Horizonte Médico (Lima)

Generalized annular lichen planus: an atypical case

2025-02-11T00:00:01+00:00

Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, mucous
membranes, and nails. Although its exact cause remains unknown, it has been associated with
hepatitis C, bacterial infections, metal allergens, medications, and emotional stress. It has also
been linked to conditions such as psoriasis, diabetes, hypertension, and thyroid disorders. There are several variants of lichen planus, among which, annular lichen planus presents with an unusual
and more uncommon distribution pattern. It is characterized by polygonal, purple, pruritic lesions,
as well as papules and plaques that are symmetrically and bilaterally distributed. We report a clinical case of annular lichen planus with an atypical and generalized presentation that responded favorably to treatment. The patient was a 67-year-old man who sought medical attention due to intense pruritus and a generalized dermatosis of six months’ duration. Physical examination revealed multiple annular plaques measuring 0.5 to 1.5 cm, with erythematous,
raised borders and atrophic centers, located on the trunk, neck, groin, and face. Dermoscopy
showed Wickham’s striae and brown globules in the depressed centers. Laboratory results were
normal, and serologic tests for hepatitis B and C, and HIV were negative. The definitive diagnosis
was disseminated annular lichen planus, confirmed by skin biopsy. Treatment consisted of topical
corticosteroids, which led to favorable clinical progress, including resolution of lesions and relief
of pruritus. This case underscores the importance of recognizing atypical variants, as appropriate diagnosis and treatment can result in excellent outcomes, even in extensive and rare presentations.

Ileocolic intussusception due to a lipoma of the ileum: a case report

2025-03-31T20:19:27+00:00

Intussusception is an uncommon cause of acute surgical abdomen in adults. It is more common in pediatric patients, who usually present with classic symptoms including rectal bleeding, abdominal distension, and nausea. In contrast, in adult cases often present with nonspecific symptoms, such as abdominal pain and distension, making diagnosis more challenging. We present the case of a 41-year-old female patient, with no significant medical or surgical history, who was admitted with abdominal pain, vomiting, abdominal distension, and inability to pass flatus. Symptom intensity gradually increased. Physical examination revealed a distended abdomen with decreased bowel sounds, abdominal tenderness predominantly in the right iliac fossa, where a palpable mass was also noted. No signs of peritoneal irritation were observed. Contrast-enhanced abdominal CT confirmed intestinal intussusception at the level of the ascending colon, with proximal dilation of bowel loops and collapse of distal loops, without evidence of pneumoperitoneum or free f luid. An emergency exploratory laparotomy was carried out, confirming ileocolic intussusception. Surgical management included a right hemicolectomy and primary end-to-side ileotransverse anastomosis performed with a circular stapler. Postoperatively, the patient had a favorable clinical course during hospitalization, with no fever, improved tolerance of oral intake, adequate pain management, and was discharged without major complications. Histopathological examination identified a polypoid tumor in the ileal segment, located 15 cm from the proximal surgical margin, corresponding to a pedunculated lipoma of the ileum associated with transmural necrosis, which had caused the ileocolic intussusception.

Fulminant rhinocerebral mucormycosis in a patient with metabolic comorbidities: an unusual case report

2025-05-24T15:15:00+00:00

Mucormycosis is a rare but fulminant invasive fungal infection caused by fungi of the order Mucorales. It primarily affects patients with risk factors such as diabetes mellitus, hematologic malignancies, solid organ or hematopoietic stem cell transplantation, and prolonged immunosuppressive therapy. Its various clinical forms include the rhino-cerebral presentation, one of the most aggressive, characterized by rapid local progression with involvement of orbital, neurological and vascular structures, and high lethality if not diagnosed and treated promptly. We present the case of a 53-year-old male patient with a history of poorly controlled type 2 diabetes mellitus, who sought medical attention due to severe headache, right periorbital edema, and diplopia that had been present for 72 hours. A computed tomography (CT) scan of the paranasal sinuses revealed occupation of the left sphenoid sinus, adjacent soft tissue thickening, and signs of bone erosion of the lamina papyracea. These findings prompted nasal endoscopy with tissue sampling for histopathological analysis, which confirmed the presence of broad, non-septate hyphae with right-angle branching, consistent with rhinocerebral mucormycosis. Systemic antifungal therapy with liposomal amphotericin B was initiated, and endoscopic surgical debridement of the affected tissues was performed. Despite a multidisciplinary approach and timely implementation of therapeutic measures, the patient experienced rapid neurological deterioration, with impaired consciousness, and died a few days after admission. This case underscores the need for high index of clinical suspicion in patients with complicated rhinosinusitis and predisposing factors, as well as the urgency of diagnosis and treatment to improve prognosis.

