There was a setting I was working on where the Aztecs were a superpower. Rome has them beat for raw industrial capacity, and even the Norse/Iroquois Confederacy (a niche similar to RL third-world countries) manages a better overall standard-of-living, but they've got the best medical technology, and that's exactly why. If you're already used to ripping the still-beating heart out of someone's chest, the idea of reinstalling a different one doesn't seem too bizzare.
Their lack of progress in the ongoing, religiously-motivated war with the Empire of Nippon (sure, both groups worship the sun, but when the issue of the orbital fusion reactor's
gender comes up, suddenly it's all "die, heretic!") can be attributed primarily to superior cybernetic technology. At some point, the armor-plating on Jaguar Marines got so thick, they lost buoyancy. So, the engineers started adding more artificial muscle, tuned for swimming, but that just put even more drain on the already-limited oxygen supply. Tanks of compressed air led to slow, painful deaths from aeroembolism; tanks of compressed oxygen, with the relatively-insoluble nitrogen removed, led to somewhat faster deaths from spontaneous ignition. Nobody thought to make proper landing craft, because they're too small for
pykrete, and compared to the near-invincible Temple Carriers, other hull materials looked too expensive and too flimsy.
Hello!
Praise be to Athè, and Hob, Her living vessel.
2<3For I have crescent pies to bake
And smiles to throw before I wake