Fabio Camilo Jaramillo Contreras

La disfunción tiroidea, representa un desafío que supera el ámbito endocrino, debido a su estrecha relación con alteraciones metabólicas, y cardiovasculares, cabe considerar, que los cambios en la función tiroidea, incluso dentro de rangos considerados normales, pueden asociarse, con modificaciones en el metabolismo lipídico, resistencia a la insulina, hipertensión arterial, y riesgo cardiovascular. El objetivo fue, analizar críticamente, la evidencia científica publicada entre 2021 y 2026, sobre la relación entre disfunción tiroidea, hipertrigliceridemia, e hipertensión arterial, con énfasis en los mecanismos fisiopatológicos que podrían integrar estas alteraciones, dentro de un eje cardiometabólico. Se realizó, una revisión sistemática, siguiendo los lineamientos PRISMA 2020, la búsqueda se efectuó en Scopus, PubMed/MEDLINE, y Web of Science, utilizando términos relacionados con función tiroidea, triglicéridos, resistencia a la insulina, índice TyG, e hipertensión arterial. La evidencia identificó, relaciones consistentes entre alteraciones de la función tiroidea, y cambios en el metabolismo de los triglicéridos, así como asociaciones entre el índice TyG, resistencia a la insulina, e hipertensión arterial. Los resultados señalaron que el IMC, la adiposidad visceral, la edad, el sexo y la diabetes, actúan como importantes modificadores de estas asociaciones. La evidencia respalda, la existencia de un eje cardiometabólico, que vincula función tiroidea, metabolismo lipídico, y regulación vascular; no obstante, aún no es posible establecer una relación causal definitiva, entre estas alteraciones; la resistencia a la insulina y el índice TyG, emergen como posibles elementos de conexión, mientras que la heterogeneidad metodológica, y la escasez de estudios longitudinales, limitan la interpretación causal de los hallazgos.

Fatigue and functional disability are among the most persistent and debilitating manifestations of systemic autoimmune diseases, frequently affecting physical performance, occupational participation, independence, and health-related quality of life. Although advances in immunomodulatory therapies have improved inflammatory disease control, many patients continue to experience substantial fatigue and functional limitations that cannot be explained exclusively by conventional measures of disease activity. This narrative review aimed to analyze the relationship between persistent inflammation, fatigue, and functional disability in rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren’s syndrome, and systemic sclerosis, emphasizing clinical assessment and personalized rehabilitation strategies. A descriptive, analytical, and integrative approach was applied to 20 selected scientific publications, including clinical trials, observational studies, systematic reviews, and international recommendations, with particular consideration of Latin American contributions. The reviewed evidence identified chronic pain, sleep disturbances, psychological factors, physical deconditioning, and accumulated disease-related damage as relevant determinants of fatigue and functional impairment. Standardized patient-reported instruments, inflammatory disease activity indices, and objective functional assessments provided complementary information for characterizing symptom burden. Rehabilitation studies documented improvements in selected measures of exercise tolerance, muscular performance, fatigue, and quality of life following structured aerobic exercise, resistance training, and supervised or home-based interventions. Latin American investigations contributed evidence concerning physical rehabilitation, occupational impairment, and clinical heterogeneity across autoimmune populations. Nevertheless, variability in study designs, assessment instruments, and intervention protocols limited direct comparisons and prevented definitive conclusions regarding the superiority of individual rehabilitation approaches. The findings support an integrated clinical framework combining inflammatory disease management, multidimensional fatigue assessment, and individualized rehabilitation. Further multicenter investigations with standardized outcomes and long-term follow-up are needed to optimize functional recovery and improve patient-centered management in systemic autoimmune diseases.

