The introduction of robotics in living donor liver transplantation has been revolutionary. We aimed to examine the safety of robotic living donor right hepatectomy (RLDRH) compared to open (ODRH) and laparoscopic (LADRH) approaches. A systematic review was carried out in Medline and six additional databases following PRISMA guidelines. Data on morbidity, postoperative liver function, and pain in donors and recipients were extracted from studies comparing RLDRH, ODRH, and LADRH published up to September 2020; PROSPERO (CRD42020214313). Dichotomous variables were pooled as risk ratios and continuous variables as weighted mean differences. Four studies with a total of 517 patients were included. In living donors, the postoperative total bilirubin level (MD: −0.7 95%CI −1.0, −0.4), length of hospital stay (MD: −0.8 95%CI −1.4, −0.3), Clavien–Dindo complications I–II (RR: 0.5 95%CI 0.2, 0.9), and pain score at day > 3 (MD: −0.6 95%CI −1.6, 0.4) were lower following RLDRH compared to ODRH. Furthermore, the pain score at day > 3 (MD: −0.4 95%CI −0.8, −0.09) was lower after RLDRH when compared to LADRH. In recipients, the postoperative AST level was lower (MD: −0.5 95%CI −0.9, −0.1) following RLDRH compared to ODRH. Moreover, the length of stay (MD: −6.4 95%CI −11.3, −1.5) was lower after RLDRH when compared to LADRH. In summary, we identified low- to unclear-quality evidence that RLDRH seems to be safe and feasible for adult living donor liver transplantation compared to the conventional approaches. No postoperative deaths were reported.

Background: The state of prior immunosuppression in cancer enhances harmful effects (eg, sepsis). Despite advances in cancer treatment and sepsis management, the number of critically ill patients with cancer is increasing. Although the overall survival of patients with cancer experiencing septic shock has improved, the mortality observed in studies remains high. Purpose: To determine the rate mortality from septic shock in patients with cancer by analyzing variations. Design: Systematic review and meta-analysis. Data Sources and Methods: A systematic search was performed in Medline, EMBASE, SCOPUS, Web of Science, and BIREME-BVS. Articles assessing mortality in patients with cancer experiencing septic shock (aged >18 years) were included. Review articles, letters to the editor, case reports, and conference proceedings were excluded. Methodological quality was assessed with the MInCir-Prognosis Scale and the Joanna Briggs Institute checklist to assess the risk of bias in prevalence studies. Results: Overall mortality rate from septic shock was 58% (95% confidence interval [95%CI]: 54-63). Mortality rate during 2000–2010 and 2010–2024 was 61% (95%CI: 53-68) and 58% (95%CI: 52-63), respectively. Mortality rate by continent was 50% (95%CI: 24-76) in Africa, 61% (95%CI: 53-69) in Asia, 53% (95%CI: 48-59) in Europe, 64% (95%CI: 48-78) in North America, and 61% (95%CI: 37-82) in South America. Mortality rate in the intensive care unit was 53% (95%CI: 50-57). In-hospital mortality rate was 59% (95%CI: 49-68), and 50% (95%CI: 43-57), 61% (95%CI: 40-81), 69% (95%CI: 58-80) at 28–30, 90 and 180 days, respectively. Conclusions: Despite advances in oncology and hematology, mortality among patients with cancer experiencing septic shock remains high and increases over time after discharge from the intensive care unit. Registration: PROSPERO [ID: CRD42023472191].

