The International Journal of Neurology is a global platform for high-quality research in clinical neurology and neurological disorders. We publish evidence-based studies on stroke, neurodegenerative diseases, epilepsy, and neurorehabilitation, supporting advanced care for adult and pediatric populations.
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Towards a Medicine with a Human Face: Contributions of Positive Psychology. A systematic literature review
Introduction: Positive psychology represents a scientific approach that studies the foundations of human well-being and happiness, systematically examining the processes underlying individuals' positive qualities. This discipline emerges as an essential complement to the traditional paradigm focused on psychopathology. Objective: To analyze the theoretical foundations of positive psychology and critically evaluate its applications in the medical field, considering its implications for both healthcare professionals' well-being and patient care optimization. Methods: A systematic literature review was conducted through comprehensive searches in PubMed, Google Scholar, and Dialnet databases. The analysis prioritized recent meta-analyses and controlled clinical trials to ensure evidence-based conclusions. Results: Evidence demonstrates that positive psychology-based interventions substantially improve healthcare professionals' well-being and significantly reduce burnout syndrome. In patient care, these approaches associate with better coping mechanisms, increased treatment adherence, and enhanced health-related quality of life. The review identifies practical implementation frameworks such as the PERMA model and documents successful applications in medical education and healthcare organizational contexts. Studies confirm that developing resources like resilience, emotional intelligence, and realistic optimism translates into greater capacity to handle the emotional demands of healthcare work. Conclusions: Positive psychology represents a valuable and necessary complement to traditional approaches in healthcare. Its systematic integration into health systems shows potential to humanize patient care, support professional well-being, and promote a comprehensive health model that addresses both disease treatment and well-being promotion.
Copyright (c) 2025 Deborah Cabrera Rodríguez , Marlon Carbonell González , Rosali Santiago Roibal , Maytee Olivera Vega , Lisbel Garzón Cutiño (Author) https://creativecommons.org/licenses/by/4.0
Rehabilitation Nursing Care for a Person with Secondary Paraparesis due to Spinal Cord Ischemia: Case Report
Introduction: spinal cord ischemia is a rare neurological condition, with an estimated incidence of between 0.6 and 1.2 cases per million inhabitants/year in Portugal. Objective: to describe the functional outcomes in a person with secondary paraparesis due to spinal cord ischemia after three weeks of a community-based rehabilitation nursing program. Clinical Case Report: this is a descriptive study, prepared in accordance with CARE guidelines. It refers to a female patient, aged between 75 and 80, diagnosed with spinal cord ischemia, presenting secondary paraparesis. Follow-up was carried out at home by a specialist rehabilitation nurse, who was part of the integrated continuing care team. The rehabilitation nursing intervention focused on muscle movement, sensory deficit, body balance, and assisted gait training. Over the three weeks of implementation of the care plan, significant functional gains were observed, namely increased muscle strength, partial recovery of tactile and proprioceptive sensitivity, improved postural balance, and increased walking safety. Conclusion: the results show that early and specialized intervention by Rehabilitation Nursing played a decisive role in the functional recovery of people with ischemic spinal cord injury, promoting gains in autonomy and independence, expressed by increased muscle strength, improved balance, and optimized gait.
Copyright (c) 2025 Patrícia Horta, Susana Esteves, Nelson Guerra, Sandy Severino, Luís Sousa (Author) https://creativecommons.org/licenses/by/4.0
Attention and Executive Functions in Attention Deficit Hyperactivity Disorder Across the Lifespan
Introduction: Attention deficit hyperactivity disorder (ADHD) is characterised by significant deficits in sustained and divided attention, working memory, response inhibition, and planning. These impairments, which are more pronounced in childhood, persist into adulthood with great clinical heterogeneity, varying in presentation according to age, gender, and associated comorbidities. Objective: To integrate the available evidence on the evolution of executive functions and attention in ADHD throughout the life cycle, describing the characteristic deficits, associated phenomena such as hyperconcentration, and the effectiveness of compensatory strategies. Development: neurobiological alterations are identified in fronto-parietal, fronto-striatal, and cerebellar networks, supported by theoretical models such as executive dysfunction and attentional networks. Hyperconcentration is described as a state of intense and absorbing attention, common in ADHD and linked to difficulties in attentional regulation. The interventions with the greatest scientific support include pharmacotherapy (especially stimulants) and cognitive-behavioural therapy, complemented by behavioural, organisational, and technological compensatory strategies that must be adapted to each stage of development. Conclusions: Attention and executive function impairments in ADHD significantly impact academic, occupational, and psychosocial functioning throughout life. Multimodal assessments and individualised therapeutic approaches, based on neurocognitive profile and life stage, are required to optimise functional outcomes. Future longitudinal research is needed to better understand the trajectory of these deficits.