Electrical storm in the setting of amiodarone-induced long QT syndrome

2025-04-26T23:30:46+00:00

A clinically significant case is reported, as it is the first to be published in the region. It refers to a patient who was admitted to the hospital through the emergency department after four days of
illness. The initial clinical presentation included lower limb edema and functional class II dyspnea, which progressed to class IV. A 12-lead electrocardiogram showed atrial tachycardia with a heart rate of 187 bpm. Sequential administration of adenosine, verapamil and electrical cardioversion was unsuccessful. Subsequently, amiodarone was given, leading to the restoration of sinus rhythm. On the second day of hospitalization, the patient developed frequent ventricular ectopic beats and episodes of supraventricular ectopic beats, for which amiodarone was continued. On the third day, he presented with an increased frequency of ventricular ectopy and non-sustained ventricular tachycardia, which progressed to sustained polymorphic ventricular tachycardia of the torsades de pointes type, accompanied by hemodynamic compromise, requiring multiple electrical shocks. The electrocardiogram after the shocks showed a prolonged QT interval. Management included discontinuation of amiodarone and correction of serum electrolyte disturbances such as hypokalemia and hypomagnesemia. Propranolol was administered, as isoproterenol is not available in our setting. Additionally, heart failure, renal dysfunction, and the infectious process were addressed. The patient had a favorable clinical course and was discharged 15 days after admission.

Validation of a virtual reality model for neuroanatomy learning: new approaches to teaching

2024-11-29T01:11:08+00:00

Objective: To validate a virtual reality (VR) model designed for neuroanatomy learning by evaluating its impact in terms of realism, usefulness, practicality, enjoyment, and recommendation. Materials and methods: A descriptive, instrument-validation study was conducted to assess the model through expert judgment in the field of neuroscience. Forty-two professionals in neurology, neurosurgery, and psychiatry participated in the study. The system was rated for realism, usefulness, practicality, enjoyment, and recommendation using a structured 13-item questionnaire based on a five-point Likert scale. The VR model, developed through advanced photogrammetry, enabled interactive manipulation of three-dimensional (3D) brain structures. Participants employed VR headsets and hand controllers to explore, in detail, the anatomical and functional relationships within the brain. Results: Participants reported high overall satisfaction with the system, emphasizing both the realism of the images (mean = 4.76, SD = 0.43) and the system’s usefulness in understanding complex 3D relationships (mean = 4.78, SD = 0.41). However, practicality received a slightly lower score (mean = 4.36, SD = 0.61), suggesting opportunities for improvement in the user interface. Enjoyment of the experience also received positive ratings (mean = 4.58, SD = 0.51). In addition, most professionals recommended integrating the system into medical education (mean = 4.64, SD = 0.48), highlighting its potential as a complementary tool to traditional teaching methods. Conclusions: The validated VR model proved to be a valuable tool for neuroanatomy learning, providing an immersive experience that facilitates the understanding of the complex spatial relationships within the brain. Although areas for improvement were identified, particularly regarding system practicality, the findings suggest that this technology has the potential to transform advanced medical education by offering a more engaging, practical, and effective approach. Further refinements in design could enhance its accessibility and acceptance, thereby solidifying its role in contemporary medical education.

