Stefano Jeampierre Figueroa Fernández

Recent developments in electrocardiographic signal analysis have redefined the diagnostic and prognostic landscape of cardiac arrhythmias. This review synthesizes current international evidence on advanced ECG-centered analytical strategies for early detection and risk stratification, incorporating studies published between 2021 and 2025 and contextualizing their applicability within healthcare systems in Mexico, Colombia, and Ecuador. The collective literature demonstrates that early identification of atrial fibrillation achieves consistently high diagnostic accuracy, supported by robust waveform characterization, rhythm-based modeling, and recognition of subtle conduction irregularities. Comparable approaches applied to supraventricular and ventricular arrhythmias also yield strong performance despite higher morphological variability. In contrast, prognostic assessment of ventricular instability and sudden cardiac death presents greater complexity; however, recent investigations highlight meaningful advances based on dynamic features such as beat-to-beat variability, QRS complexity, repolarization heterogeneity, and ectopic burden. Evidence further underscores the decisive impact of monitoring duration, with 7–14-day ambulatory patches markedly outperforming conventional ECG and short Holter recordings in detecting intermittent arrhythmic episodes. A multidimensional interpretive framework—integrating atrial conduction markers, repolarization indices, autonomic modulation, and electrical instability signatures—emerges as essential for achieving clinically relevant predictive performance. Finally, the review highlights expanding feasibility for regional adoption in Latin America, supported by progressive improvements in infrastructure, workflow integration, and clinical capacity. Overall, the findings reflect a pivotal transition toward enhanced ECG analysis as a central component of contemporary arrhythmia evaluation, with substantial implications for early diagnosis, risk prediction, and long-term patient outcomes.

The growing body of evidence linking the gut microbiota to neurodegenerative disorders has revealed the gut–brain axis as a fundamental determinant in the pathogenesis of Alzheimer’s disease (AD). This review integrates molecular, clinical, and regional data to elucidate how intestinal dysbiosis contributes to neuroinflammation, amyloidogenesis, and cognitive decline. Studies consistently demonstrate a reduction in beneficial bacteria such as Bifidobacterium, Lactobacillus, and Faecalibacterium prausnitzii, accompanied by an increase in pro-inflammatory taxa including Escherichia/Shigella, Enterobacteriaceae, and Bacteroides. These alterations reduce short-chain fatty acid (SCFA) production, increase lipopolysaccharide (LPS) translocation, and disrupt intestinal and blood–brain barrier integrity, resulting in microglial activation, oxidative stress, and neuronal degeneration. Emerging therapeutic strategies—such as probiotics, prebiotics, fecal microbiota transplantation (FMT), polyphenols, and high-fiber diets—demonstrate significant promise in modulating microbial composition, reducing systemic inflammation, and improving cognitive outcomes. The analysis also incorporates perspectives from Mexico, Colombia, and Ecuador, emphasizing that cultural dietary practices and metabolic health disparities shape regional microbiome patterns and Alzheimer’s susceptibility. The integration of Latin American contexts underscores the need for population-specific studies that combine metagenomics, metabolomics, and clinical data to design preventive and therapeutic interventions. Altogether, this work supports a paradigm shift that redefines Alzheimer’s disease as a multisystemic inflammatory condition influenced by gut ecology and systemic metabolism. By preserving microbial diversity and intestinal health through nutritional, clinical, and policy-based strategies, it may be possible to delay neurodegenerative progression and protect cognitive function in aging populations worldwide. Protecting the gut means protecting the mind.

La regeneración ósea tras fracturas complejas continúa siendo uno de los mayores retos en la medicina ortopédica y reconstructiva. Las técnicas convencionales de injerto suelen fracasar en la restauración funcional total debido a la escasa vascularización, la morbilidad del sitio donador y la falta de potencial osteoinductivo. En los últimos años, la integración de la bioimpresión tridimensional (3D) y la terapia con células madre mesenquimales (CM-M) ha surgido como una estrategia prometedora para superar dichas limitaciones. Esta revisión analiza la evidencia internacional más reciente (2015–2025), abarcando estudios experimentales, traslacionales y clínicos tempranos que exploran el papel sinérgico de las CM-M y los andamios bioprintados en la regeneración ósea posterior a fracturas complejas. Mediante una metodología estructurada basada en el modelo DMAIC (Definir–Medir–Analizar–Mejorar–Controlar), se examinaron veinte artículos arbitrados para identificar avances, limitaciones y perspectivas futuras. Los resultados muestran que los constructos bioprintados con CM-M mejoran la osteogénesis, angiogénesis e integración con el huésped, logrando consolidaciones óseas hasta un 60% más rápidas y una resistencia mecánica equivalente al 70–90% del hueso nativo en modelos preclínicos. Además, la combinación de materiales bioactivos como la hidroxiapatita, el fosfato tricálcico β y el vidrio bioactivo con células madre incrementó la mineralización y la vascularización. La discusión destaca que el éxito de estas terapias depende de la interacción coordinada entre viabilidad celular, diseño estructural y marcos regulatorios que garanticen seguridad y reproducibilidad. Aunque persisten desafíos —especialmente en la vascularización a gran escala, la estandarización y la regulación ética—, la bioimpresión 3D junto con la terapia celular se perfila como una alternativa segura, viable y biológicamente activa para la reconstrucción de defectos óseos extensos. Países latinoamericanos como México, Colombia y Ecuador emergen como protagonistas en este campo, desarrollando marcos colaborativos que vinculan la innovación global con la aplicabilidad regional. En conclusión, esta convergencia tecnológica no solo constituye una nueva estrategia terapéutica, sino un cambio de paradigma hacia una ortopedia personalizada, viva y regenerativa, en la que sanar se convierte en sinónimo de renacer biológico.