Attention Deficit Hyperactivity Disorder
Copyright (c) 2024 Yuselys de la Caridad Cordero Cabrera, Gleddys Gallardo-Pons, Marcos Alejandro Cabrera-Gallardo (Author) https://creativecommons.org/licenses/by/4.0
Mutation of the methylentetrahydrofolate reductase gene and its assosiation with changes in mood
The C677T mutation in the MTHFR gene (Methylenetetrahydrofolate reductase) reduces the activity of the enzyme responsible for converting folic acid (vitamin B9) into its active form, methylfolate, which is essential for the synthesis of neurotransmitters like serotonin, dopamine, and norepinephrine. This reduction can predispose individuals to mood disorders such as anxiety, irritability, or depression, particularly in situations of high stress, poor diet, or vitamin B deficiencies. The decreased enzymatic activity in this case can lead to less efficient production of neurotransmitters, affecting mood regulation and emotional well-being. However, these individuals often respond well to methylfolate supplementation, which helps compensate for the metabolic deficiency, improving chemical balance in the brain and reducing mood-related symptoms. Additionally, maintaining a diet rich in natural folates (found in leafy green vegetables) and other B vitamins can be helpful in minimizing the negative effects of polymorphism.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Management of patients intoxicated with psychotropic drugs attended va new admission nurses
Introduction: Poisoning is a preventable public health problem that affects the world population. In Cuba, the level of consumption was negligible; but the coincidence of economic and social factors favored the premises for the increase. In response, institutional tools were implemented, such as the National Drug Prevention Program for Adolescents and Young People. This research has as objective: to characterize the management of the patient intoxicated by psychotropic drugs directed to the nursing staff of new admission in the medical emergency services of the Clinical Surgical Teaching Hospital “Julio trigo López”. Methods: an observational, descriptive, cross-sectional study was conducted. In the period from January 2021 to March 2022. The universe was made up of 80 nurses who worked in the medical emergency services of the Julio Trigo López clinical surgical hospital of the Arroyo Naranjo municipality. Results: the need for learning related to the topic of acute poisoning was identified, which has an impact on professional training, from the scientific, human, with a transformative character, that responds to social needs. Conclusions: The management of the intoxicated patient was characterized. A training course on the management of the patient intoxicated by psychopharmaceutical from the nursing thought was proposed.
Copyright (c) 2025 Vilma Machado Arango , Yanet Ortega Dugrot , Carmen Odalys Gener Villarpanda , Marylú González Barrero , Julieth Suárez Oceguera, Susana Solís Solís (Author) https://creativecommons.org/licenses/by/4.0
Sleep disorders in patients diagnosed with Parkinson's disease at a specialized medical center in Rosario (Santa Fe, Argentina), 2024
Introduction: Sleep disorders are a common complication in patients with Parkinson's disease (PD), significantly affecting their quality of life. Objective: To describe the frequency of sleep disorders in patients diagnosed with Parkinson's disease at a specialized medical center in Rosario in 2024. Materials and Methods: Quantitative, observational study with a descriptive cross-sectional and retrospective design. Conducted at the Le Sommeil Sleep Disorders specialized medical center. The population consisted of all patients over 18 years of age diagnosed with PD. The instrument used for data collection was a survey specifically designed for this study, reviewed and validated by specialists. The variables were analyzed using absolute and relative percentage frequencies. Results: Seventy-one patients were analyzed; of these, 54% were male. The average age was 73.9 ± 10.9 years. The most common age group was 70–79 years. The highest number of patients diagnosed was recorded in the period 2020–2024, representing 57.7% of the total. On average, the time between the onset of symptoms and diagnosis was one year. Sixty-four point eight percent of patients had the right side as their dominant side. Sixty point six percent of patients reported tremor as the most common symptom. Insomnia was the most frequently reported sleep disorder symptom in 32.4% of patients. Tremor was the most common symptom in 64.8% of patients, with a greater presence on the right side of the body. Conclusion: The results showed a higher prevalence of the disease in older men, with symptoms such as tremor and sleep disorders such as insomnia. In addition, a greater impact was observed on the right side of the body, both in motor symptoms and sleep disorders.
Copyright (c) 2025 Kimberly Boschi de Abreu Cavalli , Fernando Filippini , Pablo Cortadi (Author) https://creativecommons.org/licenses/by/4.0
Introduction: Cri-du-Chat Syndrome, also known as Lejeune syndrome, is a rare congenital disorder characterized by a cry resembling a cat's meow, characteristic facial dimorphism, microcephaly, and intellectual disability. It results from a chromosomal abnormality caused by a partial or total deletion of the short arm of chromosome 5. The prognosis is poor. Patients present with significant developmental delays and a shorter life expectancy. Case presentation: A 10-year-old girl residing in the province of Pinar del Río was referred to a Clinical Genetics clinic by her health district due to dysmorphic signs and delayed psychomotor development. She was diagnosed with Cri-du-Chat Syndrome. The studies performed, as well as therapies to improve her quality of life, are described. Conclusions: Knowledge of Cri-du-Chat Syndrome is important for early detection and the early promotion of an alternative communication system with the greatest possible success.
