Hugo Fernando Cabrera Bernal

Traumatic brain injury (TBI) remains one of the leading causes of mortality and long-term neurological disability worldwide, representing a major challenge for emergency medicine, neurosurgery, radiology, and neurocritical care. In recent years, substantial advances have transformed traditional approaches to TBI management through the incorporation of multimodal neuromonitoring systems, advanced neuroimaging technologies, artificial intelligence, and personalized therapeutic strategies. This review examines current innovations in traumatic brain injury management, focusing on intracranial pressure monitoring, brain tissue oxygen monitoring, cerebral microdialysis, advanced magnetic resonance imaging techniques, machine learning applications, and contemporary neurosurgical interventions. Scientific evidence from international studies demonstrates that multimodal monitoring provides a more comprehensive assessment of cerebral physiology by integrating information related to perfusion, oxygenation, metabolism, and neurological function, facilitating earlier identification of secondary brain injury and supporting individualized treatment decisions. Likewise, advanced neuroimaging modalities such as diffusion tensor imaging, susceptibility-weighted imaging, perfusion imaging, and functional magnetic resonance imaging have improved diagnostic precision and prognostic evaluation. Artificial intelligence has emerged as a promising tool for data integration, predictive analytics, lesion characterization, and clinical decision support. Collectively, these innovations are contributing to the evolution of neurocritical care toward precision medicine models that prioritize personalized monitoring and targeted therapeutic interventions. Although challenges related to accessibility, implementation, infrastructure, and training remain, particularly in low- and middle-income countries, the available evidence suggests that the integration of advanced monitoring technologies and data-driven clinical strategies may significantly improve neurological outcomes, reduce secondary injury, and enhance quality of life among patients affected by traumatic brain injury. Continued research, multidisciplinary collaboration, and equitable adoption of emerging technologies will be essential for advancing the future of neurotrauma care worldwide.

Burnout syndrome, chronic fatigue, and mental health disorders have become major occupational health concerns among healthcare professionals worldwide. The increasing complexity of healthcare systems, growing workloads, staffing shortages, administrative pressures, and exposure to emotionally demanding clinical environments have contributed to elevated levels of psychological distress across healthcare settings. This review aimed to analyze current scientific evidence regarding the determinants, manifestations, consequences, and intervention strategies associated with burnout, chronic fatigue, and mental health outcomes among healthcare workers from an international perspective, with particular attention to findings reported in Mexico, Colombia, and Ecuador. A structured literature review was conducted using scientific publications retrieved from major biomedical and multidisciplinary databases. The evidence consistently identified emotional exhaustion, sleep disturbances, anxiety symptoms, depressive manifestations, psychological distress, and chronic fatigue as the most frequently reported outcomes. Excessive workload, prolonged working hours, staffing shortages, administrative burden, and insufficient organizational support emerged as the principal occupational determinants associated with adverse psychological outcomes. Findings from Latin America closely paralleled international trends, demonstrating similar occupational challenges across diverse healthcare systems. The review also revealed that organizational interventions, including workload optimization, leadership development, institutional support programs, and access to mental health services, were generally more effective than isolated individual-focused approaches. These findings highlight the importance of comprehensive occupational health strategies aimed at protecting healthcare worker well-being, improving workforce sustainability, and enhancing healthcare quality. Continued efforts to address organizational stressors and promote supportive work environments are essential for strengthening the resilience of healthcare professionals and healthcare systems worldwide.

Emerging viral infections continue to pose significant challenges to healthcare systems worldwide due to their capacity to generate acute disease, long-term sequelae, and substantial public health burdens. Respiratory viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) have demonstrated the ability to affect both the lower respiratory tract and otorhinolaryngological structures, resulting in a broad spectrum of clinical manifestations. This review aimed to analyze current scientific evidence regarding respiratory and otorhinolaryngological complications associated with emerging viral infections, with particular emphasis on epidemiological characteristics, pathophysiological mechanisms, clinical presentations, diagnostic considerations, and healthcare implications. A narrative literature review was conducted using scientific databases including PubMed, Scopus, ScienceDirect, Google Scholar, and Cochrane Library, complemented by reports from international health organizations. The findings revealed that viral pneumonia, persistent dyspnea, acute respiratory distress syndrome, and post-viral pulmonary dysfunction were among the most frequently reported respiratory complications. Otorhinolaryngological manifestations included anosmia, hyposmia, dysgeusia, rhinosinusitis, otitis media, dysphonia, hearing disturbances, and vestibular symptoms. The evidence also highlighted the growing importance of post-viral sequelae, particularly persistent respiratory symptoms and sensory dysfunctions that may affect quality of life long after the acute infection has resolved. Regional studies from Mexico, Colombia, and Ecuador demonstrated patterns comparable to those reported internationally, emphasizing the relevance of emerging viral diseases throughout Latin America. The available evidence supports the need for continued surveillance, multidisciplinary clinical management, and further research aimed at improving the understanding, prevention, and treatment of respiratory and otorhinolaryngological complications associated with emerging viral pathogens.

