Alejandra Samara Tenorio Arellano

Pediatric multimorbidity has emerged as a significant clinical challenge that extends beyond the traditional single-disease model of pediatric care. The coexistence of multiple chronic conditions in children and adolescents generates complex diagnostic and therapeutic scenarios that demand advanced clinical reasoning, coordinated care, and long-term management strategies. This review synthesizes current international evidence on pediatric multimorbidity, with a specific focus on its implications for diagnostic complexity, therapeutic burden, polypharmacy, and healthcare utilization, framed within an internal medicine perspective. The findings highlight that pediatric multimorbidity follows identifiable patterns of disease clustering, frequently involving neurodevelopmental, mental health, respiratory, metabolic, and neurologic conditions. These patterns are associated with increased diagnostic uncertainty due to overlapping symptoms, atypical presentations, care fragmentation, and medication-related confounding. Therapeutic management is similarly complex, with polypharmacy and cumulative treatment burden representing central risks for patient safety and quality of life. Care coordination and family-centered approaches emerge as critical mechanisms for mitigating complexity, while gaps in transition planning to adult care remain a persistent challenge. From an educational standpoint, pediatric multimorbidity offers a valuable framework for teaching core internal medicine competencies, including diagnostic reasoning under uncertainty, systems-based practice, and patient-centered care. This review underscores the need to integrate multimorbidity-focused approaches into medical training and clinical practice, particularly within healthcare systems in Mexico, Colombia, and Ecuador.

Cardiovascular disease remains the leading cause of mortality worldwide, despite significant advances in prevention and treatment strategies. Increasing evidence indicates that traditional risk factors alone are insufficient to fully explain cardiovascular risk, highlighting the importance of inflammatory and metabolic mechanisms in the development and progression of atherosclerotic disease. This review synthesizes current scientific evidence on the role of chronic low-grade inflammation and metabolic dysregulation as interconnected determinants of cardiovascular risk. The analysis integrates mechanistic, clinical, and population-level data describing how immune activation, insulin resistance, obesity, metabolic syndrome, and endothelial dysfunction interact to promote atherosclerosis and related cardiovascular outcomes. Particular attention is given to inflammatory signaling pathways, immune cell involvement, and the concept of residual inflammatory risk, which persists even in the presence of optimal lipid control. Additionally, the review examines the contribution of lifestyle factors as upstream modulators of immunometabolic processes. By adopting an integrative immunometabolic perspective, this review provides a comprehensive framework for understanding cardiovascular risk beyond conventional models. This approach is especially relevant for educational and clinical contexts in regions undergoing epidemiological transition, including Mexico, Colombia, and Ecuador. The findings support the incorporation of inflammatory and metabolic determinants into cardiovascular risk assessment, prevention strategies, and future research agendas.

Precision oncology has traditionally focused on genomic profiling to guide targeted therapies; however, increasing evidence suggests that genetic alterations alone are insufficient to fully explain tumor behavior, therapeutic response, and clinical heterogeneity. This review aims to analyze precision oncology beyond genetics by integrating metabolic flexibility, tumor microenvironment dynamics, immune profiling, and systemic physiological factors, with particular emphasis on dermatology and internal medicine in international contexts, including Mexico, Colombia, and Ecuador. A structured narrative review was conducted using the scientific method as a guiding framework, allowing for the systematic identification, analysis, and integration of relevant literature. The findings demonstrate that tumor metabolism, particularly metabolic flexibility, plays a central role in adaptation and resistance. Additionally, the tumor microenvironment and immune profiling are critical determinants of treatment response, especially in the context of immunotherapy. The concept of the kidney as a sensor organ highlights the importance of systemic physiology in oncologic outcomes, particularly regarding drug clearance, toxicity, and metabolic balance. Furthermore, cardiometabolic conditions such as obesity, diabetes, and chronic inflammation significantly influence tumor progression and therapeutic effectiveness. The integration of these dimensions supports a systems-based model of precision oncology, where tumor biology and host factors interact dynamically. This approach is particularly relevant for dermatology and internal medicine, as it allows for a more comprehensive understanding of both local and systemic disease processes. In addition, the proposed framework offers practical applicability in diverse healthcare settings, including regions with limited access to advanced molecular technologies.

Brain monitoring in anesthesia has traditionally focused on the control of anesthetic depth; however, recent advances in neuroscience and perioperative medicine suggest a broader role in systemic physiological regulation. This review aims to analyze the integration of electroencephalographic (EEG) monitoring with renal sensing mechanisms and metabolic flexibility, emphasizing their combined impact on cardiovascular outcomes. The kidney is explored as a sensor organ capable of detecting early changes in oxygenation and metabolic demand, while metabolic flexibility is examined as a key determinant of physiological adaptation under surgical stress. A narrative integrative review was conducted using high-impact literature from anesthesiology, neuroscience, nephrology, and cardiovascular medicine. Findings indicate that optimized brain monitoring may influence systemic homeostasis by modulating neural activity, which in turn affects renal oxygen balance and metabolic pathways. This interaction supports a systems-based approach to anesthesia, where brain, kidney, and metabolism function as interconnected components of perioperative regulation. The integration of these domains may improve early detection of organ dysfunction, reduce perioperative complications, and enhance patient outcomes, particularly in populations with high prevalence of cardiovascular and metabolic diseases. This work highlights the need for multidisciplinary strategies and future research focused on real-time multisystem monitoring.