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Multilevel barriers to clinical and nutritional research in Latin America: a socioeconomic comparative analysis
(Frontiers Media SA, 2025-12-31)
Evelyn Frias-Toral
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Jaime Angamarca-Iguago
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Isabel Calvo Higuera
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Jorge Carriel-Mancilla
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Guillermo Contreras
Clinical and nutritional research in Latin America faces significant challenges that limit scientific development and evidence-based healthcare. Understanding these barriers is essential for developing effective strategies to enhance research capacity in the region. This study aimed to identify multilevel barriers to clinical and nutritional research in Latin America and compare them between countries of different socioeconomic levels. Methods A cross-sectional study was conducted with 327 healthcare professionals involved in clinical and nutritional research across Latin America. Data collection occurred via an online survey in which participants rated the importance of 16 potential barriers on a 3-point Likert scale. Analysis included descriptive statistics, chi-square tests to compare barriers between upper-middle and lower-middle-income countries, logistic regression to identify predictors of research participation, and k-means cluster analysis to identify researcher profiles. Results Funding (84.4%), research materials (71.6%), and time constraints (70.9%) emerged as the most significant barriers across all countries. Three barriers showed statistically significant differences between income levels: participant commitment (73.6% vs. 42.6%, &lt; 0.001), frequent appointments (56.6% vs. 37.8%, = 0.02), and language barriers (39.6% vs. 22.9%, = 0.02), all of which were higher in lower-middle-income countries. Logistic regression identified the importance of research materials (OR = 0.36, = 0.002) and telemedicine (OR = 1.74,  = 0.044) as significant predictors of research participation. Cluster analysis revealed three distinct researcher profiles based on barrier perception patterns. Conclusion Multilevel barriers to research in Latin America are dominated by universal resource constraints (funding, materials, time), with lower-middle-income countries facing additional challenges in participant engagement and study logistics. The relative homogeneity of most barriers across income groups suggests that regional and institutional factors may be more influential than national income levels. These findings provide a foundation for developing targeted strategies to strengthen research capacity and infrastructure across Latin America.
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Adenomatoid odontogenic tumor in an unusual posterior maxillary location: a rare case report in a young male
(Frontiers Media SA, 2025-12-17)
GONZÁLEZ CALZADA, NATALI
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Estefanía Chávez-Mestanza
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Náthaly Mercedes Román-Galeano
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Claudia Reytor-González
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Daniel Simancas-Racines
The adenomatoid odontogenic tumor is a rare benign epithelial odontogenic neoplasm that most frequently affects young women and typically occurs in the anterior maxilla. Its presentation in the posterior maxilla, especially in male patients, is uncommon and can create diagnostic challenges. This case describes a large posterior maxillary adenomatoid odontogenic tumor in a 16-year-old male who presented with a one-year history of progressive, painless swelling of the right cheek. Clinical examination revealed facial asymmetry, obliteration of the right nasolabial fold, and intraoral swelling extending from tooth 1.5 to the posterior maxilla. Panoramic radiography and computed tomography showed a multilocular radiolucent lesion with a “soap bubble” appearance, internal calcifications, and displacement of tooth 1.8 toward the floor of the right orbit, which remained intact. The lesion caused root resorption of adjacent teeth and extensive destruction of the maxillary bone. Surgical treatment consisted of enucleation and extraction of teeth 1.5–1.8, followed by histopathological confirmation of adenomatoid odontogenic tumor. Due to the degree of bone involvement, a subsequent wide resection of critical maxillofacial structures was necessary. Postoperative follow-up at five months showed no recurrence but significant residual anatomical changes. This case emphasizes the importance of including adenomatoid odontogenic tumor in the differential diagnosis of posterior maxillary lesions in male patients, and the need for careful surgical planning, histopathological confirmation, and long-term follow-up.
