Browsing by Autor "Freddy Ednildon Bautista-Vanegas"

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Application of artificial intelligence in the field of legal and forensic medicine: advances and future challenges
(2025) Themis Karim Ocampo Gamboa; Jhossmar Cristians Auza-Santiváñez; E Fernández; Freddy Ednildon Bautista-Vanegas; Blas Apaza-Huanca; Ingrid Neysa Cabezas-Soliz; Jose Luis Diaz-Guerrero; Ruben Marco Antonio Soliz-Mendoza
Introduction: Artificial intelligence (AI) has emerged as a profoundly transformative tool in numerous fields of knowledge, and its application in legal and forensic medicine is opening a new chapter in forensic science. The development of the “JL-IDIF” system by the Forensic Research Institute (IDIF) has been recognized as an innovative step, setting precedents for the use of advanced technology for the recording and analysis of forensic data. AI represents an unprecedented opportunity to transform legal and forensic medicine, making these processes faster, more efficient, and more accurate. Methodology. An information search was conducted from January to May 2025. Information was collected from scientific articles, books, technical reports, and publications in specialized media, using databases such as PubMed, Scopus, Google Scholar, and websites of forensic and government institutions. This approach allowed for a comprehensive and well-founded synthesis of the available information. Conclusions. The emergence of artificial intelligence (AI) has transformed multiple areas of medicine, and its incursion into forensic and legal medicine marks the beginning of a new era in forensic practice. This review has shown that, while technological advances have demonstrated great potential, significant limitations remain related to data quality, the need for external validation, and the availability of adequate technological infrastructure. In Bolivia, initiatives such as the JL-IDIF project or the experimental implementation of generative AI models demonstrate the interest and initial capacity to explore these emerging technologies. AI should not be viewed as a substitute for human judgment, but rather as a powerful tool that enhances the work of experts, allowing them to focus on critical interpretation and decision-making.
Artificial Intelligence in the Intensive Care Unit: Present and Future
(2025) Jhossmar Cristians Auza-Santiváñez; Ariel Sosa Remón; Freddy Ednildon Bautista-Vanegas; Ingrid Neysa Cabezas-Soliz; Ismael Vargas Gallego; Blas Apaza-Huanca; Jorge Márquez-Molina; Daniel Ramiro Elías Vallejos-Rejas
Introduction: Artificial intelligence (AI) is significantly transforming critical medicine and intensive care. Its ability to process large volumes of data and generate accurate predictions has improved medical decision-making, optimizing diagnosis, treatment, and reducing the workload of healthcare personnel. Methodology: A literature review was conducted between November 2024 and February 2025, consulting databases such as SciELO, LILACS, Scopus, PubMed-MedLine, Google Scholar, and ClinicalKeys. Original articles, case reports, and open-access systematic reviews from the last 5 years were selected, using descriptors in Health Sciences (DeCS) and Boolean operators for the search. Development: Current applications of AI in the ICU include: Monitoring and early detection of adverse events using sensors and machine learning algorithms; diagnosis and prognosis through deep neural networks for medical image interpretation; treatment optimization, including adjustments in mechanical ventilation and pharmacogenomics; efficient management of hospital resources. The future of AI in critical care is oriented towards more explanatory and transparent systems, personalized precision medicine, integration with emerging technologies and automation of clinical processes. Conclusions: Artificial intelligence (AI) is redefining care in intensive care units, improving diagnostic accuracy, optimizing treatments, improving clinical decision-making and thus allowing more efficient hospital management. However, as advanced as it is, it will never replace the empathy and clinical judgment of healthcare professionals. By integrating AI responsibly, we not only save more lives, but we also humanize critical patient care, always remembering that, at the heart of intensive medicine, there is compassion and commitment to each patient.
