José Uriel Cornejo Quezada

Multimorbidity has become a defining challenge for internal medicine, characterized by the coexistence of multiple chronic diseases and shaped by functional decline, treatment burden, and socioeconomic vulnerability. This review synthesizes contemporary evidence on the epidemiology, clinical consequences, and health-system implications of multimorbidity, with a particular focus on Mexico, Colombia, and Ecuador. Findings demonstrate steep age-related increases in prevalence, strong associations with mortality, hospitalization, disability, and elevated costs, and significant variability driven by methodological differences and inequities in access to care. Functional impairment consistently emerges as a central predictor of adverse outcomes, underscoring the need for geriatric-informed, person-centered approaches. Despite extensive observational research, interventional and policy-oriented studies remain limited, especially in middle-income settings. The review highlights the urgent need for integrated care models, improved coordination between internal medicine and primary care, and equity-oriented policies capable of responding to the complex trajectories of multimorbidity. By integrating theoretical, epidemiological, and health-system perspectives, this study provides a foundation for advancing research, guiding clinical decision-making, and informing system reforms in Latin American internal medicine.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a cornerstone in modern internal medicine, demonstrating multisystem benefits that extend far beyond glycemic control. This review examines their cardiovascular, renal, hepatic, and metabolic effects, integrating evidence from major clinical trials and meta-analyses. The objective was to analyze and synthesize scientific evidence on the systemic impact of GLP-1 RAs, emphasizing their mechanisms, clinical relevance, and potential integration into internal medicine and public health strategies in Latin America. A systematic literature review was conducted following the DMAIC framework (Define–Measure–Analyze–Improve–Control). Twenty peer-reviewed studies published between 2016 and 2025 were selected from PubMed, Scopus, and The Lancet databases. Data were categorized by clinical domain and analyzed for efficacy trends and mechanistic consistency. Results showed that GLP-1 RAs consistently reduced major adverse cardiovascular events, slowed chronic kidney disease progression, improved hepatic inflammation and fibrosis, and achieved sustained weight reduction of 10–17%. Their multisystem effects were mediated by endothelial restoration, anti-inflammatory modulation, and metabolic reprogramming. GLP-1 receptor agonists represent a paradigm shift in internal medicine by integrating cardiovascular, renal, hepatic, and metabolic protection into a unified therapeutic model. Their adoption in Latin American health systems could reduce premature mortality, align regional policies with Sustainable Development Goal 3, and establish GLP-1 RAs as disease-modifying agents in global chronic disease prevention.

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (GIP/GLP-1 RAs) has redefined cardiovascular prevention and metabolic care. This review analyzes the cardiovascular, renal, and metabolic outcomes associated with these therapies, integrating evidence from major outcome trials—LEADER, SUSTAIN-6, REWIND, AMPLITUDE-O, and SELECT—and emerging dual incretin studies such as SUMMIT and SURPASS-CVOT. Across these trials, GLP-1 RAs consistently reduced major adverse cardiovascular events (MACE), cardiovascular mortality, and kidney disease progression, demonstrating benefits that extend beyond glycemic control. Mechanistic data reveal anti-inflammatory, endothelial, and neurohumoral pathways that collectively explain their cardioprotective profile. The new generation of dual incretin agonists, exemplified by tirzepatide, provides unprecedented improvements in weight reduction, insulin sensitivity, and heart failure symptoms, marking a new frontier in cardiometabolic therapeutics. For Latin American countries, including Mexico, Colombia, and Ecuador, the clinical translation of these findings faces barriers such as high cost, limited access, and physician unfamiliarity. However, strategic health policies and regional collaboration could integrate incretin-based therapy into national cardiovascular prevention frameworks. Ultimately, incretin therapy represents a paradigm shift from glucose-centric management toward comprehensive, preventive, and equitable cardiometabolic care with global implications.

Dual GIP/GLP-1 receptor agonists have emerged as an innovative therapeutic class that combines metabolic and renal protection in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This multicenter study, conducted in Mexico, Colombia, and Ecuador, evaluated the renal and metabolic effects of dual incretin therapy compared with GLP-1 receptor agonists and standard therapy (SGLT2 inhibitors plus RAAS blockade). A total of 1,150 adults with T2DM and CKD stages 1–4 were included. The dual GIP/GLP-1 group achieved the greatest improvement in kidney outcomes, with a 29% reduction in urinary albumin-to-creatinine ratio (UACR) and the smallest annual decline in estimated glomerular filtration rate (eGFR, −1.6 mL/min/1.73 m²), compared to GLP-1 monotherapy (−2.6) and standard therapy (−3.5). Additionally, participants receiving dual agonists showed superior metabolic control, including reductions in HbA1c (−17.9%), body mass index (−10.6%), and systolic blood pressure (−9.1 mmHg). Overall, 58.9% achieved composite kidney improvement and 76.3% avoided progression to a higher KDIGO risk category. These results align with international evidence from the SURPASS and FLOW trials, confirming that dual receptor activation offers synergistic mechanisms—anti-inflammatory, antifibrotic, and hemodynamic—that extend renal protection beyond glycemic control. The findings support incorporating dual GIP/GLP-1 receptor agonists into nephrology practice as a next-generation therapy capable of modifying the natural history of diabetic kidney disease and improving long-term clinical outcomes in diverse Latin American populations.

