Universidad Westhill

Gynecologic health has traditionally been approached through a reproductive-centered lens; however, growing international evidence demonstrates that gynecologic conditions, hormonal transitions, and interventions exert significant systemic and long-term clinical effects across the female lifespan. This narrative review synthesizes high-impact literature addressing gynecologic health beyond reproductive function, with particular emphasis on metabolic, cardiovascular, endocrine, immune-inflammatory, genitourinary, and oncologic outcomes. Chronic conditions such as polycystic ovary syndrome and endometriosis are examined as early and midlife determinants of long-term systemic risk, while menopause is analyzed as a critical biological transition influencing cardiometabolic health. The review also explores the long-term implications of gynecologic surgery, hormonal contraception, and menopausal hormone therapy, highlighting the complexity and context-dependence of associated risks and benefits. By adopting a life-course and systems-based perspective, this article underscores the importance of integrating gynecologic history into comprehensive risk assessment, preventive strategies, and medical education. The findings support a reframing of gynecology as a foundational component of women’s overall health, with relevance across diverse healthcare settings, including Mexico, Colombia, and Ecuador.

Augmented reality (AR) has emerged as a promising adjunct technology in microsurgery, offering new possibilities to enhance three-dimensional visualization and technical precision during vascular anastomosis. Microsurgical procedures are inherently constrained by limited depth perception, narrow fields of view, and high demands on fine motor control, making even minor spatial errors clinically significant. This review synthesizes current evidence on the application of AR-assisted microsurgery, with a particular focus on its impact on precision, spatial orientation, depth perception, procedural efficiency, and educational utility. The analysis integrates findings from experimental validation studies, training-oriented investigations, and early clinical feasibility reports, highlighting consistent patterns across diverse AR platforms. Results indicate that AR most reliably improves precision and alignment during microvascular tasks, especially when visualization cues are tightly integrated into operative microscopy. Depth perception enhancement is frequently reported but remains dependent on overlay design and system stability, while efficiency outcomes show greater variability. In educational settings, AR demonstrates meaningful benefits in skill acquisition and task repeatability among trainees. Nevertheless, persistent technical and workflow-related constraints—such as registration accuracy, interface burden, latency, and setup complexity—continue to limit widespread adoption. Overall, AR should be regarded as a precision-enhancing support tool that complements microsurgical expertise rather than replacing it. Continued refinement in system integration, human–machine interaction, and standardization of outcome metrics will be essential to advance its role in microsurgical vascular anastomosis.

The vaginal microbiome has emerged as a critical determinant of gynecologic health, influencing infectious, reproductive, endocrine, and oncologic outcomes through complex ecological and host–microbial interactions. This review synthesized evidence from 20 recent studies to characterize the relationships between microbial community structures and major gynecologic disorders, incorporating perspectives from North America, Europe, Asia, Africa, and Latin America, including Mexico, Colombia, and Ecuador. Across the literature, Lactobacillus-dominant communities consistently appeared as protective biological states, whereas anaerobic-rich dysbiosis and unstable community state types (CSTs) were strongly associated with bacterial vaginosis, pelvic inflammatory disease, infertility, implantation failure, preterm birth, HPV persistence, and chronic inflammatory conditions. Temporal analysis revealed a substantial rise in microbiome-focused publications between 2020 and 2022, while geographic mapping exposed persistent disparities, with limited representation from Latin American populations. These findings underscore the need for region-specific research to refine diagnostic frameworks and develop clinically relevant, culturally appropriate interventions. The review highlights emerging translational opportunities, including microbiome-guided diagnostics, personalized risk stratification, and targeted therapeutic strategies aimed at restoring microbial stability. Overall, the vaginal microbiome represents a promising frontier in precision gynecology with the potential to transform prevention, diagnosis, and management of complex gynecologic disorders worldwide.

Background: Incisional hernia remains one of the most frequent complications after midline laparotomy, associated with significant morbidity, readmissions, and reoperations. Although small-bite suture techniques have reduced hernia rates, mechanical failure of the fascial closure remains an unresolved problem. Objective: The reinforced tension line (RTL) technique was developed to enhance the biomechanical strength of abdominal wall closure by optimizing the distribution of tensile forces and preventing suture pull-through. Methods and Evidence: The RTL method involves the placement of a longitudinal, nonabsorbable suture parallel to the primary fascial closure. This additional suture functions as a mechanical reinforcement line that redistributes peak tensile forces from the fascial edges into surrounding tissue. Recent randomized clinical trial data demonstrate that supplementing standard small-bite closure with an RTL suture significantly reduces the incidence of incisional hernia following midline laparotomy for colorectal cancer—from 21% with standard closure to 6% with RTL augmentation—without increasing wound complications or adverse events. Results and Relevance: The RTL technique is especially useful when mesh reinforcement is contraindicated, such as in contaminated or emergent settings. It provides a cost-effective, mechanically sound, and biologically compatible alternative to mesh while maintaining a simple surgical workflow. However, mesh reinforcement remains superior for long-term prevention in high-risk elective cases. Conclusion: RTL represents an innovative approach to fascial closure that enhances mechanical stability without introducing prosthetic material. Ongoing research is needed to define its long-term outcomes and applicability in complex abdominal wall reconstruction.

