratrol, berberine, ginsenosides, quercetin, and epigallocatechin gallate restore apoptotic competence by shifting the balance between pro-survival and pro-death proteins, destabilizing mitochondrial membranes, promoting cytochrome c release, and activating caspase-dependent pathways. These agents also exert potent anti-inflammatory effects by inhibiting nuclear factor kappa B and signal transducer and activator of transcription signaling, suppressing pro-inflammatory cytokine production, reducing cyclooxygenase activity, and modulating the tumor microenvironment through changes in immune cell behavior. In parallel, multiple natural compounds function as chemo-sensitizers by inhibiting drug efflux transporters, reversing epithelial–mesenchymal transition, attenuating cancer stem cell-associated traits, and suppressing pro-survival signaling pathways that sustain resistance. Collectively, these mechanistic actions highlight the capacity of natural products to simultaneously target interconnected hallmarks of gastric cancer biology. Ongoing advances in formulation strategies may help overcome pharmacokinetic limitations; however, rigorous biomarker-guided studies and well-designed clinical trials remain essential to define the translational relevance of these compounds.

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.

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.

Introduction The COVID-19 pandemic exposed the weaknesses of epidemiological surveillance systems and highlighted the need to integrate new respiratory viruses into sentinel surveillance systems. However, current evidence on their effectiveness remains limited. Aim This project conducts a scoping review to describe the available evidence on the integration of COVID-19 into sentinel surveillance systems. Methods The included studies addressed sentinel surveillance in the context of the pandemic following the World Health Organization declaration. A systematic search was performed in databases including MEDLINE, LILACS, EPISTEMONIKOS, and DIMENSIONS, selecting observational studies and systematic reviews. Data collection and analysis were organized into categories such as clinical characteristics, timely detection, geographic representativeness, co-infection, and adaptability with genomic surveillance. Seventeen studies reporting on COVID-19 integration impact and one preliminary WHO report were identified. Results Results identified the most prevalent symptoms in the general population: fever (73%), cough (51.8%), loss of taste or smell (45.1%), hypoxemia (33%), and sputum production (23.9%). A high correlation was obtained between SARI cases or hospitalizations due to respiratory infection and the incidence of COVID-19 (ρ = 0.78 and ρ = 0.82 respectively). Conclusions Integrating COVID-19 into the sentinel surveillance system could improve detection, response, and follow-up capacity. Additionally, implementing standardized case definitions promotes more efficient use of laboratory resources, thereby enhancing the sustainability of the surveillance system.