Ericka Johanna Linzan Cedeño

The skin frequently reflects internal pathological processes, making cutaneous manifestations valuable indicators of systemic disease. This narrative integrative review analyzes current scientific evidence on dermatologic findings that function as early or concurrent markers of underlying systemic disorders. The study synthesizes peer-reviewed literature addressing renal–metabolic, inflammatory–immune, malignancy-related, and vascular–calcific conditions, emphasizing recognizable cutaneous patterns and their clinical context. Results demonstrate that paraneoplastic dermatoses are commonly described as early indicators that may precede the diagnosis of internal malignancy, whereas renal–metabolic and vascular–calcific manifestations are more frequently reported as concurrent expressions of established systemic disease. Inflammatory and immune-mediated dermatoses exhibit variable timing, reflecting heterogeneous triggers and systemic associations. Across categories, cutaneous findings consistently mirror immune dysregulation, metabolic imbalance, vascular injury, or neoplastic activity. This review highlights the diagnostic and educational relevance of dermatologic examination in general medical practice, particularly in settings where access to advanced diagnostic resources may be limited. Integrating systematic skin assessment into routine clinical evaluation can strengthen diagnostic reasoning, support earlier recognition of systemic illness, and promote a more holistic approach to patient care.

Advanced cholecystectomy represents a technically and cognitively demanding procedure within general surgery, particularly in cases involving acute inflammation, altered anatomy, or high-risk patient profiles. The emergence of compact fourth-generation surgical robotic systems has introduced new possibilities for minimally invasive management by combining modular design, improved ergonomics, and enhanced visualization. This review analyzes current international evidence on the use of compact robotic platforms in advanced cholecystectomy, integrating clinical outcomes, learning-curve behavior, workflow feasibility, and human-factor considerations. The available literature demonstrates that robotic-assisted cholecystectomy achieves perioperative safety outcomes comparable to conventional laparoscopy, including rates of complications, bile duct injury, and mortality, even in complex disease contexts. Operative efficiency follows a characteristic learning curve, with early increases in operative time that progressively converge toward laparoscopic benchmarks as experience and workflow standardization increase. Importantly, robotic systems appear to reduce physical fatigue, ergonomic strain, and mental workload, factors closely related to stress regulation, cognitive performance, and surgeon well-being. These human-factor effects position robotic surgery at the intersection of technical innovation and psychiatry-adjacent considerations in surgical practice. From a systems perspective, compact robotic platforms demonstrate growing feasibility for integration into mid-resource healthcare settings, including those in Mexico, Colombia, and Ecuador, provided that structured training and governance frameworks are in place. Overall, compact fourth-generation robotic systems represent a safe, feasible, and human-centered advancement in advanced cholecystectomy, with implications for surgical quality, education, and professional sustainability.

Regenerative dermatology and 3D skin bioprinting have advanced rapidly over the past decade, offering new possibilities for restoring complex cutaneous architecture beyond the limitations of traditional grafting techniques. This review synthesizes evidence from twenty recent studies to evaluate technological innovations, biological strategies, and translational progress in the fabrication of functional human skin. The findings indicate a clear predominance of extrusion-based platforms, supported by emerging microfluidic, hybrid, and in situ systems that enhance structural fidelity and dynamic responsiveness. Bioinks have evolved from simple hydrogels to biologically instructive matrices, including GelMA-based formulations, alginate–gelatin composites, ECM-derived hydrogels, placental matrices, and peptide-functionalized biomaterials. These materials not only support high cell viability but also modulate angiogenesis, immune responses, and extracellular matrix organization. Multicellular strategies incorporating keratinocytes, fibroblasts, endothelial cells, pericytes, and stem cells demonstrate superior performance in vascular integration, tissue maturation, and appendage regeneration. Vascularization remains the critical determinant of clinical viability, with endothelial co-printing, sacrificial-channel scaffolds, and angiogenic bioinks emerging as complementary approaches to overcome diffusion limitations. Current applications are concentrated in wound healing, where bioprinted constructs improve closure and integration, and in disease modeling, where they enable physiologically relevant platforms for pharmacologic testing. In situ bioprinting represents a developing frontier for personalized bedside reconstruction. Collectively, the evidence shows that 3D bioprinting is transitioning toward translational readiness, supported by interdisciplinary advances and growing international participation, including key contributions from Mexico, Colombia, and Ecuador. Continued progress depends on refining vascular strategies, standardizing bioinks, and expanding collaborative research to ensure equitable future clinical implementation.