Objetivo: Evaluar la eficacia y seguridad de la lipotransferencia autóloga (AFG), sola o en combinación con bioestimuladores, en el rejuvenecimiento facial y la reconstrucción oncológica. Métodos: Se realizó una revisión sistemática siguiendo la declaración PRISMA 2020. Se consultaron PubMed, Embase y Cochrane Library entre enero de 2014 y julio de 2024. Se incluyeron ensayos clínicos, estudios observacionales y revisiones sistemáticas que evaluaran AFG aislada, bioestimuladores (ácido poli-L-láctico [PLLA], hidroxiapatita cálcica [CaHA]) o la combinación de ambas en rejuvenecimiento y oncología reconstructiva. Resultados: De 642 artículos identificados, 26 cumplieron los criterios de inclusión. La AFG aislada mostró mejoras en volumen y calidad tisular, aunque con variabilidad en la supervivencia del injerto (reabsorción 20–40%). Los bioestimuladores demostraron eficacia en elasticidad y densidad dérmica, con resultados sostenidos 18–24 meses. La combinación de AFG y bioestimuladores ofreció beneficios superiores en retención volumétrica, textura cutánea y satisfacción del paciente (>90%), con complicaciones leves (<5%). En pacientes irradiados, la AFG mejoró elasticidad y vascularización sin evidencia de aumento en la recurrencia tumoral, aunque se recomienda precaución y seguimiento estrecho. Conclusión: La lipotransferencia autóloga, sola o combinada con bioestimuladores, es una técnica segura y efectiva para rejuvenecimiento facial y reconstrucción en pacientes seleccionados. Se requieren estudios multicéntricos con mayor tamaño muestral, seguimiento prolongado y estandarización de protocolos, así como investigación en biomarcadores predictivos para avanzar hacia una medicina personalizada.

This article analyzes recent advances and ethical challenges in aesthetic and reconstructive surgery in Mexico, with comparative insights from Colombia, based on demographic, clinical, technological, pharmacological, and ethical-legal dimensions observed between 2020 and 2024. Results showed that women were the majority recipients of procedures, though participation of men and semi-urban populations is increasing. Body contouring procedures dominated the aesthetic field, amplified by the widespread use of GLP-1 receptor agonists, while reconstructive practice focused on trauma and oncologic cases. Microsurgery remains the cornerstone of complex reconstructions, whereas robotic-assisted and AI-assisted techniques are emerging with promising but limited adoption. Complications were predominantly minor, yet major adverse events and arbitration cases persist, emphasizing the importance of perioperative safety, strict protocols, and robust risk communication. Failures in informed consent and unsatisfactory results were the most frequent causes of litigation, underscoring the role of ethical communication and patient-centered care. These findings suggest that the future of aesthetic and reconstructive surgery in Latin America depends on strengthening ethical frameworks, ensuring equitable access to innovation, and consolidating multidisciplinary collaboration to align technological progress with social responsibility.

Introducción: El cáncer cervicouterino continúa siendo una causa significativa de morbilidad y mortalidad en mujeres, especialmente en países de ingresos bajos y medios. Aunque la citología líquida y la colposcopia son herramientas fundamentales en el tamizaje, presentan limitaciones importantes en sensibilidad diagnóstica y dependencia del operador. La inteligencia artificial (IA), particularmente los modelos de aprendizaje profundo, ha emergido como una alternativa prometedora para optimizar estos procesos. Objetivo: Evaluar sistemáticamente la eficacia diagnóstica y la seguridad clínica de la inteligencia artificial aplicada a la detección del cáncer cervicouterino mediante citología líquida y colposcopia asistida por IA. Métodos: Se realizó una revisión sistemática siguiendo los lineamientos PRISMA. Se buscaron estudios publicados entre 2018 y 2024 en PubMed, Scopus y Web of Science. Se incluyeron ensayos clínicos, estudios diagnósticos y de cohorte que evaluaran el desempeño de modelos de IA en citología líquida y colposcopia. La calidad metodológica se evaluó mediante la herramienta QUADAS-2. Resultados: De 1,172 estudios identificados, 15 cumplieron con los criterios de inclusión. Los modelos de IA analizados reportaron sensibilidades de hasta 98 %, especificidades mayores al 90 % y áreas bajo la curva (AUC) superiores a 0.90. Ensayos como CerviCARE-AI, CAIADS y Smart‑CCS demostraron mejoras sustanciales en la detección de lesiones intraepiteliales cervicales de alto grado (NIC 2+), así como reducción en la variabilidad diagnóstica y optimización de la toma de biopsias. Conclusiones: La evidencia actual respalda la integración de la inteligencia artificial como herramienta complementaria en los programas de tamizaje para cáncer cervicouterino, especialmente en contextos con recursos limitados. Sin embargo, su implementación clínica requiere estandarización de métricas, validación multicéntrica y regulación ética que garantice transparencia, equidad y seguridad en su uso.

