Simancas Racines, Daniel

Preferred name

Main Affiliation

Facultad de Ciencias de la Salud y Bienestar Humano

Ambato

Now showing 1 - 10 of 27

Some of the metrics are blocked by your
consent settings
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
;
García-Chehab, Carol Marcelle
;
Campuzano-Donoso, Martín
;
Reytor González, Claudia
;
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.
Some of the metrics are blocked by your
consent settings
Micronutrient risk with GLP-1 receptor and dual incretin agonists in obesity: Mechanistic pathways, clinical signals, and a monitoring framework
(Elsevier BV, 2026-09)
Simancas Racines, Daniel
;
Campuzano-Donoso, Martín
;
Rossetti, Gianluca
;
Cobellis, Luigi
;
Pilone, Vincenzo
Background: Incretin-based pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have transformed obesity management by producing substantial weight loss through appetite suppression, reduced energy intake, and gastrointestinal effects. These mechanisms may also modify dietary intake, gastrointestinal physiology, and weight-loss–related metabolic adaptations, raising concern about micronutrient disturbances during long-term treatment. Methods: This narrative clinical review synthesizes evidence on mechanistic pathways, clinical signals, and monitoring considerations related to micronutrient risk during incretin-based obesity pharmacotherapy. Evidence was integrated from dietary studies, observational cohorts, mechanistic investigations, clinical trials, pharmacovigilance reports, and literature on obesity-related micronutrient physiology. Results: Micronutrient vulnerability appears to arise from the interaction between reduced food intake, lower dietary diversity, gastrointestinal intolerance, delayed gastric emptying, rapid weight loss, and baseline nutritional risk. The most relevant signals involve hematologic, fat-soluble, bone-related, trace element, and electrolyte domains, particularly iron, vitamin B12, vitamin D, calcium, magnesium, zinc, with additional context-dependent concerns involving thiamine, folate, vitamin A, other fat-soluble vitamins and potassium. Most abnormalities reported to date are subclinical or indirect, but clinically meaningful consequences may occur in susceptible individuals, including those with prior bariatric surgery, gastrointestinal disorders, poor baseline diet quality, older age, or prolonged nausea and vomiting. Conclusion: Micronutrient risk during incretin-based obesity pharmacotherapy is likely multifactorial and patient-specific. Individualized nutritional assessment and targeted laboratory monitoring should be considered for high-risk patients, while prospective studies are needed to define incidence, clinical relevance, and evidence-based monitoring strategies. © 2026 The Authors
Some of the metrics are blocked by your
consent settings
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
;
Campuzano-Donoso, Martín
;
Munizaga, Maritza Aguirre
;
Oentiono, Oki Yonatan
;
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.
Some of the metrics are blocked by your
consent settings
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
;
Loor-Cedeño, Andrés
;
Gavilanes, Dolores Jima
;
Matos, Andri
;
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.
Some of the metrics are blocked by your
consent settings
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
;
Guachamin-Catota, Viviana
;
Carrillo Zúñiga, Anahí Hilen
;
González Hidalgo, Marco Andrés
;
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.
Some of the metrics are blocked by your
consent settings
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)
Angamarca Iguago, Jaime
;
Cagua Ordoñez, Jaen
;
Parise Vasco, Juan Marcos
;
Fuentes-Tumbaco, Natasha Bella
;
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.
Some of the metrics are blocked by your
consent settings
Perception, knowledge and attitudes of Ecuadorian dentists towards patients with molar incisor hypomineralization
(Frontiers Media SA, 2026-06-08)
Armas-Vega, Ana
;
Parise Vasco, Juan Marcos
;
Angamarca Iguago, Jaime
;
Cagua Ordoñez, Jaen
;
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.
Some of the metrics are blocked by your
consent settings
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
;
Cagua Ordoñez, Jaen
;
Parise Vasco, Juan Marcos
;
de Mora, Doménica
;
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.
Some of the metrics are blocked by your
consent settings
Personalized nutrition for healthy aging: precision diets based on genomic, metabolic, and microbiome profiles
(Frontiers Media SA, 2026-08-05)
Reytor González, Claudia
;
Román-Galeano, Náthaly Mercedes
;
Castano Jimenez, Janeth
;
Oentiono, Oki Yonatan
;
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.
Some of the metrics are blocked by your
consent settings
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
(MDPI AG, 2026-07-03)
Angamarca Iguago, Jaime
;
Parise Vasco, Juan Marcos
;
Reytor González, Claudia
;
Cagua Ordoñez, Jaen
;
Simancas Racines, Daniel
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.

Simancas Racines, Daniel

Filters

Settings

Sort By

Results per page