Artificial intelligence in the Otorhinolaryngology class
(2025) José Alejandro Carías Díaz; Jhossmar Cristians Auza-Santiváñez; Pablo Carías; Vilma Díaz Bonilla; Freddy Ednildon Bautista-Vanegas; Daniel Ramiro Elías Vallejos-Rejas; Jorge Márquez-Molina
Introduction: The development of curricular changes for the training of future doctors in the use of Artificial Intelligence includes the perception that medical students have about this technology and medical students are not always familiar with Artificial Intelligence. Objective: to analyze the academic performance between two groups of students who took the Otorhinolaryngology subject in the sixth year of the medical degree, one that was exposed to Artificial Intelligence and the other to the traditional method, National Autonomous University of Honduras, 2023. Methods: quantitative, correlational study, sample of 34 students, through non-probabilistic convenience sampling, statistical analysis was carried out with SPSS version 25 doing descriptive analysis of central tendency, grouping, and inferential with p value = 0.05 using Pearson's R test.Results: 15 (44.1%) of the students had been studying medicine for 5 years; before taking the class, 2 (5.9%) of the students did not know what the Otorhinolaryngology specialty consisted of; There is a correlation between the curricular approach and the methodology of the subject, so that the student can learn, with a p value of 0.006 (0.005-0.008); there is a correlation between the level of knowledge acquired in Otorhinolaryngology and the methodology of the subject, p value of 0.042 (0.038-0.046). Conclusions: There is a significant correlation between the curricular approach and the methodology of the subject, which directly influences the student's learning process. Similarly, the level of knowledge acquired in Otorhinolaryngology is closely related to the methodology used in its teaching. In the current context, Artificial Intelligence does not replace traditional teaching given by a professor in the Medicine degree and even less so in clinical areas such as Otorhinolaryngology, where practical experience, direct observation and interaction with the patient are essential for the development of medical skills. However, it is undeniable that AI has become a valuable complementary tool, optimizing access to information, facilitating self-directed learning and offering interactive resources that enrich theoretical understanding. In addition, it allows teaching to be personalized according to different learning styles, improving knowledge retention and the overall educational experience.
Artificial intelligence, education and digital inclusion
(2025) Jhossmar Cristians Auza-Santiváñez; Nayra Condori-Villca; Isaura Oberson Santander; Luis Mariano Tecuatl Gómez; Laura Pamela Mamani Manzaneda; Adalid Rimer Condo-Gutierrez; Ariel Sosa Remón; Manashree Mane; José Alejandro Carías Díaz; Freddy Ednildon Bautista-Vanegas
Introduction: The rapid development of human scientific endeavor has enabled the implementation of increasingly automated systems that facilitate certain functions and processes in all spheres of life. Objective: To describe the application of artificial intelligence in education as a strategy to ensure digital inclusion. Method: A comprehensive literature review was conducted. The search was conducted in: SCielo, PubMed, and SCOPUS, repositories, and the Google Scholar search engine. The search strategy consisted of descriptors. 32 papers were used to develop this article. Development: AI provides significant tools, from the graphic representation of content in educational contexts to the creation of conceptual maps and the development of tests to validate acquired knowledge. However, its use must be urgent without losing the guiding and methodological thread, always recognizing that the goal is the acquisition of knowledge. Universities require projection at different scales to present their results for the sake of sociocultural and academic scientific development. With the implementation of AI, this outreach function can be fulfilled, guaranteeing direct and personalized access and promoting digital inclusion. Conclusions: The use of AI in educational subjects offers new platforms and work scenarios. Each of its capabilities adapts to the specifics of the educational environment, while also enhancing easy, affordable, and universal access to educational content.
Asymptomatic multiorgan cysticercosis. A case report from Bolivia
(2025) Mildred Ericka Kubatz La Madrid; Jennifer Collazo Cruz; Yamila Cruz Cruz; Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; Benito Aguirre-Cruz; Ingrid Neysa Cabezas-Soliz; Carmen Julia Salvatierra-Rocha
Introduction: Cysticercosis is an infectious disease caused by Taenia solium, endemic to Latin America, Asia, and Africa. It is acquired by consuming Taenia eggs in contaminated water and food, or undercooked pork. It generally causes mild or asymptomatic disease, except for neurocysticercosis, which can be severe and potentially fatal. Symptoms depend on the number of parasites, their location, and the host's immune response. Diagnosis is based on epidemiological data, clinical presentation, and imaging studies, primarily computed tomography. Objective: To use computed tomographic images to identify the degree of tissue damage caused by Taenia solium in an asymptomatic Bolivian adult. Clinical case: A 52-year-old Bolivian female patient from a rural area, with a wooden house, dirt floor, no sewage or drinking water, a housewife, who practices open defecation and raises pigs to support her household. She had a personal health history, but an inadequate diet. She was taken to the Roberto Galindo Hospital due to a traffic accident, where an emergency CT scan of the head and abdomen was performed due to direct trauma to those areas. The studies revealed calcifications in multiple organs, findings suggestive of massive cysticercosis. Conclusions: Cysticercosis is a parasitic disease transmitted fecal-orally, preventable but highly contagious from country to country due to social migration. It constitutes a serious health problem due to the biological, economic, and social damage it entails, making increased epidemiological surveillance essential.
