Stalin Omar Toapanta Usuay

Emerging synthetic drugs and new psychoactive substances represent a growing challenge for emergency medicine, clinical toxicology, and psychiatry due to their rapidly changing composition, variable potency, frequent polysubstance exposure, and capacity to produce overlapping toxicological syndromes. This study analyzed the clinical presentation, emergency stabilization strategies, and neuropsychiatric complications associated with synthetic cannabinoids, synthetic cathinones, nitazenes, designer benzodiazepines, xylazine, and other emerging psychoactive compounds. A structured analytical review based on the Scientific Method was conducted using recent clinical studies, systematic reviews, toxicological reports, and emergency medicine publications. The evidence showed that these substances can produce neurological, cardiovascular, respiratory, metabolic, and psychiatric abnormalities ranging from agitation, hallucinations, paranoia, and psychosis to seizures, hyperthermia, respiratory depression, bradycardia, hypotension, altered consciousness, and multiorgan complications. Synthetic cannabinoids and synthetic cathinones were prominently represented among psychiatric intoxication cases, while nitazene poisoning demonstrated variable naloxone requirements, including the need for prolonged infusion in selected patients. Xylazine exposure was mainly associated with central nervous system depression, bradycardia, hypotension, and respiratory compromise, particularly in the context of polysubstance use. The findings support a syndromic and physiology-first approach in which airway protection, ventilatory support, cardiovascular monitoring, temperature control, seizure management, treatment of severe agitation, correction of metabolic abnormalities, and selective antidotal therapy are prioritized according to the patient’s clinical condition. Persistent neuropsychiatric manifestations require reassessment after acute stabilization to differentiate transient intoxication from prolonged substance-induced psychiatric syndromes. An integrated approach involving emergency medicine, clinical toxicology, and psychiatry is essential for the effective management of these rapidly evolving intoxications.

Occupational dermatoses associated with chemical exposure represent an important clinical and occupational health problem due to their frequency, recurrent nature, functional consequences, and medico-legal implications. This study analyzed the relationship between workplace exposure and the development or aggravation of occupational skin disease through an integrated framework combining dermatological diagnosis, occupational exposure assessment, preventive strategies, and causal documentation. Particular attention was given to irritant and allergic contact dermatitis, wet work, individual susceptibility, occupational allergens, patch testing, and the Mathias criteria. The reviewed evidence showed that atopic dermatitis and wet work are relevant risk factors for occupational irritant contact dermatitis, while the profile of occupational allergens varies according to professional activity and includes epoxy resins, rubber accelerators, formaldehyde, metals, preservatives, and other chemical agents. Patch testing was identified as a fundamental diagnostic tool; however, positive reactions required correlation with actual workplace exposure, clinical distribution, temporal relationship, and occupational relevance. Preventive interventions, including moisturizers, barrier preparations, educational programs, personal protective equipment, and exposure reduction, showed potential to decrease occupational hand dermatitis, although the effectiveness of individual measures varied across studies. The evaluation of occupational causality was strengthened when clinical findings, exposure history, improvement away from work, re-exposure, and diagnostic testing were considered together. The Mathias criteria provided a structured framework for supporting causal assessment and medico-legal documentation. Overall, the findings support a multidisciplinary approach in which dermatology, occupational medicine, prevention, and medico-legal evaluation are integrated to improve recognition of occupational dermatoses, reduce recurrent exposure, and provide consistent documentation for clinical and occupational decision-making.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent metabolic disorder characterized by substantial clinical heterogeneity and frequent association with obesity, insulin resistance, type 2 diabetes mellitus, dyslipidemia, visceral adiposity, and alterations in body composition. This study analyzed the principal clinical phenotypes of MASLD and their relationship with personalized nutritional interventions through a structured analytical review of clinical guidelines, systematic reviews, meta-analyses, randomized controlled trials, and observational studies. The evidence showed marked differences in disease prevalence and metabolic characteristics across lean, overweight, obese, and diabetic populations. Sustained weight loss was associated with progressive hepatic improvement, with reductions of approximately 5% linked to decreased liver fat, 7–10% to improvement in inflammatory activity, and reductions of 10% or greater to greater probability of fibrosis improvement. Dietary quality was also relevant independently of absolute weight reduction, particularly through Mediterranean-style patterns, reduced intake of added sugars and ultra-processed foods, and replacement of saturated fats with unsaturated sources. Lean MASLD represented a distinct phenotype in which metabolic dysfunction may persist despite normal body mass index, requiring greater emphasis on body composition, visceral adiposity, physical activity, and preservation of lean mass rather than aggressive caloric restriction. Overall, the findings support a phenotype-oriented model of nutritional management in which common evidence-based lifestyle principles are maintained while the intensity and priority of specific interventions are adapted to individual metabolic, hepatic, anthropometric, and behavioral characteristics. Further prospective studies are required to determine whether personalized nutritional strategies improve long-term fibrosis progression, cardiovascular outcomes, liver-related complications, and mortality.

