Simancas Racines, Daniel

Preferred name

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Facultad de Ciencias de la Salud y Bienestar Humano

Ambato

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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)
Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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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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Parise Vasco, Juan Marcos
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Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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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
(Frontiers Media SA, 2026-09-08)
Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Simancas Racines, Daniel
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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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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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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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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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
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Parise Vasco, Juan Marcos
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Reytor González, Claudia
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Cagua Ordoñez, Jaen
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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.
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Associations of the exact-overlap Farm-to-Diet Coupling Index and production diversity with market dependence among smallholder farming households in Los Ríos, Ecuador: a cross-sectional study
(Frontiers Media SA, 2026-09-08)
Zambrano-Villacres, Raynier
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Cagua Ordoñez, Jaen
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Contreras-Moscol, Daniel Jossepp
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Andrade Mejia, Nelly
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Gortaire-Díaz, David
Background Smallholder farming households may produce food while remaining dependent on markets for household consumption. We examined whether household production diversity and exact production–self-consumption overlap were associated with market dependence, food insecurity, market-dependent vulnerability, and food-system buffer resilience among smallholder farming households in Los Ríos, Ecuador. Methods We conducted a cross-sectional study of 133 households. Ten primary dietary food groups were classified as produced, self-consumed from own production, or purchased. The exact-overlap Farm-to-Diet Coupling Index (FDCI) represented the proportion of food groups produced that were also self-consumed. Modified Poisson models with HC3 robust standard errors were used to estimate adjusted prevalence ratios (aPRs). Results Median household production diversity was 3 food groups (IQR: 1–4), the Self-consumed Food Group Diversity Proxy was 2 groups (IQR: 1–2), the FDCI was 0.50 (IQR 0.40–1.00), and the Market Food Dependency Index was 0.67 (IQR: 0.50–0.86). Production diversity was positively correlated with self-consumed food-group diversity (Spearman’s ρ = 0.636; p < 0.001). Vegetables, fish, and red meat showed the largest purchase–production differences. Each additional food group produced was associated with a lower prevalence of high market dependence (aPR 0.708; 95% CI 0.603–0.832), as was each 0.10-unit increase in the FDCI (aPR 0.933; 95% CI 0.874–0.996). The FDCI estimate was less precise in several sensitivity analyses and was not independently associated with food insecurity, market-dependent vulnerability, or buffer resilience. Conclusion Production diversity and exact farm-to-diet overlap captured distinct dimensions of household food acquisition. Both were associated with lower market dependence, but exact overlap was not a consistent indicator of broader food insecurity, vulnerability, or resilience. These findings support assessing production, self-consumption, and purchase as distinct pathways rather than assuming that production diversification alone improves household food security. This distinction may help nutrition-sensitive agricultural programs monitor production, household retention, and market acquisition as separate but interconnected pathways.
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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
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Campuzano-Donoso, Martín
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Rossetti, Gianluca
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Cobellis, Luigi
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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
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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.

Simancas Racines, Daniel

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