Functional rhinology has undergone significant evolution as advances in anatomy, physiology, diagnostic precision, and surgical innovation have reshaped the understanding and treatment of nasal obstruction. This review integrates evidence from key studies addressing airflow physiology, internal nasal valve dynamics, diagnostic methods, and surgical outcomes to construct a comprehensive framework for functional nasal airway evaluation. Physiological and computational investigations demonstrate that small geometric alterations in the internal nasal valve produce disproportionately large changes in airflow resistance, underscoring the valve’s central role in nasal patency. Diagnostic strategies combining patient-reported outcomes, bedside functional maneuvers, and imaging-derived anatomical metrics enhance the accuracy of identifying valve dysfunction. Surgical interventions—including spreader grafts, alar batten grafts, functional septoplasty, and lateral wall support techniques—consistently yield significant improvements in NOSE scores and quality-of-life measures, while emerging bioabsorbable implants offer minimally invasive alternatives for selected cases. The historical progression of innovations reveals a steady transition toward evidence-based, standardized, and outcome-driven practice. Taken together, the findings emphasize that successful management of nasal valve dysfunction requires an integrated approach that unites physiological insight, diagnostic rigor, and structurally oriented reconstruction. Future research should continue expanding region-specific data and refining approaches that adapt to diverse clinical realities in Latin America and beyond.

Mixed-reality technologies, including augmented reality, virtual reality, and holographic visualization, have emerged as transformative tools in neurovascular surgery. Their integration into the management of intracranial aneurysms and arteriovenous malformations provides enhanced three-dimensional understanding, improved intraoperative orientation, and advanced simulation-based training opportunities. This review synthesizes evidence from 20 peer-reviewed studies originating from North America, Europe, Asia, and Latin America, including contributions from Mexico, Colombia, and Ecuador. The findings demonstrate that mixed reality significantly strengthens preoperative planning by enabling volumetric exploration of vascular structures and improves intraoperative decision-making through dynamic overlays and fluorescence-integrated navigation. Virtual reality platforms further expand their role by offering high-fidelity rehearsal of microsurgical techniques, contributing to more consistent skill acquisition. Despite these advantages, limitations remain regarding registration accuracy, display stability, and accessibility in resource-limited settings. Nevertheless, the overall balance of evidence suggests that mixed reality is reshaping neurovascular workflows and will likely become a foundational component of future cerebrovascular care. Continued innovation, multicenter validation, and broader integration across diverse healthcare environments will be essential to fully realize its clinical and educational potential.

Orbital pathology is a relatively rare pathology in our environment. The anatomy of the orbit can be divided into preseptal, intraconal, extraconal, intrabulbar, subperiosteal, cranial orbit, and orbital sinus. The nature of these lesions varies, and may be congenital or acquired, inflammatory, cystic, vascular, or neoplastic. Therefore, the treatment for each one will be different depending on the circumstances. In circulation, varicose veins can become quite large, creating a mass effect. There is considerable overlap in orbital venous malformations, such as orbital varicose veins, varicocele, and venous hemangioma, which may represent a spectrum. Additionally, there is controversy over whether varicose veins and lymphangiomas are the same entity. It should be noted that orbital varicose veins are associated with orbital bone defects and head bulging, in which case thrombotic varicose veins can cause meningitis. A case is presented of a 12-year-old male pediatric patient with the presence of orbital varicose veins that causes unilateral postural exophthalmos, a rare cause. La patología orbitaria es una patología relativamente rara en nuestro medio. La anatomía de la órbita se puede dividir en órbita preseptal, intraconal, extraconal, intrabulbar, subperióstica, craneal y seno orbitario. La naturaleza de estas lesiones varía, pudiendo ser congénitas o adquiridas, inflamatorias, quísticas, vasculares o neoplásicas. Por tanto, el tratamiento para cada uno será diferente según las circunstancias. En circulación, las venas varicosas pueden llegar a ser bastante grandes, creando un efecto de masa. Existe una superposición considerable en las malformaciones venosas orbitarias, como las venas varicosas orbitarias, el varicocele y el hemangioma venoso, que pueden representar un espectro. Además, existe controversia sobre si las venas varicosas y los linfangiomas son la misma entidad. Cabe señalar que las venas varicosas orbitarias están asociadas con defectos óseos orbitarios y abultamiento de la cabeza, en cuyo caso las venas varicosas trombóticas pueden causar meningitis. Se presenta un caso de un paciente masculino de 12 años pediátrico con presencia de varice orbitaria que le provoca exoftalmos postural unilateral una causa rara.

El embarazo molar es un embarazo anormal caracterizado por diversos grados de proliferación del trofoblasto (citotrofoblasto y sincitiotrofoblasto) e inflamación de las vesículas calcáreas placentarias asociadas con la ausencia o anomalías del feto/embrión. Según criterios morfológicos y citogenéticos se han descrito dos tipos de mola: mola completa y mola parcial. Aunque los lunares generalmente se consideran benignos, son lesiones precancerosas que pueden volverse malignas e invasivas. El tratamiento de elección es la evacuación uterina y la monitorización estricta de la gonadotropina coriónica humana (hCG), especialmente el control de los niveles de β-hCG, fundamental para el diagnóstico precoz de la neoplasia trofoblástica durante el embarazo. Se reporta una paciente femenina de 23 años sin antecedentes de importancia, al momento embarazado de 9 semanas de gestación acude por presentar vómitos por varias ocasiones de contenido alimentario acompañado de sangrado transvaginal.