Cagua Ordoñez, Jaen

Preferred name

Cagua Ordoñez, Jaen

Main Affiliation

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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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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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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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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Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment
(2026)
Sebastián Chapela
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Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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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 < 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 < 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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Phase-Related Resting Energy Expenditure in Critically Ill Adults: Metabolic Phenotypes and Determinants of Weight-Normalized Indices—A Retrospective Study
(2026)
Sebastián Chapela
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Cagua Ordoñez, Jaen
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Angamarca Iguago, Jaime
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Daniel Tettamanti
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Claudia Kecskes
Precise measurement of resting energy expenditure (REE) is essential in the intensive care unit (ICU), where metabolic requirements evolve throughout the course of critical illness. Predictive equations frequently fail to capture this variability, and limited data describe phase-dependent changes in REE using indirect calorimetry (IC). This study aimed to evaluate phase-related variation in REE and metabolic phenotypes in mechanically ventilated adults and to identify clinical and physiological correlates of both absolute REE and REE normalized by ideal body weight (REE/IBW). Methods: We conducted an observational, retrospective cross-sectional study in two ICUs at different hospitals. A total of 149 mechanically ventilated adults with a valid IC measurement were included and classified by illness phase: acute (0–3 days), intermediate (4–14 days), or chronic (>14 days). Differences in metabolic and gas-exchange variables were assessed using ANOVA or Kruskal–Wallis tests. Two multivariable linear regression models were fitted, one using absolute REE and a second using REE/IBW, incorporating metabolic phenotype categories to account for body-size heterogeneity. Results: Metabolic profiles differed across illness phases. Median REE increased from the acute (1664 kcal/day) to the intermediate (1869 kcal/day) and chronic (2074 kcal/day; p = 0.024) phases. Hypometabolic profiles were more frequent in the acute phase (64%), whereas hypermetabolic profiles were more prevalent in later phases (48%). RQ values were higher in the chronic phase compared with the acute phase (median 0.99 vs. 0.80; p < 0.001). In multivariable analyses, illness severity scores showed weak or inconsistent associations with REE after adjustment for gas-exchange variables. VCO2 was independently associated with absolute REE (adjusted R2 = 0.83). In the REE/IBW model, VCO2, RQ, BMI, and metabolic phenotype were associated with normalized energy expenditure, with higher adjusted R2 (0.87) and lower prediction error metrics. Conclusions: Resting energy expenditure and metabolic phenotypes vary across phases of critical illness. Gas-exchange variables, particularly VCO2, were more closely associated with measured energy expenditure than severity scores. Normalization of REE by ideal body weight reduced variability and improved model performance, highlighting the analytical value of indirect calorimetry for characterizing phase-dependent metabolic patterns in critically ill adults.
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Traditional Foods, Oral Microbiome, and Systemic Health: Molecular Pathways Linking Nutrition and Oral Disease Prevention
(2026)
Parise Vasco, Juan Marcos
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Angamarca Iguago, Jaime
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Cagua Ordoñez, Jaen
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Beatriz Cabrera
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Dolores Jima Gavilanes
Periodontal disease affects 10–50% of the global population and is associated with various systemic conditions, including diabetes, cardiovascular disease and adverse pregnancy outcomes. Emerging evidence highlights diet as a critical, modifiable factor that influences the composition of the oral microbiome and periodontal health. This narrative review explores the molecular mechanisms through which traditional foods modulate the oral microbiome and contribute to oral and systemic health. A comprehensive literature search was conducted in PubMed/MEDLINE, the Cochrane Library, LILACS and Epistemonikos, prioritizing systematic reviews, meta-analyses and randomized controlled trials. The oral microbiome harbors over 700 bacterial species, and dysbiosis, characterized by pathogen enrichment, drives periodontal inflammation. Anti-inflammatory dietary patterns, including the Mediterranean diet, demonstrate protective effects. Omega-3 fatty acids, vitamins C and D, polyphenols and dietary fiber support periodontal health, whereas refined carbohydrates, saturated fats and pro-inflammatory nutrients can exacerbate disease. Probiotics show promise as an adjunctive therapy. However, the translation to clinical guidelines is impeded by methodological challenges, including the limited number of randomized controlled trials with oral endpoints, confounding by hygiene practices, and the lack of standardized multi-omics approaches. Nutritional counselling should be integrated into periodontal care as a modifiable risk factor. Future research priorities include precision nutrition approaches, the validation of salivary biomarkers, and interprofessional collaboration between dental and nutrition professionals. © 2026 by the authors.
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Cagua Ordoñez, Jaen

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