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    CBCT-guided Caldwell–Luc management of a dentigerous cyst associated with an ectopic maxillary third molar in the maxillary sinus: a case report
    (Frontiers Media SA, 2026-08-04)
    Llanos-Arteaga, José Luis
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    Delgado-Piedra, Daniel Andrés
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    Llanos-Arteaga, Luis Alberto
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    Llanos-Arteaga, Anderson Daniel
    ;
    A dentigerous cyst associated with an ectopic third molar in the maxillary sinus is an extremely rare pathological entity that poses diagnostic and therapeutic challenges. We report the case of a 22-year-old woman with a four-month history of chronic nasal congestion and postnasal drip sensation, without a relevant medical history. Cone-beam computed tomography (CBCT) confirmed a cystic lesion associated with an ectopic third molar, allowing accurate three-dimensional assessment for surgical planning, with partial involvement of the left maxillary antrum. Given the size and location of the lesion, complete cystic capsule enucleation and ectopic tooth odontectomy were performed using the Caldwell–Luc approach under local anesthesia. Histopathological examination confirmed the diagnosis of a dentigerous cyst. Clinical and imaging follow-up at six months showed complete resolution of sinonasal symptoms and no evidence of recurrence. This case highlights that the Caldwell–Luc approach guided by CBCT remains a viable and effective option for treating extensive odontogenic cystic lesions involving the maxillary sinus. © 2026 Llanos-Arteaga, Delgado-Piedra, Llanos-Arteaga, Llanos-Arteaga and Parise-Vasco.
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    Reconstructing severe acute respiratory infection dynamics from ICD-10 hospital discharge data: a 10-year analysis of 11.2 million discharges in Ecuador, 2014–2023
    (Frontiers Media SA, 2026-07-22) ; ; ;
    Fuentes-Tumbaco, Natasha Bella
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    Escobar-Naranjo, Mónica
    Background – In many low- and middle-income countries, surveillance of severe acute respiratory infections (SARI) relies on administrative hospital data without virological confirmation, and its ability to capture epidemic dynamics and age-specific burden remains uncertain. Methods – We analyzed 11, 232, 698 hospital discharges recorded by Ecuador's National Institute of Statistics and Censuses between 2014 and 2023, identified SARI episodes using International Classification of Diseases, 10th Revision (ICD-10) codes under broad and length-of-stay–restricted case definitions, and incorporated a neonatal component that included perinatal respiratory codes for infants younger than 1 year. Serfling harmonic regression was used to estimate seasonal baselines and excess SARI admissions at national, provincial, and age-stratified levels. Results – Administrative data identified 538, 272 SARI discharges and revealed marked heterogeneity in incidence and case fatality across provinces and age groups. A previously unrecognized shift in ICD-10 coding from respiratory to perinatal chapters produced an apparent 99% decline in infant SARI after 2014; reclassifying perinatal respiratory codes restored stable high SARI rates in infants and increased their estimated burden by nearly ten-fold. Nationally, we identified 50 epidemic weeks with 77, 352 excess SARI discharges (95% CI 70, 030–85, 982), while the COVID-19 pandemic disrupted typical seasonality, reducing admissions but increasing mortality among older adults. Conclusions – Routinely collected hospital discharge data can reconstruct SARI epidemic dynamics and geographic disparities in the absence of virological surveillance, but are highly sensitive to coding practices. Incorporating neonatal perinatal respiratory codes into SARI definitions is essential to avoid underestimating infant burden and misinforming public health priorities. Copyright © 2026 Angamarca-Iguago, Cagua-Ordónez, Parise-Vasco, Fuentes-Tumbaco, Escobar-Naranjo, Reytor-González and Simancas-Racines.