Plataforma integral para seguimiento en tiempo real de un prototipo de bombas de infusión peristáltica, Universidad Privada del Valle, Cochabamba, Bolivia

2025-01-04T01:27:11+00:00

Objective: To design and implement a comprehensive platform for the real-time tracking, traceability, and monitoring of infusion pumps, incorporating a prototype of a peristaltic infusion pump, with the purpose of optimizing intravenous therapy monitoring and enhancing the efficiency of medical and nursing staff. Materials and methods: A prototype of a peristaltic infusion pump was developed using 3D printing, a method that enables the precise and customized creation of highly durable and functional components. The prototype integrates microcontrollers and sensors capable of detecting
anomalies during drug administration, ensuring constant flow control. In parallel, a digital platform
was designed with access through a web interface, allowing continuous real-time monitoring of
the pumps. This low-cost solution, developed in Bolivia, aims to facilitate implementation in
settings where existing commercial systems—although technologically advanced—are less accessible due to their high cost. The proposed system centralizes supervision and optimizes medical staff resources. Results: A series of experimental tests were conducted to evaluate the prototype’s accuracy compared to standard commercial infusion pumps by analyzing the percentage error in infusion rates. The prototype achieved an acceptable error range between -2.68 % and +2.57 %, demonstrating its accuracy and functionality. Furthermore, the digital platform proved effective in optimizing monitoring time, enabling healthcare personnel to focus on higher-priority tasks. Conclusions: The implementation of this comprehensive platform
and the first prototype of a peristaltic infusion pump marks a significant step forward in intravenous therapy monitoring in Bolivia. Its low-cost design makes it a viable alternative for expanding access to real-time monitoring, promoting technological innovation, and optimizing both human and material resources in hospital settings.

Envejecimiento poblacional y geriatría en el Perú: un análisis de la fuerza de trabajo y sus desafíos

2025-02-12T16:27:42+00:00

Objective: To assess the capacity of the geriatric workforce in Peru, considering its age and geographic distribution, as well as its distribution across health subsystems. In addition, to determine the ratio of geriatricians to the older adult population (OAP) in each department and within each subsystem: the Seguro Social de Salud (EsSalud – Social Health Insurance) and the Seguro Integral de Salud (SIS – Comprehensive Health Insurance). Materials and methods: An observational, descriptive, and cross-sectional study based on 2024 data from the Instituto Nacional de Estadística e Informática (INEI – National Institute of Statistics and Informatics) and the Colegio Médico del Perú (CMP – Medical Council of Peru), complemented by information obtained through the transparency portals of each public health subsystem. The private sector was excluded from the analysis. Results: A total of 426 board-certified geriatricians were registered in the Registro Nacional de Especialista (RNE – National Registry of Medical Specialists) nationwide. Based on INEI’s 2024 projections, which estimated 4,747,803 older adults, each geriatrician would be responsible for an average of 11,145 individuals. Of these specialists, 324 were employed within public health subsystems. EsSalud accounted for the largest share with 157 specialists, followed by the Ministry of Health–SIS (MINSA–SIS) with 93. The geographic distribution was highly uneven, with 61.6 % of geriatricians located in Lima and none in departments such as Tumbes, Huancavelica, and Madre de Dios. The OAP registered in the aforementioned subsystems totals 4,168,570, implying that each geriatrician is, on average, responsible for 16,674 patients. These findings underscore a significant gap between the rising demand for care and the capacity for specialized geriatric care in recent decades. Conclusions: The geriatric workforce in Peru faces critical challenges, particularly in terms of geographic distribution, service demand, and integration across health subsystems. Although the number of geriatricians has increased in recent years, the exponential growth of the OAP continues to widen the gap in access to specialized geriatric care.

