Nathy Rodriguez Pequeño

The skin microbiome has emerged as a key regulator of immune function with significant implications for systemic disease. This review aims to analyze the role of cutaneous microbial communities in immune modulation and their contribution to the development, diagnosis, and treatment of systemic conditions. A structured narrative review was conducted using a scientific methodological framework, integrating evidence from dermatology, immunology, and microbiology. The findings indicate that microbial dysbiosis is consistently associated with immune imbalance, barrier dysfunction, and systemic inflammation. Key mechanisms include Toll-like receptor activation, cytokine modulation, and T-cell differentiation, which collectively influence disease progression. Additionally, the study highlights the growing relevance of the gut-skin axis as a pathway connecting local microbial changes with systemic outcomes. Diagnostic applications, particularly microbiome-based biomarkers, demonstrate potential for disease prediction and monitoring, while therapeutic strategies such as probiotics, bacteriotherapy, and antimicrobial peptides represent emerging approaches in personalized medicine. However, variability across populations and methodological heterogeneity remain significant challenges. This review underscores the importance of the skin microbiome as a central component in human health and supports its integration into future clinical and research frameworks, particularly in diverse international contexts..

The growing convergence between neurology and psychiatry has led to the emergence of the brain–mind continuum as a unifying framework for understanding disorders affecting cognition, behavior, and neurological function. This review aims to analyze and synthesize recent high-impact evidence on the integration of neurological and psychiatric perspectives in modern clinical practice, including implications for general surgery and hospital-based care. A structured narrative review was conducted using 20 peer-reviewed articles published from 2020 onward, selected from major scientific databases and journals. The analysis focused on shared neurobiological mechanisms, overlapping clinical manifestations, perioperative implications, and international applicability, particularly in healthcare systems such as those of Mexico, Colombia, and Ecuador. The results demonstrate that neural circuitry dysfunction, genetic factors, and neuroinflammatory processes constitute common pathways across a wide range of conditions. Additionally, significant overlap was identified in clinical presentations, including mood, cognitive, and behavioral disturbances. Emerging approaches such as neuroimaging, computational psychiatry, biomarkers, and precision medicine further support an integrative model of care. The findings highlight the limitations of traditional categorical classifications and emphasize the need for interdisciplinary diagnostic and therapeutic strategies. In conclusion, the brain–mind continuum represents a clinically relevant and scientifically supported framework that enhances patient care, promotes interdisciplinary collaboration, and provides a foundation for future research and medical education.

Clinical decision-making in internal medicine has become increasingly complex due to the growing prevalence of multimorbidity, particularly in patients with overlapping cardiovascular and psychiatric conditions. This review analyzes the role of advanced decision-support strategies in enhancing clinical reasoning, diagnostic accuracy, and therapeutic planning in complex cases. A structured methodological approach was applied to evaluate current evidence from high-impact literature, focusing on applications in internal medicine, cardiology, and psychiatry. The findings indicate that decision-support strategies provide their greatest contribution in diagnostic support and risk stratification, where their capacity to process multidimensional clinical data allows for improved identification of patterns and early detection of disease. In cardiology, these approaches demonstrate strong utility in electrocardiographic analysis and cardiovascular risk prediction, while in psychiatry they contribute to treatment response prediction, behavioral assessment, and adherence monitoring. The results also highlight the significant impact of multimorbidity—particularly polypharmacy, cardiovascular burden, and psychiatric comorbidity—on increasing clinical complexity. Despite their potential, the implementation of these strategies is influenced by structural barriers such as limited digital infrastructure, lack of clinician training, interoperability challenges, and economic constraints, especially in healthcare systems such as those of Mexico, Colombia, and Ecuador. The analysis emphasizes that the effectiveness of these tools depends on their integration into a physician-centered model, where clinical judgment remains central.

