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A second-hit conceptual framework for pulmonary arterial hypertension in adult congenital heart disease: genetics, hemodynamics, and treat-and-repair
(Frontiers Media SA, 2026-08-04)
Del Salto-Campuzano, Daniel Alejandro
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García-Chehab, Carol Marcelle
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Campuzano-Donoso, Martín
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Reytor González, Claudia
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Simancas Racines, Daniel
Pulmonary arterial hypertension (PAH) complicates a clinically important subset of adult congenital heart disease (ACHD) and contributes to substantial morbidity and premature mortality. This narrative review synthesizes direct and indirect evidence within a second-hit conceptual framework for ACHD-associated PAH. In this framework, baseline pulmonary vascular susceptibility interacts over time with sustained hemodynamic or hypoxemic exposure and with superimposed biological or clinical stressors. SOX17 has the clearest direct genetic association with ACHD-PAH, whereas evidence involving BMPR2-related metabolic, inflammatory, and proliferative pathways is derived predominantly from heritable PAH, broader PAH populations, and experimental models. Experimental and computational studies also suggest that disturbed flow and mechanobiological signaling may contribute to endothelial dysfunction and endothelial-to-mesenchymal transition, although these mechanisms have not been established as a causal sequence in longitudinal ACHD cohorts. Four-dimensional flow magnetic resonance imaging and cardiopulmonary exercise testing may characterize abnormal flow patterns and impaired pulmonary vascular reserve in research settings, but neither is validated for screening patients with borderline ACHD hemodynamics or for selecting therapy. Evidence supporting treat-and-repair remains observational and defect-specific, with the most developed adult data derived from carefully selected patients with atrial septal defects; these findings should not be extrapolated directly to ventricular septal defects, patent ductus arteriosus, or complex congenital heart disease. Fontan physiology is considered separately as a low-flow, low-reserve pulmonary vascular state rather than as classical high-pressure PAH. The principal contribution of this review is to organize heterogeneous evidence according to its directness, distinguish established clinical practice from investigational approaches, and identify priorities for prospective validation. The second-hit framework should therefore be interpreted as a hypothesis-generating conceptual synthesis rather than as a validated diagnostic or therapeutic algorithm. © 2026 Del Salto-Campuzano, García-Chehab, Campuzano-Donoso, Reytor-González and Simancas-Racines.
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Personalized nutrition for healthy aging: precision diets based on genomic, metabolic, and microbiome profiles
(Frontiers Media SA, 2026-08-05)
Reytor González, Claudia
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Román-Galeano, Náthaly Mercedes
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Castano Jimenez, Janeth
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Oentiono, Oki Yonatan
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Yoong, Washington A.
The global increase in life expectancy has been accompanied by a parallel rise in the burden of chronic diseases, many of which are influenced by diet and lifestyle. Conventional dietary guidelines, though broadly beneficial, often fail to account for the wide heterogeneity in nutritional needs, metabolic responses, and health trajectories observed among older adults. This limitation has spurred interest in personalized nutrition—a precision approach that leverages individual genomic, metabolomic, and gut microbiome profiles to tailor dietary interventions for healthy aging. Recent advances in omics technologies have deepened our understanding of how genes, circulating metabolites, and microbial ecosystems interact with diet to influence disease risk, physical function, and longevity. This review explores the conceptual foundations, technological enablers, and clinical applications of personalized nutrition, highlighting key evidence from 2020 to 2025. It examines how precision models are being used to improve outcomes in older adults, discusses ethical and social barriers to implementation, and outlines future directions including artificial intelligence and real-time monitoring tools. Personalized nutrition represents a transformative opportunity to shift from population-based dietary advice to individualized strategies that can promote resilience, reduce frailty, and extend healthspan in the aging global population. Copyright © 2026 Reytor-González, Román-Galeano, Castano Jimenez, Oentiono, Yoong, Montalvan and Simancas-Racines.
