Nilmar Del Valle Toro Arvelaiz

Fragility fractures have become one of the most significant health challenges associated with global population aging, generating substantial consequences for functional independence, healthcare systems, and quality of life. This review aimed to analyze the current scientific evidence regarding the epidemiology, pathophysiology, risk factors, modern orthogeriatric management, and functional recovery of older adults sustaining fragility fractures. A structured literature review was conducted using international scientific databases and evidence-based clinical guidelines published by recognized organizations. The available evidence demonstrates that fragility fractures are multifactorial conditions resulting from the interaction of osteoporosis, sarcopenia, frailty syndrome, multimorbidity, nutritional deficits, and age-related physiological decline. Contemporary orthogeriatric care, based on multidisciplinary collaboration, Comprehensive Geriatric Assessment, timely surgical management, individualized rehabilitation, nutritional optimization, osteoporosis treatment, and secondary fracture prevention, consistently improves mobility, functional independence, postoperative outcomes, and long-term quality of life. Early rehabilitation and coordinated follow-up through structured fracture prevention programs were also associated with lower complication rates and reduced risk of recurrent fractures. Furthermore, the findings emphasize the growing importance of integrating orthopedic surgery, geriatrics, rehabilitation medicine, nutrition, and preventive care into patient-centered management strategies. As demographic aging continues to accelerate worldwide, particularly in Latin America, strengthening orthogeriatric services and implementing evidence-based multidisciplinary models represent essential strategies for preserving autonomy, reducing disability, and improving long-term clinical outcomes among older adults with fragility fractures.

Cardiovascular disease remains the leading cause of mortality worldwide despite substantial advances in lipid-lowering therapies. Although achieving recommended low-density lipoprotein cholesterol (LDL-C) targets significantly reduces cardiovascular risk, many patients continue to experience recurrent cardiovascular events, a phenomenon known as residual cardiovascular risk. Increasing evidence indicates that chronic low-grade inflammation is a major contributor to this persistent risk. This review analyzes current scientific evidence regarding the biological mechanisms, inflammatory biomarkers, and emerging therapeutic strategies associated with residual inflammatory risk beyond LDL cholesterol. The literature demonstrates that activation of the NLRP3 inflammasome and the interleukin-1β/interleukin-6 pathway plays a central role in endothelial dysfunction, plaque progression, and atherosclerotic instability. High-sensitivity C-reactive protein (hs-CRP) remains the most widely validated biomarker for identifying persistent inflammatory activity in clinical practice. Landmark clinical trials, including CANTOS, COLCOT, and LoDoCo2, have demonstrated that selective anti-inflammatory therapies reduce recurrent cardiovascular events independently of additional LDL-C lowering, whereas nonspecific anti-inflammatory approaches have shown limited benefit. Furthermore, obesity, type 2 diabetes mellitus, metabolic syndrome, and chronic kidney disease substantially amplify residual inflammatory risk through shared pathophysiological mechanisms. Current evidence supports a transition toward comprehensive cardiometabolic prevention integrating lipid management, lifestyle modification, metabolic optimization, and targeted anti-inflammatory therapy. Future precision medicine strategies incorporating inflammatory biomarkers and individualized risk assessment may further improve cardiovascular outcomes and reduce the global burden of atherosclerotic disease.

Artificial vision restoration has emerged as one of the most innovative fields in translational medicine, combining advances in ophthalmology, neurology, genetics, biomedical engineering, regenerative medicine, and computational sciences to address irreversible blindness. This review critically analyzes current international evidence regarding retinal prostheses, gene therapy, genome editing, optogenetics, regenerative medicine, bionic eye technologies, and artificial intelligence-assisted visual systems. The available literature demonstrates that retinal prostheses remain the most established neuroprosthetic approach for restoring functional vision, while gene therapy has become the first clinically successful molecular treatment for selected inherited retinal diseases. Emerging strategies such as CRISPR-based genome editing, optogenetic interventions, and stem cell therapies continue to expand the therapeutic landscape by targeting different stages of retinal degeneration. Artificial intelligence further enhances image processing, environmental recognition, and personalized visual rehabilitation, improving the functional performance of existing technologies. Although complete restoration of physiological vision has not yet been achieved, substantial improvements have been reported in light perception, object localization, mobility, environmental interaction, and quality of life. Scientific production remains concentrated in North America, Europe, and Asia, with increasing contributions from Mexico, Colombia, and Ecuador through collaborative genetic research, ophthalmological innovation, and visual rehabilitation programs. Future progress will likely depend on the integration of molecular medicine, neuroprosthetics, regenerative biology, computational intelligence, and multidisciplinary rehabilitation to provide individualized therapeutic strategies for patients with irreversible retinal diseases.