David Vicente Toapanta Chimba

Imagenología Diagnóstica en Patologías Complejas presenta un enfoque práctico y actualizado sobre el uso de las técnicas de diagnóstico por imágenes en la evaluación de enfermedades complejas. La obra destaca la interpretación de hallazgos imagenológicos y su utilidad para orientar el diagnóstico, la toma de decisiones clínicas y el manejo integral del paciente.

Enfoque Clínico de las Enfermedades Gastrointestinales presenta una visión práctica y actual de las principales enfermedades del aparato digestivo. Su contenido facilita la comprensión del diagnóstico, evaluación y manejo clínico, constituyéndose en una herramienta útil para estudiantes y profesionales de la salud interesados en la gastroenterología.

Brain monitoring in anesthesia has traditionally focused on the control of anesthetic depth; however, recent advances in neuroscience and perioperative medicine suggest a broader role in systemic physiological regulation. This review aims to analyze the integration of electroencephalographic (EEG) monitoring with renal sensing mechanisms and metabolic flexibility, emphasizing their combined impact on cardiovascular outcomes. The kidney is explored as a sensor organ capable of detecting early changes in oxygenation and metabolic demand, while metabolic flexibility is examined as a key determinant of physiological adaptation under surgical stress. A narrative integrative review was conducted using high-impact literature from anesthesiology, neuroscience, nephrology, and cardiovascular medicine. Findings indicate that optimized brain monitoring may influence systemic homeostasis by modulating neural activity, which in turn affects renal oxygen balance and metabolic pathways. This interaction supports a systems-based approach to anesthesia, where brain, kidney, and metabolism function as interconnected components of perioperative regulation. The integration of these domains may improve early detection of organ dysfunction, reduce perioperative complications, and enhance patient outcomes, particularly in populations with high prevalence of cardiovascular and metabolic diseases. This work highlights the need for multidisciplinary strategies and future research focused on real-time multisystem monitoring.

Workplace health systems have emerged as a strategic intersection between occupational medicine, public health, and healthcare management, particularly in response to the growing burden of chronic diseases and the need for sustainable health interventions. This study aimed to analyze the integration of these disciplines within workplace settings and to identify key factors influencing their effectiveness at the population level. A structured narrative review was conducted using a scientific method-based approach, incorporating evidence from international sources with a particular focus on Latin American contexts, including Mexico, Colombia, and Ecuador. The findings indicate that integrated workplace health systems significantly contribute to improved health outcomes, including better chronic disease control, reduced absenteeism, enhanced mental health, and increased organizational productivity. The results also highlight critical barriers such as limited funding, system fragmentation, and lack of trained personnel, as well as facilitating factors including leadership commitment, intersectoral collaboration, and policy support. Comparative analysis revealed variability in implementation across the selected countries, reflecting differences in health system structures and resource allocation.

Mechanobiology has emerged as a fundamental discipline in understanding tissue regeneration in orthopedic and reconstructive contexts. This review analyzes how mechanical forces—such as tension, compression, shear stress, and controlled loading—regulate biological processes involved in healing across bone, tendon, cartilage, and skin. A structured narrative approach was used to synthesize current evidence from experimental and clinical studies, focusing on mechanotransduction pathways and their clinical implications. The findings demonstrate that tissue regeneration is optimized within a specific mechanical range, where controlled loading enhances cellular activity, extracellular matrix organization, and functional recovery. Conversely, both insufficient mechanical stimulation and excessive loading negatively impact healing outcomes. Additionally, mechanobiological responses are tissue-specific and vary according to the stage of healing, highlighting the importance of progressive and individualized rehabilitation strategies. In reconstructive surgery, mechanical tension plays a critical role in scar formation, where excessive stress is associated with pathological scarring. Overall, this review supports the integration of mechanobiological principles into clinical practice, emphasizing their relevance in improving outcomes in traumatology, orthopedics, and plastic surgery, particularly in diverse healthcare settings.