Copyright (c) 2025 Jéssica Sánchez Rodríguez, Angel Oshumaré Chacón Alpí, Adrian Marín García, Yoleiny de la Caridad Lescalle Ortiz (Author) https://creativecommons.org/licenses/by/4.0
Non-epileptic paroxysmal disorders of childhood and adolescence
Introduction: non-epileptic paroxysmal disorders constitute a heterogeneous group of polymorphic situations from a semiological Paint of view that are very frequent in pediatric ages. Objective: to clinically and epidemiologically characterize pediatric patients with non-epileptic paroxysmal disorders admitted to the" Pepe Portilla "Provincial Pediatric Teaching Hospital of Pinar del Río in the years 2022 and 2023. Method: observational, descriptive, cross-sectional study. Universe: 282 patients diagnosed with paroxysmal nonepileptic disorder. A simple of 237 patients was selected using simple randon sampling. Descriptive and inferential statistics were used. Results: the female sex predominated in 57,8 %. The age groups of 1 to 3 years and 10 to 12 years represented 19,8 % and 18,6 % of the cases studied. A personal history of paroxysmal nonepileptic disorder was found in 12,2 %females and 9,7 % of males. A family history of paroxysmal nonepileptic disorder was identified. Epileptics seizures occurred in 12,2 % of girls and 9,7 % of boys. Vasovagal syncope accounted for 29,1 % of the patients studied. Conclusions: It was evident that paroxysmal nonepileptic disorders of childhood constitute a clinical challenge for the pediatrician with a significant social impact.
Copyright (c) 2025 Yuselys de la Caridad Cordero Cabrera, Sarah Álvarez Reinoso, Sandra Haydee Hernández García, Maura Vives Pérez, Risell Mahyté Madera Torres (Author) https://creativecommons.org/licenses/by/4.0
Cerebrovascular disease course proposal on the Moodle platform
Introduction: cerebrovascular disease is one of the leading causes of death and disability worldwide. The development of a course on this pathology contributes to increasing knowledge for making this challenging diagnosis. Objective: make a course proposal on the Moodle platform on diagnosis and management of cerebrovascular disease. Methods: A qualitative pedagogical research was carried out. The observation of the educational teaching process was carried out in the use of new information and communication technologies. The following theoretical methods were used: systematization, the historical-logical method and documentary analysis. Results: a proposal for a Virtual Course on the Moodle Platform on the diagnosis and management of Cerebrovascular Disease, featuring 5 instructional units, each with different resources and activities designed to meet the stated objectives. Conclusions: this learning model allows healthcare professionals to update their knowledge flexibly and represents a fundamental contribution to continuing medical education.
Copyright (c) 2025 Amanda López Reyes, Luis Daniel Guzmán Camps, Sara Patricia Aguilar Ocampo (Author) https://creativecommons.org/licenses/by/4.0
Neurological Effects of Gluten Intake in Patients Aged 30-35 Years, in the Province of Panama, Year 2024.
The main objective of this research is to determine the neurological effects of gluten intake in patients aged between 30-35 years, in the province of Panama in the year 2024. This study is based on the importance of understanding how gluten in the daily diet specifically affects the nervous system. The developed points explain the effects of gluten in the field of neurology in patients aged 30 to 35 years, in the province of Panama in the year 2024. In conclusion, it is crucial to consider a gluten-free diet as an integral part of symptom management.
Copyright (c) 2025 DRA. ANLLY AÑEZ, Sonia Daana Al Rida, María Fernanda Montenegro Vargas, Luz Natalia Real, Diana Othon, Katherine Ibeth Vega Ortega (Author) https://creativecommons.org/licenses/by/4.0
Parkinson's disease and sleep: from biomarkers to clinical stratification
Introduction: The study described Parkinson's disease (PD) as a multisystemic neurodegenerative process whose diagnosis had shifted from a clinical approach to one supported by biomarkers and imaging. It noted that nigrostriatal dopaminergic degeneration, α-synuclein aggregation and propagation, and neuroinflammation explained the TRAP motor phenotype and a broad spectrum of non-motor symptoms. It emphasized that sleep disorders (SD), especially REM sleep behavior disorder (RSBD) and hyposmia, acted as early markers with prodromal relevance. Development: The study integrated evidence from pathophysiology, diagnosis, and clinical manifestations. It showed that, in the early stages, dopaminergic involvement manifested as an asymmetric striatal pattern (greater damage in the posterior putamen and relative preservation of the caudate). It documented that SDs—insomnia, obstructive sleep apnea, excessive daytime sleepiness, restless legs syndrome, and RSDS—achieved high prevalences and were associated with cognitive impairment, falls, and poorer quality of life. He noted that polysomnography provided objective confirmation of RLS, OSA, and periodic leg movements, while standardized scales facilitated screening and follow-up when resources were limited. He also highlighted the contribution of psychiatric and autonomic comorbidities (nocturia, bladder dysfunction) and the impact of drugs on sleep architecture. Conclusions: The study concluded that systematically incorporating the screening for TS and other non-motor symptoms into longitudinal neurological assessment enabled early detection, risk stratification, and individualized treatment. It proposed a multidisciplinary approach combining dopaminergic optimization, specific sleep interventions, management of comorbidities, and caregiver education. Finally, it prioritized the validation of multimodal biomarkers and the exploration of modifying therapies targeting neuroinflammation and proteostasis to intervene earlier and more effectively on the course of PD.