Abdominal extranodal lymphomas represent a heterogeneous group of hematological malignancies characterized by diverse anatomical presentations, histopathological features, and molecular abnormalities that complicate accurate diagnosis and therapeutic selection. This narrative review examines the diagnostic relevance of surgical biopsy, immunophenotypic profiling, and comprehensive histopathological characterization in the classification and personalized management of these neoplasms. International scientific literature, including contributions from Latin American research groups, was analyzed to examine tissue acquisition strategies, diagnostic classifications, immunohistochemical markers, molecular investigations, and subtype-specific therapeutic approaches. The reviewed evidence indicates that adequate tissue sampling is essential for definitive lymphoma subclassification, particularly when morphological architecture and ancillary studies are required. Laparoscopic biopsy may provide greater specimen adequacy than percutaneous techniques in selected cases, although procedural selection should consider anatomical accessibility, clinical conditions, and diagnostic requirements. Immunophenotypic and molecular characterization allows differentiation among diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, mantle cell lymphoma, follicular lymphoma, and intestinal T-cell lymphomas, each exhibiting distinct biological and therapeutic characteristics. These diagnostic differences influence the selection of systemic immunochemotherapy, targeted interventions, infection-directed treatment, and surgical management when clinically indicated. Evidence from Mexico, Peru, and Brazil contributes regional perspectives on biopsy performance and lymphoma characterization, although further multicenter investigations remain necessary. Overall, the findings support an integrated multidisciplinary approach in which appropriate tissue acquisition and precise pathological classification constitute essential foundations for personalized treatment and improved diagnostic decision-making in abdominal extranodal lymphomas.

Long-duration spaceflight exposes astronauts to environmental and physiological conditions that challenge circadian synchronization, sleep regulation, and cardiovascular homeostasis. Understanding the interactions among these processes is essential for preserving physiological performance and operational safety during future lunar and interplanetary missions. This narrative review aimed to examine the relationship between circadian disruption, sleep disturbances, and cardiovascular adaptation during prolonged exposure to microgravity, while evaluating the available evidence concerning preventive countermeasures. Scientific literature addressing aerospace physiology, chronobiology, sleep medicine, and cardiovascular regulation was critically synthesized, with particular emphasis on observational studies involving astronauts, physiological investigations, and specialized reviews. The findings revealed persistent sleep restriction during orbital missions, with reported mean sleep durations of approximately six hours per night. Changes in cardiovascular autonomic regulation were documented through alterations in heart rate variability, including modifications in fractal scaling and spectral power. Hemodynamic investigations demonstrated reductions in arterial pressure and systemic vascular resistance, accompanied by increases in cardiac output and stroke volume during prolonged microgravity exposure. Although these findings indicate substantial physiological adaptation, the independent contribution of circadian misalignment to cardiovascular deconditioning remains uncertain. Countermeasures involving controlled lighting, structured sleep schedules, exercise training, and mechanical loading address different physiological demands, but their combined effectiveness has not been adequately established. The available evidence is limited by small astronaut populations, methodological heterogeneity, and insufficient simultaneous monitoring of circadian and cardiovascular parameters. An integrated approach combining biological rhythm assessment, cardiovascular monitoring, and individualized preventive interventions may improve the characterization of physiological adaptation during extended missions. Further longitudinal investigations are required to clarify causal mechanisms and establish effective strategies for maintaining astronaut health during sustained human exploration beyond Earth.

La parálisis facial periférica representa una condición neurológica y reconstructiva compleja que compromete la expresión facial, la protección ocular, la competencia oral y el bienestar psicosocial. Las estrategias terapéuticas contemporáneas han evolucionado hacia la reanimación facial dinámica, priorizando la recuperación de movimientos coordinados por encima de la restauración exclusiva de la simetría estática. Esta revisión narrativa tuvo como objetivo analizar críticamente la evidencia científica relacionada con la recuperación neural, las transferencias nerviosas, la reconstrucción muscular funcional y la rehabilitación en pacientes con parálisis facial periférica. Se realizó un análisis descriptivo y comparativo de 20 publicaciones científicas internacionales, incluyendo revisiones sistemáticas, metaanálisis, investigaciones clínicas y recomendaciones especializadas, con incorporación de contribuciones latinoamericanas. Los resultados mostraron que la transferencia nerviosa maseterino-facial se asoció con una recuperación motora más temprana y mayores puntuaciones funcionales compuestas en comparación con la transferencia hipogloso-facial en síntesis comparativas publicadas, aunque esta última presentó resultados favorables en determinadas mediciones de simetría en reposo. El trasplante libre del músculo grácil y la reconstrucción mediante el músculo temporal se asociaron con mejorías agrupadas de la excursión de la sonrisa de 7,50 mm y 7,06 mm, respectivamente, según metaanálisis independientes. Sin embargo, la heterogeneidad metodológica impidió establecer conclusiones definitivas sobre la superioridad quirúrgica. La regeneración neural, la sincinesia posoperatoria y la rehabilitación neuromuscular se identificaron como componentes fundamentales de la recuperación funcional, destacando la diferencia entre restaurar la contracción muscular y recuperar una expresión emocional coordinada. Las contribuciones científicas de México y Brasil evidenciaron la relevancia de la experiencia regional en innovación reconstructiva y atención multidisciplinaria. La evidencia revisada respalda la selección terapéutica individualizada según la duración de la denervación, la viabilidad muscular, la disponibilidad de nervios donantes y los objetivos funcionales centrados en el paciente. No obstante, persisten limitaciones relacionadas con la falta de estandarización de los resultados y la escasez de evidencia comparativa a largo plazo. La reanimación facial integral requiere un abordaje interdisciplinario que combine reconstrucción quirúrgica, recuperación neural, rehabilitación y evaluación funcional estandarizada para mejorar la expresión facial, la comunicación y la calidad de vida.