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From remote screening to precision prevention: responsible multimodal AI for risk prediction and equitable oral healthcare
(Frontiers Media SA, 2026-07-24)
Iglesias-Pérez, Heydi Daniela
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Gallo-Sánchez, Maria Emilia
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López-Loachamin, Ariel Sebastián
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Paccha-Melgar, Daniela Alejandra
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Rivadeneira-Ahuilar, Julio Damián
Artificial intelligence (AI) applications in oral healthcare have expanded considerably over the past decade. Deep-learning systems now report diagnostic performance exceeding 0.85 sensitivity and 0.90 specificity for several image-based tasks, with the highest pooled estimates reported in AI-assisted clinical photography for oral cancer and oral potentially malignant disorder (OPMD) detection (diagnostic odds ratio 68.4; AUC 0.938). These figures, however, mask three translational gaps. First, many studies often carry high risk of bias, lack external validation, and rest on heterogeneous reference standards. Second, datasets often provide limited demographic reporting, leaving uncertainty about model performance in the populations most likely to benefit from remote screening. Third, teledentistry and mHealth tools have outpaced the regulatory, validation, and fairness-auditing, and clinical-integration frameworks required for safe deployment. Preventive value emerges most clearly when AI is embedded in multimodal systems, such as imaging, sensors, behavioural feedback, clinician support rather than evaluated as an isolated classifier. Progress will be defined less by additional accuracy gains and more by external validation in diverse populations, transparent demographic reporting, equity-focused evaluation, and integration into prevention-oriented care pathways. © 2026 Iglesias-Pérez, Gallo-Sánchez, López-Loachamin, Paccha-Melgar, Rivadeneira-Ahuilar, Luna-Ponce, Gallo-Achig, Pillajo-Villalba, Campuzano-Donoso and Reytor-González.
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Bridging the gap: technology-driven solutions to overcome food insecurity and improve nutrition access for older adults
(Frontiers Media SA, 2026-07-07)
Reytor González, Claudia
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Campuzano-Donoso, Martín
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Munizaga, Maritza Aguirre
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Oentiono, Oki Yonatan
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Jimenez, Janeth Castano
Food insecurity and social isolation are interrelated challenges affecting many older adults, with overlapping pathways that include limited income, reduced mobility, difficulty shopping or preparing meals, loss of shared mealtime routines, and lack of practical support for food procurement. These pathways may contribute to poorer dietary intake, malnutrition risk, deteriorating health, and reduced quality of life. As the global population ages, digital health and assistive technologies may support selected aspects of nutrition access, care coordination, and social connectedness, although their effects depend on implementation context and the availability of human and community support. This review explores the potential of tools such as wearable devices, telehealth services, virtual community centers, GIS mapping, and mobile markets in addressing these challenges. It also highlights the importance of integrating caregivers and coordinated care teams into technology-driven interventions to improve outcomes for older adults with limited access to traditional services. While these innovations present exciting opportunities, barriers such as the digital divide, limited digital literacy, data privacy concerns, and the risk of widening existing health disparities must be addressed. Ensuring that technologies are designed inclusively, ethically, and with input from older users is essential for building scalable, sustainable solutions that truly enhance the quality of lives of aging individuals. As digital health continues to evolve, it must prioritize equity, accessibility, and human-centered design to effectively support aging in place and reduce the burden of food insecurity and social isolation. Copyright © 2026 Reytor-González, Campuzano-Donoso, Munizaga, Oentiono, Jimenez, Montalvan and Simancas-Racines.
