CENTRO DE INVESTIGACIÓN DE EVIDENCIA, IMPLEMENTACIÓN Y TOMA DE DECISIONES EN SALUD

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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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Parise Vasco, Juan Marcos
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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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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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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
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Parise Vasco, Juan Marcos
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)
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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A second-hit conceptual framework for pulmonary arterial hypertension in adult congenital heart disease: genetics, hemodynamics, and treat-and-repair
(Frontiers Media SA, 2026-08-04)
Del Salto-Campuzano, Daniel Alejandro
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García-Chehab, Carol Marcelle
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Campuzano-Donoso, Martín
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Reytor González, Claudia
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Simancas Racines, Daniel
Pulmonary arterial hypertension (PAH) complicates a clinically important subset of adult congenital heart disease (ACHD) and contributes to substantial morbidity and premature mortality. This narrative review synthesizes direct and indirect evidence within a second-hit conceptual framework for ACHD-associated PAH. In this framework, baseline pulmonary vascular susceptibility interacts over time with sustained hemodynamic or hypoxemic exposure and with superimposed biological or clinical stressors. SOX17 has the clearest direct genetic association with ACHD-PAH, whereas evidence involving BMPR2-related metabolic, inflammatory, and proliferative pathways is derived predominantly from heritable PAH, broader PAH populations, and experimental models. Experimental and computational studies also suggest that disturbed flow and mechanobiological signaling may contribute to endothelial dysfunction and endothelial-to-mesenchymal transition, although these mechanisms have not been established as a causal sequence in longitudinal ACHD cohorts. Four-dimensional flow magnetic resonance imaging and cardiopulmonary exercise testing may characterize abnormal flow patterns and impaired pulmonary vascular reserve in research settings, but neither is validated for screening patients with borderline ACHD hemodynamics or for selecting therapy. Evidence supporting treat-and-repair remains observational and defect-specific, with the most developed adult data derived from carefully selected patients with atrial septal defects; these findings should not be extrapolated directly to ventricular septal defects, patent ductus arteriosus, or complex congenital heart disease. Fontan physiology is considered separately as a low-flow, low-reserve pulmonary vascular state rather than as classical high-pressure PAH. The principal contribution of this review is to organize heterogeneous evidence according to its directness, distinguish established clinical practice from investigational approaches, and identify priorities for prospective validation. The second-hit framework should therefore be interpreted as a hypothesis-generating conceptual synthesis rather than as a validated diagnostic or therapeutic algorithm. © 2026 Del Salto-Campuzano, García-Chehab, Campuzano-Donoso, Reytor-González and Simancas-Racines.
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Surgical excision of an infraorbital nerve schwannoma via a transconjunctival approach with lateral canthotomy: a case report
(Frontiers Media SA, 2026-08-03)
Panchi-Lasluisa, Jonathan Andrés
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Acuña-Peña, Virgen María
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Álvarez-Razo, Sebastián
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Parise Vasco, Juan Marcos
Schwannoma is a benign, encapsulated, slow-growing tumor that arises from Schwann cells. Approximately 25%–45% of extracranial schwannomas occur in the head and neck region, accounting for 1%–8% of all neoplasms. However, involvement of the infraorbital nerve is exceptionally rare. This report describes the surgical management of an infraorbital nerve schwannoma using a transconjunctival approach with lateral canthotomy, and documents the clinical, functional and aesthetic outcomes at 12 months. A 32-year-old woman with a history of hypochromic microcytic anemia presented with a progressively enlarging mass in the right infraorbital region that had been present for four years, associated with mild paresthesia in the nasolabial region. The main reason for consultation was aesthetic concern due to facial protrusion. Physical examination revealed a firm, painless subcutaneous mass without local inflammatory signs. Contrast-enhanced computed tomography revealed a solid, lobulated lesion measuring approximately 60 mm in maximum diameter in the right infraorbital region. Imaging features suggested an origin from the infraorbital foramen and involvement of the corresponding nerve; there was no evidence of osteolysis. Fine-needle aspiration cytology (FNAC) suggested a mesenchymal neoplasm. Surgical excision was performed under general anesthesia via a transconjunctival approach with lateral canthotomy. The infraorbital nerve was identified and preserved intraoperatively. Histopathological examination confirmed a schwannoma, showing spindle-shaped cells with Verocay bodies. The patient had a favorable clinical course. At the 12-month follow-up, facial symmetry and preserved sensory function were confirmed, as was the absence of recurrence. © 2026 Panchi-Lasluisa, Acuña-Peña, Álvarez-Razo and Parise-Vasco.