Attention Deficit Hyperactivity Disorder: Advances in Epidemiology, Pathogenesis, and Neurobiology
(2025) Freddy Ednildon Bautista-Vanegas; Rodolfo R. Rosales; Ingrid Neysa Cabezas-Soliz; Daniel Ramiro Elías Vallejos-Rejas; Carmen Julia Salvatierra Rocha; Jhossmar Cristians Auza-Santiváñez; L. Castedo; Delly Espejo-Alanoca; Isaura Oberson Santander
Introduction. ADHD is a neurodevelopmental condition that affects approximately 5-7% of children and adolescents and persists in a significant number of cases into adulthood, with an estimated prevalence of 2.5% in adults globally. The impact goes far beyond school or work performance; it is associated with an increased risk of accidents, risky behaviors, comorbid disorders such as anxiety, depression, substance use disorders, and a significant reduction in quality of life. Methods. A search was conducted in the databases SciELO, Scopus, PubMed/MedLine, Google Scholar, Cochrane Library, as well as Clinical Keys services. The search terms for the search formulation were "ADHD", "Attention Deficit Disorder", "Hyperactivity", "depression", "autism spectrum", "anxiety", as well as their translations into English. Results. The reported prevalence of ADHD in children ranges from 2 to 18 percent depending on the diagnostic criteria and the population studied. The prevalence in school-aged children is estimated to be between 9 and 15 percent, making it one of the most common childhood disorders. Possible etiological factors include comorbid disorders, oppositional defiant disorder, conduct disorder, anxiety disorder, depression, developmental coordination disorder, autism spectrum disorder, and sleep disorders. Conclusion: ADHD constitutes a complex neurodevelopmental condition whose impact transcends clinical boundaries to become a multifaceted challenge for public health, neuroscience, and social justice.
Bibliographic review on the application of biomaterials in neurological disorders
(2025) Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; José Alejandro Carías Díaz; Blas Apaza-Huanca; Ariel Sosa Remón; Adalid Rimer Condo-Gutierrez; Laura Pamela Mamani Manzaneda; Luis Mariano Tecuatl Gómez; Isaura Oberson Santander; Nayra Condori-Villca
Introduction: the process of endogenous neurogenesis is not capable of replenishing lost cells after an injury that can result in massive cell loss. Biomaterials are being developed to mimic the brain’s extracellular matrix, providing scaffolds that promote tissue repair and regeneration. The objective was to characterize the application of biomaterials in neurological affections.Methods: a literature review was conducted, where 20 articles in English and Spanish were selected, published in the last five years on the subject, in databases such as: Scopus, PubMed, Springer.Results: biomaterials play an essential role in the human body by serving as artificial substitutes or implants that interact with living tissues, organs, and bodily fluids. Emerging approaches, including stem cell therapy, biomaterials, immune cell therapy, and exosome-based treatments, show promise in modulating the inflammatory response while avoiding broad suppression of immune function. With that in mind, researchers are exploring how these materials could help repair nerve damage once thought to be permanent, boost brain function, and play a key role in fields like neuro-oncology and neuro-rehabilitation. Conclusions: biomaterials enable safe contact with living tissue and offer promise in neuroscience. Research is still needed to address ethics and ensure safe use.
Bioprocess Engineering: Advances in Cell Culture Systems, Reactor Design, Scale-up Strategies, and Intensification Processes for the Production of Biological and Bioactive Compounds
(2025) Freddy Ednildon Bautista-Vanegas; Jose Luis Diaz-Guerrero; Ingrid Neysa Cabezas-Soliz; Blas Apaza-Huanca; E Fernández; Jhossmar Cristians Auza-Santiváñez; Themis Karim Ocampo Gamboa; Rodolfo R. Rosales; Luis Mariano Tecuatl Gómez; Pablo Carías
Bioprocess engineering is undergoing an unprecedented transformation, driven by the growing demand for complex and bioactive biological products across diverse industries, from pharmaceuticals to food and energy. Recent advances have redefined the efficiency, scalability, and sustainability of biomanufacturing. Key elements of this evolution include the widespread adoption of single-use systems, the integration of automation and artificial intelligence (AI) for precise control and predictive optimization, and the fundamental shift toward continuous bioprocessing. These innovations not only reduce costs and production times but also improve product quality and consistency, enabling the manufacturing of personalized therapies and high-value compounds. Scaling strategies have diversified to include both scale-up and parallel expansion (scale-out), tailored to specific product needs. Together, these developments are laying the foundation for more agile, cost-effective, and environmentally responsible biomanufacturing, preparing the industry to address global challenges in health and sustainability.