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Higher-Protein Nutrition and Concurrent Exercise in Obesity: A Narrative Review of Body Composition, Metabolic Health, and Physical Function
(MDPI AG, 2026-07-11)
Reytor González, Claudia
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Loor-Cedeño, Andrés
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Gavilanes, Dolores Jima
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Matos, Andri
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Parise Vasco, Juan Marcos
Obesity care increasingly requires outcomes that extend beyond total body weight. Although weight reduction remains clinically meaningful, the scale alone does not indicate whether fat mass, lean tissue, muscle quality, strength, mobility, or physiological reserve have changed in a favorable direction. This narrative review examines the combined role of higher-protein dietary strategies and concurrent exercise in adults with obesity, with emphasis on body composition, metabolic health, and physical function. Higher-protein dietary strategies may support satiety, improve the tolerability of energy restriction in some patients, and attenuate lean-tissue loss during weight reduction, while evidence for superior long-term weight loss remains inconsistent. Exercise provides complementary stimuli to protein-focused nutrition: resistance training supports strength, muscle function, and lean-tissue preservation, while aerobic and interval-based training contribute to cardiorespiratory fitness, regional adiposity reduction, and selected cardiometabolic adaptations. Concurrent training offers a practical framework for integrating these stimuli, with value primarily as multidomain coverage rather than as evidence of universal superiority over other modalities. The main rationale for combining protein adequacy with exercise is preservation of usable physical function during weight loss, particularly in older adults, patients with sarcopenic-obesity risk, and individuals undergoing rapid pharmacological or surgical weight reduction. Overall, the available evidence is most consistent with viewing higher-protein nutrition and structured exercise as complementary strategies for improving the quality of weight loss, rather than as a single protocol for maximizing scale-weight reduction. Longer pragmatic trials are needed to clarify phenotype-specific responses, feasible protein targets, exercise progression, monitoring strategies, and functional outcomes. © 2026 by the authors.
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Socioeconomic disparities and nutritional aging: how food insecurity and financial hardship accelerate health decline in older adults
(Frontiers Media SA, 2026-06-08)
Reytor González, Claudia
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Campuzano-Donoso, Martín
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Román-Galeano, Náthaly-Mercedes
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Castano Jimenez, Janeth
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Paz-Yépez, Carolina
This narrative review examines how socioeconomic disparities accelerate health decline in older adults. As the global population ages, older age represents a major risk factor for chronic diseases, frailty, and disability, particularly in socially disadvantaged groups. While adequate nutrition is essential to healthy aging, approximately 28% of the global population experiences moderate or severe food insecurity, with older adults disproportionately affected in resource-limited settings. Food insecurity and financial hardship are consistently associated with poorer diet quality, including lower Healthy Eating Index scores (e.g., ~51 vs. >57 in food-secure peers), and increased risk of adverse outcomes such as sarcopenia, frailty, and cognitive decline. Notably, food-insecure older adults are also more likely to experience overweight or obesity (OR ≈ 1.29), reflecting reliance on energy-dense, nutrient-poor diets. These disparities are shaped by structural and socioeconomic factors, including low income, limited education, inadequate social safety nets, and inequitable neighborhood food environments. Addressing these challenges requires a shift from individual-level interventions to systemic, interdisciplinary, and culturally-tailored approaches. Copyright © 2026 Reytor-González, Campuzano-Donoso, Román-Galeano, Castano Jimenez, Paz-Yépez, Montalvan and Simancas-Racines.
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Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance
(MDPI AG, 2026-05-29)
Zambrano-Villacres, Raynier
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Campuzano-Donoso, Martín
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Reytor González, Claudia
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Rossetti, Gianluca
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Cobellis, Luigi
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists have transformed obesity treatment, producing substantial weight loss during active therapy. However, real-world effectiveness may be limited by gastrointestinal adverse events, reduced dietary intake, fat-free mass loss as part of total weight reduction, and weight regain after discontinuation. Methods: This narrative review synthesizes current pharmacological, nutritional, gastrointestinal, body-composition, and implementation evidence to propose an evidence-informed nutrition-first framework for patients receiving incretin-based therapy for obesity. Results: We translate pharmacologic mechanisms into practical dietary strategies, including protein prioritization, structured meal patterns, hydration and fiber management, symptom-targeted interventions, resistance-training support, and maintenance planning. Because direct trials of structured nutrition interventions in GLP-1RA- or dual incretin-treated populations remain limited, several recommendations are extrapolated from the broader obesity, caloric restriction, body-composition, gastrointestinal, and expert-consensus literature. Conclusions: Integrating structured nutrition care into pharmacotherapy pathways may help address meal-related symptom burden, support protein and fluid adequacy, identify patients at higher nutritional or body-composition risk, and prepare patients for long-term weight-management behaviors. Embedding practical nutrition management within multidisciplinary obesity care may help translate pharmacologic efficacy into durable, patient-centered outcomes. © 2026 by the authors.
