Marijose Santillán Guevara

Este libro ofrece un análisis profundo y multidimensional de los sistemas de salud en América Latina, abordando sus avances, desigualdades estructurales, crisis recientes y oportunidades de transformación. A través de evidencia actualizada y una mirada crítica, propone caminos viables hacia sistemas más equitativos, resilientes y sostenibles, con la cobertura universal como horizonte. Dirigido a tomadores de decisiones, académicos, profesionales de la salud y estudiantes, constituye una herramienta clave para comprender los desafíos del presente y diseñar estrategias efectivas para el futuro de la salud en la región.

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.

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.