Perioperative patient safety remains a major challenge for healthcare systems worldwide, as preventable adverse events continue to contribute to postoperative morbidity, avoidable mortality, prolonged hospitalization, and increased healthcare costs. This narrative review aimed to analyze the epidemiological burden, clinical determinants, and organizational factors associated with preventable perioperative adverse events, emphasizing the contribution of epidemiological surveillance, safety culture, and continuous process improvement. Twenty scientific publications were examined, integrating international evidence with investigations conducted in Latin America. A descriptive and comparative analytical approach was employed, using the Define, Measure, Analyze, Improve, and Control (DMAIC) framework to organize the evaluation of patient safety challenges and preventive strategies. The reviewed evidence identified surgical adverse events affecting approximately 14.4% of patients, with potentially preventable events affecting 5.2%. International studies demonstrated reductions in postoperative complications and in-hospital mortality following the implementation of standardized surgical safety checklists and comprehensive perioperative safety systems. Latin American investigations documented a substantial burden of healthcare-associated adverse events, with nearly 60% of identified events considered potentially preventable in the Iberoamerican Study of Adverse Events. Additionally, institutional quality improvement initiatives demonstrated marked increases in anesthesia-related incident reporting, highlighting the importance of distinguishing improved surveillance capacity from changes in actual patient harm. The findings indicate that sustainable perioperative safety depends on coordinated clinical protocols, reliable epidemiological monitoring, multidisciplinary communication, institutional leadership, and continuous organizational learning. Strengthening these interconnected components may contribute to reducing avoidable harm and improving surgical care quality, particularly in healthcare environments characterized by heterogeneous resources and institutional capacities.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder frequently associated with dermatological manifestations that may precede the recognition of reproductive or metabolic abnormalities. Hyperandrogenism and insulin resistance play important roles in the development of acne, hirsutism, female pattern hair loss, and acanthosis nigricans, although their clinical expression varies according to peripheral androgen sensitivity, genetic susceptibility, and metabolic characteristics. This narrative review aimed to analyze the pathophysiological relationships between hormonal and metabolic disturbances and cutaneous manifestations of PCOS, emphasizing diagnostic considerations and comprehensive therapeutic strategies for acne and hirsutism. International clinical guidelines, systematic reviews, meta-analyses, and relevant clinical investigations were examined, incorporating evidence from Latin American populations. The reviewed findings indicate that hirsutism exhibits a more consistent association with biochemical hyperandrogenism, whereas acne involves additional inflammatory, follicular, and microbial mechanisms that limit its specificity as an indicator of androgen excess. Insulin resistance contributes to increased androgen bioavailability through compensatory hyperinsulinemia and reduced sex hormone-binding globulin concentrations, while acanthosis nigricans may indicate associated metabolic dysfunction. Therapeutic evidence demonstrates variable effectiveness among combined oral contraceptives, antiandrogenic medications, insulin-sensitizing agents, and conventional dermatological interventions, supporting individualized treatment selection according to clinical presentation, metabolic risk, and reproductive preferences. Differences in diagnostic criteria, study populations, and outcome assessment methods limit direct comparisons across investigations. The findings emphasize the importance of multidisciplinary collaboration and the adaptation of international recommendations to Latin American healthcare contexts. Overall, dermatological manifestations of PCOS should be approached as components of a systemic endocrine-metabolic disorder, requiring integrated assessment, personalized management, and further research involving diverse populations.