Clinical Features and Outcomes of Dengue Encephalitis: Analysis of five deaths in the 2023-2024 Epidemic, Paraguay
Introduction: Dengue encephalitis is a rare but severe neurological complication of dengue fever, the incidence of which increases during epidemics. This disorder results from direct invasion of the virus into the central nervous system or from an exacerbated inflammatory response. Objective: To describe and analyze clinical cases of 5 patients who died from dengue fever during the 2023-2024 epidemic. Clinical case: The analysis included the 5 confirmed clinical cases of dengue encephalitis that resulted in death. The patients' ages ranged from 10 to 97 years, with a predominance of women (n = 3). The findings are presented according to the research objectives, with emphasis on common patterns observed before the fatal outcome. Discussion: During the dengue outbreak in Paraguay (2023–2024), five fatal cases of encephalitis were reported, all with severe neurological symptoms such as seizures and coma. Most presented with high viral load and elevated levels of proinflammatory cytokines, associated with cerebral edema and multiorgan failure. The DENV-2 serotype predominated in patients with comorbidities. Neurological manifestations appeared early, without the need for thrombocytopenia. These findings reflect an intense inflammatory response and underscore the importance of timely diagnosis and treatment. Conclusions: The five patients who died from dengue were successfully described. The implementation of active surveillance strategies and specific protocols could improve early detection and reduce associated mortality.
Copyright (c) 2025 Alcide Florenciano Ramírez, María Adela Pérez Velilla, Luciana Daniela Garlisi Torales (Author) https://creativecommons.org/licenses/by/4.0
The Use of Neuroleptics in Elderly Patients with Dementia: A Systematic Review
Background: Dementia is a syndrome, generally chronic or progressive in nature, characterized by a gradual decline in cognitive function. It can be caused by various etiologies, and regardless of the underlying cause, patients exhibit a wide range of symptoms. Neuroleptics are considered first-line drugs for reducing dementia-related symptoms; however, their use is limited due to associated adverse effects. Several studies have demonstrated the effectiveness of neuroleptics in managing symptoms associated with dementia; nonetheless, they also emphasize the need for cautious use due to the potential adverse effects linked to their administration. Materials and Methods: A retrospective and observational systematic literature review was conducted in 2025 at the Universidad Abierta Interamericana in Buenos Aires, Argentina. The search was carried out using databases such as PubMed, Medline, LILACS, SciELO, and Cochrane. Results: Five studies from the preselected bibliography that met the inclusion and exclusion criteria were included. Conclusion: This study highlights the adverse effects associated with the use of neuroleptics in elderly patients with dementia. It is essential to recognize these effects in order to adequately assess the risk-benefit ratio of their use in each patient and to ensure proper monitoring during treatment.
Copyright (c) 2025 Julia Dall Cero , Marcelo Adrián Estrin (Author) https://creativecommons.org/licenses/by/4.0
Merkel Cell Carcinoma: Literature Review and Clinical Case Analysis
Backgroud: Merkel cell carcinoma is a cutaneous tumor, also known as neuroendocrine carcinoma, that is infrequent and highly aggressive, with a high mortality rate. 1 It primarily affects individuals over 60 years of age, those with immunosuppression, or those infected with the polyomavirus (MCPyV). It is an underdiagnosed tumor due to the nonspecificity of its clinical and dermatological manifestations. The definitive diagnosis is made by histopathological study, with identification of the sentinel lymph node being essential, since the presence of metastases is associated with a significant decrease in five-year survival. Although there is no optimal treatment, surgery remains a therapeutic pillar, complemented by radiotherapy and immunotherapy as adjuvant treatments. Material And Methods: The study was conducted using a mixed-method design, comprising a descriptive literature review conducted in scientific databases (PubMed, SciELO, Cochrane Library, and Elsevier), prioritizing recent population-based studies addressing the incidence, mortality, and survival associated with Merkel cell carcinoma. This was complemented by clinical follow-up of a 55-year-old female patient diagnosed with the condition in 2021. Results: The patient consulted on 06/25/2021 for a painless red nodule in an exposed region. The diagnosis was confirmed by biopsy on 01/07/2021. Despite the treatment, he developed lymph node and distant metastases and died in 2023. The revised bibliography shows a low overall survival, especially in advanced stages. Conclusion: The CCM continues to be an underdiagnosed neoplasm. Its early detection is key to improving prognosis and increasing survival. Despite the early diagnosis, the patient did not exceed three years of survival, which shows that the CCM can have aggressive clinical behavior even in the initial stages.
Copyright (c) 2025 Martina Cardenas , Gabriela Cavillon (Author) https://creativecommons.org/licenses/by/4.0
Alzheimer's Prevention and Treatment Strategies in Older Adults
Background: Alzheimer's disease represents an increasing challenge in the context of global aging. The objective of this systematic review was to identify effective strategies for the prevention and treatment of Alzheimer's disease in older adults. Material and methods: A structured search was conducted in SciELO and Google Scholar, selecting articles published between 2014 and 2024. Both pharmacological and non-pharmacological interventions were analyzed, including cognitive stimulation, physical activity, and dietary modifications. Results: The findings showed that combined approaches provide better outcomes in preserving cognitive function and slowing disease progression. Conclusion: We conclude that integrating pharmacological treatments with non-pharmacological strategies is the most effective option for managing Alzheimer's disease in older adults. Early diagnosis and comprehensive intervention are crucial factors for improving patients' quality of life.