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    Perception, knowledge and attitudes of Ecuadorian dentists towards patients with molar incisor hypomineralization
    (Frontiers Media SA, 2026-06-08)
    Armas-Vega, Ana
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    ; ; ;
    Ribadeneira-Morales, Jennifer
    Background – Molar Incisor Hypomineralization (MIH) is one of the most prevalent enamel development defects in contemporary dental practice. Understanding perceptions, knowledge, and attitudes of professionals towards this condition is key to optimizing clinical protocols and improving therapeutic results. Objective – To evaluate the perception, knowledge and attitudes of Ecuadorian dentists about diagnosis and management of patients with MIH. Methods – A cross-sectional observational study was carried out using a self-administered survey of registered dentists in Ecuador. A validated 19-question questionnaire was applied that explored demographic characteristics, knowledge of etiology and prevalence, attitudes towards clinical management, and therapeutic choices. In addition, two clinical cases with photographic support were included to evaluate treatment decisions. The statistical analysis incorporated descriptive statistics, chi-square or Fisher's exact tests, and multivariate logistic regression models. Results – A total of 352 dentists participated, predominantly working in private practice (71.9%), particularly in general dentistry (61.1%). Most practitioners reported observing MIH monthly (45.7%) and perceived an increase in its occurrence (67.0%). Demarcated opacities were the most frequent clinical manifestation (93.2%), with antibiotics being the main reported etiological factor (31.8%). The frequency of observation varied significantly between specialties (p < 0.05). Management was considered difficult, with durability of restorations being the main concern. Glass ionomer (37.5–71.4%) was the primary therapeutic choice, followed by fluoride varnish (22.6–37.5%). In the multivariate logistic regression model, professionals with 6–10 years of experience showed significantly higher odds of adequate knowledge (adjusted OR = 2.23, 95% CI: 1.14–4.37, p = 0.019). No independent predictors of favorable attitude towards MIH management reached statistical significance after multivariate adjustment. Conclusions – MIH is recognized as a growing and complex problem. It is frequently observed with demarcated opacities as the predominant sign and antibiotics as the main etiological factor. Its management is challenging, and professional experience appears to influence clinical knowledge. Continuing education and the development of standardized clinical protocols are needed to strengthen professional competence in MIH management. © 2026 Armas-Vega, Parise-Vasco, Angamarca-Iguago, Cagua-Ordoñez, Reytor-González, Ribadeneira-Morales, Rösing, Noal and Simancas-Racines.
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    Local thermal anomalies and the altitudinal rise of dengue hospitalisation rates in Ecuador, 2011–2024: a national ecological study
    Introduction Dengue is expanding beyond its traditional lowland range as rising temperatures may enable Aedes aegypti establishment at progressively higher altitudes. Ecuador, spanning sea level to above 4500 m, offers a natural altitudinal experiment, yet hospital-based evidence on the thermal drivers of Andean dengue is lacking. Methods We conducted a national ecological time-series analysis at the canton level using Ecuador's hospital discharge registry (INEC) for 2011–2024, the period with standardised canton coding, identifying dengue hospitalisations by ICD-10 codes A90, A91 and A97. Monthly land surface temperature, precipitation and vegetation index were derived from MODIS and GPM products. A distributed lag non-linear model estimated the temperature–hospitalisation association; a quasi-Poisson model restricted to Andean cantons (≥1500 m), with canton, calendar-month and year fixed effects, tested whether thermal anomalies above each canton's 2007–2015 baseline were associated with hospitalisation rates. Results Among 74,601 dengue hospitalisations with a resolvable canton of residence (232 deaths; case fatality 0.31%), dengue was recorded in 68 cantons above 1500 m, including altitudes exceeding 3000 m. The national hospitalisation rate rose from 29.7 to 77.0 per 100,000 and the Andean rate approximately 7-fold (1.9 to 12.8). The minimum hospitalisation temperature was 18.4°C nationally and 18.9°C in Andean cantons. A +1°C anomaly versus zero was associated with a 1.07-fold increase in hospitalisation rates (95% CI 1.02–1.13; p  = 0.012). Without canton fixed effects, the same contrast yielded 1.21 (1.07–1.36); the within-canton association fell to 1.04 (1.00–1.08) when the 2024 epidemic year was excluded. Discussion Positive deviations from local historical baselines, rather than absolute temperature, were associated with rising dengue hospitalisation rates among Andean residents, by a modest margin that depends materially on the 2023–2024 epidemic. In-hospital case fatality was nearly twice as high in low Andean cantons (0.62%, 95% CI 0.20–1.45; five deaths) as on the coast (0.33%), a non-significant difference that nonetheless supports strengthening dengue recognition in highland facilities.
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    Endodontic Retreatment Using Rotary System and Aesthetic Rehabilitation of a Deciduous Central Maxillary Incisor in a 5‐Year‐Old Child: A Case Report
    (Wiley, 2026-01)
    Domínguez-Gaibor, Esthefany
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    Ribadeneira-Morales, Leslee
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    Sempertegui, Paulina
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    Wesley, Hannah
    Introduction Early childhood caries (ECC) affects the primary dentition of preschool children and can result in the need for pulp treatment. Endodontic retreatment in deciduous teeth is indicated when initial treatment fails, representing a conservative alternative to extraction. Objective This case describes pulp retreatment using a rotary system and complete aesthetic rehabilitation of the anterosuperior sector in a pediatric patient. Case Report A 5‐year‐old systemically healthy male patient attended the clinic with ECC affecting the maxillary central and lateral incisors. Clinical examination revealed a temporary dentition with bilateral Class I molar relationship. The left maxillary central incisor presented a previous deficient endodontic obturation with material extending only one‐third of the root length. The treatment plan included pulp retreatment of Tooth 61, fiberglass postplacement, and celluloid crowns on maxillary incisors, in addition to comprehensive oral cavity rehabilitation. Canal debonding was performed with K‐files, removing zinc oxide eugenol. Reinstrumentation was performed with Hedstrom File #30 and the U1 file rotary system (0.40 mm, torque 2.5 N·m, and 400 RPM), with a working length of 11.5 mm. An irrigation protocol was performed using physiological saline, as well as 2.5% and 5% sodium hypochlorite. Obturation was performed with Metapex. Subsequently, a fiberglass post cemented with RelyX dual and celluloid crown with Filtek Supreme resin were placed. One‐year follow‐up demonstrated an asymptomatic tooth, remaining in the mouth in favorable conditions with successful aesthetic and functional restoration. The mother and patient expressed high satisfaction with the outcome. Conclusion In this pediatric case, endodontic retreatment of a deciduous maxillary central incisor using a rotary system, combined with fiberglass post placement and celluloid crown rehabilitation, resulted in favorable clinical and radiographic outcomes at 12‐month follow‐up. Within the limitations of a single‐case report, these findings suggest that retreatment may be considered a viable conservative alternative to extraction in carefully selected clinical scenarios.
