The evolution of public health surveillance has accelerated in response to digital transformation, expanding from traditional reporting systems toward integrated, data-driven epidemiological frameworks. This review analyzes how digital surveillance systems, big data analytics, and predictive modeling approaches influence population-level decision-making within international contexts, with particular attention to Latin American settings including Mexico, Colombia, and Ecuador. A structured narrative review grounded in the scientific method was conducted, synthesizing peer-reviewed evidence on surveillance modernization, computational forecasting, geospatial analytics, precision public health, and governance frameworks. The results indicate a predominance of digital and hybrid surveillance architectures integrating electronic health records, internet-derived signals, genomic sequencing, and environmental datasets. Machine learning approaches were more frequently reported than traditional statistical models, particularly in outbreak forecasting and real-time anomaly detection. Evaluation metrics most commonly emphasized timeliness and predictive accuracy, reflecting a shift toward anticipatory governance. Decision-support applications were primarily associated with early warning systems and situational awareness dashboards. Governance themes, especially privacy protection and legal interoperability, were consistently identified as critical determinants of sustainability. Regional analysis suggests that while high-income countries demonstrate advanced digital integration, middle-income contexts increasingly adopt hybrid models to balance modernization with infrastructure constraints. Overall, data-driven epidemiology strengthens early detection capacity and operational responsiveness when embedded within interoperable, ethically governed, and institutionally supported systems. The findings underscore that technological innovation must be accompanied by governance alignment and workforce capacity development to ensure equitable and sustainable public health transformation.

Clinical decision-making under extreme time pressure represents one of the most demanding cognitive challenges in emergency medicine. This review analyzes how temporal compression, cognitive load, workflow interruptions, and stress exposure interact to influence diagnostic accuracy and patient safety. Drawing on foundational literature in diagnostic reasoning, cognitive psychology, and patient safety research, the study synthesizes evidence demonstrating that increasing interruption frequency and cognitive burden are associated with measurable rises in task error and progressive declines in diagnostic reliability. Temporal constraints appear to accelerate reliance on intuitive processing, increasing susceptibility to premature closure, particularly in ambiguous or evolving clinical presentations. Additionally, elevated stress levels are associated not only with reduced mean diagnostic accuracy but also with greater variability in performance. The findings suggest that diagnostic vulnerability in emergency settings is not random but emerges predictably from the interaction between cognitive architecture and system design. Structured mitigation strategies—including micro-reflective checkpoints, diagnostic prompts, workflow protection from unnecessary interruptions, and simulation-based reasoning training—are associated with reductions in error patterns without compromising response time. The implications are particularly relevant for emergency departments operating under structural constraints, including middle-income health systems in Latin America. Strengthening diagnostic safety requires an integrated approach that aligns clinical expertise, environmental design, and institutional safety culture.

Modern surgical practice unfolds in environments characterized by uncertainty, time pressure, technological complexity, and high clinical stakes. Within these conditions, cognitive load emerges as a critical determinant of surgical judgment and intraoperative decision-making. This integrative review synthesizes interdisciplinary evidence from cognitive neuroscience, human factors engineering, and surgical education to examine how mental workload influences performance stability, error vulnerability, and adaptive reasoning during high-risk procedures. The reviewed literature consistently demonstrates that increased cognitive load is associated with performance degradation, particularly when stress amplifies attentional demands and working memory capacity is exceeded. Expertise moderates this relationship by promoting automaticity and efficient cognitive resource allocation; however, even experienced surgeons remain susceptible to overload under unstable or unfamiliar conditions. Measurement methodologies—including subjective workload scales, physiological indicators, behavioral proxies, and neurophysiological signals—reflect ongoing efforts to operationalize cognitive strain within clinical environments. Simulation-based training, deliberate practice frameworks, team communication protocols, and cognitive offloading strategies are repeatedly described as mechanisms capable of enhancing decision stability under pressure. The findings suggest that cognitive load should be conceptualized as a modifiable patient safety variable rather than an unavoidable byproduct of surgical complexity. Integrating cognitive science principles into surgical training and workflow design may strengthen adaptive decision-making and reduce preventable errors. These implications are particularly relevant for diverse international healthcare systems, including those with heterogeneous institutional resources, where optimizing cognitive performance can contribute meaningfully to operative reliability and patient safety.

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.

