Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

DOI: https://doi.org/10.46296/ig.v8i15.0256 Electricity consumption increases year after year, particularly due to population growth, as well as the growth of the industrial zone. The first relevant aspect to be considered is that an increased production of electric energy is associated with an intensification of CO2 emissions, so leading to global warming and climate change; especially when this source of energy is produced by conventional means. According to this, apart from the generation of clean energy, legal instruments such as the Long-Term Energy Competitiveness Draft Law must be promoted whose Technical and Economic Evaluation was evaluated in this research. The methodology combined qualitative and quantitative approaches: a bibliographic review was carried out in order to study the historical evolution of subsidies and tools such as SWOT were used to evaluate the current situation. The study design was documentary and descriptive with a quasi-experimental component by using data from secondary sources which was organized and analyzed with Microsoft Excel to present results through graphics and tables. The results showed that in a long term, the law will not only maintain the observed growth in the electricity sector, but also it will support the use of sustainable energy sources at low costs. Moreover, from a prospective point of view, it is expected that the law will attract both national and foreign investment to improve the growth of the sector and to increase the average of energy efficiency based on the implementation of clean technologies. Keywords: Optimization, nonlinear, power flow, loss electric, transformer.

Digital health is an area that involves the use of modern technologies that have an impact on the provision of medical services. In this sense, this study conducts a theoretical review on digital health that allows those involved to have an overview of it. Because of this, a historical-logical approach methodology was used with a three-stage model: planning, review and documentation supported by the EPPI-Reviewer tool. In this sense, it details relevant aspects ranging from theoretical contributions to models, policies and strategies related to the health system. Therefore, the data reveal various aspects that make it possible to automate processes, improve the quality of life, reduce waiting times, facilitate the availability of health care services, among others, and are essential for patients and health science professionals.

DOI: https://doi.org/10.46296/gt.v8i15.0227 Mirizzi syndrome is a rare complication of cholelithiasis, characterized by extrinsic compression of the common hepatic duct due to stones lodged in the cystic duct or in the vesicular infundibulum. It can lead to biliary obstruction and cholangitis, which makes its early diagnosis essential. Objective: To present a clinical case of Mirizzi syndrome secondary to choledocholithiasis, highlighting the importance of clinical, laboratory and imaging evaluation for its diagnosis and management. Results: We report the case of an 80-year-old man with a history of cholecystectomy, who presented with right hypochondrium pain and scleral jaundice. Laboratory studies showed direct hyperbilirubinemia and alterations in liver tests. Abdominal ultrasound showed a dilated common bile duct and a hyperechogenic image with posterior acoustic shadow in the distal cystic duct. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed extrinsic compression of the common hepatic duct, leading to the diagnosis of Mirizzi syndrome. Conclusions: Mirizzi syndrome should be suspected in patients with a history of cholelithiasis presenting with obstructive jaundice. The combination of imaging studies is key to its diagnosis, allowing timely treatment and preventing complications such as cholangitis or biliary fistulas. Keywords: Mirizzi's syndrome, Choledocholithiasis, Jaundice, Biliary obstruction, CPRE.

DOI: https://doi.org/10.46296/gt.v8i16.0281 Abstract Hand vascularized composite allotransplantation (VCA) has become an established reconstructive option over the past two decades for upper-limb amputees, offering a living limb with the potential for sensory and motor function. However, it is a life-enhancing rather than life-saving procedure, which raises ethical dilemmas due to the risks associated with lifelong systemic immunosuppression. This narrative review analyzes literature from the last 10 years on hand VCA, focusing on minimal-immunosuppression strategies and patient-centered outcomes. Advances in immunosuppressive protocols aimed at reducing toxicity are discussed, including the use of specific induction agents, mTOR inhibitors, and biologic agents such as belatacept, together with their reported benefits and limitations. Complications related to immunosuppression—opportunistic infections, neoplasms, and chronic rejection—and strategies to manage them are also addressed. Regarding functional outcomes and quality of life, recent evidence suggests that many transplant recipients achieve significant improvements in hand function and independence, with generally high satisfaction, although in some objective domains performance may be comparable to that achieved with advanced prostheses. Notwithstanding, major challenges persist: frequent episodes of acute rejection (usually controlled with appropriate therapy), the development of chronic rejection in some long-term cases, and the need for strict adherence to the immunosuppressive regimen. The importance of careful candidate selection, comprehensive psychosocial evaluation, and multidisciplinary, patient-centered follow-up is emphasized to optimize outcomes. In conclusion, hand VCA can provide notable anatomic and functional restoration and improve quality of life in selected patients, but it requires balancing the benefits against the risks of immunosuppression. Current trends aim for minimized-immunosuppression protocols and, ultimately, tolerance induction, along with objective metrics and patient-reported outcomes to assess success from the patient’s perspective, with the goal of achieving a safer and more effective application of this therapy in the near future. Keywords: Hand transplant; Vascularized composite allograft; Minimal immunosuppression; Functional outcomes; Quality of life; Chronic rejection.