Current perspectives in the diagnosis and management of bacterial meningitis. Literature review and update
(2025) Jhossmar Cristians Auza-Santiváñez; Blas Apaza-Huanca; C. Roman; P. Ussetti Gil; José Bernardo Antezana-Muñoz; Freddy Ednildon Bautista-Vanegas; Jorge Márquez-Molina; Mildred Ericka Kubatz La Madrid; Eloy Paycho Anagua
Introduction: Bacterial meningitis is a serious and potentially fatal disease that has represented a significant challenge to medicine since its identification in the 19th century. Despite advances in antimicrobial treatment, it remains a major cause of morbidity and mortality worldwide. This review aims to update current perspectives on the diagnosis and management of bacterial meningitis, focusing on its pathogenesis, clinical manifestations, diagnostic methods, and therapeutic strategies. Methods: A search for information was carried out in the period August-December 2024 in the SciELO, LILACS, Scopus, PubMed-MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. For the recovery of information, an advanced search strategy was used and the terms “meningitis or bacterial meningitis” were used, as well as their translations into the English language. To combine the terms, Boolean operators were used, with search formulas according to the syntax requested by each database. Furthermore, in order to achieve a review based on the best possible evidence, only studies of the type case series, original articles or systematic reviews were selected. Results and discussion: Bacterial meningitis develops when pathogens overcome the host's defense mechanisms, colonizing mucous membranes, invading the bloodstream and penetrating the subarachnoid space. The main pathogens include Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. The most common clinical manifestations are fever, headache, stiff neck and altered mental status. Diagnosis is based on analysis of cerebrospinal fluid (CSF), which shows pleocytosis, increased protein and decreased glucose. Empirical treatment includes antibiotics such as cefotaxime, ceftriaxone and vancomycin, together with dexamethasone as adjuvant therapy to reduce inflammation. Conclusions: Bacterial meningitis is a serious infection of the central nervous system, a medical emergency whose mortality and sequelae can be reduced with timely diagnosis and treatment. The key is to start treatment immediately and without delay. Prevention is the cornerstone of its control. Only through multidisciplinary management, which could include an expert infectious disease specialist, an intensive care physician, a specialized nurse and adequate laboratory equipment, can the impact of this devastating disease be mitigated.
Electrolyte and Internal Environment Imbalances in Emergencies (Spanish Edition)
(2025) Jorge A. Barrios Flores; Freddy Ednildon Bautista-Vanegas; José Bernardo Antezana-Muñoz; Mauricio Paz del Rio; Luis Mariano Tecuatl-Gómez; Alberto Martin Diaz-Seminario; Manuel Alejandro Brito del Castillo; Ariel Sosa Remón; Adalid Rimer Condo-Gutierrez; Isis Scarleth Funes-Galindo
Electrolyte and internal environment disorders represent some of the most frequent and clinically significant challenges in emergency and critical care settings. Their impact can be abrupt, severe, and life-threatening. In many cases, a subtle change in sodium, potassium, chloride, or water balance may determine the difference between stability and rapid clinical deterioration. For this reason, the ability to recognize, interpret, and intervene promptly is a core skill for physicians who care for critically ill patients, whether in emergency departments, intensive care units, or high-dependency hospital settings.This book was conceived as a practical and accessible clinical tool. It is designed to integrate physiological understanding with bedside decision-making, providing a clear bridge between foundational science and real-time therapeutic action. Each chapter has been developed collaboratively by clinicians actively engaged in emergency and critical care practice across various healthcare systems. Their contributions reflect not only scientific knowledge, but the lived experience of caring for patients in contexts where urgency, uncertainty, and limited time demand clarity and precision.While electrolyte and internal environment alterations are deeply rooted in complex physiology, our goal has been to make their clinical reasoning straightforward. Diagnostic approaches, pathophysiological mechanisms, and treatment strategies are presented in a concise and applicable manner. We emphasize concepts that are essential for rapid assessment, careful correction, and prevention of iatrogenic harm.This work is dedicated to the medical professionals who stand at the bedside in the most critical moments, and to the patients whose resilience gives meaning to every clinical effort. It is our hope that this book will serve as a support, a guide, and a companion in the demanding and noble responsibility of emergency medicine and critical care.
