Rafael Rodríguez Ornelas

Neuromodulation has emerged as an innovative therapeutic approach that extends neurosurgical indications beyond structural disease toward the dynamic regulation of neural networks and brain–body interactions. This review analyzes the current and potential role of neuromodulation in emergency neurology, focusing on its capacity to influence key physiological mechanisms such as thalamocortical connectivity, autonomic regulation, neuroinflammation, and neuroplasticity. A structured narrative review was conducted using scientific databases including PubMed, Scopus, and Web of Science, selecting peer-reviewed studies relevant to neuromodulation techniques such as deep brain stimulation, vagus nerve stimulation, and transcranial magnetic stimulation. The findings indicate that neuromodulation demonstrates significant applicability in conditions such as refractory epilepsy, traumatic brain injury, stroke, and disorders of consciousness, particularly when conventional therapies are insufficient. Non-invasive techniques show advantages in feasibility and safety, while invasive approaches provide targeted and sustained modulation in selected cases. Additionally, the analysis highlights disparities in implementation across international contexts, including Mexico, Colombia, and Ecuador, where access to advanced technologies varies. Overall, neuromodulation represents a promising and evolving strategy in emergency neurology, with the potential to improve outcomes through the modulation of complex neural and systemic processes.

Alzheimer’s disease (AD) represents one of the most complex neurodegenerative disorders, demanding a transition from symptom-based management toward biologically informed, patient-centered precision medicine. This review analyzes recent advances in molecular biomarkers, proteomic profiling, and monoclonal antibody therapies, integrating global evidence and expert consensus from Mexico, Colombia, and Ecuador. A systematic analysis of 24 high-impact studies published between 2018 and 2025 demonstrated that plasma and CSF biomarkers—especially p-tau217, p-tau181, and proteomic signatures—provide exceptional accuracy for early diagnosis and disease staging, surpassing traditional clinical criteria. Evidence from phase 3 trials with lecanemab and donanemab confirmed that amyloid-targeted therapies can significantly slow cognitive and functional decline when guided by validated biomarkers. Complementary Delphi consensus findings revealed strong expert agreement on adopting p-tau217 as a first-line test, incorporating APOE genotyping and MRI safety monitoring, and ensuring ethical and equitable implementation of precision medicine in Latin America. This review concludes that Alzheimer’s research is undergoing a paradigm shift toward molecular definition, individualized therapy, and ethically responsible innovation. Future efforts should focus on expanding biomarker validation in diverse populations, integrating artificial intelligence for real-time monitoring, and reinforcing multidisciplinary education. Precision medicine thus represents not only a scientific advance but also an ethical and social commitment to global equity in dementia care.

Augmented reality (AR) has emerged as a promising adjunct technology in microsurgery, offering new possibilities to enhance three-dimensional visualization and technical precision during vascular anastomosis. Microsurgical procedures are inherently constrained by limited depth perception, narrow fields of view, and high demands on fine motor control, making even minor spatial errors clinically significant. This review synthesizes current evidence on the application of AR-assisted microsurgery, with a particular focus on its impact on precision, spatial orientation, depth perception, procedural efficiency, and educational utility. The analysis integrates findings from experimental validation studies, training-oriented investigations, and early clinical feasibility reports, highlighting consistent patterns across diverse AR platforms. Results indicate that AR most reliably improves precision and alignment during microvascular tasks, especially when visualization cues are tightly integrated into operative microscopy. Depth perception enhancement is frequently reported but remains dependent on overlay design and system stability, while efficiency outcomes show greater variability. In educational settings, AR demonstrates meaningful benefits in skill acquisition and task repeatability among trainees. Nevertheless, persistent technical and workflow-related constraints—such as registration accuracy, interface burden, latency, and setup complexity—continue to limit widespread adoption. Overall, AR should be regarded as a precision-enhancing support tool that complements microsurgical expertise rather than replacing it. Continued refinement in system integration, human–machine interaction, and standardization of outcome metrics will be essential to advance its role in microsurgical vascular anastomosis.