Introducción: La hiponatremia es el trastorno electrolítico más frecuente en pacientes hospitalizados, con una prevalencia de hasta el 30 %. Su presencia se asocia a un aumento significativo de la mortalidad, morbilidad y complicaciones como caídas, fracturas y deterioro neurológico. Objetivo: Evaluar la asociación entre hiponatremia y mortalidad hospitalaria, así como las estrategias terapéuticas de corrección y su impacto en la toma de decisiones clínicas. Métodos: Se realizó una revisión sistemática siguiendo las guías PRISMA. Se buscaron estudios en PubMed, Scopus, Web of Science, Cochrane Library y Embase hasta agosto de 2025. Se incluyeron ensayos clínicos, cohortes, metaanálisis y revisiones sistemáticas que analizaran mortalidad y tratamiento en pacientes hospitalizados con hiponatremia. Resultados: De 543 registros iniciales, se incluyeron 18 estudios. La mayoría reportó una asociación significativa entre hiponatremia y mayor mortalidad hospitalaria. Además, se observó que una corrección adecuada (8–10 mmol/L en 24 h) con monitoreo estricto reduce la mortalidad sin aumentar el riesgo de mielinólisis. Conclusión: La hiponatremia es un factor pronóstico independiente y modificable que impacta en la evolución clínica y la mortalidad hospitalaria. Su detección temprana y tratamiento adecuado deben ser una prioridad en la atención médica.

Introducción: La presencia de microplásticos (MPs) en el cuerpo humano ha sido documentada en diversos tejidos y fluidos biológicos como sangre, placenta, heces y pulmones [1,2]. Sin embargo, sus posibles efectos sobre la función gastrointestinal y endocrina continúan siendo motivo de debate científico [3,4]. Objetivo: Realizar una revisión sistemática de la literatura reciente que evalúe la detección de MPs en humanos y su correlación con marcadores clínicos y moleculares de disfunción gastrointestinal y endócrina. Métodos: Se llevó a cabo una búsqueda sistemática en PubMed, Scopus y Embase de artículos publicados entre 2019 y 2024. Se incluyeron estudios observacionales, experimentales y revisiones que abordaran la detección de MPs en humanos y sus posibles efectos sobre el sistema digestivo o endócrino. La calidad metodológica se evaluó mediante la herramienta GRADE y se aplicó el diagrama PRISMA para documentar el proceso de selección [5]. Resultados: Se identificaron 17 estudios relevantes. La mayoría reportó detección de MPs en heces [6], placenta [1], sangre [7] y tejidos intestinales [8]. En modelos animales y humanos, se observó disbiosis intestinal [9], aumento de la permeabilidad epitelial [10], activación de vías inflamatorias (ROS, TNF-α, IL-6) [11], y alteraciones hormonales como insulinorresistencia y disfunción tiroidea [12,13]. La evidencia directa en humanos es aún limitada, aunque consistente con los hallazgos preclínicos [14]. Conclusión: La exposición a microplásticos representa un riesgo emergente para la salud humana. Existe una correlación potencial con alteraciones gastrointestinales y endocrinas, aunque se requiere mayor estandarización en los métodos de detección y estudios longitudinales para establecer causalidad [15]. La vigilancia epidemiológica y el desarrollo de políticas preventivas son esenciales ante este nuevo desafío ambiental y sanitario.

ABSTRACT Introduction Gauss (G) or miliTesla (mT) units measure electromagnetic field (EMF) stimulation. Tarlov Scale (TS) assesses motor impairment, Finger Abduction Scale (FAS) measures finger separation. The objective is to evaluate mobility using EMF in a Sciatic Nerve Injury (SNI) model. Materials & Methods SNI caused paresis in the right hind limb to observe motor changes in male Sprague-Dawley rats (372–529 g) (N = 30). Three groups of (n = 10) rats were created. Control Group (CG) was just injured. The experimental groups were EMF-treated two hours a day for four weeks (2/24, 5/7, 4/4), applying Gauss intensities: Low-Intensity (LIMF) 60–100 (6–10 mT) & High-Intensity (HIMF) 140–200 (14–20 mT). The mobility was measured each week with TS & FAS. Sciatic nerve & skeletal muscle histological slides were made with traditional staining technique to evaluate cellular inflammation. We used two-tailed repeated ANOVA measures & Bonferroni post hoc tests, with a significance p < 0.05 (α = 0.05) and β = 80%. Results EMFs effectively treat SNI in rats, improving the mobility of the right hind limb in experimental groups. In the last week, TS scores were CG 3.5 (±1.35) p = 0.006, LIMF 4 (±0) p = 0.0001 & HIMF 4.3 (±0.82) p = 0.02. FAS scores were CG 0.2 (±0.42) p = 0.000001, LIMF 1.5 (±0.70) p = 0.05 & HIMF 1.8 (±0.42) p = 0.1. In histological findings, CG had inflammation in nerve & muscle, LIMF & HIMF diminished cellular activity. Discussion TS & FAS helped to improve mobility in experimental groups using EMFs after SNI. The nerve repairing mechanism should be studied in future models.