Rogelio Adrián Llanes González

Neuroimmune interactions have emerged as a central framework for understanding the complexity of gastrointestinal diseases, integrating immune regulation, neural signaling, and microbiota-driven mechanisms within the gut–brain axis. This review synthesizes current evidence on the role of neuroimmune pathways in both inflammatory and functional gastrointestinal disorders, with particular emphasis on inflammatory bowel disease and irritable bowel syndrome. The analyzed literature demonstrates that gastrointestinal symptom generation and disease expression result from dynamic interactions among immune cells, enteric and autonomic neural circuits, microbial signaling, and stress-related modulation rather than from isolated pathological processes. In inflammatory conditions, immune dysregulation and macrophage-mediated pathways predominate, while neural and autonomic mechanisms contribute to symptom persistence and variability. In functional disorders, immune–neural coupling, mast cell–nerve interactions, and visceral sensory sensitization emerge as key drivers of pain and altered bowel habits despite minimal structural abnormalities. Across both disease categories, the intestinal microbiota acts as a cross-cutting regulator influencing immune tone, barrier integrity, and neural responsiveness. From a clinical and diagnostic perspective, these findings support a mechanism-based approach that complements traditional inflammatory and structural assessments with neuroimmune-informed reasoning. This integrative framework has particular relevance for medical education and clinical practice in diverse healthcare settings, including Latin America, where resource variability necessitates strong pathophysiological interpretation. Overall, neuroimmune models provide a coherent and biologically grounded perspective for advancing diagnosis, teaching, and future translational strategies in gastroenterology.

Contemporary general surgery is practiced in environments characterized by high cognitive complexity, time pressure, and uncertainty, where surgeons must make rapid decisions with significant clinical consequences. While technical proficiency remains essential, increasing evidence highlights the central role of cognitive processes, non-technical skills, and system-level factors in shaping surgical performance and patient safety. This study aimed to synthesize current evidence and expert convergence regarding the cognitive and decision-making demands of contemporary general surgery and to organize these demands into a coherent framework relevant to surgical education and clinical practice. A narrative review was conducted integrating foundational and contemporary literature on cognitive psychology, human factors, and surgical safety, supported by a structured Delphi-based framework to consolidate and refine key domains through iterative thematic convergence. Findings identified six core domains: cognitive load and multitasking, fatigue and decision fatigue, cognitive bias and heuristics, non-technical skills, team communication and coordination, and system and environmental stressors. Cognitive load emerged as the central domain, closely interacting with fatigue and bias, while progressive convergence across Delphi rounds supported the robustness of the final framework. Alignment with Bloom’s taxonomy highlighted the educational relevance of these domains. Overall, surgical decision-making is a multidimensional process shaped by individual cognition, team dynamics, and system design, underscoring the need to address cognitive demands alongside technical training to enhance decision quality, surgical performance, and patient safety in contemporary general surgery.

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.

Major surgery induces a complex physiological stress response characterized by metabolic disruption, systemic inflammation, and accelerated protein catabolism, all of which significantly influence perioperative outcomes. Despite advances in surgical and anesthetic techniques, postoperative complications and delayed recovery remain common, particularly among patients with reduced functional reserve, malnutrition, or metabolic vulnerability. In this context, immunometabolic and nutritional prehabilitation has emerged as a proactive strategy aimed at optimizing patients’ physiological condition prior to surgery. This narrative review analyzes current evidence on immunometabolic and nutritional prehabilitation in major surgery, with a specific focus on its relevance to anesthesiology and perioperative medicine. The review synthesizes data related to functional capacity, postoperative morbidity, hospital length of stay, and feasibility of implementation across different healthcare settings. Emphasis is placed on multimodal prehabilitation approaches that integrate structured exercise, nutritional optimization, and immunonutritional principles, as well as their alignment with Enhanced Recovery After Surgery (ERAS) protocols. The findings highlight consistent associations between comprehensive prehabilitation strategies and improved perioperative trajectories, including better preservation of functional capacity, reduced overall postoperative morbidity, and shorter hospitalization. Additionally, the review explores the applicability of these strategies within diverse healthcare systems, with particular consideration of Mexico, Colombia, and Ecuador. By framing prehabilitation as a core component of anesthesiology-led perioperative care, this work supports a shift toward preventive, patient-centered models aimed at enhancing surgical resilience and recovery.