The most common sexually transmitted infection is human papillomavirus (HPV) infection (1). This oncogenic virus can infect the superficial skin of the anogenital and upper aerodigestive tracts (1). Sometimes the infection can persist, progress, and cause cancer, and is therefore attributed to approximately 5% of human cancers (1). Among the malignant lesions it produces are cervical and anogenital cancers, as well as oral and respiratory squamous cell carcinomas (1). Most cases of cervical cancer worldwide are caused by persistent infections with one of the cancercausing genotypes of HPV (2). According to the U.S. Centers for Disease Control and Prevention (CDC), the prevalence of genital HPV in adults aged 18 to 59 is approximately 40% in women and 45% in men (3). To prevent HPV infection from the most common high-and low-risk subtypes, the CDC recommends that both girls and boys receive HPV immunization (3). Vaccination between the ages of 9 and 12 can prevent approximately 90% of cervical cancers and precancerous lesions (2).In Ecuador, cervical cancer has an incidence rate of 16 cases per 100,000 women and a mortality rate of 8.2 cases per 100,000 women, placing it in an intermediate position compared to other countries (4). However, the situation regarding cervical cancer in Quito, Ecuador's capital city, between 2015 and 2019, presents a concerning picture (4). The incidence rate in Quito has been higher than the global average (16.1 vs. 13.1 per 100,000 women), and the standardized mortality rate is also higher than the global average (10.4 vs. 7.1 per 100,000 women) (4). While the incidence trend has decreased over the years, the mortality rate has not shown significant change (4). The observed stagnation in cervical cancer mortality rates in Quito, despite declining incidence, likely reflects multifactorial challenges within the healthcare system. Evidence from Ecuador indicates that delays in treatment initiation significantly impact survival: patients initially managed in the public health system experienced a mean delay of 162 days to start treatment compared to 62 days for those receiving comprehensive care at specialized centers, with advanced-stage patients (FIGO III-IV) showing the greatest survival disadvantage (HR: 0.48; 95% CI: 0.37-0.63) (5). Additional contributing factors include fragmented healthcare delivery, limited screening coverage in rural and marginalized populations, and socioeconomic barriers that affect timely access to diagnosis and treatment (6,7). While Ecuador has achieved high first-dose HPV vaccination coverage among girls, the protective effect of vaccination on cervical cancer mortality will require decades to manifest at the population level, given the long latency between HPV infection and invasive cancer. Therefore, strengthening secondary prevention, through equitable access to HPV testing, timely colposcopy, and prompt treatment of precancerous lesions, remains critical to reducing mortality in the short to medium term. But a significant advance in Ecuador's public health has been achieved with the recent inclusion of boys in the HPV vaccination campaign, which took place between May and June 2024 and aimed to vaccinate approximately 595,000 children (8). This event represents an important step for the country and highlights Ecuador's role in the fight against HPV-related diseases. This step is crucial not only for men's health but also for the prevention of HPV-related infections in the general population. To ensure the success of this initiative in Ecuador, it is essential to implement effective vaccine distribution and administration strategies continuously, supported by ongoing campaigns. This includes training healthcare workers, optimizing accessible vaccination centers, and implementing campaigns that promote public awareness and education. A crucial factor is vaccine acceptance to achieve adequate immunization. Furthermore, constant monitoring and evaluation of the vaccination program's implementation are essential. This will allow for continuous adjustments and improvements to vaccination strategies, guaranteeing their effectiveness and sustainability in the future. Several ongoing improvements and forward-looking strategies are being implemented to strengthen Ecuador's HPV vaccination program and ensure its long-term sustainability. First, Ecuador is progressively transitioning toward a school-based delivery model (9), which has demonstrated superior coverage outcomes in regional peers: Peru and Mexico have achieved over 90% HPV vaccination coverage by integrating vaccination into the educational calendar and mandating reporting mechanisms (10). Second, in alignment with the WHO's April 2024 position paper endorsing single-dose HPV vaccination schedules for individuals aged 9-20 years, Ecuador adopted in 2025 this simplified regimen on its immunization schedules for boys and girls aged nine years (11). This policy shift could reclassify children and adolescents who have received one dose as fully vaccinated, while reducing logistical burdens on the health system. HPV vaccination coverage in men is exceptionally low (12). In 2019, only 4% of the male population was vaccinated against HPV (12). The vaccine's effectiveness has been high among men who had never been vaccinated against HPV (13). This supports the recommendation to vaccinate boys before they become sexually active in order to establish optimal protection through vaccination (13). It is important to contextualize the burden of HPV-associated malignancies in men. In Ecuador, the estimated age-standardized incidence rates for HPV-related cancers in males include penile cancer (1.4 per 100,000 men), anal cancer (0.42 per 100,000 men), and oropharyngeal cancer (0.60 per 100,000 men) (14). Although these rates are lower than those observed for cervical cancer in women, they represent a preventable disease burden that disproportionately affects vulnerable populations....

Background: Febrile neutropenia (FN) is the most common and serious adverse event of chemotherapy for solid and hematological neoplasms, with infection as a major complication. FN occurs in 10%–50% of patients with solid tumors and over 80% with hematological malignancies, with mortality rates up to 11%. Objective: To characterize bloodstream pathogens in post-chemotherapy FN through a systematic review and meta-analysis of studies published from 2013 to February 13, 2024. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, Web of Science, Scopus, and Embase were searched using MeSH, Emtree, and keywords. Risk of bias was assessed using the JBI checklist. Random-effects proportions meta-analysis was performed. Results: Twenty-two studies ( n = 23,319) reported 8665 positive blood cultures: 59% Gram-negative (95% CI: 46.8–67.5), 39.7% Gram-positive (95% CI: 31.3–48.2), and 2.5% fungi (95% CI: 0.9–4.1). Random-effects meta-analysis showed high heterogeneity ( I ² = 98.92%, p < 0.01). Meta-regression by sample size, economic development, and risk of bias did not explain this variability. Conclusion: Gram-negative pathogens slightly predominate over Gram-positives in bloodstream infections among post-chemotherapy FN patients. Trial registration: PROSPERO (CRD42023472191).