The growing prevalence of diabetic kidney disease (DKD) underscores the urgent need for therapies that go beyond glycemic control to achieve meaningful renal protection. This multicenter international study evaluated the impact of GLP-1 receptor agonists—semaglutide (Ozempic) and tirzepatide (Mounjaro)—on kidney outcomes in adults with type 2 diabetes mellitus and chronic kidney disease across Mexico, Colombia, and Ecuador. A total of 1,200 participants were followed for 12 months and compared with matched controls under standard care. Both semaglutide and tirzepatide significantly reduced the incidence of the composite renal endpoint (≥40% decline in eGFR, renal replacement therapy, or cardiovascular death) by 22% and 26%, respectively, versus control. The annual decline in estimated glomerular filtration rate was markedly slower in treated groups (−1.2 to −1.3 mL/min/1.73m²/year) compared with standard care (−3.4 mL/min/1.73m²/year), and urinary albumin-to-creatinine ratio decreased by 35–40%. These benefits were consistent across subgroups, including sex, age, CKD stage, and country, and remained significant after adjustment for confounders. The nephroprotective effects observed likely reflect multifactorial mechanisms—hemodynamic stabilization, anti-inflammatory modulation, endothelial protection, and synergy with SGLT2 inhibitors and RAAS blockade. Results parallel those from major global trials such as FLOW, SURPASS-4, and REWIND, confirming reproducible benefits in Latin American populations. Integrating GLP-1 receptor agonists into diabetic kidney disease management may represent a transformative, evidence-based strategy to delay renal failure and reduce cardiovascular mortality worldwide.

Electronic cigarettes have gained popularity worldwide, particularly among adolescents and young adults, raising serious concerns regarding their pulmonary health impacts. In Latin America, where regulatory responses differ across countries, Mexico, Colombia, and Ecuador provide a valuable context to examine vaping behaviors, respiratory risks, and policy frameworks. This study evaluated prevalence, usage patterns, respiratory outcomes, risk perceptions, and device preferences through a cross-sectional design with stratified random sampling of 3,000 participants (Mexico: 1,200; Colombia: 1,000; Ecuador: 800). Data were collected through validated questionnaires and complemented with secondary sources from WHO, PAHO, and national health surveys. Results showed that e-cigarette use was most frequent in individuals aged 15–24 years, with Mexico reporting the highest prevalence (28%), followed by Colombia (24%) and Ecuador (18%). Users reported higher rates of cough (42% vs. 15%), wheezing (28% vs. 9%), and dyspnea (35% vs. 12%), as well as increased medical consultations (30% vs. 10%) and hospitalizations (12% vs. 3%) compared with non-users. Misperceptions of reduced harm were more common among participants with lower education, while pods and disposables dominated device preferences, often with medium-to-high nicotine concentrations. These findings confirm the association of vaping with respiratory morbidity, misperceptions of safety, and rising dependence on high-nicotine devices. Pulmonologists and policymakers in Latin America must prioritize prevention, accurate risk communication, and enforcement of comprehensive regulations to protect vulnerable populations, especially adolescents and young adults, from the long-term burden of vaping-related lung disease.

This review article compares the diagnostic and prognostic performance of C-reactive protein (CRP) and procalcitonin (PCT) in detecting bacterial respiratory infections in adults. Evidence published between 2004 and 2025 was analyzed, including observational studies, clinical trials, and meta-analyses. Findings indicate that CRP shows higher sensitivity, whereas PCT demonstrates superior specificity and faster kinetic response to the onset and resolution of infection. The combined use of both biomarkers emerges as a balanced strategy to enhance diagnostic accuracy, optimize antibiotic use, and support antimicrobial stewardship programs. Clinical implications, methodological limitations, and future research directions are discussed, emphasizing the need for standardized diagnostic protocols and cost-effectiveness studies.

Heart failure (HF) is a leading cause of morbidity, mortality, and healthcare utilization worldwide. β-blockers are a cornerstone of guideline-directed medical therapy, yet uncertainties remain regarding their impact on hospitalization frequency, particularly when therapy is suboptimally dosed. In this retrospective study, we analyzed 480 patients with HF treated at two tertiary hospitals between January 2022 and June 2024, stratified into three groups: no β-blocker therapy, suboptimal therapy, and optimal therapy (≥50% of the target dose). The primary outcome was hospitalization frequency within 12 months, while secondary outcomes included 30-day readmission and median length of stay. Patients without β-blocker therapy had the highest hospitalization rate (62.1%), compared with 47.3% in the suboptimal group and 33.7% in the optimal therapy group. Rehospitalization within 30 days occurred in 22.9%, 15.8%, and 8.0% of patients, respectively, and median length of stay declined progressively from 8 days in untreated patients to 6 days in those optimally treated. Multivariate analysis confirmed that absence of β-blockers and suboptimal therapy were strong predictors of hospitalization, along with diabetes mellitus and reduced ejection fraction. These findings confirm that optimal β-blocker therapy is associated with fewer hospitalizations, reduced early readmissions, and shorter hospital stays, underscoring the importance of both initiation and dose optimization as key strategies in HF management.