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Evaluación crítica de la Guía de Práctica Clínica para malaria de la OMS utilizando el instrumento AGREE II
(Ciespal, 2024-03-27)
Claudia Reytor-González
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Daniel Simancas-Racines
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Andrés Viteri-García
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Juan Marco Parise-Vasco
Objetivo: Evaluar críticamente la calidad metodológica de la Guía de Práctica Clínica para malaria de la Organización Mundial de la Salud. Metodología: Tres revisores de forma independiente utilizaron el instrumento AGREE II para evaluar la calidad metodológica de la Guía de Práctica Clínica para malaria. Las calificaciones fueron recogidas y analizadas en una matriz de EXCEL. Se utilizó el coeficiente de concordancia de Fleiss Kappa para determinar la medida de acuerdo entre los evaluadores. Resultados: La Guía de Práctica Clínica (GPC) destacó en claridad, objetivos, y participación de los implicados, pero identificó áreas de mejora en rigor de elaboración y aplicabilidad. Con puntuaciones altas en la mayoría de los dominios y una buena gestión de la independencia editorial, se recomienda su uso a pesar de los desafíos en implementación práctica. Conclusiones: La evaluación AGREE II de la Guía de la OMS para malaria 2022 destaca su calidad y claridad, pero señala áreas de mejora en metodología y aplicabilidad. Subraya la necesidad de adaptación local y colaboración para actualizar continuamente las recomendaciones.
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Endometriosis as a Systemic and Complex Disease: Toward Phenotype-Based Classification and Personalized Therapy
(MDPI AG, 2026-01-16)
Daniel Simancas-Racines
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Emilia Jiménez Flores
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Martha Montalvan
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Raquel Horowitz
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Valeria Araujo
Endometriosis is traditionally conceptualized as a pelvic lesion–centered disease; however, mounting evidence indicates it is a chronic, systemic, and multifactorial inflammatory disorder. This review examines the molecular dialog between ectopic endometrial tissue, the immune system, and peripheral organs, highlighting mechanisms that underlie disease chronicity, symptom variability, and therapeutic resistance. Ectopic endometrium exhibits distinct transcriptomic and epigenetic signatures, disrupted hormonal signaling, and a pro-inflammatory microenvironment characterized by inflammatory mediators, prostaglandins, and matrix metalloproteinases. Immune-endometrial crosstalk fosters immune evasion through altered cytokine profiles, extracellular vesicles, immune checkpoint molecules, and immunomodulatory microRNAs, enabling lesion persistence. Beyond the pelvis, systemic low-grade inflammation, circulating cytokines, and microRNAs reflect a molecular spillover that contributes to chronic pain, fatigue, hypothalamic–pituitary–adrenal axis dysregulation, and emerging gut–endometrium interactions. Furthermore, circulating biomarkers—including microRNAs, lncRNAs, extracellular vesicles, and proteomic signatures—offer potential for early diagnosis, patient stratification, and monitoring of therapeutic responses. Conventional hormonal therapies demonstrate limited efficacy, whereas novel molecular targets and delivery systems, including angiogenesis inhibitors, immune modulators, epigenetic regulators, and nanotherapeutics, show promise for precision intervention. A systems medicine framework, integrating multi-omics analyses and network-based approaches, supports reconceptualizing endometriosis as a systemic inflammatory condition with gynecologic manifestations. This perspective emphasizes the need for interdisciplinary collaboration to advance diagnostics, therapeutics, and individualized patient care, ultimately moving beyond a lesion-centered paradigm toward a molecularly informed, holistic understanding of endometriosis.
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Heavy Metal-Contaminated Soils and Gastric Cancer Risk: Molecular Insights and the Relevance of a One Health Perspective
(MDPI AG, 2025-11-27)
Claudia Reytor-González
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LEYVA RICARDO, SONIA EMILIA
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Yasniel Sánchez Suárez
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Vianey Ariadna Burboa Charis
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Emilia Jiménez-Flores
Heavy metal contamination in agricultural soils has emerged as a critical environmental and public health issue associated with increased gastric cancer incidence worldwide. Among the most concerning pollutants are cadmium, arsenic, and lead, which persist in the environment and enter the human body primarily through the soil–plant–food chain. This review integrates environmental, molecular, and epidemiological evidence to explain how these metals alter gastric mucosal biology and promote carcinogenesis. Mechanistically, cadmium, arsenic, and lead trigger oxidative stress, mitochondrial dysfunction, DNA damage, and epigenetic reprogramming, resulting in genomic instability, resistance to programmed cell death, and the transformation of epithelial cells into invasive phenotypes. These molecular disruptions interact with Helicobacter pylori infection, microbial imbalance, chronic inflammation, and hypoxia-driven remodeling of the gastric stroma, all of which enhance angiogenesis and tumor progression. Advanced experimental platforms, such as gastric organoids, immune co-cultures, and humanized animal models, are improving the understanding of these complex interactions. Adopting a One Health perspective reveals the continuity between environmental contamination, agricultural production, and human disease, underscoring the importance of integrative monitoring systems that combine soil and crop analysis with molecular biomarkers in exposed populations. Strengthening this interdisciplinary approach is essential to design preventive strategies, guide remediation policies, and protect human, animals, and environmental health.