Epidemiological, clinical, and therapeutic profile of tuberculosis in a high-burden Latin American capital: Tegucigalpa, Honduras
(2025) Alejandro Carías; Lourdes Carolina Vega; Pablo Carías; Jhossmar Cristians Auza-Santivañez; Sara Milca Robles-Nina; Freddy Ednildon Bautista-Vanegas; Ingrid Neysa Cabezas Soliz; Jose Bernardo Antezana-Muñoz; Jaykel Evelio Gómez-Triana
Introduction: Tuberculosis (TB) remains a major public health problem in Honduras, particularly in urban areas such as Tegucigalpa. Identifying clinical and epidemiological patterns helps guide control strategies. Objective: To describe the sociodemographic, clinical, and treatment outcome characteristics of patients diagnosed with TB in Tegucigalpa between 2022 and 2024. Methods: A descriptive, retrospective study was conducted with 165 patients diagnosed with TB. Data on sociodemographics, medical history, diagnostic methods, type of TB, treatment regimen, and discharge condition were collected. Analysis was performed using frequencies and percentages. Results: Males accounted for 61.2% of patients. Unemployed individuals represented 15.8%, prisoners 14.5%, and housewives 8.5%. A total of 14.5% had completed preschool education, and another 14.5% had no formal education. The most common comorbidity was diabetes mellitus (11.5%), followed by diabetes mellitus/hypertension (8.5%). The most frequent diagnostic method was smear microscopy (80.6%). Pulmonary TB accounted for 97.6% of cases. Basic treatment was administered to 96.4% of patients. Cure rate was 84.8%, with 3.6% relapses and 1.8% deaths. Conclusion: Most TB cases in Tegucigalpa occurred in adult men with low education levels and chronic comorbidities such as diabetes. Diagnosis was mainly through smear microscopy, with a high cure rate, though challenges remain in relapse monitoring and prevention in vulnerable populations.
Evidence-based pediatric podiatry: literature review and update
(2025) Freddy Ednildon Bautista-Vanegas; Magaly Zurita Villazón; Marlon Carbonell González; Jhossmar Cristians Auza-Santiváñez; Abigail Jazmin Arce-Santivañez; Camila Tassoula Egüez-Pereira; Daniel Ramiro Elías Vallejos-Rejas; C. Roman; Ingrid Neysa Cabezas-Soliz; Liliana Heydi Suarez Laime
Introduction: Pediatric podiatry has become established as an essential discipline in the comprehensive approach to the developing child. Alterations in the morphology and functionality of the children's foot, such as flexible flatfoot, are frequent reasons for consultation and require careful evaluation based on scientific evidence. Objective: This narrative review aims to analyze the evolution of knowledge on the anatomy and physiology of the children's foot, identify the prevalent podiatric conditions in childhood, review the main therapeutic interventions available and update the role of the podiatrist in the current clinical context. Methods. A search for information was carried out in the period May - July 2025, in the databases SciELO, Scopus, PubMed / MedLine, the Google Scholar search engine, Cochrane Library, as well as in the Clinical Keys services. Only those studies of the type systematic reviews, meta-analyses, randomized controlled trials (RCTs), controlled clinical trials (CCTs), observational studies and cross-sectional designs were selected. Results: Evidence shows that most cases of flexible flatfoot in childhood are physiological and do not require treatment, except in the presence of symptoms. Foot orthoses, functional re-education exercises, and appropriate footwear have proven effective in selected cases. In particular, intrinsic muscle strengthening programs have shown improvements in the plantar arch and gait. Current clinical practice remains variable, making ongoing training and the adoption of standardized protocols crucial. Conclusions: Timely, individualized, and evidence-guided intervention can prevent long-term musculoskeletal complications, improve locomotor function, and contribute to a better quality of life in childhood. The role of the pediatric podiatrist should be integrated into the multidisciplinary team for a comprehensive approach to child development.
