Introduction: Most melanomas are in the skin (95%), and it is less common in the mucosa (oral, digestive tract, genital), retina or meninges (5%), 3% of patients develop hidden melanomas. Despite not being the most frequent skin cancer, melanoma is a tumor that has great molecular complexity, being the tumor with the highest proportion of mutations. Studying some of these mutations is important when establishing treatment strategies, and the study of the presence or absence of mutations in the BRAF oncogene is undoubtedly essential today. Thus, the BRAF V600 E mutation occurs in approximately 60% of patients with melanoma. Objectives: To demonstrate the extended survival of metastatic melanoma with the use of immunotherapy. Methodology: Next, we present a documentary, analytical and correlational investigation of a patient diagnosed with metastatic melanoma at the Dr. Julio Villacreses Colmont Oncology Hospital in the Clonic Oncology service. Clinical and imaging data were collected from the clinical history. Results: In our case report, the patient underwent 37 treatment cycles with pembrolizumab for 2 years, observing an improvement in survival of 53 months with 12 months without relapse. Subsequently, rechallenge was performed for 7 months with pembrolizumab. Conclusions: Immunotherapy has shown improved overall survival for people with BRAF-mutant advanced melanoma. It was shown that the administration of pembrolizumab improved patient survival for a period of 53 months. General study area: Medicine. Specific area of ​​study: Oncology. Article type: Clinical Case.

Introduction: Human papillomavirus belongs to the Papillomaviridae family, it is responsible for 95% of cervical cancer cases worldwide, there are more than 200 HPV genotypes including between fifteen to nineteen high-risk HPV genotypes, among the most prevalent we have HPV 16, 18, 39, 58 and 31 which are responsible for the development of cervical cancer and the most prevalent low-risk HPV genotypes are 6 and 11 which are implicated in the development of genital warts. Objective: To identify the presence of human papillomavirus genotypes in altered cervical cytology. Methodology: A systematic review was carried out using the PRISMA protocol for the collection of information in works from search engines such as PubMed, ScienceDirect and Scopus looking for human papillomavirus genotypes in altered cervical cytology. Conclusions: There is evidence that high-risk papillomaviruses 16 and 18 followed by 39, 58 and 31 are involved in cervical cell transformation. HPV infection plays an important role in the development of cervical neoplasia and is the main risk factor for cervical neoplasia. However, the development of HPV vaccines may reduce the burden of HPV disease, and another finding reveals that there is no vaccine for infection caused by genotype.

Introduction: Ground beef is a food source because of its protein content, however, when handled improperly, there is the possibility of contamination by microorganisms harmful to health such as Escherichia coli. Objective: To determine the presence of Escherichia coli and total coliforms in ground beef sold in the 12 de Abril market in the city of Cuenca, Ecuador. Methodology: Experimental, descriptive, and observational cross-sectional design. A non-probabilistic convenience sampling was carried out to obtain 120 samples of ground beef. Results: Of the 120 samples collected, a frequency of Escherichia coli was determined in 75% and 16.67% of total coliforms in ground beef. Conclusion: The presence of Escherichia coli and total coliforms was evidenced in the samples obtained from ground beef sold in the 12 de Abril market in the city of Cuenca, this may be due to the lack of hygiene and poor handling of the product by the vendors.

Introduction. Vaginal infections are caused by the invasion and multiplication of microorganisms that cause dysbiosis of the vaginal ecosystem. Some of the frequent signs and symptoms are vulvar itching, burning, and irritation, among others. It is usually common during pregnancy and is due to hormonal changes. Species of the Enterobacteriaceae family are the main responsible microorganisms. Objective. To characterize vaginal infections of bacterial origin and the main resistance mechanisms reported in Latin America and the Caribbean. Methodology. In this systematic review, the Prisma methodology was used, which presents information regarding vaginal infections, causative agents involved, resistance mechanisms, resistance genes, and molecular methods involved in the diagnosis. Results. The predominant gene was bla _CTX-M in E. coli and K. pneumoniae. In addition, it refers that cephalosporins, penicillins, and ciprofloxacin, among other antibiotics; are not effective for treatment. In the same way, colistin is used as the last line of treatment, and high rates of resistance are reflected in Latin America. Conclusion. Several studies were conducted in Latin America and the Caribbean were findings revealed that the most prevalent species were E. coli and K. pneumoniae. The mechanisms used by these bacteria were extended-spectrum carbapenems and beta-lactamase enzymes. While the responsible genes in most of the studies belonged to the bla _CTX-M   classification. Additionally, the elevated levels of resistance that they presented against colistin indicate a health problem, due to the reduction of options to treat vaginal infections.