Copyright (c) 2025 Lucas Reis Simões Neri, Patrícia Susana Salgueiro (Author) https://creativecommons.org/licenses/by/4.0
Prevalence of stroke in adults over 40 years of age, who consulted a public hospital in Paraguay, from January to June 2024
Introduction: Stroke is a common cause of disability and death. It occurs when blood flow to the brain is interrupted due to a damaged blood vessel, leading to oxygen and nutrient deficiency, causing paralysis and permanent damage, especially in people with other pathologies. Objectives: To determine the prevalence of stroke in the population over 40 years of age, from January to June, in a public hospital in Paraguay. Materials and methods: An observational, descriptive, retrospective, and cross-sectional study was conducted, the sample consisted of 45 patients. Results and discussion: Regarding the temporal distribution, the month with the most cases was April, with 14 patients (31.1%). Regarding sex, males predominated with 26 cases (57.8%). Regarding age, the most frequent age group was 62–72 years (35.6%). The most common district of residence was Villa Elisa, with 27 patients (60%). The predominant symptoms were dyspnea, dizziness, dysphagia, and hypertension. Regarding diagnosis, 12 patients had ischemic stroke (26.7%), 7 were diagnosed with hemorrhagic stroke (15.6%), and in 8 cases the etiology was undetermined (17.8%). In 16 patients (35.5%), stroke occurred as a secondary episode to associated diseases. Conclusion: The findings show that stroke mainly affects elderly men residing in Villa Elisa, with a predominance of ischemic stroke and a high frequency of associated comorbidities. Therefore, it is essential to strengthen prevention strategies and timely diagnosis in the at-risk population.
Copyright (c) 2025 Maria Eduarda Toro Persch , Letícia Soares Teixeira, Fabyana Rossany Monteiro Gomes, María Adela Pérez Velilla (Author) https://creativecommons.org/licenses/by/4.0
The postpartum period and mental health: women's perceptions of their experiences and emotional challenges in the postpartum period
Bacground: The puerperium is a stage of great physical and emotional transformations. Understanding women's emotional experiences during this period is essential to improve family and professional accompaniment. Material and methods: A mixed, descriptive and cross-sectional study was carried out through a structured questionnaire distributed using Google Forms. 54 women over 18 years of age who went through the puerperium participated. The instrument included closed questions with a Likert scale of 1 to 5 and open-ended questions. The quantitative data were statistically analyzed, and the qualitative data were analyzed through thematic analysis. Results: Moderate levels of emotional support from the couple and family were identified. The emotional care provided by health professionals was perceived as limited. Frequent emotional symptoms such as anxiety, sadness, and feelings of guilt were also observed. Access to informational and psychological resources was insufficient. Conclusion: Participants evidenced significant emotional challenges during the postpartum period, especially in relation to access to professional and emotional support. The need for more humanized interventions focused on maternal mental health at this stage is highlighted.
Copyright (c) 2025 Camila Candido Alsina , Karina Bustamante Galarza (Author) https://creativecommons.org/licenses/by/4.0
Background: Traumatic brain injury (TBI) from road traffic accidents is a major cause of morbidity and mortality in adults. This systematic review evaluates whether early surgical intervention combined with intensive hospital management improves clinical outcomes in these patients. Material and methods: A systematic literature review was conducted focusing on studies from the last ten years. Selected studies included adult patients with severe TBI due to traffic accidents, treated with early surgery and intensive care. Outcomes analyzed included mortality, neurological sequelae, and long-term quality of life. Results: Most studies found that early surgical decompression within hours of trauma, along with intensive monitoring, significantly reduced mortality rates and improved functional neurological recovery and quality of life. Fewer secondary complications were also observed. Conclusion: Early surgical treatment combined with intensive hospital management is an effective strategy to improve outcomes in patients with TBI due to road traffic accidents. Systematic implementation and future prospective studies are recommended
Copyright (c) 2025 Vitor Toniato e Silva, Javier Argote Gonzales (Author) https://creativecommons.org/licenses/by/4.0
Acute and Chronic Complications of High-Dose Corticosteroid Use in Patients with Spinal Shock: Systematic Revision
Background: During The use of methylprednisolone (MP) in patients with acute spinal cord injury has been widely debated due to its potential neurological benefits and associated risks of complications. While the administration of MP in the early hours following the injury has been adopted in many protocols, its use during surgical procedures remains controversial because of the high incidence of adverse effects. Materials and Methods: A systematic review of studies evaluating the use of MP during surgery in patients with acute spinal cord injury was conducted. The search included databases such as PubMed and the Cochrane Library, utilizing MeSH terms such as "methylprednisolone", "spinal cord injury", and "surgical complications". The selected studies included retrospective cohorts and controlled clinical trials. Results: The reviewed studies showed an increase in the incidence of severe complications, such as respiratory infections, gastrointestinal bleeding, and sepsis, in patients treated with methylprednisolone (MP) during surgical procedures. Some studies reported short-term motor improvements, but these were not consistent over the long term. Overall, patients receiving MP were at higher risk for complications like deep vein thrombosis and pneumonia compared to those who did not receive the drug (p < 0.01). These findings suggest that the risks associated with MP may outweigh its potential benefits in the surgical context. Conclusion: The use of prophylactic methylprednisolone during spinal stabilization surgery in patients with acute spinal cord injury is associated with a notable increase in the risk of severe complications. While some studies suggest initial motor improvements, the overall evidence points to significant risks, including infections and thrombotic events. These findings highlight the need to carefully reassess clinical guidelines regarding the use of MP in surgical settings and encourage exploration of alternative approaches that minimize potential adverse outcomes.