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Digital workflow with intraoral scanning and CAD/CAM PMMA crowns in a non-cooperative pediatric patient with early childhood caries: a case report
(Frontiers Media SA, 2026-05-22)
Reytor González, Claudia
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Guachamin-Catota, Viviana
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Carrillo Zúñiga, Anahí Hilen
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González Hidalgo, Marco Andrés
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Román-Galeano, Náthaly Mercedes
Early childhood caries can cause extensive coronal destruction in preschool children, often requiring complex rehabilitation at an age when cooperation is limited. This case report describes a behavior-adapted digital workflow used to complete full-mouth rehabilitation in a four-year-old boy with severe early childhood caries and very limited cooperation. Clinical and radiographic assessment showed advanced multi-tooth carious involvement, with marked destruction of the maxillary anterior segment. Differential diagnostic reasoning supported severe early childhood caries as the most consistent diagnosis. Because conventional impression-taking was not tolerated, a two-step intraoral scanning workflow was used to support treatment planning and definitive anterior rehabilitation. Management included disease control, caregiver education, sealants, restorative procedures, pulpectomies where indicated, post-and-core reconstruction, and full-coverage restorations. In the maxillary anterior segment, biologic posts were used for severely destroyed primary incisors, followed by computer-aided design and computer-aided manufacturing fabrication of polymethyl methacrylate crowns. The crowns were tried in, adjusted, and cemented under controlled isolation. No pain or immediate complications were observed. At the six-month follow-up, the restorations remained intact, gingival tissues were healthy, occlusion was clinically acceptable, and periapical findings were unremarkable, with no radiographic signs suggestive of pathological resorption. This case suggests that intraoral scanning and digital restorative workflows may provide a practical pathway for completing definitive rehabilitation in selected non-cooperative pediatric patients, provided that disease control, isolation, fit verification, cementation quality, and structured follow-up are maintained. © 2026 Reytor-González, Guachamin-Catota, Carrillo Zúñiga, González Hidalgo, Román-Galeano and Simancas-Racines.
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Tuberculosis in prisons: an integrated prevention and care cascade for a persistent structural epidemic
(Frontiers Media SA, 2026-07-08)
Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Angamarca Iguago, Jaime
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Fuentes-Tumbaco, Natasha Bella
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Simancas Racines, Daniel
Tuberculosis (TB) remains disproportionately concentrated in prison populations worldwide, driven by overcrowding, poor ventilation, HIV co-infection, delayed diagnosis, treatment interruption, social vulnerability, and weak integration between correctional health services and national TB programs. This structured narrative review synthesizes current evidence across the prison TB prevention and care cascade, including screening, diagnosis, treatment, transmission reduction, TB/HIV integration, surveillance, and continuity after release. We conducted an expert-led narrative synthesis informed by systematic-review principles, distinguishing direct prison-specific evidence from mathematical modeling, policy guidance, systematic reviews, and indirect evidence from adjacent fields such as HIV care and TB infection treatment. Symptom screening alone has limited sensitivity in high-burden prisons. Digital chest radiography with computer-aided detection can improve case detection when linked to confirmatory molecular testing and treatment capacity. Xpert MTB/RIF or Ultra are central to rapid confirmation and rifampicin-resistance detection. Shorter rifamycin-based regimens for TB infection generally achieve higher completion than longer isoniazid-based regimens, while shorter all-oral MDR/RR-TB regimens may offer programmatic advantages but remain insufficiently studied in correctional settings. Ventilation improvement, safer spaces, peer-supported case detection, and integrated TB/HIV services are important components of transmission reduction. Decongestion may have substantial population-level impact, but this conclusion is supported mainly by mathematical modeling and should be interpreted as a projected effect rather than direct prison-specific causal evidence. Post-release continuity remains a major implementation gap, with limited direct evidence for active TB interventions. Sustainable prison TB control requires moving from isolated activities to an integrated, measurable prison–community cascade linking risk-adapted screening, rapid diagnosis, effective treatment, environmental controls, data systems, and confirmed linkage to community care after release. Copyright © 2026 Cagua-Ordoñez, Parise-Vasco, Angamarca-Iguago, Fuentes-Tumbaco and Simancas-Racines.