Antimicrobial resistance represents a growing challenge in the management of community-acquired sepsis because it reduces the effectiveness of conventional empirical therapy and increases the complexity of initial clinical decision-making. This study analyzed the relationship between antimicrobial resistance, epidemiological surveillance, empirical antimicrobial treatment, and antimicrobial stewardship in adult patients with community-acquired sepsis. A structured integrative review based on the Scientific Method was conducted using scientific literature, clinical guidelines, and international surveillance reports. The evidence showed that resistant microorganisms are increasingly relevant in community-onset infections and that both inadequate initial antimicrobial coverage and unnecessarily broad-spectrum therapy may be associated with unfavorable clinical outcomes. Previous antimicrobial exposure, history of resistant organisms, prior Gram-negative infections, infection source, and local susceptibility patterns were identified as important variables for estimating the probability of resistance. Epidemiological surveillance and local antibiograms were essential for guiding empirical therapy, while microbiological reassessment and antimicrobial de-escalation contributed to reducing unnecessary exposure. Procalcitonin-guided strategies were also associated with shorter antibiotic treatment duration when integrated with clinical judgment. Overall, the findings support an individualized approach based on early recognition of sepsis, appropriate empirical treatment, assessment of resistance risk, microbiological diagnosis, and systematic therapeutic reassessment. Integrating clinical management with surveillance and antimicrobial stewardship may improve therapeutic precision while contributing to the preservation of antimicrobial effectiveness.

Precision in high-risk surgical fields has evolved into a multidimensional paradigm that integrates technological innovation, advanced surgical techniques, and structured perioperative care. This review analyzes the translational principles shared between general surgery, neurosurgery, and minimally invasive approaches, with the aim of understanding how these elements interact to improve surgical outcomes. A structured integrative review was conducted using high-impact literature published from 2020 onward, focusing on key domains such as artificial intelligence, intraoperative monitoring, advanced visualization, laparoscopic and robotic surgery, and Enhanced Recovery After Surgery (ERAS) protocols. The findings demonstrate that precision in surgery is not determined by a single factor, but by the coordinated interaction of multiple components. Minimally invasive techniques serve as the structural foundation, while visualization technologies and intraoperative monitoring enhance real-time decision-making and safety. Artificial intelligence contributes to the standardization and support of surgical cognition, and perioperative protocols optimize recovery and reduce complications. Together, these elements form an integrated system that extends beyond the operating room and encompasses the entire surgical process. The review also highlights the adaptability of these principles across diverse healthcare settings, including regions such as Mexico, Colombia, and Ecuador, where variability in resources requires context-sensitive implementation. Ultimately, precision surgery is defined as a system-based approach that aligns technique, technology, and perioperative care to achieve optimal patient outcomes. This framework has important implications for clinical practice, surgical education, and future research.