Copyright (c) 2025 Bruno Fogo, Mauro Perugino (Author) https://creativecommons.org/licenses/by/4.0
Visual disturbances due to semaglutide: A systematic review of the literature
Introduction: Semaglutide is a widely used medication for the management of type 2 diabetes and, more recently, for the treatment of obesity. While it is known for its efficacy in controlling glycemia and promoting weight loss, side effects have also been reported, including some related to vision. These side effects are uncommon but may be indirectly linked. Objectives: This study aimed to analyze the available evidence on visual disturbances associated with the use of semaglutide, describing the possible pathophysiological mechanisms involved and its clinical impact on patients. Materials and methods: A systematic review of the literature was conducted in scientific databases such as PubMed, Medscape, Scopus, and Cochrane, evaluating the incidence, severity, and reversibility of these adverse effects. Results: Several studies that demonstrated the ophthalmological risk associated with the use of semaglutide were selected. Conclusion: Although semaglutide has several proven benefits as a medication for type 2 diabetes, its use poses some risks that should be actively investigated, primarily the ophthalmological risks associated with semaglutide, especially in patients with a history of eye disease.
Copyright (c) 2025 Camila Barreto Maciel, Marcelo Adrian Estrin (Author) https://creativecommons.org/licenses/by/4.0
Mental health, artificial intelligence and clinical management: evolution of the sigileip-cuvalles system from a digital perspective
La gestión eficiente de los servicios de atención psicológica representa un desafío constante para las instituciones de salud, particularmente en entornos educativos, donde es necesario responder a dinámicas académicas específicas, a la alta rotación de usuarios y a limitaciones de recursos. Este trabajo presenta una serie de mejoras funcionales al Sistema para la Gestión de la Información del Laboratorio de Evaluación e Intervención Psicológica del Centro Universitario de los Valles (SIGILEIPCUValles), desarrollado para apoyar la gestión integral de servicios de salud mental en contextos universitarios. Si bien esta primera versión constituyó un avance relevante en la transformación digital de la atención psicológica en la institución, su implementación se vio limitada por restricciones funcionales y operativas. SIGILEIP 2.0, el centro de este trabajo, surge como una evolución funcional de este sistema inicial, concebida para superar dichas limitaciones y ampliar sus capacidades. Esta nueva versión incorpora un módulo para la generación dinámica de reportes, basado en técnicas de Procesamiento de Lenguaje Natural (Natural Language Processing, NLP) y un Modelo de Lenguaje Pequeño (en inglés: Small Language Model, SLM), así como un módulo para la planificación y programación de citas fundamentado en la satisfacción de restricciones. Además de reducir tareas manuales que limitaban la escalabilidad del sistema, la nueva versión introduce mejoras en la seguridad, el rendimiento y la usabilidad.
Copyright (c) 2026 Rosa Elena Peña Lallanilla, Francisco Eduardo Oliva Ibarra, Maritza Mandujano Munguía (Author) https://creativecommons.org/licenses/by/4.0
Encephalopathy in the emergency department. A case of Listeria monocytogenes.
Introduction: Encephalopathy in the emergency department represents a diagnostic challenge due to its multifactorial etiology, which includes metabolic, infectious, and vascular causes. Listeria monocytogenes meningitis is a serious infection with high morbidity and mortality, which mainly affects older adults and immunosuppressed individuals. Clinical case: A 65-year-old male patient with multiple comorbidities was admitted to the emergency department due to altered consciousness, fever, headache, vomiting, and a seizure. Physical examination revealed hypoglycemia, hypernatremia, hyperammonemia, uremia, hypertension (180/90 mmHg), and hypoxia (saturation 80%). Metabolic alterations were corrected, empirical antibiotic therapy (vancomycin, ceftriaxone, dexamethasone) was initiated, and a lumbar puncture was performed. CSF culture confirmed Listeria monocytogenes meningitis, and treatment was adjusted to ampicillin and gentamicin. The patient's outcome was favorable. Discussion. This clinical case illustrates the diagnostic complexity of encephalopathy in patients with multiple comorbidities, where metabolic, infectious, and hypertensive factors converge. The identification of Listeria monocytogenes as the etiologic agent by CSF culture underscores the need to include this bacterium in the differential diagnosis of meningoencephalitis in older adults with risk factors, especially in settings of relative immunosuppression. Conclusions: The patient's favorable outcome was possible thanks to a comprehensive and timely approach, which combined the stabilization of critical metabolic alterations, hemodynamic monitoring, and the early initiation of targeted antibiotic therapy. This case reinforces the importance of maintaining a high index of clinical suspicion in atypical neurological presentations and of using complementary diagnostic tools such as lumbar puncture, especially when classic signs may be masked. In the emergency setting, this systematic and multidisciplinary approach is essential to reduce morbidity and mortality associated with treatable infectious causes of encephalopathy, such as neurolisteriosis.
