Alan Chavez Rubio

Adolescent vaccination is a critical component of preventive public health strategies, yet persistent inequities in vaccine coverage continue to affect adolescents in Latin America. This review examines patterns of inequality in adolescent immunization coverage, with a multiregional focus on Mexico, Colombia, and Ecuador. Drawing on peer-reviewed literature, regional policy reports, and international immunization datasets, the study analyzes temporal trends, socioeconomic and geographic disparities, and differences associated with vaccination delivery platforms. The findings indicate that adolescent vaccination coverage shows incomplete recovery over time and remains strongly patterned by social determinants, including socioeconomic position, urban–rural residence, and linkage to school-based delivery systems. School-based vaccination strategies are associated with higher coverage, while facility-based and outreach approaches demonstrate greater vulnerability to access barriers. Structural and organizational factors, such as service availability and missed vaccination opportunities, appear to contribute more substantially to inequities than vaccine hesitancy alone. Overall, the results highlight that improvements in national coverage averages mask persistent disparities affecting disadvantaged adolescent populations. Addressing these inequities requires equity-oriented immunization strategies that integrate delivery platforms, strengthen monitoring systems, and prioritize adolescents in vulnerable social and territorial contexts.

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.

Sensorineural hearing loss remains a major global health challenge due to the limited regenerative capacity of the mammalian cochlea and the predominantly compensatory nature of current therapeutic options. In recent years, gene therapy has emerged as a promising strategy aimed at restoring auditory function by directly targeting the molecular and cellular mechanisms underlying cochlear dysfunction. This review analyzes and synthesizes contemporary advances in cochlear regeneration through gene-based interventions, including gene replacement, gene editing, transcription factor–mediated reprogramming, and RNA-based therapies. The evidence highlights that gene replacement approaches, particularly for monogenic forms of hearing loss with preserved cochlear architecture, currently demonstrate the most direct translational potential. Regenerative strategies focused on reactivating developmental pathways show encouraging structural and functional outcomes, although their long-term integration and stability remain critical challenges. Across all modalities, delivery platforms and administration routes emerge as decisive factors influencing efficacy, safety, and clinical feasibility. Functional auditory outcomes and translational readiness are increasingly emphasized as essential benchmarks for therapeutic relevance. This review also underscores the importance of international collaboration and the inclusion of research and healthcare contexts from Mexico, Colombia, and Ecuador to support equitable translation and implementation. Collectively, the findings position cochlear gene therapy as a rapidly evolving and clinically relevant field, with realistic prospects for biological hearing restoration contingent upon continued interdisciplinary and global efforts.

Advances in genomics and immunology have redefined the understanding of immune regulation, disease susceptibility and therapeutic response. This review synthesizes evidence across multiple biological scales—including germline variation, somatic mutations, epigenomic architecture and single-cell immune heterogeneity—to elucidate how genomic mechanisms shape immune function in health and disease. Emphasis is placed on the translational relevance of these mechanisms, particularly in the context of cancer immunotherapy, autoimmune risk stratification and emerging engineered-immunity platforms such as CRISPR-based editing and CAR T-cell therapies. The analysis also highlights the persistent underrepresentation of populations from Mexico, Colombia and Ecuador in genomic datasets, underscoring the need for inclusive precision-medicine strategies. By integrating mechanistic, technological and clinical dimensions, this review outlines the conceptual foundations of immunogenomics and identifies the opportunities and challenges that will shape its evolution as a global, population-relevant discipline.

Trauma remains a leading global cause of morbidity and mortality, demanding an integrated understanding of biomechanics, physiological responses, surgical stabilization, and long-term functional outcomes. This review analyzes the complex continuum of trauma care by synthesizing evidence from mechanobiological models, stabilization strategies, and functional recovery data, incorporating perspectives from Mexico, Colombia, and Ecuador. Results demonstrate that injury patterns are predominantly characterized by long bone fractures and traumatic brain injury, reflecting global epidemiological trends. Early definitive fixation is more common in resource-available settings, while staged approaches are increasingly utilized where physiological instability or systemic barriers exist. Complication rates rise significantly when definitive fixation is delayed beyond 72 hours, supporting established trauma physiology frameworks such as the systemic inflammatory response and the two-hit model. Despite successful stabilization, long-term outcomes remain heterogeneous: while nearly half of patients achieve full recovery, a substantial proportion experiences persistent limitations or permanent disability. These findings emphasize that trauma care is inherently multidimensional, requiring coordinated biomechanical, surgical, physiological, and rehabilitative strategies. Strengthening trauma systems—especially rehabilitation access and physiologically guided surgical decision-making—is essential for improving outcomes across Latin America