Severe extremity trauma represents a critical challenge in reconstructive plastic surgery, requiring decision-making that extends beyond anatomical restoration toward long-term functional and psychosocial recovery. This review analyzes the evidence surrounding limb salvage and amputation, reconstructive timing strategies, microsurgical and perforator-based techniques, and patient-reported outcome measures (PROMs), with emphasis on functional performance, psychological adaptation, and quality of life. Comparative data suggest that long-term global functional outcomes between salvage and amputation may converge under specific conditions, although recovery pathways and treatment burdens differ. Early definitive coverage has been associated with improved local wound control when physiologically feasible, whereas staged approaches aligned with damage control principles remain essential in unstable patients. Advances in free flaps, perforator flaps, and upper-extremity reconstruction have expanded technical capabilities, yet durable recovery depends on rehabilitation access, complication management, and patient-centered evaluation. PROM-based research underscores that physical function, social participation, symptom burden, and emotional well-being are central domains in outcome assessment. Long-term trajectories reveal persistent disability in a subset of patients despite partial quality-of-life adaptation over time. From an international perspective, including Latin American contexts such as Mexico, Colombia, and Ecuador, reconstructive decisions must integrate healthcare system capacity and socioeconomic realities. Reconstructive surgery after trauma, therefore, must be interpreted as a longitudinal restorative process aimed at preserving autonomy, dignity, and meaningful life participation rather than solely achieving anatomical survival.

Se presenta el caso clínico de una paciente femenina con antecedentes de herida en el cuero cabelludo y diagnóstico de tumor maligno de las meninges cerebrales, que requirió resección quirúrgica y reconstrucción compleja de la región parieto-temporal. Para la cobertura del defecto se utilizó un colgajo miocutáneo de trapecio con isla cutánea de 10x9 cm, complementado con un colgajo de rotación del cuero cabelludo y un injerto de piel de espesor parcial. La intervención se realizó bajo anestesia general, con técnicos especializados en cirugía, anestesia y cuidados perioperatorios. Durante el procedimiento, la paciente presentó una crisis hipertensiva controlada según protocolo institucional. Los drenajes tipo Jackson Pratt fueron colocados en el área donadora y en el cuello para evitar acumulación de líquidos y favorecer la integración del injerto y colgajos. La técnica permitió una cobertura adecuada respetando la vascularización y minimizando complicaciones. Al cierre, el estado de los tejidos fue favorable. Este caso ejemplifica la utilidad del colgajo de trapecio para defectos craneales complejos derivados de tumores meníngeos, así como la importancia de un manejo multidisciplinario para optimizar resultados funcionales y estéticos. Se discuten las indicaciones, limitaciones y posibles complicaciones relacionadas con esta técnica reconstructiva. En conjunto, este reporte aporta evidencia práctica en cirugía reconstructiva en neurooncología, contribuyendo a la literatura clínica sobre tratamiento integral de tumores meníngeos a nivel regional.

La cicatrización intracraneal posterior a intervenciones neuroquirúrgicas representa un desafío clínico importante debido no solo a las posibles secuelas funcionales y estéticas, sino también al impacto que estas alteraciones generan en la calidad de vida de los pacientes. En este contexto, la fotobiomodulación ha surgido como una alternativa terapéutica prometedora, capaz de modular favorablemente los procesos biológicos involucrados en la regeneración tisular y la neuroplasticidad. La fotobiomodulación utiliza la acción de fuentes lumínicas, como láseres de baja potencia y LED, para estimular procesos celulares que favorecen la reparación de tejidos nerviosos y cutáneos, promoviendo una integración más armónica de las cicatrices intracraneales. Diversos estudios recientes han reportado que, además de mejorar los aspectos estructurales de la cicatriz, la fotobiomodulación contribuye a la modulación del dolor, la inflamación y la reintegración sensorial y motora, potenciando los mecanismos de plasticidad neuronal. Tales efectos cobran relevancia particularmente en el trabajo conjunto entre equipos de dermatología y neurocirugía reconstructiva, quienes buscan estrategias eficaces y seguras para optimizar la recuperación y el bienestar global del paciente. A pesar de los avances, aún existen controversias en relación con la estandarización de protocolos, la individualización de parámetros terapéuticos y la identificación de qué pacientes pueden beneficiarse más de esta tecnología. Este artículo revisa la evidencia científica disponible, analiza la experiencia clínica multidisciplinaria y plantea perspectivas de futuro para la consolidación de la fotobiomodulación como pilar en el abordaje integral de las cicatrices intracraneales.