Copyright (c) 2026 Roberto Shigeru Oizumi Leigue, Edson Grover Sañez Liendo, Freddy Ednildon Bautista-Vanegas, Marco Antonio Gumucio Villarroel, Eloy Paycho Angua, Carmen Julia Salvatierra Rocha, Ismael Vargas Gallego, Jhossmar Cristians Auza-Santivañez (Author) https://creativecommons.org/licenses/by/4.0
Neurological effects of gluten intake in patients aged 30–35 years, in the province of Panama
Copyright (c) 2025 Anlly Añez, Sonia Daana, María Fernanda Montenegro, Luz Natalia Real, Diana Othon, Katherine Vega (Author) https://creativecommons.org/licenses/by/4.0
A Foundational Approach to Biomedical Image Enhancement for Brain Tumor Detection
The treatment of biomedical images through preprocessing and enhancement techniques draws the attention of everyone in the field of medical imaging due to the fact that such treatments will contribute to the improvement of the diagnostic accuracy. The present study investigates preprocessing and enhancement techniques applied to MRI brain tumor imaging. The tumor regions, consequently, become more visible and clearer. The methods used are Gaussian filtering, adaptive histogram equalization, and wavelet-based enhancement that remove the noise and make the image brighter at the same time. The power of the combination of these methods in yielding great images was astounding; the image quality measures used registered very significant changes—Peak Signal-to-Noise Ratio (PSNR) increased from 28,6 dB to 36,8 dB, Structural Similarity Index (SSIM) from 0,82 to 0,94, and Mean Squared Error (MSE) decreased by approximately 40 %. The tumor boundary delineation got better as a result of such advancements leading to more accurate segmentation and classification. This research verified that good preprocessing and enhancement were prerequisites for the reliable analysis of brain MRI images, besides, it pointed out the future directions of diagnostic and machine learning applications in the area of biomedical image processing.
Copyright (c) 2026 V Rajesh, B Rakesh Babu, Sk Hasane Ahammad, Ebrahim E. Elsayed (Author) https://creativecommons.org/licenses/by/4.0
The Hidden Cost of USMLE Preparation Among International Medical Graduates
Introduction: Preparing for the United States Medical Licensing Examination (USMLE) represents one of the most demanding stages in the career of international medical graduates (IMGs). Between 2020 and 2025, prolonged isolation, economic instability, and academic pressure have contributed to rising levels of psychological stress, family breakdown, and even suicidal behavior among USMLE candidates. Objective: To analyze the psychosocial and relational impact of USMLE preparation among international medical graduates, focusing on stress, burnout, divorce, and suicidal ideation. Methods: A narrative review of literature from 2020–2025 was conducted using PubMed, JAMA, and psychological databases. Sources included peer-reviewed studies, surveys, and editorials addressing physician mental health, academic stress, and marital instability. Results: USMLE preparation is associated with high rates of perceived stress (70–80%), anxiety (60%), and depression (45%) among candidates. Approximately 1 in 5 report relationship deterioration or separation during the process. Key predictors include prolonged study isolation, financial strain, self-comparison, and fear of failure. Female candidates and foreign-trained physicians exhibit higher vulnerability to psychological distress and suicidal ideation, particularly during repeated exam attempts or visa uncertainty. Conclusions: The USMLE preparation process imposes severe emotional and relational costs that remain largely overlooked. Institutional mental health programs, mentorship, and community support are urgently needed to mitigate burnout and prevent tragic outcomes among international physicians striving for U.S. licensure.
Copyright (c) 2025 Marlon Carbonell González, Rosali Santiago Roibal, Deborah Cabrera Rodríguez (Author) https://creativecommons.org/licenses/by/4.0
Feature Extraction and Selection Techniques for Brain Tumor MRI Analysis Using Artificial Intelligence
Feature extraction and selection are the main elements which lead to the correct classification and diagnosis of brain tumors with the help of medical imaging techniques. The detailed method of getting the distinguishing features of the MRI brain images through the combination of statistical, texture, and deep learning-based methods is shown in the analysis of this chapter. At first, it is the tumor regions that are subjected to enhancement and segmentation, done in the preprocessing steps, which are then handled for feature computation via Gray Level Co-occurrence Matrix (GLCM), Histogram of Oriented Gradients (HOG), and Discrete Wavelet Transform (DWT). Then onward, feature reduction is done by applying Principal Component Analysis (PCA) and Genetic Algorithms (GA) techniques in order to take away non-informative features and lower dimensionality. The suggested method promotes the classification effectiveness as well as the diagnostic accuracy. Trials on MRI datasets with MATLAB 2017b exhibit an average accuracy of 96,8 % and F1-score of 0,94, thus validating that optimal feature extraction and selection practices are great supporters of AI-based medical image analysis frameworks.