Immune thrombocytopenia a key piece of the puzzle for the diagnosis of atypical systemic lupus erythematosus in critically ill patients. Case report
(2025) P. Ussetti Gil; Felipe Verscheure Peralta; Jhossmar Cristians Auza-Santiváñez; Mariela Marpartida Vildoso; Eduardo Ustarez; Jovanna Baptista; F. Gavilán Carrasco; Freddy Ednildon Bautista-Vanegas
Introduction: immune thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibody-mediated destruction of platelets, resulting in low platelet count and increased risk of bleeding, and may be an initial manifestation of systemic lupus erythematosus (SLE), especially in patients with findings suggestive of autoimmunity.Clinical Case: a 52-year-old male presented with fever, hematuria, generalized petechiae (including mucous membranes), myalgia, mucosal bleeding, oliguria progressive to anuria, and severe arterial hypertension. Initial studies revealed severe anemia, severe thrombocytopenia, and acute kidney injury, which led to his admission to the Intensive Care Unit (ICU). Complementary studies showed positive ANA, low complement (C3, C4), and positive anti-Ro, while anti-dsDNA antibodies, ANCA, and markers of antiphospholipid syndrome were negative. Imaging revealed pulmonary edema with mild alveolar hemorrhage and renal ultrasound findings consistent with active lupus nephritis. These findings raised the possibility that severe thrombocytopenia was a prelude to SLE. After initial treatment refractory, the patient was escalated to rituximab, with a favorable response without complications, which allowed discharge from the ICU.Conclusions: this case highlights the importance of considering SLE in patients with refractory thrombocytopenia without apparent cause, even in men, and underlines the need for a multidisciplinary approach for timely diagnosis and treatment, thus preventing serious complications.
Impact of Altitude on Cardiovascular Physiology: Literature Review and Update
(2025) Jhossmar Cristians Auza-Santiváñez; Henrry Temis Quisbert Vasquez; Freddy Ednildon Bautista-Vanegas; Delly Espejo-Alanoca; Ponciano Chiri-Chambi; Victor Hugo Mamani Huarachi; Benito Aguirre-Cruz; Katrin Daniela Sivila-Marquez; Jose Luis Diaz-Guerrero
Introduction: More than 140 million people in the world live at high altitudes, above 2,500 meters (m) above sea level. Oxygen is vital for cellular metabolism; therefore, hypoxic conditions found at high altitude affect all physiological functions. Metods: A search for information was carried out in the SciELO, Scopus, PubMed/MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. Advanced search strategies were used to retrieve the information, by structuring search formulas using the terms "Cardiovascular Physiology", "Cardiovascular Physiology at Altitude", as well as their translations into Spanish " Fisiología Cardiovascular " and " Fisiología Cardiovascular en la altitud ". Results discussion: The heart is composed of three main types of cardiac muscle: atrial muscle, ventricular muscle, and specialized excitatory and conductive muscle fibers. The efficiency and work of the heart as a pump is often measured in terms of cardiac output, or the amount of blood the heart pumps per minute. Cardiac output is the product of stroke volume and heart rate Cardiovascular Changes at Altitude It is possible to think of the goal of acclimatization as maintaining oxygen delivery to the tissues as close to normal as possible. The cardiovascular system is central to this. Acute exposure to high altitude produces an increase in heart rate and cardiac output both at rest and for a given amount of work compared with sea level. In general, the normal heart tolerates even severe hypoxia very well. The heart, as a hemodynamic pump, has two mechanisms at its disposal to enhance its performance: heart rate and stroke volume, which together constitute cardiac output. The altitude electrocardiogram shows a variably increased amplitude of the P wave, deviation of the QRS axis to the right, and signs of right ventricular overload and hypertrophy. Conclusions: Advances in high-altitude research have shown that the cardiovascular system deploys some efficient mechanisms of acclimatization to oxygen deprivation, and the healthy heart adapts to hypoxia, even when severe, with preservation of systolic function and only minor impairment of LV and RV diastolic function. With acclimatization, desensitization of the adrenergic system, together with increased parasympathetic influence, leads to a decrease in maximum heart rate and protection of the myocardium against potentially damaging energy imbalances. Acute exposure to high altitude stimulates the adrenergic system, increasing heart rate and cardiac output; although arterial pressure remains stable, pulmonary artery pressure increases due to hypoxic pulmonary vasoconstriction. Our improved understanding of the effect of altitude hypoxia on the cardiovascular system will allow better-informed, evidence-based advice for patients with pre-existing cardiovascular disease
Management of neuromyelitis optica spectrum disorder at the Escuela Hospital, Honduras
(2025) D Escalante; G. Lagos; Harlis Estrada Pastrana; Pablo Carías; José Alejandro Carías Díaz; Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; Dilma Villca-Villca
Neuromyelitis optica spectrum disorder is an autoimmune-based nosological entity with inflammatory characteristics that affects the central nervous system: optic nerves, spinal cord and brainstem. Objective: To present a series of clinical cases to briefly review the management of neuromyelitis optica spectrum disorder. Methodology: A retrospective and descriptive analysis was performed on the patients who attended the outpatient clinic of the Teaching Hospital and who have been diagnosed and followed up for neuromyelitis optica spectrum disorder over the last 20 years. Results: Eight patients (100.0%) were female, ranging in age from 19 to 45 years, with a mean of 32 years. All patients (8) (100.0%) underwent anti-aquapurin 4 antibodies for diagnosis; four (50.0%) had unremarkable brain and orbital magnetic resonance imaging (MRI). Neuromyelitis optica spectrum disorder is a disease that requires an accurate diagnosis based on clinical features, anti-aquapurin 4 antibodies, and imaging studies. Treatment may begin with steroids, although in cases where the disease is not controlled, rituximab may be used.
