Hospital Metropolitano

Struma ovarii is a rare ovarian teratoma composed predominantly of thyroid tissue, representing less than 1% of all ovarian tumors. The clinical presentation of struma ovarii can vary widely, from an asymptomatic palpable abdominal mass, hyperthyroidism (elevated free T4 and/or T3; low TSH), and, in rare cases, pseudo-Meigs syndrome. Diagnosis is often based on postoperative histopathological confirmation of thyroid tissue. We present a case of a 44-year-old Hispanic female with an incidental finding of an adnexal mass, pleural effusion, and ascitic fluid, but with normal tumor markers, cancer antigen 125 (CA-125), and carcinoembryonic antigen (CEA). Postoperative pathological examination confirmed struma ovarii, with pseudo-Meigs syndrome. Unexpectedly, the patient developed ovarian remnant syndrome (ORS). This case contributes to the limited literature describing struma ovarii associated with pseudo-Meigs syndrome and normal tumor markers, highlighting the diverse clinical spectrum of this tumor. It also underscores the need for a high index of suspicion for struma ovarii in atypical cases, regardless of tumor marker levels. The development of ORS further emphasizes the importance of long-term follow-up after definitive surgical management.

La educación superior ha incrementado sostenidamente el uso de entornos virtuales en disciplinas de alta exigencia operativa y clínica para garantizar continuidad, flexibilidad y acceso que favorecen experiencias formativas de calidad. El presente estudio analizó la influencia de diversas estrategias de aprendizaje en línea microlearning, videoconferencias interactivas, foros de discusión y aprendizaje basado en proyectos o casos sobre la motivación, la participación y la satisfacción de estudiantes de formación policial y médica en entornos virtuales en el Ecuador. Se aplicó un enfoque cuantitativo, descriptivo - correlacional y transversal, con una muestra de 144 estudiantes, en su mayoría jóvenes entre 18 y 24 años y con experiencia previa en cursos virtuales. Los resultados evidenciaron una valoración positiva hacia el microlearning y las videoconferencias interactivas por su capacidad para incrementar la motivación y mantener el interés en los contenidos. Asimismo, los foros de discusión y el aprendizaje basado en proyectos se destacan como recursos efectivos para fortalecer la participación activa y el sentido de comunidad académica. En cuanto a la satisfacción, si bien predominó la percepción favorable, se observaron respuestas más moderadas que sugieren la necesidad de ajustes pedagógicos, especialmente en la retroalimentación y la alineación de expectativas. Estos hallazgos resaltan la importancia de integrar estrategias activas y recursos digitales en la educación superior, particularmente en áreas críticas como la formación policial y médica, donde la motivación, la participación y la satisfacción influyen directamente en la adquisición de competencias aplicables al ejercicio profesional

Small (<5 mm) intracranial aneurysms present a therapeutic challenge due to their low annual rupture risk and uncertainties regarding procedure-related morbidity. Evidence from Latin America remains limited. We conducted a retrospective multicenter observational study including 1,519 patients treated between 2017 and 2023 in eight referral centers across five Latin American countries. Demographic, clinical, morphological, and treatment-related variables were analyzed. Logistic regression was used to identify independent predictors of treatment-related complications. The overall complication rate was 6%. Surgical treatment showed higher crude complication rates (11%) compared with endovascular therapy (6%), largely reflecting a greater proportion of ruptured aneurysms. Independent predictors of treatment-related complications were a history of aneurysmal subarachnoid hemorrhage (odds ratio [OR] = 5.03), intraparenchymal hematoma before treatment (OR = 3.56), and ruptured aneurysm status (OR = 2.13). Complications were associated with higher mortality (31% vs. 7%; P < 0.001) and worse 1-year outcomes (Modified Rankin Scale 3-6: 41% vs. 12%; P < 0.001). In this first regional multicenter series, treatment of small intracranial aneurysms in Latin America demonstrated low complication rates and favorable safety profiles for both surgical and endovascular techniques. The predictors identified may support clinical decision-making and improve prognostic assessment.