Upper airway disorders are traditionally approached as localized conditions affecting the nasal cavity, paranasal sinuses, pharynx, and related structures. However, accumulating evidence indicates that these disorders exert clinically meaningful systemic effects through interconnected physiological, inflammatory, and neurohumoral mechanisms. This narrative integrative review examines the systemic clinical implications of major upper airway disorders, including obstructive sleep apnea, allergic rhinitis, chronic rhinosinusitis, and tonsillopharyngitis. The analysis integrates epidemiological data, mechanistic insights, and clinical outcome evidence to characterize how upper airway dysfunction contributes to cardiovascular disease, metabolic dysregulation, neurocognitive impairment, immune and inflammatory alterations, and lower-airway comorbidity. The findings highlight distinct systemic association profiles across conditions: obstructive sleep apnea demonstrates strong links with cardiovascular, metabolic, and neurocognitive domains, whereas allergic rhinitis and chronic rhinosinusitis are more closely associated with immune-mediated pathways and lower-airway disease within the unified airway framework. Tonsillopharyngitis shows a more focused inflammatory profile with limited multisystem extension. Collectively, the evidence supports a systems-based perspective in which upper airway disorders are understood as modifiers of systemic health rather than isolated local diseases. This integrative approach has important implications for medical education, interdisciplinary clinical practice, and early identification of systemic risk, particularly in healthcare contexts with high burdens of chronic disease.

Contemporary general surgery is practiced in environments characterized by high cognitive complexity, time pressure, and uncertainty, where surgeons must make rapid decisions with significant clinical consequences. While technical proficiency remains essential, increasing evidence highlights the central role of cognitive processes, non-technical skills, and system-level factors in shaping surgical performance and patient safety. This study aimed to synthesize current evidence and expert convergence regarding the cognitive and decision-making demands of contemporary general surgery and to organize these demands into a coherent framework relevant to surgical education and clinical practice. A narrative review was conducted integrating foundational and contemporary literature on cognitive psychology, human factors, and surgical safety, supported by a structured Delphi-based framework to consolidate and refine key domains through iterative thematic convergence. Findings identified six core domains: cognitive load and multitasking, fatigue and decision fatigue, cognitive bias and heuristics, non-technical skills, team communication and coordination, and system and environmental stressors. Cognitive load emerged as the central domain, closely interacting with fatigue and bias, while progressive convergence across Delphi rounds supported the robustness of the final framework. Alignment with Bloom’s taxonomy highlighted the educational relevance of these domains. Overall, surgical decision-making is a multidimensional process shaped by individual cognition, team dynamics, and system design, underscoring the need to address cognitive demands alongside technical training to enhance decision quality, surgical performance, and patient safety in contemporary general surgery.

No existe una definición, ni distinción clara entre los suplementos alimenticios y los nutracéuticos por parte de las autoridades reguladoras a nivel mundial. Los nutracéuticos han recorrido un largo camino desde su concepción como un puente entre la nutrición y la farmacoterapia a finales del siglo XX. Los nutracéuticos son productos derivados de alimentos que, además de su valor nutricional básico, ejercen efectos biológicos específicos con impacto preventivo y terapéutico con calidad farmacológica. Este artículo busca definir y distinguir los dos conceptos desde una perspectiva de causa-efecto; abordando ambas definiciones, comprendiendo su propósito, mecanismo de acción y uso clínico. Se realiza un análisis narrativo basado en la literatura científica, estableciendo que mientras los suplementos dietéticos están dirigidos a corregir deficiencias nutricionales, los nutracéuticos implican una acción biológica específica con fines preventivos o terapéuticos. Esta distinción es clave para informar una recomendación que sea ética, segura y basada en evidencia. Basado en una perspectiva causa-efecto, y atendiendo la investigación con base en la Biosemiómica Clínica Aplicada, este artículo se centra no sólo en la definición de nutracéutico para esclarecer su participación en la modulación de vías fisiopatológicas, la prevención de enfermedades y la necesidad de una recomendación ética, individualizada y basada en la ciencia.