Measles: A Comprehensive Review of the Virus and Its Public Health Implications
(2025) C. Roman; Jhossmar Cristians Auza-Santiváñez; Cleotilde U. Torres; Freddy Ednildon Bautista-Vanegas; Daniel Ramiro Elías Vallejos-Rejas; Henrry Temis Quisbert-Vasquez; José Bernardo Antezana-Muñoz; Giovanni Callizaya Macedo; Mildred Ericka Kubatz La Madrid
Historically, measles has been an infectious disease responsible for significant morbidity and mortality worldwide. Global vaccination efforts have had a transformative impact, with measles immunization estimated to have prevented more than 60 million deaths globally between 2000 and 2023. Despite these successes, the global goal of measles elimination by 2030, outlined in the Measles and Rubella Strategic Framework 2021-2030, is now under considerable threat due to the recent re-emergence of the disease. Addressing the measles crisis is not only about containing this specific virus, but also about strengthening the fundamental resilience of public health systems worldwide to prepare for and mitigate a broader spectrum of infectious disease threats. This narrative review article aims to provide a comprehensive analysis of the global re-emergence of measles. Clinical and epidemiological trends will be detailed, key factors contributing to this resurgence will be identified, and public health implications will be examined. An analysis of the situation in Bolivia will be included, offering localized perspectives on the challenges and responses. Finally, the article will conclude with strategic recommendations for public health interventions and future preparedness.
Neurological emergencies in cancer: pathophysiological and prognostic implications with a focus on the elderly
(2025) Ana Esperanza Jeréz Álvarez; Ariel Sosa Remón; Jhossmar Cristians Auza-Santiváñez; Miguel Emilio García Rodríguez; Arian Jesús Cuba Naranjo; Yudiel Pérez Yero; Jorge Márquez-Molina; Freddy Ednildon Bautista-Vanegas
Introduction: Neurological emergencies in cancer patients are associated with high mortality. This mortality rate is particularly prevalent in the older adult population, for whom limited scientific evidence exists. The objective of this review was to describe the pathophysiological mechanisms and prognosis of the main neurological emergencies that occur in older patients with cancer and lead to their admission to the Intensive Care Unit. To this end, a narrative review of the literature available in databases and search engines such as PubMed, Medline, Scopus, Scielo, and Google Scholar was conducted using the search terms: neuro-oncological emergencies, neurological complications, oncological intensive care, prognostic factors for cancer mortality, and their English translations. The review was conducted between November 2024 and March 2025. Forty-nine references from articles that met the inclusion criteria were used. Among the main results, it is worth highlighting that the main neurological complications described are predominantly metabolic encephalopathy, stroke, status epilepticus, and intracranial hypertension. These factors share mechanistic relationships with neurocritical patients in general, although cancer appears to be a significant factor in their onset and mortality prognosis. This is accompanied by other variables of prognostic interest such as advanced age, cancer stage, individual functional status, hyperglycemia, sepsis, septic shock, and artificial ventilation. It is concluded that pathophysiological and prognostic knowledge of critically ill older neuro-oncology patients is still limited and warrants multiple investigations in their own clinical context. This is because the greatest available evidence corresponds to young adult neurocritical patients without cancer.