Self-inflicted dermatoses, particularly excoriation disorder and dermatitis artefacta, represent complex clinical conditions involving interactions between psychopathological mechanisms, behavioral disturbances, and recurrent cutaneous injury. This narrative review aimed to analyze the psychological factors, dermatological characteristics, diagnostic challenges, and interdisciplinary therapeutic strategies associated with these disorders, integrating international scientific evidence with contributions from Latin America. Relevant publications addressing epidemiology, psychiatric comorbidities, clinical manifestations, differential diagnosis, and treatment outcomes were examined through a descriptive and comparative approach. Epidemiological findings identified a current prevalence of excoriation disorder of 2.1%, a lifetime prevalence of 3.1%, and a pooled prevalence of 3.45% across different investigations. Anxiety, emotional dysregulation, compulsivity, and difficulties in behavioral inhibition emerged as relevant factors associated with symptom persistence. Diagnostic analysis revealed important differences between excoriation disorder and dermatitis artefacta, particularly regarding behavioral awareness, psychological context, and lesion characteristics. Therapeutic evidence supported behavioral interventions, including habit reversal training and cognitive behavioral therapy, while pharmacological investigations demonstrated favorable but variable outcomes with N-acetylcysteine. Interdisciplinary management involving dermatology, psychiatry, and psychology was identified as a clinically relevant approach for addressing cutaneous complications, psychiatric comorbidities, and recurrent behaviors. Nevertheless, methodological heterogeneity, limited long-term follow-up, and insufficient regional representation restrict the generalizability of available findings. In conclusion, accurate diagnostic differentiation, individualized psychological intervention, and coordinated clinical management constitute fundamental components of comprehensive care for self-inflicted dermatoses. Further multicenter investigations are necessary to strengthen therapeutic evidence and improve accessibility to specialized psychodermatological services.

Regenerative dermatology has emerged as a transformative field that integrates advances in regenerative medicine, molecular biology, and aesthetic dermatology to promote tissue repair through biological rather than purely corrective mechanisms. Among the most promising innovations, exosomes and polynucleotides have attracted considerable scientific attention because of their ability to stimulate fibroblast activity, enhance collagen synthesis, regulate inflammatory responses, promote angiogenesis, and improve extracellular matrix remodeling. The objective of this review was to analyze the current scientific evidence regarding the biological foundations, clinical applications, therapeutic effectiveness, safety profile, and future perspectives of these next-generation regenerative therapies. A narrative literature review was conducted following the scientific method using peer-reviewed publications from major biomedical databases. The available evidence demonstrates encouraging results in facial rejuvenation, photoaging, scar remodeling, chronic wound healing, periocular rejuvenation, and hair restoration, with improvements in skin quality and high patient satisfaction while maintaining a favorable short-term safety profile. Nevertheless, important methodological limitations remain, including heterogeneous treatment protocols, limited randomized clinical trials, and insufficient long-term follow-up. Continued international collaboration, standardized manufacturing processes, rigorous regulatory frameworks, and high-quality multicenter clinical studies will be essential to establish evidence-based therapeutic guidelines and consolidate regenerative dermatology as a mature clinical discipline.

La tuberculosis resistente es considerada como uno de los principales problemas de salud pública en América Latina, debido al incremento sostenido de casos y a las desigualdades en el acceso al diagnóstico y tratamiento; las limitaciones estructurales, sociales y sanitarias favorecen la persistencia de la enfermedad, especialmente en poblaciones vulnerables y pediátricas. El objetivo fue, analizar las brechas existentes en la cobertura terapéutica y el diagnóstico molecular de la tuberculosis en países latinoamericanos, con énfasis en la farmacorresistencia y su impacto epidemiológico. La investigación utilizó información de la Organización Mundial de la Salud y la Organización Panamericana de la Salud correspondiente a Argentina, Bolivia, Colombia, Ecuador, México y Perú durante el periodo 2019-2024; el enfoque fue cuantitativo, cualitativo, descriptivo y crítico; los indicadores evaluados fueron la cobertura terapéutica, resistencia a medicamentos, poblaciones vulnerables y acceso a pruebas rápidas. Se mostraron avances importantes en Ecuador y Colombia, países que alcanzaron los mayores incrementos en cobertura diagnóstica y acceso a pruebas moleculares rápidas, por otra parte, Perú presentó la mayor carga de casos resistentes; mientras que, México mantuvo bajos niveles de cobertura diagnóstica; a su vez, Bolivia evidenció un deterioro significativo en la cobertura del tratamiento y en el uso de pruebas rápidas; además, persistieron altas proporciones de afectación en menores de cinco años y personas privadas de libertad. Se concluyó que la tuberculosis resistente continúa representando un desafío regional que requiere fortalecer la vigilancia epidemiológica, ampliar el acceso al diagnóstico oportuno y consolidar estrategias integrales en poblaciones de mayor riesgo.