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Tuberculosis in prisons: an integrated prevention and care cascade for a persistent structural epidemic
(Frontiers Media SA, 2026-07-08)
Cagua Ordoñez, Jaen
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Parise Vasco, Juan Marcos
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Angamarca Iguago, Jaime
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Fuentes-Tumbaco, Natasha Bella
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Simancas Racines, Daniel
Tuberculosis (TB) remains disproportionately concentrated in prison populations worldwide, driven by overcrowding, poor ventilation, HIV co-infection, delayed diagnosis, treatment interruption, social vulnerability, and weak integration between correctional health services and national TB programs. This structured narrative review synthesizes current evidence across the prison TB prevention and care cascade, including screening, diagnosis, treatment, transmission reduction, TB/HIV integration, surveillance, and continuity after release. We conducted an expert-led narrative synthesis informed by systematic-review principles, distinguishing direct prison-specific evidence from mathematical modeling, policy guidance, systematic reviews, and indirect evidence from adjacent fields such as HIV care and TB infection treatment. Symptom screening alone has limited sensitivity in high-burden prisons. Digital chest radiography with computer-aided detection can improve case detection when linked to confirmatory molecular testing and treatment capacity. Xpert MTB/RIF or Ultra are central to rapid confirmation and rifampicin-resistance detection. Shorter rifamycin-based regimens for TB infection generally achieve higher completion than longer isoniazid-based regimens, while shorter all-oral MDR/RR-TB regimens may offer programmatic advantages but remain insufficiently studied in correctional settings. Ventilation improvement, safer spaces, peer-supported case detection, and integrated TB/HIV services are important components of transmission reduction. Decongestion may have substantial population-level impact, but this conclusion is supported mainly by mathematical modeling and should be interpreted as a projected effect rather than direct prison-specific causal evidence. Post-release continuity remains a major implementation gap, with limited direct evidence for active TB interventions. Sustainable prison TB control requires moving from isolated activities to an integrated, measurable prison–community cascade linking risk-adapted screening, rapid diagnosis, effective treatment, environmental controls, data systems, and confirmed linkage to community care after release. Copyright © 2026 Cagua-Ordoñez, Parise-Vasco, Angamarca-Iguago, Fuentes-Tumbaco and Simancas-Racines.
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Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance
(MDPI AG, 2026-05-29)
Zambrano-Villacres, Raynier
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Campuzano-Donoso, Martín
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Reytor González, Claudia
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Rossetti, Gianluca
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Cobellis, Luigi
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists have transformed obesity treatment, producing substantial weight loss during active therapy. However, real-world effectiveness may be limited by gastrointestinal adverse events, reduced dietary intake, fat-free mass loss as part of total weight reduction, and weight regain after discontinuation. Methods: This narrative review synthesizes current pharmacological, nutritional, gastrointestinal, body-composition, and implementation evidence to propose an evidence-informed nutrition-first framework for patients receiving incretin-based therapy for obesity. Results: We translate pharmacologic mechanisms into practical dietary strategies, including protein prioritization, structured meal patterns, hydration and fiber management, symptom-targeted interventions, resistance-training support, and maintenance planning. Because direct trials of structured nutrition interventions in GLP-1RA- or dual incretin-treated populations remain limited, several recommendations are extrapolated from the broader obesity, caloric restriction, body-composition, gastrointestinal, and expert-consensus literature. Conclusions: Integrating structured nutrition care into pharmacotherapy pathways may help address meal-related symptom burden, support protein and fluid adequacy, identify patients at higher nutritional or body-composition risk, and prepare patients for long-term weight-management behaviors. Embedding practical nutrition management within multidisciplinary obesity care may help translate pharmacologic efficacy into durable, patient-centered outcomes. © 2026 by the authors.