Introduction: Social determinants of health influence outcomes in cervical cancer. This study aimed to characterize the socioeconomic factors affecting survival in patients with cervical cancer receiving palliative care. Material and methods: We conducted a retrospective cohort study of 368 women who attended social work services at an oncology hospital in Quito, Ecuador, between 2017 and 2021. Descriptive statistics, bivariate analysis, Kaplan-Meier survival curves, and Cox regression models were applied. Results: The median age was 52.5 years (IQR 45–65), with 46.5% identifying as mestizo and 46.5% as indigenous. Most patients (80.4%) had incomes below the basic salary, and the proportion of married individuals declined from 53.3% to 38.9% upon transition to palliative care. The average stay in palliative care was 46 days. Tertiary education was associated with a higher mortality risk (adjusted HR: 3.16; 95% CI: 1.51–6.60; p = 0.002). In contrast, having children was linked to lower mortality risk (one child: HR 0.56; 95% CI: 0.31–0.99; p = 0.046; two or more children: HR 0.47; 95% CI: 0.27–0.82). Patients with middle income had reduced mortality risk (HR: 0.71; 95% CI: 0.53–0.97; p = 0.032). No significant differences in survival were observed based on ethnicity or province of residence. Conclusion: Survival among cervical cancer patients in palliative care is short. Socioeconomic factors—particularly education, income, and family structure—significantly influence mortality. Integrating social support into cancer care is essential to improve health outcomes and equity in this population.

Introduction: Overweight/obesity are a pandemic, which leads to an increase in the probability of suffering from metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease. The current literature is controversial between the association of overweight or obesity with post-surgical complications. Objective: To evaluate the association between overweight/obesity and postoperative complications in a general hospital in Quito-Ecuador in 2019. Methods: The sample consisted of individuals with surgical intervention in October 2019. Those who presented underweight (BMI<18.5 kg/m2) were excluded. The independent variable was overweight/obesity versus normal weight (BMI≥25 kg/m2, vs <18.5 kg/m2, respectively); the dependent one was the presence of postsurgical complications, using the Clavien-Dindo classification, dichotomizing the absence (0, I, II) and the presence (IIIa, IIIb, IVa, IVb, V) of complications. A bivariate analysis was performed using chi square test (p<0.05) and unadjusted and adjusted logistic regression models to obtain “Odds Ratio” and 95% confidence intervals. Results: Overweight or obesity did not show a statistically significant association with the presence of complications (OR: 3.23; CI 95%: 0.42-24.83). Of 120 participants, 50.8% were male. The mean BMI was 27.54 ± 4.97 kg/m2. The postoperative complication rate was 8.33%, of which 50% were overweight or obese. The predominant approach was laparoscopy. Conclusions: No association was found between overweight/obesity and postoperative complications. However, a high prevalence of overweight and obesity was evidenced. It is recommended to carry out future longitudinal studies and these with a larger population to contrast results. Introducción: Sobrepeso y obesidad son enfermedades inflamatorias de bajo grado, que incrementan la probabilidad de padecer síndrome metabólico, diabetes mellitus tipo 2, enfermedad cardiovascular, apnea obstructiva del sueño, ciertos tipos de cáncer, entre otros problemas de salud. La literatura actual es controversial al asociar sobrepeso u obesidad con complicaciones postquirúrgicas. Objetivo: Evaluar la asociación entre sobrepeso/obesidad y complicaciones postquirúrgicas en un hospital general en Quito-Ecuador en 2019. Métodos: La muestra estuvo constituida por individuos intervenidos quirúrgicamente en octubre del 2019. Se excluyeron a quienes presentaron infrapeso (IMC<18.5 kg/m2). La variable independiente fue sobrepeso/obesidad versus peso normal (IMC≥25 kg/m2; <25 kg/m2, respectivamente); la variable dependiente fue la presencia de complicaciones postquirúrgicas, utilizando la clasificación Clavien-Dindo, dicotomizando en ausencia (0, I, II) y presencia (IIIa, IIIb, IVa, IVb, V) de complicaciones. Se realizó análisis bivariado usando prueba chi cuadrado (p<0.05) y modelos de regresión logística no ajustados y ajustados para obtener “Odds Ratio” e intervalos de confianza al 95%. Resultados: Sobrepeso/obesidad no mostró asociación estadísticamente significativa con la presencia de complicaciones (OR:3.23; IC 95%:0.42-24.83). De 120 participantes, 50.8% fueron masculinos. La media de IMC fue 27.54±4.97 kg/m2. La tasa de complicaciones postoperatorias fue 8.33%, de los cuales 50% presentaron sobrepeso u obesidad. El abordaje predominante fue laparoscopía. Conclusiones: No se encontró asociación entre sobrepeso/obesidad y complicaciones posquirúrgicas. Sin embargo, se evidenció una prevalencia elevada de sobrepeso y obesidad. Se recomienda realizar futuros estudios longitudinales y con mayor población para contrastar estos resultados.