Bryan Andrés Ramírez Vásquez

Imaging-guided strategies have become a fundamental component of emergency medicine, significantly influencing diagnostic accuracy, clinical decision-making, and patient outcomes in critical care settings. This review analyzes the role of key imaging modalities, including point-of-care ultrasonography (POCUS), computed tomography (CT), and artificial intelligence (AI)-assisted tools, in the rapid evaluation and management of acute conditions. A structured analysis of recent high-impact literature (2020 onward) was conducted to identify patterns in imaging utilization, diagnostic performance, workflow efficiency, and clinical impact. The findings demonstrate that CT remains the gold standard for definitive diagnosis in high-risk scenarios, while POCUS provides rapid bedside assessment that facilitates early intervention. AI integration contributes to improved workflow efficiency, triage prioritization, and reduction in reporting times. However, challenges such as imaging overutilization and variability in resource availability persist, highlighting the need for evidence-based protocols and optimized decision-making frameworks. The integration of multimodal imaging approaches, adapted to diverse healthcare systems, is essential to enhance diagnostic precision and improve patient outcomes. These results support the concept that imaging is a strategic and dynamic element in emergency medicine, with a critical role in the evolution of modern critical care.

Musculoskeletal injuries remain a leading cause of disability worldwide, yet successful structural repair does not consistently translate into full functional recovery. This review analyzes current evidence (2020 onward) on functional recovery after musculoskeletal injury, emphasizing the transition from structure-centered to function-oriented models of care. A structured narrative review with systematic components was conducted following PRISMA-based principles, including high-impact studies from databases such as PubMed, Scopus, and Web of Science. The findings demonstrate a persistent discrepancy between anatomical healing and functional outcomes, with frequent deficits in strength, neuromuscular control, endurance, and psychological readiness despite successful treatment. Rehabilitation strategies centered on neuromuscular training, progressive load management, and criteria-based progression were consistently associated with improved functional outcomes. In contrast, time-based protocols showed limited reliability for determining readiness to return to activity. Additionally, psychological factors such as fear of reinjury and reduced confidence were identified as key determinants influencing recovery trajectories and return-to-activity decisions. The analysis also revealed that return to activity does not necessarily indicate full recovery, as many patients resume participation with limitations or at a reduced level.

Real-time fluorescence-guided surgery has become an increasingly important intraoperative tool in abdominal oncologic surgery, providing surgeons with dynamic visual information that supports critical decision-making during complex procedures. This review analyzes current evidence on fluorescence-guided imaging techniques, with particular emphasis on near-infrared fluorescence using indocyanine green and tumor-targeted probes, and explores their potential integration with assistive surgical technologies such as exoskeleton-based support systems. The available literature demonstrates that fluorescence guidance plays a central role in margin refinement, perfusion assessment, identification of critical anatomy, and detection of occult disease, thereby enhancing intraoperative precision and safety. Furthermore, recent studies highlight the importance of visualization workflows and interface design, underscoring the need to consider how surgeons interpret and act upon fluorescence-derived information in real time. From a workflow-oriented perspective, the combination of advanced imaging and biomechanical support may contribute to more consistent execution of fluorescence-informed decisions, particularly during prolonged and technically demanding oncologic procedures. This review contextualizes these findings within international surgical practice, with specific relevance to educational and clinical settings in Mexico, Colombia, and Ecuador. Overall, the evidence supports a holistic view of precision surgery in which fluorescence-guided imaging and assistive technologies function synergistically to enhance surgical performance, decision-making, and training in abdominal oncologic 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.