Diva Dalesska Herrería Quiñónez

Chronic pruritus is a multifactorial clinical condition characterized by persistent itching and complex interactions among immune signaling, neuronal sensitization, psychological disturbances, and behavioral responses. Its clinical significance extends beyond cutaneous manifestations, frequently affecting sleep quality, emotional well-being, daily functioning, and overall quality of life. This narrative review aimed to analyze the neuroimmune mechanisms underlying chronic pruritus, examine its relationship with psychiatric comorbidities, and evaluate current multimodal therapeutic strategies from an international perspective, incorporating scientific contributions from Latin America. A qualitative, descriptive, and analytical approach was adopted to synthesize evidence from experimental investigations, observational studies, clinical trials, and international guidelines. The reviewed literature identified IL-4, IL-13, IL-31, and thymic stromal lymphopoietin as relevant mediators of neuroimmune communication, with signaling pathways involving JAK1, TRPV1, and TRPA1 contributing to sensory neuronal activation and hypersensitivity. Peripheral and central sensitization were associated with persistent sensory amplification and maintenance of the itch–scratch cycle. Psychiatric findings demonstrated clinically relevant associations with anxiety, depression, psychological stress, and sleep disturbances, although causal relationships remain incompletely established. Randomized clinical trials showed meaningful reductions in itch intensity following targeted inhibition of IL-4/IL-13 and IL-31 receptor signaling in patients with prurigo nodularis. Latin American evidence highlighted substantial symptom burden, quality-of-life impairment, and regional limitations in access to specialized healthcare. Overall, the findings support understanding chronic pruritus as a multidimensional condition requiring individualized assessment and coordinated dermatological, neurological, and psychological approaches. Further longitudinal and comparative investigations are necessary to clarify neuroimmune biomarkers, establish the clinical relevance of central sensitization, and determine the effectiveness of integrated multimodal interventions across different pruritic disorders.

Precision in high-risk surgical fields has evolved into a multidimensional paradigm that integrates technological innovation, advanced surgical techniques, and structured perioperative care. This review analyzes the translational principles shared between general surgery, neurosurgery, and minimally invasive approaches, with the aim of understanding how these elements interact to improve surgical outcomes. A structured integrative review was conducted using high-impact literature published from 2020 onward, focusing on key domains such as artificial intelligence, intraoperative monitoring, advanced visualization, laparoscopic and robotic surgery, and Enhanced Recovery After Surgery (ERAS) protocols. The findings demonstrate that precision in surgery is not determined by a single factor, but by the coordinated interaction of multiple components. Minimally invasive techniques serve as the structural foundation, while visualization technologies and intraoperative monitoring enhance real-time decision-making and safety. Artificial intelligence contributes to the standardization and support of surgical cognition, and perioperative protocols optimize recovery and reduce complications. Together, these elements form an integrated system that extends beyond the operating room and encompasses the entire surgical process. The review also highlights the adaptability of these principles across diverse healthcare settings, including regions such as Mexico, Colombia, and Ecuador, where variability in resources requires context-sensitive implementation. Ultimately, precision surgery is defined as a system-based approach that aligns technique, technology, and perioperative care to achieve optimal patient outcomes. This framework has important implications for clinical practice, surgical education, and future research.