Type 2 diabetes mellitus (T2DM) in non-obese individuals represents a growing clinical challenge, particularly in regions where metabolic risk is not adequately captured by body mass index alone. In recent years, metabolic surgery has gained attention as a potential therapeutic option for selected non-obese patients, based on evidence suggesting that its benefits extend beyond weight reduction and involve sustained endocrine modulation. This narrative review analyzes the evolving role of metabolic surgery in non-obese patients with T2DM, focusing on emerging selection criteria and reported endocrine outcomes. The review synthesizes international literature and conceptual frameworks of chronic disease management to identify consistent patterns in patient selection, underlying physiological mechanisms, and clinically relevant outcomes. Across the reviewed evidence, selection criteria increasingly prioritize beta-cell reserve, disease duration, metabolic phenotype, and glycemic refractoriness over anthropometric thresholds. Reported outcomes predominantly emphasize sustained glycemic control, reduction in pharmacologic treatment burden, and improvements in insulin sensitivity, while remission is described as a variable outcome dependent on baseline metabolic capacity and follow-up duration. The findings support the interpretation of metabolic surgery as a durable endocrine-modifying intervention that requires careful patient selection and structured long-term follow-up. This perspective is particularly relevant for Latin American healthcare systems, including those in Mexico, Colombia, and Ecuador, where chronic disease management is influenced by system-level factors such as continuity of care and access to multidisciplinary monitoring.

The human gut microbiota plays a central role in gastrointestinal health, yet its alterations in Latin American populations remain understudied. This study aimed to characterize microbial diversity, taxonomic composition, and short-chain fatty acid (SCFA) profiles in patients with gastrointestinal disorders in Mexico and Ecuador. A total of 430 adults (54% female, mean age 42.5 years, mestizo and indigenous backgrounds) were recruited and divided into five groups: inflammatory bowel disease (n=120), irritable bowel syndrome (n=80), colorectal cancer (n=70), celiac disease (n=60), and healthy controls (n=100). Demographic and clinical data were collected using structured questionnaires and validated instruments, while stool samples were analyzed through 16S rRNA sequencing and SCFA quantification. Results showed that alpha diversity was highest in healthy controls and significantly reduced in inflammatory bowel disease and colorectal cancer, with intermediate values in irritable bowel syndrome and celiac disease. Beta diversity analysis demonstrated distinct clustering between healthy and diseased groups, with greater heterogeneity among Ecuadorian participants. Taxonomic analysis revealed depletion of Faecalibacterium prausnitzii and enrichment of Ruminococcus gnavus, Fusobacterium nucleatum, and Bacteroides fragilis in diseased groups. Functional profiling indicated butyrate depletion as a consistent marker of gastrointestinal disorders, with higher propionate levels observed in Ecuador. These findings reinforce the role of microbial diversity and specific taxa as hallmarks of gastrointestinal health and disease, while highlighting the importance of regional research. The study underscores the potential of microbiota-based biomarkers and therapies to inform clinical practice and public health strategies in Latin America.

Precision chemotherapy represents a paradigm shift in oncology, tailoring cytotoxic regimens to molecular tumor profiles to improve efficacy and reduce toxicity. A multicenter observational study was conducted in Mexico and Ecuador with patients diagnosed with breast, colorectal, ovarian, and cervical cancers. Clinical and demographic data were collected, and molecular profiling was performed using tissue-based next-generation sequencing (NGS) and plasma-derived circulating tumor DNA (ctDNA). Outcomes included objective response rate (ORR), progression-free survival (PFS), overall survival (OS), toxicity, and patient-reported quality of life (QoL). High concordance above 80% was observed between NGS and ctDNA for key biomarkers, with BRCA1/2 and MMR/MSI alterations associated with superior ORR, PFS, and OS, whereas KRAS mutations correlated with poorer outcomes. Biomarker-guided chemotherapy significantly reduced grade ≥3 adverse events compared with conventional regimens and improved QoL scores by 8–10 points across functional domains (EORTC QLQ-C30). These findings confirm that precision chemotherapy enhances efficacy, tolerability, and patient-centered outcomes, while the binational experience in Mexico and Ecuador highlights both feasibility and the urgent need for equitable access to molecular diagnostics in Latin America. Precision chemotherapy should be prioritized as a central component of global cancer control strategies.