Urethral reconstruction remains a complex challenge in contemporary urology, particularly in patients with long-segment defects, recurrent strictures, or significant systemic comorbidities. Conventional techniques such as buccal mucosa graft urethroplasty provide reliable functional outcomes but are limited by donor-site morbidity and variable long-term durability. Advances in tissue engineering have introduced regenerative strategies aimed at restoring urethral structure while preserving physiological function, sexual health, and reproductive potential. This review synthesizes current experimental and clinical evidence on tissue-engineered urethral reconstruction, integrating a clinical urology perspective with considerations relevant to internal medicine. A structured narrative analysis of peer-reviewed studies was performed, focusing on scaffold design, cellularization strategies, functional urinary outcomes, complication profiles, reintervention burden, and patient-centered sexual and reproductive outcomes. The available evidence indicates that tissue-engineered urethral constructs are clinically feasible and capable of achieving sustained urethral patency in selected patients. Cell-seeded tubular scaffolds demonstrate favorable durability in carefully selected cohorts, while tissue-engineered buccal mucosa grafts reduce donor-site morbidity but show greater variability in long-term outcomes. Across all reconstructive strategies, reintervention rates increase with extended follow-up, reflecting the chronic nature of urethral stricture disease. Sexual and reproductive function is generally preserved, with trends favoring regenerative approaches, although these outcomes remain inconsistently reported. Overall, tissue-engineered urethral reconstruction represents a promising complementary strategy to conventional techniques, with its optimal application dependent on construct design, patient selection, and systemic health factors. Continued refinement and standardized outcome reporting are essential to support broader clinical adoption.

The reconstruction of extensive skin defects remains a major challenge in plastic and reconstructive surgery, largely due to the limited vascularization and integration capacity of conventional skin grafts and substitutes. In recent years, three-dimensional bioprinting has emerged as a promising biofabrication strategy capable of addressing these limitations through precise spatial organization of cells, biomaterials, and vascular architectures. This review analyzes current advances in the bioprinting of vascularized skin grafts, with particular emphasis on vascularization strategies, cellular composition, bioink selection, and features relevant to translational application. The findings indicate a clear trend toward hybrid vascularization approaches that combine predefined architectural guidance with endothelial cell–driven self-organization, enabling improved perfusion and viability in thicker constructs. Tri-cellular configurations incorporating keratinocytes, fibroblasts, and endothelial cells are most frequently reported, reflecting efforts to recreate essential skin–vascular interactions. Material strategies increasingly favor decellularized extracellular matrix–based and hybrid bioinks to balance biological fidelity with mechanical stability. Although significant progress has been made toward functional and perfusable skin constructs, challenges remain regarding surgical handling, long-term vascular stability, and standardized personalization workflows. Overall, vascularized bioprinted skin grafts represent a rapidly evolving platform with strong potential to support personalized reconstruction, bridging experimental biofabrication and future reconstructive practice.

Esta ponencia examina las posibilidades que ofrece la narrativa pedagógica como recurso para la investigación educativa en el contexto de la formación inicial docente en la Escuela Normal. Se parte del reconocimiento de una problemática persistente: la dificultad de transformar las experiencias pedagógicas significativas en objetos de investigación, debido a que suelen quedar reducidas a registros formales y formatos institucionales que limitan su profundidad y dificultan su reconocimiento como conocimiento válido. No obstante, estudios recientes (Ripamonti y Boggia, 2023) muestran un incremento en el uso de métodos narrativos que, desde enfoques como la fenomenología, la hermenéutica y el interaccionismo simbólico (Bolívar, 2002; Biglia y Bonet-Martí, 2009), permiten visibilizar realidades complejas, comprender los significados atribuidos por los actores educativos y revalorar sus voces y trayectorias. Metodológicamente, este estudio se inscribe en el paradigma cualitativo (Denzin y Lincoln, 1992) y recurre a la triangulación de informantes (Amezcua y Gálvez, 2002). Se realizaron entrevistas semiestructuradas a ocho docentes y ocho estudiantes de la Escuela Normal de los Reyes Acaquilpan, seleccionados mediante muestreo propositivo teórico (Mendieta, 2015). Para resguardar la identidad de los participantes se emplearon códigos como D1 y E1, con entrevistas efectuadas del 24 al 26 de junio de 2025. Los resultados evidencian que los docentes reconocen en la narrativa pedagógica aportes para la construcción de significados, el diálogo reflexivo, la triangulación, el fortalecimiento curricular y la formación docente. Los estudiantes, por su parte, destacan su potencial para comprender procesos educativos, reflexionar sobre sus experiencias, explorar su identidad profesional y legitimar el conocimiento producido en el aula. En conjunto, la narrativa pedagógica se consolida como una alternativa que articula experiencia, reflexión e investigación en la formación docente inicial.