I was the Director of the medical program at the National University of Loja, and a professor in the undergraduate programs of medicine and nursing, as well as in the Master's program in Heberty at the National University of Loja. I was also the Director of the Department of Health Sciences at UTPL.
Currently, I am a research professor at the Private Technical University of Loja, a professor in the undergraduate medical program, and a professor in the postgraduate program specializing in family and community medicine.
EDUCATION
PhD. en Ciencias Morfológicas
Mg en Hebeatría
Doctora en medicina y cirugía
RESEARCH, TEACHING, or OTHER INTERESTS
Anatomy, Psychiatry and Mental health, Health Informatics, Public Health, Environmental and Occupational Health
13
Scopus Publications
Scopus Publications
Attitudes toward and perceptions of barriers to research among medical students in the context of an educational and motivational strategy Beatriz Quintero, Ruth Maldonado-Rengel, Solbey Morillo-Puente, Emilia Burneo-Sánchez BMC Medical Education, 2025 BACKGROUND: Scientific research is a key component of medical education, fostering critical thinking and evidence-based practice. However, international studies have reported wide variability in medical students' attitudes toward research, shaped by institutional culture, exposure, and curricular design. In parallel, perceived barriers-such as academic overload, lack of mentorship, and insufficient training-are frequently cited as major obstacles that limit student involvement. Understanding students' predispositions and the barriers they face is essential for developing effective strategies, especially in educational contexts where research participation is limited. This study aimed to evaluate the situation at a private medical school in Ecuador. OBJECTIVE: To evaluate medical students' attitudes toward and perceptions of barriers to research and to analyze changes in these variables following an educational and motivational intervention. METHODS: A quasiexperimental study (without a control group) was conducted with 90 undergraduate medical students. The intervention consisted of educational and motivational audiovisual content delivered over one month. A validated questionnaire assessed students' attitudes and perceived barriers before and after the intervention. Descriptive statistics and a one-sample t-test were used to assess changes. RESULTS: Prior to the intervention, the mean attitude score was 104.72, well above the scale midpoint (78), indicating a generally favorable predisposition. Most students (73.3%) scored above 75% of the maximum possible score in attitudes. For perceived barriers, the initial mean was 109.61, also above the scale midpoint (87), reflecting a high level of perceived obstacles. A total of 96.7% of students scored above 50%, with key concerns related to time constraints, lack of mentorship, and insufficient training in scientific writing and statistics. After the intervention, both the mean attitude score and the mean barrier score remained statistically unchanged. CONCLUSIONS: Although the intervention produced a small increase in favorable attitudes, it did not reduce perceived barriers. These findings suggest that short, self-directed strategies are insufficient to address institutional challenges. More effective approaches may require long-term, interactive programs supported by curricular integration, structured mentorship, and institutional investment to foster meaningful research engagement among medical students. TRIAL REGISTRATION: Not applicable.
Pro-Inflammatory Biomarkers And Depression: A Study Performed In A Group Of Health Sciences University Students Ruth Maldonado-Rengel, Kleber Garrochamba, Jenny Vélez Pangay, Angelica Arrobo Rodas, Katty Naranjo Vélez, Domenica Racines Aguirre, Ximena Lozano Masías Neuropsychiatric Disease and Treatment, 2025 Introduction: Depression is one of the most prevalent mental illnesses worldwide, and its etiology is still the subject of multiple studies that strive to clearly identify the causes of this disorder and guide the appropriate form of treatment. The present study aimed to establish the correlation between elevated levels of circulating proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) with depression. Materials and Methods: An analytical correlational study was conducted in which 300 medicine and nursing students from a university in the city of Loja, Ecuador participated. They were assessed with the Beck Depression Inventory II (BDI II) to determine the presence of depression, and peripheral levels of interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured using the ELISA technique. Results: 65% of the participants reported depression according to the Beck Depression Inventory II, which in turn were divided into mild (23%), moderate (20.3%) and severe depression (21.7%) according to the score obtained. A statistically significant correlation was found between elevated levels of IL-6 and TNF-α with depression in the group of nursing students. However, no such correlation was found in the group of medical students. Discussion: Elevations in both inflammatory cytokines measured in this study were evident in both study groups. This could be explained by the high emotional stress generally associated with healthcare career training, which in turn could reinforce the hypothesis of inflammatory states and their relation to the pathophysiology of depression. However, the percentage of depression cases was higher in the nursing student group, in which the female gender accounted for 83.3% of the group, a fact that could explain the reason why in this group there was a statistically significant relationship between elevated cytokines and the presence of depression.