Malnutrition and mortality risk among older adult patients with cancer in Peru

2025-04-10T10:18:03+00:00

Objective: Malnutrition is common among cancer patients and even more prevalent in older
adults. Although its association with mortality risk is well established, further studies in Latin
America are needed to delve deeper into this relationship. This study aimed to evaluate the
association between malnutrition and mortality risk among Peruvian older adult patients (≥ 60 years)
with cancer. Materials and methods: Comprehensive geriatric assessment (CGA) records of older
adult patients with cancer evaluated at the Geriatrics Department of Hospital Almenara in Lima,
Peru, from 2018 to January 2024, were reviewed. Nutritional status was assessed using the Mini
Nutritional Assessment Short Form (MNA-SF), which classifies patients into three groups: normal,
at risk of malnutrition, or malnourished. This retrospective observational study comprised both
cases (patients at risk of malnutrition or malnourished) and controls. Results: The study included 171 patients (mean age of 77.8 ± 7.5 years), 60 % of whom were men. According to the MNA-SF,
66 patients (38.5 %) were classified as having normal nutritional status, 77 (45.0 %) as at risk of malnutrition, and 28 (16.4 %) as malnourished. The frequency of malnutrition was higher among males (60.7 %) than females (39.3 %) (p < 0.05). The mean follow-up period was 41.1 ± 20.9 months, ranging from 0.9 to 68 months. The most common cancer
types were colorectal (23.4 %), prostate (13.5 %), stomach (11.7 %), skin (11.7 %), breast (9.4 %), non-Hodgkin lymphoma (5.4 %), head and neck (4.7 %), lung (3.5 %), endometrial (3.5 %), and pancreatic (2.9 %). In the multivariate Cox regression analysis,
patients who were at risk of malnutrition or malnourished had a higher mortality risk compared to those with normal nutritional status (hazard ratio [HR], 2.9; 95 % confidence interval [CI], 1.37–7.26; p < 0.01). Conclusions: Peruvian older adult patients
with cancer at risk of malnutrition or malnourished have a higher mortality risk compared with their counterparts with normal nutritional status.

Factors associated with the length of hospital stay among pediatric patients with urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in two Peruvian hospitals

2025-04-15T03:06:58+00:00

Objective: To identify factors associated with the length of hospital stay among pediatric patients with urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in two Peruvian hospitals. Materials and
methods: A retrospective cohort study was conducted through a review of medical records of children with UTIs caused by ESBL-E hospitalized between 2016 and 2022 at Hospital Nacional Edgardo Rebagliati Martins (Seguro Social de Salud [EsSalud] – Peru’s Social Health Insurance) and Hospital Nacional Docente Madre Niño San Bartolomé (Ministerio de Salud [MINSA] – Ministry of Health). The primary outcome variable was the length of hospital stay, defined as the number of days between admission and discharge. Linear regression with logarithmic transformation was used to identify factors associated with longer hospital stays. Additionally, factors related to prolonged hospital stays (> 7 days) were analyzed using Poisson regression models with robust variance. Results: A total of 149 patients were included, with a median hospital stay of five days (interquartile range [IQR: 4–8 days]). Linear regression
analysis identified the factors contributing to longer hospital stays: prior exposure to intravenous antibiotic therapy (coefficient [coef]: 1.48; 95 % confidence interval [95 % CI]: 1.18–1.85; p = 0.001); resistance to the initially prescribed antibiotic (coef: 1.31; 95 % CI: 1.02–1.68; p = 0.036); low weight-for-age (coef: 1.41; 95 % CI: 1.10–1.82; p = 0.009); and delayed urine culture results (coef: 1.28; 95 % CI: 1.02–1.61; p = 0.036). In contrast, a history of genitourinary disorder was associated with a shorter hospital stay (coef: 0.80; 95 % CI: 0.64-0.99; p = 0.048). In the secondary analysis, hospitalization at EsSalud was associated with an increased risk of prolonged stay (risk ratio [RR]: 2.27; 95 % CI: 1.41–3.64). Conclusions: Several factors were associated with prolonged hospital stay among children with UTIs caused by ESBL-E. These findings may help optimize therapeutic and hospital management strategies, ultimately reducing complications and associated healthcare costs.

