Andres Mauricio Jaimes Lázaro

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.

The vaginal microbiome has emerged as a fundamental determinant of female reproductive health and a promising therapeutic target for the prevention and management of gynecological and obstetric complications. This review aimed to critically analyze the current scientific evidence regarding emerging microbiome-targeted therapeutic approaches, emphasizing their biological mechanisms, clinical effectiveness, therapeutic potential, and future applications in personalized reproductive medicine. A structured narrative review based on the Scientific Method was conducted using publications retrieved from internationally recognized databases, including PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink, Nature Portfolio, and Google Scholar. Recent evidence demonstrates that vaginal dysbiosis is strongly associated with bacterial vaginosis, recurrent vulvovaginal candidiasis, infertility, recurrent urinary tract infections, preterm birth, and other adverse pregnancy outcomes. The analyzed literature indicates that probiotics currently possess the strongest clinical evidence, while live biotherapeutic products, vaginal microbiota transplantation, postbiotics, prebiotics, and advanced vaginal drug delivery systems represent rapidly evolving therapeutic alternatives with considerable potential for restoring microbial homeostasis. These interventions extend beyond pathogen elimination by promoting immune regulation, epithelial barrier integrity, long-term microbial stability, and personalized therapeutic strategies. Although important methodological limitations remain, including heterogeneity among studies and limited long-term clinical data, microbiome-directed therapies are expected to play an increasingly significant role in precision reproductive medicine. Continued multidisciplinary research and high-quality clinical trials will be essential to facilitate their safe and effective integration into routine gynecological and obstetric practice.