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Assessing the impact of a business intelligence program on the employability and well-being of low-income women: a quasi-experimental study protocol
(Frontiers Media SA, 2025-11-13)
Marco Faytong-Haro
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Alonso Quijano-Ruiz
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Daniel Sanchez-Pazmiño
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Patricio Alvarez-Muñoz
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Jose Diaz-Montenegro
Women are underrepresented globally in the field of data analytics, particularly in underdeveloped countries. We present a protocol to assess the impact of the New Dimensions program, a data analytics and business intelligence course sequence that aims to address this gender gap by providing free business intelligence training to disadvantaged women in Ecuador. The program offers both technical (Business Intelligence) and soft skills training, including Excel, Power BI, SQL, GitHub, R, Tableau, statistics, Python, and workshops on empowerment, employability, and public speech. The purpose of this quasi-experimental study is to assess the impact of this training program on employability and other well-being outcomes of the participants. A total of 80 individuals will be part in the study, of which 70 will be selected to participate in the program, 50 will receive both hard and soft skills training, and 20 only soft skills training. Ten individuals will form part of the control group with no intervention. The study design involves a nonrandomized control group composed of rejected applicants. Data will be collected through an online application form and a computer-based exam. The outcome measures are participants' labor market outcomes, income, food security, and economic stratification, among others. This protocol will prospectively evaluate the program's potential effectiveness; findings will inform future, larger randomized studies focused on employability and well-being in underrepresented groups.
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From meal to malfunction: exploring molecular pathways, biomarkers and interventions in postprandial cardiometabolic health
(Frontiers Media SA, 2025-10-29)
Claudia Reytor-González
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Cevallos-fernández Emilia Luciana
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JÁCOME VILLACRÉS, MARÍA BELÉN
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Daniel Simancas-Racines
Cardiometabolic diseases—including type 2 diabetes, cardiovascular disease, and metabolic dysfunction–associated steatotic liver disease—are increasingly driven by near-continuous after-meal exposure to glucose and lipid surges that traditional fasting tests often miss. This review prioritizes human studies from 2020 to 2025 and uses earlier work only as foundational anchors; non-English reports were excluded and preclinical findings are cited solely for mechanistic context. Evidence converges on six processes that amplify risk within hours after eating: impaired insulin signaling, delayed clearance of dietary lipids, mitochondrial and oxidative stress, loss of endothelial nitric oxide, inflammasome-mediated inflammation, and microbiome–hormone interactions. Dynamic, after-meal markers and simple composites such as the triglyceride–glucose index outperform fasting measures for identifying risk and guiding care. Practical strategies to shorten the “damage window” include Mediterranean-style meals with low glycemic index swaps and unsaturated fats, earlier distribution of daily energy and early time-restricted eating, a small pre-meal protein portion, and brief post-meal walking. Fast-acting medicines—glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonists, rapid-acting insulin analogues, sodium–glucose cotransporter 2 inhibitors taken before meals, and proprotein convertase subtilisin/kexin type 9 inhibitors—further blunt peaks, while continuous glucose monitoring with algorithmic feedback enables timing-aware, person-specific adjustments. A tiered workflow—screen, stratify, and personalize—reframes prevention and treatment around after-meal physiology, with particular relevance to settings where resources are limited.