Prevalence of sleep-disordered breathing and associated factors among patients at a tertiary care center

2025-05-28T16:52:34+00:00

Objective: To determine the prevalence of obstructive sleep apnea (OSA), as confirmed by
respiratory polygraphy, and to analyze its association with sociodemographic, anthropometric, lifestyle, and comorbidity-related variables among patients attending outpatient pulmonary consultations. Materials and methods: An observational, analytical, and retrospective study was conducted based on the medical records of adult patients evaluated for suspected OSA at the Pulmonology Department of Hospital de Especialidades No. 2, a tertiary care center of the Instituto Mexicano del Seguro Social (IMSS – Mexican Social Security Institute) in Ciudad Obregón, Sonora, between January 2023 and December 2024. Patients who had undergone respiratory polygraphy and had recorded variables such as age, sex, weight, height, body mass index (BMI), neck and abdominal circumference, physical activity, smoking history, comorbidities (including
diabetes mellitus, hypertension, dyslipidemia, among others), and place of origin were included. Statistical analysis comprised measures of central tendency and dispersion, absolute and relative frequencies, and Pearson’s chi-square tests to assess associations, with a significance level set at p ≤ 0.05. Results: Out of 1,920 patients seen during the study period, 187 were assessed for suspected OSA, and 140 cases were confirmed by polygraphy, resulting in a prevalence of 7.29 %. The mean age was 53.1 years, and the mean BMI was 33.7 kg/m², with obesity observed in 55.1 % of patients. The mean neck and abdominal circumferences were 39.9 cm and 125.7 cm, respectively. The most frequent comorbidities were diabetes mellitus (27.8 %) and hypertension (34.2 %). Only 31 % of patients reported engaging in regular physical activity, and 25.7 % had a smoking history. Most patients were from Cajeme and Guaymas. Conclusions: In this population, OSA is associated with middle age, central obesity, sedentary lifestyle, and metabolic comorbidities. Active screening in pulmonary consultations is recommended, preferably through a multidisciplinary approach.

Frequency distribution of the 1236T>C polymorphism in the ABCB1 gene among Peruvian populations and its comparison with populations from the Americas, Asia, Europe, and Africa

2025-04-23T23:36:03+00:00

Objective: Mutations in the ABCB1 gene have an impact on the response to various drugs and may be associated with the development of neoplasms. This study explores and compares the frequency distribution of the 1236T>C polymorphism in the
ABCB1 gene among nine Peruvian populations from different geographical origins and altitudes, as well as the genotype/allele frequencies reported in populations from various continents worldwide. Materials and methods: Sampling was carried out in the following departments and localities: Lima (n = 8), Loreto–Andoas (n = 16), San Martín–Lamas (n = 16), Puno–Uros (n = 7), Puno–Taquile (n = 5), Arequipa–Chivay (n = 10), Arequipa–Cabanaconde (n = 6), Ancash–Parobamba (n = 10), and Apurímac–Andahuaylas (n = 10). Biological samples (peripheral blood and/or epithelial cells) were collected via buccal swabs. Deoxyribonucleic acid (DNA) was extracted using a standard protocol. The 1236T>C polymorphism (rs1128503) was identified using real-time polymerase chain reaction (PCR). Variables were categorized by geographical origin (coast, highlands, or jungle) and altitude (< 2,500 or > 2,500
meters above sea level [m a.s.l.]). Statistical analyses included the Hardy–Weinberg equilibrium and Pearson’s chi-square test, with a significance level of p < 0.05 and a 95 % confidence interval (95 % CI). Results: The frequency distribution of the 1236T>C
polymorphism in the ABCB1 gene was determined for the Peruvian populations studied. Across coastal, highland, and jungle regions, the heterozygous C/T genotype (associated with intermediate P-glycoprotein activity) was the most prevalent, with the
highest frequency (60 %) observed on Taquile Island (Lake Titicaca, Puno). In the overall Peruvian sample (n = 88), the frequency of the C/T genotype was 43 % at < 2,500 and 50 % at > 2,500 m a.s.l. In contrast, the homozygous C/C (normal activity) and T/T (slow activity) genotypes showed similar frequencies at < 2,500 m a.s.l. (30 % and 28 %, respectively) but differed at > 2,500 m a.s.l. (35 % and 15 %, respectively). The overall genotype distribution in the Peruvian populations studied was 47 % C/T, 33 % C/C, and 20 % T/T. The Hardy–Weinberg equilibrium achieved no statistical significance. Conclusions: The 1236T>C polymorphism in the ABCB1 gene among Peruvian populations showed a predominance of the heterozygous C/T genotype, with variations associated with geographic region and altitude. In general, the same trend was observed across countries and continents.