Moderate midazolam sedation is often used in gastrointestinal endoscopy to induce stress-free conscious sedation. Conversely, flumazenil can reverse midazolam-induced sedation and cause temporary awakening and resedation. However, the effects of flumazenil disuse on the incidence of inpatient falls are unknown. In this study, we performed a retrospective cohort analysis of the incidence of falls in inpatients who underwent gastrointestinal endoscopy under midazolam-induced sedation with or without flumazenil. This study included 1,424 procedures, of which 559 involved flumazenil use. The frequency of inpatient falls did not significantly differ between the flumazenil and nonflumazenil use groups (2/559 episodes [0.36%] vs. 2/865 episodes [0.23%], P = 0.648). The inverse probability of treatment weighting analysis could not determine the association of flumazenil disuse with the incidence of inpatient falls (odds ratio, 0.57; 95% confidence interval, 0.08-4.14; P = 0.58). Our results indicate that the association between flumazenil disuse and the incidence of inpatient falls remain unclear.

Abstract Introduction The use of social networks as source of medical information has grown steadily in recent years. In the field of urology, where barriers such as stigma and limited formal consultation persist, these platforms offer a useful window into the concerns of the population in real time. This study analyzes digital health behavior around six relevant urological pathologies, identifying the most searched terms, the most frequently asked questions, and their possible correlation with epidemiological data. Objective General objective: To analyze the digital behavior around specific urological diseases through the study of search terms, frequently asked questions and interactions generated in social networks, in order to identify patterns of interest, information gaps and their possible influence on the diagnosis or treatment of these conditions. Methods A cross-sectional observational study with an exploratory approach was conducted. Two platforms were used: Google Trends and AnswerThePublic, to collect data on erectile dysfunction, premature ejaculation, male infertility, benign prostatic hyperplasia (BPH), prostate cancer, male hypogonadism, and Peyronie's disease. Search terms, frequency, associated questions, and temporal trends were analyzed. The results were compared with prevalence figures reported in recent scientific literature. Results General searches (broad or unspecific phrases that are not focused on clinical aspects such as causes, treatments, age or consequences, but express general doubts, colloquial language or expressions related to the pathology) were predominant in all pathologies, with relative frequencies above 75 % in each one: erectile dysfunction (77.3 %), premature ejaculation (83.5 %), male infertility (86.4 %), BPH (90.6 %), prostate cancer (91.2 %), male hypogonadism (83.1 %) and Peyronie's disease (87.0 %). The most frequent clinical searches corresponded to age (up to 9.0 % in erectile dysfunction and 7.4 % in Peyronie's) and treatments (up to 7.9 % in infertility). In Google Trends, erectile dysfunction showed the highest sustained interest, with multiple peaks close to 100; in contrast, Peyronie's, hypogonadism and infertility presented stable curves, with no peaks above 65. Conclusions Digital analysis offers a tool for understanding how the general population perceives urological diseases. The information generated can guide medical communication strategies, public education, and prevention, as well as provide the medical community with a better understanding of patients' doubts and uncertainties. Disclosure No

IntroductionThe COVID-19 pandemic has deeply affected Latin America and Ecuador. Coinfections and superinfections increase the risk of morbidity and mortality in COVID-19 patients. This study examined co-infections and superinfections in critically ill COVID-19 patients admitted to the ICU of a tertiary hospital in Ecuador.MethodsA cross-sectional study was conducted from February to August 2021, including patients with a confirmed SARS-CoV-2 infection. Demographic data, clinical characteristics, and microbiological findings were analyzed to evaluate the presence of coinfections and superinfections.ResultsA total of 24 patients were included, of whom 70.83% (17/24) experienced either coinfection or superinfection. Community-acquired coinfections were identified in 12.5% (3/24) of patients, whereas hospital-acquired superinfections were detected in 58.3% (14/24). The most frequently isolated pathogens were Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. Molecular testing revealed Streptococcus pneumoniae was the most prevalent organism. Bloodstream infections were the most common superinfections, with an attack rate of 92.8% (13/14). The median time from hospital admission to superinfection diagnosis was 5 days. The study also found that 33% (8/24) of patients died, all of whom were men; 62% (5/8) of the patients who died have superinfection. However, infections were not identified as independent predictors of death, given the small cohort size (n = 24) and descriptive statistical design.DiscussionThese findings underscore the importance of robust monitoring of co-infections and superinfections in critically ill COVID-19 patients, especially in resource-limited settings. The high prevalence of these infections highlights the need for continued investment in microbiological surveillance, rapid diagnostics, and antimicrobial stewardship programs to mitigate long-term consequences and address the increasing threat of antimicrobial resistance.