DOI: https://doi.org/10.46296/gt.v8i16.0285 Abstract Nonsurgical rhinoplasty with hyaluronic acid fillers has emerged as a minimally invasive alternative to surgery, although it carries infrequent but potentially severe vascular risks. This critical narrative review examines the scientific evidence from the last 5 years on the use of Doppler ultrasound guidance for nasal filler injections. We describe the key nasal arteries and their anatomical variability, highlighting danger zones where vascular occlusion may cause skin necrosis or even blindness (1,2). Injection techniques are compared between the conventional “blind” approach and ultrasound-guided technique, analyzing injection planes (supraperichondrial vs subdermal), slow microbolus deposition, choice of blunt cannula vs sharp needle, aspiration, and minimal per-site volumes (3,4). We also detail the clinical application of Doppler ultrasound in rhinomodeling: modalities (high-frequency ultrasound with color Doppler), recommended settings (≥12 MHz) and advantages such as precise real-time vascular mapping and detection of existing filler, countered by a significant learning curve (5,6). Preliminary evidence suggests that ultrasound guidance may reduce vascular complications (no occlusions were reported in recent case series with Doppler mapping) (6), potentially improving safety compared to the conventional technique, without compromising aesthetic satisfaction as measured by global scales (GAIS) in appropriately selected patients. We discuss rescue algorithms for ischemic or ocular complications, emphasizing early administration of high-dose hyaluronidase under ultrasound guidance, topical vasodilators (nitroglycerin), and urgent ophthalmologic care for retinal emboli (7,15). Finally, we propose interdisciplinary Dermatology–ENT management strategies, including shared protocols, pre-procedure checklists, and referral pathways to optimize safety and cosmetic outcomes. The findings underscore the importance of anatomical knowledge, ultrasound training, and multi-specialty collaboration to minimize risks in rhinomodeling. Keywords: Hyaluronic Acid; Rhinoplasty; Ultrasonography, Doppler; Cosmetic Techniques.

DOI: https://doi.org/10.46296/gt.v8i16.0283 Abstract Atrial fibrillation (AF) is common in advanced chronic kidney disease (CKD) and dialysis, with higher ischemic-stroke and mortality risks, but a uremic bleeding diathesis; conventional scores (CHA₂DS₂-VASc, HAS-BLED) are not validated, creating a therapeutic “gray zone” (1)(2). Objective: To critically appraise oral anticoagulation in non-valvular AF with CKD stage 5 or dialysis, comparing vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs), focusing on efficacy, safety (intracranial and gastrointestinal bleeding), all-cause mortality, and drug discontinuation. Methods: Narrative review (last ~5–7 years) of PubMed/MEDLINE, Scopus, and clinical summaries including adults with CKD5/dialysis, comparing dose-adjusted DOACs versus warfarin (INR 2–3). Outcomes: ischemic stroke/systemic embolism, major bleeding (ISTH), mortality, and discontinuation; risk of bias and certainty assessed with standard tools. Results: No large RCTs exist; two small trials—RENAL-AF (n=154) and AXADIA (n=97)—showed no significant differences between apixaban and VKAs for stroke/embolism or major bleeding (3)(4). Observational evidence and meta-analyses suggest DOACs—particularly apixaban—yield similar or better outcomes than warfarin in CKD5/dialysis (5)(6)(7). In U.S. registries, standard-dose apixaban (5 mg twice daily) was associated with lower stroke/embolism (~36%), major bleeding (~28%), and mortality (~37%) versus warfarin; reduced-dose apixaban (2.5 mg twice daily) was less effective (5). Rivaroxaban/dabigatran lack robust dialysis data and have been linked to excess bleeding off-label (6)(7). Warfarin has not shown convincing stroke reduction and may increase hemorrhagic stroke and calciphylaxis (12)(14). One-year mortality is ~35–40%, with discontinuation >20%/year. Conclusions: Anticoagulation should be individualized via shared decision-making. When pursued, apixaban (5 mg twice daily; 2.5 mg if ≥2 reduction criteria) is a reasonable option with at least comparable safety and lower ICH, though overall certainty remains low (5)(7). COVID-19 favored DOACs by reducing laboratory visits, while requiring vigilance for drug interactions (18). Keywords: Atrial Fibrillation; Renal Insufficiency, Chronic; Renal Dialysis; Anticoagulants; Factor Xa Inhibitors; Warfarin; Stroke; Hemorrhage.