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Evidence-based evaluation of MARPE versus SARPE in cases of maxillary transverse deficiency: overview of reviews and GRADE assessment
(Informa UK Limited, 2026-06-04)
Carvajal-Álvarez, Mishell
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Echeverría-Carrera, Cynthia
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Villareal-Ortega, Byron
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Parise Vasco, Juan Marcos
Purpose: To synthesize the comparative effects of mini-implant assisted rapid palatal expansion (MARPE) and surgically assisted rapid palatal expansion (SARPE) on upper airway, skeletal, and dentoalveolar dimensions in patients with maxillary transverse deficiency, and to assess certainty of evidence for each outcome using GRADE approach. Materials and methods: A hybrid evidence synthesis was undertaken, combining a FRISBEE-based overview of systematic reviews with a de novo random-effects meta-analysis of primary studies identified from those reviews. Analyses were done in RevMan Web, and certainty of evidence was assessed with GRADEpro. Prespecified outcomes were anterior nasal width, posterior nasal width, upper first molar inter-cusp distance, posterior maxillary basal width, and posterior nasal floor width. Results: Two systematic reviews comprising three primary studies (84 participants) were included. Certainty of evidence was very low for all outcomes according to GRADE. Although point estimates showed numerical differences between techniques, with trends favouring MARPE for posterior nasal width and posterior nasal floor width and SARPE for upper first molar inter-cusp distance, these findings were highly uncertain and did not support reliable comparative inferences. No definitive conclusions could be drawn from the available evidence. Conclusions: MARPE and SARPE seem to produce measurable skeletal and nasal dimensional changes, but the available evidence is of very low certainty and does not include functional respiratory outcomes. Current data are more consistent with possible clinical equivalence than with superiority of either technique. High-quality randomized trials incorporating functional respiratory outcomes and stratification by age and skeletal maturity are needed. © 2026 Japanese Orthodontic Society. Published by Informa UK Limited, trading as Taylor & Francis Group.
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From remote screening to precision prevention: responsible multimodal AI for risk prediction and equitable oral healthcare
(Frontiers Media SA, 2026-07-24)
Iglesias-Pérez, Heydi Daniela
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Gallo-Sánchez, Maria Emilia
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López-Loachamin, Ariel Sebastián
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Paccha-Melgar, Daniela Alejandra
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Rivadeneira-Ahuilar, Julio Damián
Artificial intelligence (AI) applications in oral healthcare have expanded considerably over the past decade. Deep-learning systems now report diagnostic performance exceeding 0.85 sensitivity and 0.90 specificity for several image-based tasks, with the highest pooled estimates reported in AI-assisted clinical photography for oral cancer and oral potentially malignant disorder (OPMD) detection (diagnostic odds ratio 68.4; AUC 0.938). These figures, however, mask three translational gaps. First, many studies often carry high risk of bias, lack external validation, and rest on heterogeneous reference standards. Second, datasets often provide limited demographic reporting, leaving uncertainty about model performance in the populations most likely to benefit from remote screening. Third, teledentistry and mHealth tools have outpaced the regulatory, validation, and fairness-auditing, and clinical-integration frameworks required for safe deployment. Preventive value emerges most clearly when AI is embedded in multimodal systems, such as imaging, sensors, behavioural feedback, clinician support rather than evaluated as an isolated classifier. Progress will be defined less by additional accuracy gains and more by external validation in diverse populations, transparent demographic reporting, equity-focused evaluation, and integration into prevention-oriented care pathways. © 2026 Iglesias-Pérez, Gallo-Sánchez, López-Loachamin, Paccha-Melgar, Rivadeneira-Ahuilar, Luna-Ponce, Gallo-Achig, Pillajo-Villalba, Campuzano-Donoso and Reytor-González.

CENTRO DE INVESTIGACIÓN DE EVIDENCIA, IMPLEMENTACIÓN Y TOMA DE DECISIONES EN SALUD

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