Cardiovascular disease remains the leading cause of mortality worldwide, and traditional risk stratification models based on static variables are often insufficient to explain the complexity of cardiometabolic disorders. In this context, metabolic flexibility—defined as the ability of the organism to adapt substrate utilization according to physiological demands—has emerged as a relevant integrative concept linking endocrinology and cardiovascular disease. This review analyzes metabolic flexibility as a central mechanism in cardiovascular risk, exploring its physiological basis, its relationship with insulin resistance and metabolic disorders, and its implications in cardiovascular pathology. Evidence shows that impaired metabolic flexibility is associated with altered substrate utilization, mitochondrial dysfunction, systemic inflammation, and increased cardiovascular risk. These alterations contribute to inefficient myocardial energy metabolism, vascular dysfunction, and disease progression. Additionally, current therapeutic strategies that improve metabolic regulation have demonstrated significant cardiovascular benefits, supporting the relevance of metabolic pathways in disease prevention and management. The analysis also highlights the importance of considering metabolic flexibility in populations with a high burden of cardiometabolic disease, particularly in Latin American countries such as Mexico, Colombia, and Ecuador.

Aging is associated with a progressive increase in chronic low-grade inflammation, known as inflammaging, which has been identified as a key mechanism underlying the development of multimorbidity. This review aims to analyze the role of inflammaging in aging and its impact across internal medicine, immunology, and gynecology. A structured narrative review was conducted using high-impact scientific literature, focusing on biological mechanisms, clinical implications, and interdisciplinary perspectives. The findings indicate that inflammaging is driven by interconnected processes such as immune dysregulation, cellular senescence, mitochondrial dysfunction, metabolic imbalance, and hormonal changes. These mechanisms contribute to the development of chronic diseases including cardiovascular disorders, type 2 diabetes, frailty, neurodegeneration, and postmenopausal alterations. Additionally, inflammatory biomarkers such as IL-6, TNF-α, and CRP were consistently associated with disease progression. The results also highlight the importance of lifestyle interventions, metabolic control, and emerging geroscience-based therapies in modulating chronic inflammation. Overall, inflammaging represents a central biological axis that links aging with multimorbidity, supporting the need for integrated and preventive approaches in clinical practice.

The skin has increasingly been recognized as a clinically significant interface reflecting systemic disease. This review analyzes recent international evidence (2020–2025) on the relationship between cutaneous manifestations and underlying systemic conditions, emphasizing their diagnostic value in modern clinical practice. A structured narrative review was conducted using high-impact literature indexed in major databases, focusing on autoimmune, inflammatory, infectious, vascular, and neoplastic diseases. The findings demonstrate that dermatologic manifestations frequently serve as early indicators of systemic pathology, often preceding or complementing internal clinical findings. Immune dysregulation, chronic inflammation, endothelial injury, and autoantibody-mediated mechanisms were identified as the primary pathophysiological links between skin and systemic disease. Additionally, the analysis highlights the importance of clinicopathologic correlation, lesion pattern recognition, and interdisciplinary collaboration in improving diagnostic accuracy. The results also underscore the relevance of dermatologic evaluation across different levels of care, particularly in primary care and internal medicine settings, where early recognition can significantly influence clinical outcomes. This is especially important in regions such as Mexico, Colombia, and Ecuador, where clinical examination remains a fundamental component of patient assessment.

Adaptive anesthesia has emerged as a paradigm shift in modern perioperative medicine, integrating neurophysiologic monitoring and individualized anesthetic control to optimize patient outcomes. This review analyzes current evidence on the role of electroencephalographic monitoring, depth-of-anesthesia indices, and closed-loop systems in guiding anesthetic management. A structured analysis of high-impact studies published from 2020 onward was conducted, focusing on neurophysiological mechanisms, perioperative outcomes, and technological advancements. The findings demonstrate that EEG-based monitoring improves the accuracy of anesthetic depth assessment and allows for more precise titration of anesthetic agents. Excessive anesthetic depth was consistently associated with higher rates of postoperative delirium, cognitive dysfunction, and hemodynamic instability, while adaptive strategies contributed to improved intraoperative stability and recovery profiles. Closed-loop systems showed potential in reducing variability and enhancing anesthetic precision, although their implementation remains limited. From an international perspective, the adoption of adaptive anesthesia is increasing, including in Latin American contexts such as Mexico, Colombia, and Ecuador, despite existing disparities in resources and training. Overall, adaptive anesthesia represents a transition toward precision-based, patient-centered perioperative care. Further research is required to standardize protocols, validate emerging technologies, and ensure broader clinical applicability.