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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) ; ; ;
    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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    Temporal Dynamics of Innate Immune Activation and Viral Interference During Sequential Co-Infection with Influenza A Virus and SARS-CoV-2: Molecular Mechanisms, Clinical Evidence, and Therapeutic Implications
    The concurrent circulation of influenza A virus (IAV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has unveiled complex host–pathogen interactions governed by temporal dynamics of innate immune activation. This narrative review synthesizes evidence from human air–liquid interface (ALI) epithelial models, animal studies (hamster, ferret), clinical cohorts, and randomized controlled trials (2015–2026) to delineate the molecular mechanisms underlying viral interference between these two major respiratory pathogens. Prior IAV infection induces a robust type I/III interferon (IFN) response and broad interferon-stimulated gene (ISG) upregulation that restricts subsequent SARS-CoV-2 replication within a critical 24–72 h temporal window. Conversely, SARS-CoV-2 employs a multi-layered immune evasion strategy that blunts IFN induction, providing minimal heterologous protection. Simultaneous co-infection tends to exacerbate disease severity. Host genetic determinants, including OAS1 and TLR7 variants, modulate interference capacity. Therapeutically, early pegylated IFN-λ shows clinical benefit, while experimental evidence from in vitro and animal models suggests oseltamivir may paradoxically reduce IAV-induced interference. These findings underscore the need for multi-pathogen diagnostics, temporally informed clinical decision-making, and IFN-based therapeutic strategies during co-circulation periods. © 2026 by the authors.
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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) ;
    Loor-Cedeño, Andrés
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    Gavilanes, Dolores Jima
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    Matos, Andri
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    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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    Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment
    (2026)
    Sebastián Chapela
    ;
    ; ;
    Daniel Tettamanti Miranda
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    Claudia Kecskes
    Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I–III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p &lt; 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = −13 to −15 kcal·kg−1·day−1; p &lt; 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.
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    Sociodemographic Factors and Childhood Growth: Associations with Environmental Sanitation Phases
    (2026)
    Yadira Morejón-Terán
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    Ana Clara P. Campos
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    Leila Denise A. F. Amorim
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    Laura C. Rodrigues
    Early childhood growth trajectories can influence the risk of chronic diseases in adulthood. Improvements in environmental sanitation may affect child development in low-resource settings. Objective: to examine the associations among socioeconomic factors with nutrition indicators, and trajectories of anthropometric indicators across three epidemiological cohorts that reflect different phases of environmental sanitation implementation. Methods: A longitudinal study was conducted in Salvador, Brazil, from 1997 to 2013. A total of 1429 children were recruited across three epidemiological cohorts, corresponding to the phases of a sanitation program: pre-intervention (n = 299), intervention (n = 1007), and post-intervention (n = 123). Height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were assessed at four time points. Multilevel linear models were used to adjust for socioeconomic factors. Results: A total of 992 children (68.7%) completed follow-up. Post-intervention children showed improved HAZ trajectories, with sex-specific patterns that varied across cohorts. Birth weight is positively associated with HAZ across all cohorts (0.34–0.49 kg increase per z-score). Household overcrowding (&gt;2 persons/room) is consistently associated with lower HAZ (−0.34 to −0.63 z-score reduction). Children who were never exclusively breastfed in the post-intervention phase had a higher BAZ (0.76 z-score increase). Caesarean delivery is associated with higher BAZ in the pre-intervention (0.23) and intervention (0.27) cohorts. Conclusions: Children born in later time periods showed better growth trajectories, which may reflect the combined effects of sanitation improvements, economic development, and other societal changes in Brazil during this period. Further research using experimental or quasi-experimental designs is needed to isolate the specific contribution of sanitation to child growth.
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