Adrian Jhair Flores Equilea

En América Latina, la hipertensión arterial constituye un factor de riesgo de alta prevalencia; sin embargo, la carga cardiovascular difiere entre países debido a desigualdades en el acceso a los servicios de salud, las condiciones socioeconómicas y la capacidad institucional de cada región; a su vez, la escasez de estudios comparativos regionales limita la comprensión de estas diferencias y dificulta el diseño de políticas públicas ajustadas a cada contexto. El objetivo de la investigación fue; analizar la evolución temporal de la hipertensión arterial y la carga de enfermedad cardiovascular en países de América Latina. Se desarrolló una investigación cuantitativa, comparativa, y longitudinal con información de la Organización Panamericana de la Salud correspondiente al período 2010–2019 para Argentina, Bolivia, Colombia, Ecuador, México y Perú; el análisis incluyó estadística descriptiva, series temporales, diagramas de dispersión, correlación de Pearson, regresión lineal simple y análisis de varianza mediante R Studio 4.6.0. Como resultados; Colombia, y Ecuador, registraron las mayores prevalencias de hipertensión, mientras que, México presentó la mayor carga cardiovascular; la correlación entre ambas variables fue negativa, y de baja magnitud (r = -0,27), sin evidencia de cambios temporales estadísticamente significativos; los resultados evidenciaron trayectorias diferenciadas entre los países. Se concluyó que, la carga cardiovascular no depende únicamente de la prevalencia de hipertensión, sino también de factores sanitarios, institucionales y socioeconómicos; las diferencias observadas respaldan la necesidad de diseñar estrategias de prevención y control adaptadas a las características de cada país.

La transformación digital, ha modificado profundamente el acceso al conocimiento, y los procesos educativos; en América Latina y el Caribe, los gobiernos han impulsado iniciativas para ampliar la conectividad, y reducir la brecha digital; sin embargo, persisten desigualdades económicas, institucionales, y tecnológicas, que limitan el impacto de estas acciones. El objetivo fue, analizar la relación entre la transformación digital, y el desempeño educativo en Bolivia, Colombia, Ecuador, México y Perú durante el período 2010–2024. Se desarrolló una investigación cuantitativa, explicativa, y longitudinal, mediante datos de panel balanceado con 75 observaciones país-año; se utilizaron indicadores de acceso a internet, banda ancha, telefonía móvil, PIB per cápita, desempleo juvenil y gasto público en educación, la variable de resultado fue, la tasa de finalización de la educación secundaria. Los países estudiados evidenciaron un crecimiento sostenido de la conectividad digital; el acceso a internet, y la telefonía móvil, presentaron efectos positivos, y significativos sobre la finalización de la educación secundaria; en contraste, la banda ancha, el PIB per cápita, el gasto en educación, y el desempleo juvenil, mostraron relaciones negativas con el indicador educativo; Perú registró el mayor promedio de culminación escolar, mientras que México, presentó el menor desempeño. La transformación digital favorece el desempeño educativo, cuando amplía el acceso efectivo a internet, y a tecnologías de uso cotidiano; no obstante, la infraestructura tecnológica por sí sola, no garantiza mejores resultados; la calidad institucional, las estrategias pedagógicas, y las condiciones socioeconómicas, determinan el aprovechamiento de los recursos digitales en la educación.

Neuropsychiatric manifestations associated with medical diseases represent a major diagnostic challenge because cognitive, behavioral, affective, psychotic, and consciousness-related symptoms may closely resemble primary psychiatric disorders. This review aimed to analyze the principal medical conditions associated with neuropsychiatric manifestations, identify clinical warning signs that suggest a secondary medical origin, evaluate the diagnostic tools used for differential diagnosis, and examine the role of interdisciplinary management. A descriptive and analytical integrative review was conducted using the Scientific Method as the methodological framework. Twenty scientific publications addressing neurological, autoimmune, endocrine, metabolic, nutritional, infectious, and systemic conditions were analyzed. The most frequently represented etiological group was autoimmune/neurological disorders (40%), followed by endocrine diseases (20%), metabolic/nutritional conditions (15%), other general medical conditions (15%), systemic autoimmune diseases (5%), and infectious conditions (5%). Cognitive impairment was the most frequently identified neuropsychiatric manifestation (75%), followed by behavioral changes (70%), psychosis (65%), mood disturbances (60%), and altered consciousness or delirium (50%). The main clinical red flags were acute or subacute onset (60%), neurological abnormalities (55%), altered consciousness (50%), seizures (45%), and rapid cognitive decline (45%). Laboratory studies and neuroimaging were the most frequently represented diagnostic tools, while neurology, psychiatry, and internal medicine showed the greatest interdisciplinary participation. These findings indicate that the differential diagnosis of neuropsychiatric symptoms should not rely exclusively on psychiatric phenomenology. A structured approach integrating temporal evolution, neurological and systemic warning signs, targeted complementary testing, and interdisciplinary evaluation may improve the recognition of potentially reversible medical causes, facilitate appropriate treatment, and reduce diagnostic delay.