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Obesity and breast cancer: exploring the nexus of chronic inflammation, metabolic dysregulation, and nutritional strategies
(Informa UK Limited, 2025-06-23)
Claudia Reytor-González
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Daniel Simancas-Racines
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Náthaly Mercedes Román-Galeano
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Martín Campuzano-Donoso
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Angelo Michele Carella
The global prevalence of obesity has risen to epidemic proportions, posing significant health challenges across populations and contributing to increased morbidity and mortality from non-communicable diseases. Among its many consequences, obesity is now firmly established as a modifiable risk factor for breast cancer, particularly in postmenopausal women. The association between obesity and breast cancer is driven by complex and interrelated biological mechanisms, including chronic low-grade inflammation, hormonal imbalances, adipokine dysregulation, insulin resistance, and metabolic dysfunction. These factors collectively create a pro-tumorigenic environment that supports cancer initiation, progression, and recurrence. This review explores the multifaceted nexus between obesity and breast cancer, emphasizing the critical role of inflammatory, hormonal, and metabolic pathways in mediating disease risk and outcomes. Additionally, it highlights the emerging contribution of gut microbiome dysbiosis in modulating host immunity and systemic inflammation in the context of obesity. Nutritional strategies—ranging from dietary pattern modification to caloric restriction and time-restricted feeding (TRF)—are examined for their potential to reduce risk, enhance treatment efficacy, and improve survivorship in breast cancer patients.
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Navigating the weight: The impact of obesity on gastrointestinal cancer surgery and strategies for improved outcomes
(Elsevier BV, 2025-09-01)
Gerardo Sarno
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Claudia Reytor-González
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Evelyn Frias-Toral
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Martín Campuzano-Donoso
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Christos S. Katsanos
Obesity significantly affects gastrointestinal cancer surgery outcomes by creating complex challenges throughout the preoperative, intraoperative, and postoperative stages. This narrative review explores the intricate relationship between obesity and GIC surgery, highlighting the dual burden of obesity as a global public health issue and a determinant of surgical complications. The review aims to analyze physiological and technical hurdles, including limited visibility, prolonged operative times, increased perioperative risks, and adverse recovery outcomes associated with obesity. Evidence emphasizes the critical role of excess visceral fat, systemic inflammation, and insulin resistance in elevating surgical risks. Mitigation strategies involve preoperative nutritional optimization, use of advanced surgical technologies such as robotic-assisted and laparoscopic systems, and individualized postoperative care, encompassing early mobilization, tailored pain management, and close monitoring of metabolic parameters. Despite advancements, knowledge gaps remain, particularly regarding sarcopenic obesity and the long-term impact of preoperative dietary interventions. Future research should focus on refining minimally invasive techniques, integrating personalized medicine, and exploring innovative perioperative protocols to address obesity-related risks effectively. By fostering a multidisciplinary approach, this review underscores the necessity for targeted interventions to enhance outcomes and improve the quality of care for patients with obesity undergoing gastrointestinal cancer surgery.
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Chrononutrition and Energy Balance: How Meal Timing and Circadian Rhythms Shape Weight Regulation and Metabolic Health
(MDPI AG, 2025-06-27)
Claudia Reytor-González
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SIMANCAS RACINES, DANIEL ALEJANDRO
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Náthaly Mercedes Román-Galeano
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Giuseppe Annunziata
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Martina Galasso
Obesity and metabolic disorders remain major global health concerns, traditionally attributed to excessive caloric intake and poor diet quality. Recent studies emphasize that the timing of meals plays a crucial role in determining metabolic health. This review explores chrononutrition, a growing field that examines how food intake patterns interact with endogenous circadian rhythms to influence energy balance, glucose and lipid metabolism, and cardiometabolic risk. The circadian system, which includes a central clock in the suprachiasmatic nucleus and peripheral clocks in metabolic tissues, regulates physiological functions on a 24 h cycle. While light entrains the central clock, feeding schedules act as key synchronizers for peripheral clocks. Disrupting this alignment—common in modern lifestyles involving shift work or late-night eating—can impair hormonal rhythms, reduce insulin sensitivity, and promote adiposity. Evidence from clinical and preclinical studies suggests that early time-restricted eating, where food intake is confined to the morning or early afternoon, offers significant benefits for weight control, glycemic regulation, lipid profiles, and mitochondrial efficiency, even in the absence of caloric restriction. These effects are particularly relevant for populations vulnerable to circadian disruption, such as adolescents, older adults, and night-shift workers. In conclusion, aligning food intake with circadian biology represents a promising, low-cost, and modifiable strategy to improve metabolic outcomes. Integrating chrononutrition into clinical and public health strategies may enhance dietary adherence and treatment efficacy. Future large-scale studies are needed to define optimal eating windows, assess long-term sustainability, and establish population-specific chrononutritional guidelines.

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