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Regional, altitudinal, and age-specific heterogeneity of bronchiolitis hospitalization seasonality in Ecuador, 2007–2024, and implications for RSV immunoprophylaxis timing
(Frontiers Media SA, 2026-08-03)
Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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de Mora, Doménica
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Escobar-Naranjo, Mónica
Background – Acute bronchiolitis, mainly attributed to respiratory syncytial virus (RSV), is the leading cause of infant hospitalization for lower respiratory tract disease worldwide. Nirsevimab and maternal RSVpreF (Abrysvo) confer about 6 months of protection, so timing relative to the season affects their impact. Ecuador spans the equator from sea level to valleys above 4, 000 m and is considering introducing these products, yet lacks subnational evidence on the seasonality of bronchiolitis, altitudinal patterning, or post-pandemic stability. Methods – We conducted a national ecological time-series analysis of hospital discharges from the Ecuadorian Statistics Institute, 2007–2024 (19, 788, 097 discharges; 204 of 224 cantons had complete data and formed the analytic panel). The primary outcome was acute bronchiolitis (ICD-10 code J21) in children younger than 12 months (n = 23, 190 nationally; 22, 724 in the panel), with secondary outcomes across three RSV-relevant age bands, ICD-10 code J21 under 5 years, and two RSV-specific ICD-10 codes (J12.1 and J20.5; 2018–2024). K35 (appendicitis) was a negative control. Analyses combined circular seasonality metrics with block-bootstrap confidence intervals (CIs), year-by-year disaggregation, and complementary sensitivity analyses [Moving Epidemics Method (MEM), Bai–Perron breaks, and lagged climate correlations]. Results – The weighted circular peak month of infant bronchiolitis hospitalizations shifted after the pandemic in Costa (+2.16 months), Sierra (+1.22), and Amazonía (+1.91), attenuating with altitude from +2.19 months below 500 m to +0.88 at 1, 500–3, 000 m. Costa was stable across 2022–2024; Sierra and, more so, Amazonía varied widely year to year (Amazonía peak ranged March–July, n = 37–42/year), so the pooled estimate should be read with caution. The composite RSV-coded outcome tracked ICD-10 code J21's timing closely in Costa (0.15-month difference) and Sierra (0.40), supporting ICD-10 code J21 as a reasonable RSV proxy in both, and the three regional peaks now span 2 months. Conclusion – Bronchiolitis seasonality in Ecuador changed after the pandemic, most clearly and stably in Costa; Sierra showed a transient 2022 perturbation with partial reversion by 2023–2024, and Amazonía's estimates remained unstable and underpowered. As region-tailored estimates are less stable in Sierra and Amazonía than in Costa, a single national window (nirsevimab February–April; maternal RSVpreF for pregnancies expected to deliver January–May) is a more defensible starting point, pending confirmation from further seasons and, ideally, laboratory-confirmed surveillance. Copyright © 2026 Angamarca-Iguago, Cagua-Ordóñez, Parise-Vasco, de Mora, Escobar-Naranjo, Bruno and Simancas-Racines.

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