Overweight, Obesity and High Blood Pressure: Early Atherogenic Signs in Children Aged 3 to 7 Years
(2025) Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; Ingrid Neysa Cabezas-Soliz; Henrry Temis Quisbert Vasquez; Yenifer Zelaya-Espinoza; Jorge Márquez-Molina; Delly Espejo-Alanoca; Paola Kattya Barrientos Lujan; Isaura Oberson Santander
Introduction: Human atherosclerosis has been considered for centuries as one of the greatest predators of health, its distribution on the planet is so wide that it overwhelmingly surpasses any other pathological process and reaches epidemic proportions, both in economically developed populations and in the process of becoming so.Objective: To identify the presence of overweight, obesity and arterial hypertension as early signs of atherosclerosis in children aged 3-7 years.Methods: A descriptive-analytical cross-sectional epidemiological study was carried out in 5 clinics of the "19 de abril" University Polyclinic, in the Plaza de la Revolución municipality, Havana City, during the period 2022-2023. The sample consisted of 152 children aged 3 to 7 years who met the inclusion criteria. The data were collected using the new model (AtecomR) and stored in an automated database in Microsoft Access. Statistical processing was performed using the SPSS statistical package, through a Toshiba Intel (R) Pentium IV microprocessor.Conclusion: This study constitutes a preamble for other investigations that address the problem of cardiovascular disease from the perspective of intrauterine life. The results have provided certain evidence, which, together with a review of the literature, has allowed us to propose the following conclusions. A high frequency of obesity, overweight and high blood pressure levels was identified in the study population. It was observed that in the obese and overweight group they had a tendency to increase with age, being higher their frequency between five and six years respectively. It was shown that overweight and obesity in children were factors for the presence of alterations in blood pressure.
Prognostic scale for death in critically ill cancer patients due to neurological complications
(2025) Ariel Sosa Remón; Freddy Ednildon Bautista-Vanegas; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Yudiel Pérez-Yero; Arian Jesús Cuba Naranjo; Miguel Emilio García Rodríguez; Jhossmar Cristians Auza-Santiváñez; Ana Esperanza Jeréz Álvarez; J. Triana
Introduction: The scales used to predict death in cancer patients are scarce and have not been adequately validated in populations with neurological complications. Objective: To design a prognostic scale for death in critically ill cancer patients due to neurological complications. Method: An observational, prospective cohort study was conducted from January 2017 to 2024 in the Oncology Intensive Care Unit of the Institute of Oncology and Radiobiology in Havana, Cuba. The study population consisted of 265 patients. Clinical, oncological, laboratory, and life support variables were studied. Binary logistic regression analysis was used to determine the variables with the best prognostic power for the model. The final variable was mortality in the Intensive Care Unit. Results: The final model consisted of the following variables: ECOG III (OR: 3.62; 95% CI: 1.05 - 12.46; p= 0.041), absence of pupillary reflex (OR: 9.35; 95% CI: 2.24 - 38.99; p= 0.002), intracranial hypertension (OR: 17.91; 95% CI: 3.02 - 105.91; p= 0.001), hyperglycemia (OR: 5.85; 95% CI: 2.07 - 16.49; p= 0.001), hypoxemia (OR: 19.09; 95% CI: 2.91 - 61.67; p= 0.000) and artificial mechanical ventilation (OR: 9.59; 95% CI: 2.59 – 35.51; p = 0.001).Conclusions: The prognostic score classified mortality into 3 risk groups: low (0 to 2 points), moderate (3 to 6 points), and high (7 to 13 points). Mortality was higher in patients with higher scores. Internal validation showed excellent calibration and discrimination.
Structural and functional disorders in children’s feet, motor development, and preventive approaches in early life
(2025) Jhossmar Cristians Auza-Santiváñez; Freddy Ednildon Bautista-Vanegas; José Alejandro Carías Díaz; Blas Apaza-Huanca; Ariel Sosa Remón; Adalid Rimer Condo-Gutierrez; Laura Pamela Mamani Manzaneda; Luis Mariano Tecuatl Gómez; Isaura Oberson Santander; Nayra Condori-Villca
Pediatric podiatry addresses structural and functional disorders of the foot in children (0-18 years), which are crucial for motor and postural development and overall health. Children's feet, which are constantly evolving until the age of 14, have tissue plasticity that favors early corrections but also makes them vulnerable to deformities such as flexible flat feet (physiological in infants, resolves spontaneously in >90% of cases), clubfoot (requires early Ponseti method), and adducted metatarsus (90% spontaneous resolution in flexible cases). . Gait abnormalities (intra/extraversion, idiopathic toe walking) are usually normal transient variants. Early detection is vital: persistent pain, limping, visible deformities, or asymmetrical shoe wear require evaluation. Diagnosis combines physical examination (toe walking test, alignment analysis) and imaging (X-ray, MRI) to differentiate physiological variants from pathologies (e.g., tarsal coalition in rigid flatfoot). Key preventive strategies include the use of appropriate footwear, motor stimulation, and good postural/hygienic habits. Multidisciplinary intervention (podiatrist, orthopedist, physical therapist) should take advantage of the window of childhood plasticity (<7 years), prioritizing conservative approaches (orthotics, exercises) over surgical ones. Annual checkups starting at 3-4 years of age optimize prognoses and prevent complications in adulthood.