Gastroprotective effect of mucilage extracted from Aloe vera L. leaves in albino rats

2025-07-08T23:56:18+00:00

Objective: To evaluate the gastroprotective effect of mucilage extracted from Aloe vera (A. vera) leaves in albino rats. Materials and methods: The technique used was observation, and the method was based on inducing gastric ulcers with 96 % ethanol. The animals were divided into seven treatment groups: (I) control group, which received normal saline (4 mL/kg); (II)
group administered 96 % ethanol (1 mL/animal); (III) group treated with ranitidine (100 mg/kg); (IV) group administered sucralfate (50 mg/kg); and (V–VII) groups treated with mucilage at doses of 25, 50, and 100 mg/kg, respectively. Results: The mean volumes of gastric content in animals treated with mucilage at doses of 50 and 100 mg/kg were statistically comparable to those in the ranitidine and sucralfate groups. The percentage efficiency in increasing gastric pH of the experimental animals was highest with ranitidine, followed by sucralfate, and then the different doses of mucilage. Ulcer inhibition was 54.45 %, 64.45 %, and 73.33 % with mucilage at doses of 25, 50, and 100 mg/kg, respectively, compared with 58.89 % for ranitidine and 73.33 % for sucralfate (p < 0.05). The 100 mg/kg mucilage dose was statistically comparable to sucralfate, while the 50 mg/kg dose was comparable to ranitidine. Histopathological analysis revealed a mild to moderate inflammatory component that was dispersed and perivascular, and extended to the submucosa. In the 96 % ethanol group, ulcerative lesions with acute inflammation reaching the submucosa were observed. In contrast, ulcer formation was inhibited in the mucilage-treated and standard drug groups. Conclusions: The mucilage extracted from Aloe vera leaves demonstrated a gastroprotective effect in experimental animals.

Evaluación de la función renal en personas mayores

2025-07-02T22:35:38+00:00

Assessing renal function in older adults (OAs) is essential, as it guides the adjustment of geriatric medication dosages, particularly for drugs primarily cleared through the kidneys. Such assessment also enables the diagnosis of chronic kidney disease (CKD), a risk factor for higher rates of hospitalization, cardiovascular events, and mortality.

Aging is often accompanied by a reduction in glomerular filtration rate (GFR) ranging from 0.4 to 2.6 mL/min per year; however, this decline is not uniform. Longitudinal studies have shown that in 36 % to 44 % of individuals over 60 years of age, renal function remains relatively stable (1).

Fahr’s syndrome in the elderly

2025-03-21T19:40:20+00:00

Dear Editor: We have read the recent article published by Damián-Mucha et al. in this journal, which addresses the main features of Fahr's disease in an older adult ⁽¹⁾. The diagnosis was incidental, based on non-contrast CT scan of the brain performed during the evaluation of an accidental fall, which revealed typical basal ganglia calcifications with lenticular predominance. Due to multiple comorbidities, the patient received multidisciplinary care during 41 days of hospitalization and subsequently remained under specialized home medical care for older adults ⁽¹⁾. The authors emphasized the role of comprehensive clinical evaluation, laboratory and imaging tests, and geriatric counseling in providing quality care to these patients ⁽¹⁾. In addition, they underscored the main features of Fahr's disease: progressive neurological dysfunction, basal ganglia calcifications, absence of endocrine or mitochondrial changes, toxins, or trauma, and no family history of autosomal dominant inheritance ⁽¹⁾. Therefore, the following comments aim to highlight the importance of the referenced article.