Hybrid Deep–Classical Models for Brain Tumor Classification and Diagnosis
New approaches for diagnosing complex diseases with aid of computers such as artificial intelligence and CT scans have resulted from the recent developments in medical imaging as well as artificial intelligence. Deep learning architectures are one of the key strengths in feature learning; however, classical machine learning algorithms provide interpretability and computational efficiency besides their lesser accuracy. A model called Hybrid Deep-Classical Model is elaborated on, which consists of deep feature extraction by utilizing CNN architectures (VGG16, ResNet50) combined with classical classifiers like Support Vector Machine (SVM) and Random Forest (RF). The combination leads to an increase in accuracy and generalization particularly in the case of small medical datasets. The experiments conducted on the BRATS 2020 and Kaggle Brain MRI datasets show that the results improve with the hybrid model having an average accuracy of 97,8 %, precision of 96,9 %, and F1-score of 97,2 % respectively. It can thus be concluded from the results that the hybrid models are superior to the others in the case of biomedical imaging for the purpose of obtaining reliable and efficient diagnosis of diseases.
Psychopedagogical intervention strategy to address shyness in adolescents
Introduction: socioemotional development is a crucial social need in school learning because it helps students establish healthy relationships and achieve academic and professional success. Objective: to determine the importance of a psychopedagogical intervention strategy to address shyness in adolescents. Method: an observational, descriptive, and cross-sectional study was conducted. Twenty students were selected through purposive sampling because they met the criteria for a direct relationship. Similarly, four teachers from the 9th Grade EBG (Bachelor's College of Education) and the parents of the students included in the sample were surveyed. Results: the data obtained indicate that low self-esteem, a lack of social skills, and the influence of the immediate environment are key elements in the development of this behavior. Teaching methodology and classroom dynamics have a significant impact on the manifestation of shyness. Many students with high levels of shyness come from homes where overprotection or a lack of positive reinforcement predominates. Conclusions: it is necessary to implement strategies that help boost self-esteem, the development of social skills, and the academic performance of shy adolescents.
Copyright (c) 2025 Karem Kadeesi Barrionuevo Alvarado, Yisell Vigoa Escobedo (Author) https://creativecommons.org/licenses/by/4.0
Psychopedagogical intervention strategies for shyness in adolescents
Introduction: adolescence constitutes a critical stage of human development, characterized by profound biological, psychological, and social transformations. Objective: to characterize aspects related to pedagogical interventions for adolescents with shyness. Methods: a bibliographic review was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases for the period 2018–2024. Original studies, reviews, and meta-analyses in Spanish and English were included. A total of 14 reference articles were used. Results: shyness is identified as a multifactorial phenomenon, influenced by biological, familial, pedagogical, and social components. The most effective interventions are those of a comprehensive nature, which combine the development of social skills (role-playing, assertive communication), the strengthening of self-esteem and self-efficacy, and the creation of a safe and inclusive school environment. Strategies such as cooperative learning, group dynamics, and family involvement are crucial for reducing social anxiety and encouraging active participation. Conclusion: psychopedagogical intervention strategies for adolescent shyness should be systemic and multimodal, simultaneously addressing the emotional, social, and cognitive dimensions.
Benefits of using dry needling for the treatment of pain in patients with headaches. Systematic review
The aim of this study was to evaluate the effectiveness of dry needling in reducing the intensity and frequency of pain in patients with headaches, especially chronic tension headaches and cervicogenic headaches. To this end, a systematic review was conducted based on an exhaustive search of the PubMed, Scielo, and Google Scholar databases, using Boolean operators and MeSH terms related to headaches and dry needling. Of a total of 475 articles identified, three studies that met the previously established inclusion criteria were selected. The total sample consisted of 371 patients, of both sexes and over 12 years of age, diagnosed with chronic headaches. The included studies were randomised clinical trials comparing dry needling with sham needling, conventional physiotherapy, therapeutic exercises and combinations with spinal manipulation. The main variables analysed were headache intensity and frequency, measured using validated scales such as the visual analogue scale, headache diaries and disability indices. The results consistently showed that dry needling produced significant and clinically relevant reductions in both headache intensity and frequency compared to the control groups. Improvements were also observed in associated disability, cervical function, and patients' quality of life. These effects were maintained in the short- and medium-term follow-ups. In conclusion, the evidence analysed supported the efficacy of dry needling as an effective therapeutic intervention within the kinesiological approach to chronic headaches, highlighting its potential to comprehensively improve the condition and quality of life of patients.
Copyright (c) 2024 Hugo Rubén Martínez, Cesar Martinez (Author) https://creativecommons.org/licenses/by/4.0