Alterations of Liver Morphology in Senescent Rats Ruth Maldonado-Rengel, Zaida Sócola-Barsallo, Bélgica Vásquez International Journal of Molecular Sciences, 2024 Age-related liver changes can have important implications for health and metabolic function. This study aimed to describe the morphoquantitative alterations of the liver in senescent rats compared to adult rats. Twelve male rats were used, divided into 6-month-old adults (group A) and 36-month-old senescent rats (group S). Morphometric and histopathological studies, quantification of collagen types I and III, and stereological analyses were performed to determine the volume density of mononucleated (VvhepM) and binucleated (VvhepB) hepatocyte nuclei, surface area density (SvhepM), and number density (NvhepM) of mononucleated hepatocyte nuclei. The findings reveal an alteration of the normal liver tissue architecture in senescent rats and the presence of inflammatory lesions and fibrosis. In addition, there was a decrease in body and liver mass and volume. Group S showed a significant reduction in VvhepM and NvhepM; however, SvhepM was significantly higher. No significant differences were noted in the percentage of binucleated hepatocytes between the two groups. This study reveals substantial morphological changes in the aging liver, with possible functional implications. More research is needed on the underlying mechanisms and their consequences at older ages.
Impact of Aging on the Morphology of the Adrenal Gland in Rats Ruth Maldonado-Rengel, Zaida Sócola-Barsallo, Bélgica Vásquez International Journal of Morphology, 2024 SUMMARY: Aging is an inevitable biological process that affects the function of all organs, including the adrenal gland, which is essential for producing steroid hormones that regulate metabolism, stress response, and immune activation. Understanding how aging affects the morphology of this gland is crucial to developing interventions to mitigate its adverse effects. Thus, this study aimed to describe the morphoquantitative alterations of the adrenal gland in senescent Sprague Dawley rats compared to adult rats. Twelve male rats were divided into 6 adult rats aged 6 months (group A) and 6 senescent rats aged 36 months (group S). Histopathological studies, quantification of collagen fibers types I and III, and stereological analysis were performed to determine the volume density (Vv), surface area (Sv), and number (Nv) of the nuclei of the zona fasciculata cells. Adrenal gland tissue from group S presented dysplasia, metaplasia, intracellular fat accumulation, fibrosis, blood vessel dilation, and increased presence of apoptotic cells. Capsule thickening and increased collagen type I were also observed. There was a significant decrease in Vv, Sv, and Nv of zona fasciculata nuclei in group S compared to group A. The results indicate that aging induces significant morphoquantitative changes in the adrenal gland, which could contribute to the decrease in glucocorticoid production and alterations in aldosterone and cortisol secretion observed in senescence. Understanding these alterations is crucial to developing interventions that mitigate the adverse effects of aging on the endocrine system.
Barriers and Advantages of Self-Sampling Tests, for HPV Diagnosis: A Qualitative Field Experience Before Implementation in a Rural Community in Ecuador Bernardo Vega-Crespo, Vivian Alejandra Neira, Ruth Maldonado - Rengel, Diana López, Dayanara Delgado-López, Gabriela Guerra Astudillo, Veronique Verhoeven International Journal of Women S Health, 2024 Introduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test's reliability as well as the user's proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users' proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers.
Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study Estefanía Bautista-Valarezo, Bernardo Vega Crespo, Ruth Maldonado-Rengel, María Espinosa, Vivian Neira, Veronique Verhoeven International Journal of Environmental Research and Public Health, 2022 Background: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish “El Valle”. Method: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. Results: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. Conclusions: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.
Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador Bernardo Vega Crespo, Vivian Alejandra Neira, José Ortíz S, Ruth Maldonado-Rengel, Diana López, Andrea Gómez, María José Vicuña, Jorge Mejía, Ina Benoy, Tesifón Parrón Carreño, Veronique Verhoeven Healthcare Switzerland, 2022 Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67–52.8), and urine sampling, OR 16.63 (6.79–40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44–18.93), and urine sampling, OR 19.5 (5.83–65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03–0.16), and urine sampling, OR 0.01 (0–0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07–0.34), and urine sampling, OR 0.05 (0.01–0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71–9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.
Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador Bernardo Vega Crespo, Vivian Alejandra Neira, José Ortíz Segarra, Ruth Maldonado Rengel, Diana López, María Paz Orellana, Andrea Gómez, María José Vicuña, Jorge Mejía, Ina Benoy, Tesifón Parrón Carreño, Veronique Verhoeven International Journal of Environmental Research and Public Health, 2022 Background: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Results: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2–99.9), and specificity 92.1% (IC 85.2–95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2–96.9). The negative predictive value was 98.9% (IC 94.2–99.8) for vaginal self-sampling and 97.6% (IC 92.6–99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.
The Terms Rubrum, Luteum and Albicans in Terminologia Anatomica of the Ovary Víctor Vaca-Merino, Ruth Maldonado-Rengel, Cristopher Nicolson, Bélgica Vásquez, Mariano del Sol International Journal of Morphology, 2022 El objetivo del presente artculo fue revisar la etimologa de los trminos Corpus rubrum, Corpus luteum y Corpus albicans, identificar si la forma de nombrarlos en las diferentes nminas y terminologas internacionales estn acorde a las sugerencias de la FIPAT y, analizar y reflexionar respecto de la pertinencia de estos trminos en la Terminologia Anatomica. Se busc en primer lugar el significado de las races latinas de los trminos: Corpus rubrum, Corpus luteum y Corpus albicans, en el Diccionario de la Real Academia de la Lengua, ltima actualizacin; en
Nutrition Status of Pregnant Women and its Relationship with Complications of Pregnancy and the Newborn Víctor Vaca-Merino, Ruth Maldonado-Rengel, Pablo Tandazo-Montaño, Arianna Ochoa-Camacho, Daniela Guamán-Ayala, Lizbeth Riofrio-Loaiza, Cristian Vaca-Sarango, Mariano del Sol International Journal of Morphology, 2022 RESUMEN: El estado nutricional materno determina las condiciones de salud y nutricionales del recién nacido, así como las complicaciones durante el embarazo y el parto. Se realizó el estudio en 894 mujeres que tuvieron su parto en los Hospitales de la ciudad de Loja Ecuador durante el periodo enero - junio del 2019. Se determinó la antropometría de la madre y de su hijo, así como se tomó datos de complicaciones durante el embarazo y el parto, de su historia clínica. Además, se efectuó la correlación entre el estado nutricional pre-gestacional de la madre con el recién nacido, de igual forma con el estado de salud de la madre. El objetivo de este trabajo fue determinar el estado nutricional pre-gestacional y su relación con la condición de salud y nutricional del niño. El IMC pre-gestacional reportó 47,3 % de sobrepeso y obesidad y 2,6 % de bajo peso. En un porcentaje mayor al 10 % las madres con sobrepeso y obesidad tuvieron hijos grandes para la edad gestacional, de igual forma las madres con bajo peso tuvieron el 26,1 % recién nacidos pequeños. Las principales complicaciones de las madres relacionadas con sobrepeso y obesidad fueron: diabetes gestacional, hemorragia postparto y pre-eclampsia durante el embrazo. Importante señalar la alta frecuencia de infecciones de las vías urinarias 53,9 % (478); y vaginitis 22,3 % (199); aunque estas no están directamente relacionadas con procesos metabólicos como etiología, más si están favorecidos por ellos. Durante el parto la complicación más frecuente fue el parto distócico con un 8,9 % (77), además del total de partos el 41,8 % (374) terminaron en cesárea, de estos el 51, 6 % (193) corresponden a sobrepeso y obesidad. Las complicaciones del recién nacido fueron: Síndrome de dificultad respiratoria aguda, asfixia neonatal e hipoglicemia. En conclusión, el estado nutricional pre-gestacional de la madre está relacionado directamente con el estado de salud y nutricional del recién nacido.