Association between the immunohistochemical profile and clinical outcome in patients with medulloblastoma treated at a Peruvian pediatric hospital, 2013-2022

2025-02-10T22:12:27+00:00

Medulloblastomas are the most common malignant brain neoplasms in children. Immunohistochemical
(IHC) markers can determine a molecular classification, using the markers GAB1, YAP1, β-catenin, P53, and Ki67. The classification of these neoplasms into molecular groups has proven to be clinically and therapeutically significant. The clinical outcomes of medulloblastoma include death, adverse
effects or conditions, and tumor recurrence. The objective of this research was to determine the individual association between the IHC markers used for molecular group classification and the clinical outcome in patients with medulloblastoma treated at the Instituto Nacional de Salud del Niño (INSN - National Institute of Child Health) during the period 2013–2022. The population consisted of 58 patients. The individual IHC expression of GAB1, YAP1, β-catenin, p53, and Ki67 in paraffin-embedded biopsies was compared with the clinical outcomes. Descriptive statistics and bivariate analysis were used to determine associations. The desmoplastic/nodular variant was the most commonly observed histological type of medulloblastoma, and there was a high frequency of IHC expression of YAP1 and an association between IHC expression of YAP1 and adverse effects. The clinicopathological characteristics of our cases were similar to those described in China. The finding may be useful as a prognostic marker of adverse effects in pediatric medulloblastoma.

Obesity in older adults: comprehensive approach and management

2025-03-25T02:21:42+00:00

Obesity is a global pandemic with serious consequences for public health, directly associated
with vascular diseases, diabetes, dementia, osteoarthritis, increased mortality and functional
disability. In older adults, the diagnosis and management of obesity require specific considerations that differ from approaches applied to younger populations. The relationship between aging
and obesity is particularly complex and multifactorial, sharing common pathways associated with chronic disease and systemic inflammatory processes. Interventions should focus on the individual, carefully evaluating the impact on both functional and intrinsic capacities, while also considering the expected time to achieve therapeutic benefits. Beyond changes in body mass index and weight, therapeutic strategies should primarily aim to reduce fat mass while simultaneously improving muscle mass and functionality. This approach is more beneficial than simple weight loss, particularly given the risk of sarcopenia associated with aging. The safest and most effective interventions are non-pharmacological and include dietary changes, adapted physical activity, and lifestyle modifications. Advanced age should not be considered a contraindication for prescribing appropriate interventions, including pharmacotherapy or surgical procedures in selected cases. The approach requires an individualized and multidimensional assessment that considers
functional, cognitive, emotional, and social aspects influencing both the development of obesity
and treatment adherence and response.

Thanatomicrobiome and artificial intelligence: forensic microbiology today

2025-04-24T23:37:45+00:00

Forensic microbiology enables, among other applications, the estimation of the post-mortem interval (PMI), the identification of individuals, and the location of crime scenes through microbiome analysis and the geolocation of biological remains. Artificial intelligence (AI), together with new sequencing techniques, has revolutionized this field, markedly improving the accuracy and speed of forensic analyses. In this study, a systematic review was conducted following PRISMA guidelines. Databases such as PubMed, Scopus, Web of Science, and Google Scholar were searched using keywords related to forensic microbiology, IA, and PMI. Inclusion criteria included studies published in English or Spanish, regardless of the publication date. Exclusion criteria included duplicate studies or those that did not address the thanatomicrobiome analysis using AI tools. After the search and selection process, 20 articles published between 2016 and 2024 were analyzed. The f indings show that some machine learning models, such as Random Forest (RF) and Convolutional Neural Networks (CNN), provide relatively accurate estimates of the PMI. Recent studies focusing on the thanatomicrobiome are emerging as a promising tool in the forensic field, as this microbiome is unique and individualizing. These characteristics render it useful in the various stages of human identification and geolocation in criminal investigations. However, the review underscores the need for studies with larger sample sizes and for exploring the role of microorganisms beyond bacteria, in order to broaden and enhance the research landscape in this emerging field.