DOI: https://doi.org/10.46296/gt.v8i16.0282 Abstract Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is an exceptionally rare and aggressive neoplasm that predominantly affects young women and is associated with paraneoplastic hypercalcemia and poor outcomes. The objective of this case report is to synthesize the clinical–radiologic course and diagnostic hallmarks in a 19-year-old with fulminant SCCOHT, highlighting early red flags for recognition. The patient initially presented with short-duration lower abdominal pain. During the initial assessment, ultrasound revealed a large left abdominopelvic mass with solid–cystic components, most consistent with ovarian origin; precise characterization was limited by the tumor’s considerable size and extension into the retroperitoneal space. Cross-sectional imaging subsequently confirmed ascites, a left pleural effusion, bulky retroperitoneal conglomerates with massive nodal spread to pelvic and supradiaphragmatic stations, and a lytic osseous metastasis in L2. Surgical biopsies of the tumor and lymph nodes disclosed small cell carcinoma; immunohistochemistry demonstrated loss of SMARCA4 (BRG1) with focal epithelial marker positivity, confirming SCCOHT. Owing to rapid clinical decline and the patient’s decision, she was discharged home on request; no oncologic treatment was initiated, and death occurred at home before one month from symptom onset. This case underscores SCCOHT’s extreme aggressiveness and the need to consider it in atypical ovarian masses in adolescents or young adults—especially when hypercalcemia, extensive lymphatic dissemination, and osseous involvement coexist. Early recognition, immunohistochemical confirmation (SMARCA4 loss), and intensive multidisciplinary planning are crucial while more effective therapies are developed. Keywords: Carcinoma, Small Cell; Ovarian Neoplasms; Hypercalcemia; Lymphatic Metastasis; Bone Metastasis; SMARCA4.

DOI: https://doi.org/10.46296/gt.v8i16.0280 Abstract Tuberculosis (TB) remains a major health burden in Latin America, with recent increases and a disproportionate impact on vulnerable groups (1,4). Primary Health Care (PHC) is pivotal for early case detection and preventive therapy. This critical review synthesizes evidence on active case-finding (ACF) strategies in PHC—including the programmatic definition of respiratory symptomatic individuals (cough with expectoration ≥15 days) (7)—and modalities such as household contact investigation, “cough clinics,” community campaigns, and integration within care pathways. We appraise performance (sensitivity, specificity, number needed to screen, cost per case) and the role of chest radiography as a triage test, including AI-assisted reading in high-risk settings (1,15). We compare tests for latent TB infection (LTBI)—tuberculin skin test versus IGRA—highlighting lower specificity of tuberculin among BCG-vaccinated persons and operational considerations in PHC (16,17). Preventive treatment regimens (isoniazid, rifampicin, and shorter combinations), adherence patterns, and effective PHC-based interventions (education, DOT/vDOT, incentives, packaging, pharmacist-led follow-up) are summarized (10–13,17). We present the programmatic cascade from screening to completion, with key indicators and gaps in PHC, and address equity-focused approaches for children <5 years, people living with HIV, migrants, incarcerated populations, and indigenous communities (1,4,5,14,18). Finally, we provide pragmatic recommendations and a checklist for PHC teams to strengthen community-based TB detection and prevention, contributing to End TB goals in the region (1,2,15,16). Keywords: Tuberculosis; Primary Health Care; Active case finding; Respiratory symptomatic; Latent tuberculosis infection; Tuberculin skin test; IGRA; Treatment adherence; Preventive therapy; Health equity.

DOI: https://doi.org/10.46296/gt.v8i16.0279 Abstract Aquatic fungi produce the most frequent mycoses in freshwater fish. Infections generally begin when animals are immunosuppressed by a sudden change in temperature, probably with a worrying increase in ammonium levels or due to factors that influence the environment, such as drastic changes in the physical and chemical conditions of the water, etc., Saprolegniasis is a disease that harms freshwater fish in its different stages. The research was carried out in the San Juan Pamba area of the San Miguel canton through a diagnosis of direct observation, three natural treatments against saprolegniasis were established: T1 (200g of macerated garlic in 20l of H2O), T2 (15g of propolis in 20l of H2O) and T3 (absolute control). According to the results obtained, it is established that the highest prevalence of Saprolegniasis due to treatment was T3 with 84%. For the mortality variable there were 6.67% of dead trout. In addition, an efficiency of 98% was obtained in T1, 94% in T2 and 44% in T3. When evaluating the effect of the treatments, in the control of Saprolegniasis in rainbow trout, it was observed that the group of control trout, their macroscopic lesions worsened as the days passed and some even died, however, at the end of the study the treated trout Based on the maceration of garlic and propolis, they showed improvements in their appearance, since there was a decrease in lesions caused by the fungus. Keywords: Rainbow trout, saprolegniasis, garlic, propolis.

DOI: https://doi.org/10.46296/gt.v8i16.0277 Abstract The objective of this study was to compare the reproductive efficiency of two prolonged proestrus synchronization protocols (J-Synch 6 days and Split-Synch 5 days) in cyclic beef heifers. A total of 40 crossbred Bos taurus × Bos indicus heifers were used, divided into two groups of 20 animals each, in a field-based experimental design. Estrus expression, ovulation, and conception rates were evaluated, as well as the effect of insemination timing under the Split-Synch protocol. Results showed that the J-Synch protocol achieved higher estrus manifestation (60%) and pregnancy rates (45%) compared to Split-Synch (45% and 35%, respectively), although without statistically significant differences (p > 0.05). Regarding insemination timing, conception rates were 28% at 64 hours and 38% at 72 hours post-device removal, also not statistically significant. The findings suggest both protocols provide comparable reproductive performance, with a slight tendency favoring J-Synch. In addition, insemination at 72 hours may be more effective under field conditions. It is recommended to consider physiological factors such as body condition, cyclicity, and herd management to improve reproductive outcomes. Keywords: TAI, J-Synch, Split-Synch, estrus synchronization, pregnancy rate.