Image-guided minimally invasive neurosurgery has transformed the management of intracranial lesions by integrating advanced imaging, neuronavigation, stereotactic planning, intraoperative visualization, and reduced surgical corridors. The objective of this study was to analyze the anatomical precision, patient-selection criteria, clinical outcomes, and current limitations associated with minimally invasive image-guided neurosurgical approaches. A structured integrative review based on the scientific method was conducted using evidence from PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The analysis included studies addressing neuronavigation, diffusion tensor imaging and tractography, intraoperative magnetic resonance imaging, intraoperative ultrasound, tubular and parafascicular approaches, neuroendoscopy, augmented reality, and laser interstitial thermal therapy. The reviewed evidence showed that intraoperative MRI can significantly increase complete resection rates in selected glioma patients, while intraoperative ultrasound and tubular approaches also demonstrate favorable resection outcomes in appropriately selected populations. Navigation systems showed mean target registration errors of approximately 2.5–2.6 mm, although their accuracy may progressively decrease because of brain shift and intraoperative anatomical deformation. Patient selection was strongly influenced by lesion depth, accessibility, proximity to eloquent structures, lesion size and geometry, previous treatments, neurological status, and expected therapeutic benefit. Current limitations include registration error, imaging artifacts, restricted operative maneuverability, learning curves, procedure-specific complications, cost, technological availability, and heterogeneity of the available evidence. Overall, image-guided minimally invasive neurosurgery can improve anatomical localization and support safer, function-preserving interventions when combined with rigorous patient selection and intraoperative adaptability. Its clinical value should not be defined exclusively by the size of the surgical corridor, but by the capacity to achieve adequate lesion control while minimizing unnecessary disruption of healthy neural structures.

Retinal microcirculation provides a unique opportunity to observe vascular alterations directly and noninvasively. This study analyzed its potential as a biomarker of cerebral and systemic vascular damage and examined emerging applications of fundus photography, optical coherence tomography, optical coherence tomography angiography, and image-based predictive models. An integrative literature review was conducted using the scientific method and included 20 publications comprising prospective cohorts, cross-sectional studies, systematic reviews, meta-analyses, narrative reviews, and predictive investigations. Evidence was organized according to clinical application, methodological design, retinal biomarker, and systemic outcome. Cerebrovascular disease and stroke represented 50% of the publications, followed by cognitive decline and dementia with 25%. Prospective or longitudinal cohorts accounted for 50% of the methodological designs, while systematic reviews and meta-analyses represented 25%. Arteriolar or venular caliber was reported in 70% of the evidence, retinopathy and visible lesion signs in 65%, and arteriovenous ratio, focal narrowing, or arteriovenous nicking in 35%. The greatest concentration of evidence involved retinopathy in relation to cerebral small vessel disease and brain imaging abnormalities. Retinal findings were also associated with incident and lacunar stroke, silent cerebral infarction, white matter lesions, cognitive decline, dementia, coronary disease, biological aging, and mortality. Associations with renal dysfunction were less consistent. Retinal imaging may complement conventional vascular-risk assessment by identifying high-risk phenotypes and supporting targeted systemic evaluation. However, it should not replace neuroimaging or specialized cardiovascular, neurological, or renal assessment. Standardized acquisition, prospective validation, multimodal integration, and transparent predictive models are required before routine clinical implementation.

Damage control surgery (DCS) has evolved from a trauma-focused strategy into an essential component of modern emergency general surgery for selected patients with non-traumatic abdominal emergencies. This review aimed to analyze the current scientific evidence regarding the expanding indications, physiological rationale, perioperative management, and clinical outcomes associated with DCS in conditions such as abdominal sepsis, acute mesenteric ischemia, severe acute pancreatitis, massive gastrointestinal hemorrhage, abdominal compartment syndrome, and vascular emergencies. A structured narrative literature review was conducted using the scientific method. Relevant publications were identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, prioritizing systematic reviews, meta-analyses, clinical guidelines, international consensus statements, and high-quality observational studies. The reviewed evidence demonstrated that DCS is primarily indicated in patients with profound physiological instability characterized by hemodynamic compromise, metabolic acidosis, coagulopathy, hypothermia, severe intra-abdominal contamination, or uncertain bowel viability. Across the analyzed studies, the staged approach consisting of abbreviated surgery, temporary abdominal closure when required, intensive care resuscitation, planned re-exploration, and delayed definitive reconstruction was consistently associated with improved physiological recovery in carefully selected patients. However, postoperative complications including surgical-site infection, respiratory dysfunction, ventral hernia, and enteroatmospheric fistula remain important challenges requiring multidisciplinary management. Although current evidence supports the expanding role of DCS in non-traumatic emergencies, additional prospective multicenter studies are needed to standardize patient selection criteria and optimize clinical protocols. Overall, damage control surgery represents a physiology-guided strategy that has broadened therapeutic possibilities in emergency abdominal surgery while emphasizing individualized clinical decision-making and coordinated multidisciplinary care.