Stress occurs when a person views what is happening as exceeding their available resources and threatening their personal well-being. The objective of this study is to identify work stress, stress factors that affect the labor productivity of the Donum Foundation staff in the city of Cuenca. For this, the method that was used is descriptive correlational, with the help of a questionnaire that was submitted to validation of experts, the same one that is applied to 20 workers of the Donum Foundation with the following results: Reward: 37% of the workers The evaluators stated that they had presented levels of stress due to their low remuneration. Effort: 32% demonstrated that work overload was the main cause of their stress. Effects (quality of sleep) 31% indicate that stress directly affects the quality of sleep. In conclusion, stress is affected in the staff of the Donum Foundation: emotionally, in their sleep/rest habits, a situation that is worrying about the effects that may occur on the health of its workers, due to the information obtained, especially those that are over 49 years of age. In the area of ​​health, work stress is not being given due importance. It is corroborated by studies that show that, with constant exposure to high levels of stress, there are changes in the physiological health of workers, abnormal behaviors, including poor sleep quality.

Introduction. In most thermal waters, the sanitary and microbiological quality is unknown, enabling the growth of certain microorganisms inherent to these environments, which have evolved to adapt to the extreme conditions of these ecosystems. The water quality depends on its physicochemical properties, such as temperature, pH, and electrical conductivity. Objective. To analyze the physicochemical and bacteriological status of the most visited thermal pools in Baños parish, Cuenca - Ecuador. Methodology. The study was descriptive, experimental, and cross-sectional. The universe was the three spas, "El Riñón" Spa, "Durán Inn," and “Durán" Spa, along with one spring sample, from where 16 samples were obtained for the physicochemical and bacteriological analysis of these spas. Results. In the bacteriological analysis, Staphylococcus aureus was identified with a percentage of 77%. In the physicochemical analysis, an average pH value of 7.92 was observed at "Riñón” Spa and in the spring, an average of 8.43 at "Durán Inn" and "Durán" Spa. The temperature was around 35 °C, except for the spring. Conclusion. These thermal waters depend on the physicochemical conditions; they are mesothermal and alkaline waters, and their microbiological quality is excellent since the presence of Staphylococcus aureus does not represent a risk for individuals who visit these recreational facilities.

Resins are materials used to treat damaged dental pieces, restoring their morphology and function. At the same time, they are used to preserve the esthetics of the patient's smile, attempting to resemble the natural color of teeth. Objective: To identify the different types of resins and their application according to their composition. Methodology: A descriptive and documentary bibliographic search was conducted employing inclusion and exclusion criteria in the different digital databases utilizing keywords obtained from the MeSH and DeCS, combined with the Boolean terms AND/OR. Conclusion: It is essential to know the properties of resins to restore treated dental pieces to their morphology and function, as in the anterior teeth area, where a high esthetic level is required; this is achieved using microparticles or nanoparticles. Hybrid resins, microparticles, and condensable resins should be used for posterior teeth area with higher strength loads.

Introduction. Fungi have been causing various diseases in humans; these diseases have been treated with antifungal drugs that, while attacking the fungus, have also brought adverse effects such as health conditions and drug resistance development, among others. The development of phytopharmaceuticals has meant a natural option for treating these diseases, reducing the adverse effects. Objective. To identify the plants evaluated for treating fungal diseases and their efficacy. Methodology. The present research consists of a bibliographic review of several studies that use plants in different pharmaceutical forms to treat fungal diseases. The studies were extracted from the digital databases of Scopus, Google Scholar, Science Direct, Taylor & Francis, Redalyc, and Ovid; considering investigations conducted from 2018 to date, their characteristics were tabulated for analysis. Results. It was possible to identify that the Candida fungus causes the most common affections, and Aloe Vera is the most effective plant; however, all the plants evaluated presented positive efficiency percentages in treating the different fungi. Conclusion. It is necessary to continue with the studies on different plants to take advantage of their antifungal potential and to have the possibility of treating naturally a vast number of health conditions caused by fungi, with less risk of side effects, of developing fungal resistance, and above all accessible to the population.