Aging is associated with a progressive increase in chronic low-grade inflammation, known as inflammaging, which has been identified as a key mechanism underlying the development of multimorbidity. This review aims to analyze the role of inflammaging in aging and its impact across internal medicine, immunology, and gynecology. A structured narrative review was conducted using high-impact scientific literature, focusing on biological mechanisms, clinical implications, and interdisciplinary perspectives. The findings indicate that inflammaging is driven by interconnected processes such as immune dysregulation, cellular senescence, mitochondrial dysfunction, metabolic imbalance, and hormonal changes. These mechanisms contribute to the development of chronic diseases including cardiovascular disorders, type 2 diabetes, frailty, neurodegeneration, and postmenopausal alterations. Additionally, inflammatory biomarkers such as IL-6, TNF-α, and CRP were consistently associated with disease progression. The results also highlight the importance of lifestyle interventions, metabolic control, and emerging geroscience-based therapies in modulating chronic inflammation. Overall, inflammaging represents a central biological axis that links aging with multimorbidity, supporting the need for integrated and preventive approaches in clinical practice.

Antecedentes: El cierre adecuado de la pared abdominal tras una laparotomía es un paso crítico para prevenir complicaciones postoperatorias a corto y largo plazo, siendo la hernia incisional la más prevalente y costosa. La elección del material de sutura ha evolucionado desde materiales naturales hasta polímeros sintéticos avanzados. Objetivo: Analizar la eficacia, seguridad y resultados clínicos del uso de suturas absorbibles (de absorción lenta y rápida) en el cierre de la pared abdominal, comparándolas con los estándares actuales. Método: Se realizó una revisión sistemática de la literatura y ensayos clínicos aleatorizados disponibles en bases de datos biomédicas (PubMed, Cochrane, Scopus), centrados en el cierre de la línea media y laparotomías transversas. Resultados: Las suturas absorbibles sintéticas de monofilamento y absorción lenta (ej. polidioxanona) demuestran una tasa significativamente menor de hernias incisionales en comparación con las suturas de absorción rápida. El uso de la técnica de "small bites" (bocados pequeños) con sutura absorbible monofilamento presenta la menor incidencia de complicaciones. Conclusiones: La evidencia actual respalda el uso de suturas monofilamento de absorción lenta en sutura continua como el estándar de oro para el cierre de la pared abdominal en cirugía electiva, reduciendo el riesgo de hernia incisional y dehiscencia sin aumentar el riesgo de dolor crónico asociado a suturas no absorbibles.

El sangrado digestivo alto (SDA) en pacientes sometidos a terapia con anticoagulantes orales representa en la actualidad una de las emergencias médico-quirúrgicas de mayor complejidad en el entorno hospitalario, asociándose a una tasa de mortalidad que, en presentaciones graves, supera el 15-20 %. La incidencia de esta patología ha experimentado un incremento exponencial en la última década, fenómeno atribuible tanto al envejecimiento progresivo de la población como a la expansión en la prescripción de anticoagulantes orales directos (ACOD) para el manejo de la fibrilación auricular y la enfermedad tromboembólica. El manejo clínico de estos pacientes exige un enfoque multidisciplinar y sincrónico que integre la resucitación hemodinámica inmediata, la reversión farmacológica urgente de la anticoagulación adaptada a la farmacocinética del agente implicado, la realización de una endoscopia terapéutica dentro de una ventana de oportunidad óptima y la implementación de estrategias de prevención secundaria. El presente artículo revisa exhaustivamente la evidencia científica disponible hasta diciembre de 2025, proponiendo un algoritmo de manejo práctico y analizando en profundidad las controversias persistentes respecto al uso de agentes reversores específicos, como el idarucizumab y el andexanet alfa, frente a las estrategias convencionales, así como el momento idóneo para la reintroducción de la terapia antitrombótica.