Diego Roberto Orrala Mendoza

Introduction: Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder characterized by infiltration of IgG4-positive plasma cells in multiple organs, which can affect the cardiovascular system with life-threatening complications such as aneurysms and aortic dissection (Zen et al., 2012; Ghaffari Jolfayi et al., 2025). Multiorgan involvement, including renal pseudotumors and orbital involvement, can present synchronously or metachronously, posing a diagnostic challenge (Maccagno et al., 2022; Haraguchi et al., 2012). Objective: To synthesize the available evidence on multiorgan IgG4-related vasculitis with manifestations of dissecting abdominal aortic aneurysm, renal pseudotumor and fulminant bilateral visual loss. Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 2000 and 2026 on IgG4-related vasculitis with aortic involvement, pseudotumors and ophthalmological manifestations. Results: Eight relevant studies documenting the association between IgG4-RD and cardiovascular, renal and orbital manifestations were identified. IgG4-related aortitis/periaortitis predominantly affects the abdominal aorta and iliac arteries, with higher prevalence in elderly males (Ghaffari Jolfayi et al., 2025; Zen et al., 2012). IgG4-related pseudotumors are extremely rare lesions, representing approximately 0.05% of evaluated lesions (Maccagno et al., 2022). Orbital IgG4 involvement can cause compressive optic neuropathy with fulminant visual loss, which responds favorably to systemic corticosteroids (Haraguchi et al., 2012). Conclusion: Multiorgan IgG4-related vasculitis is an exceptional but potentially lethal entity that requires a high index of suspicion. Synchronous presentation of aortic aneurysm, renal pseudotumor and bilateral visual loss should suggest the possibility of IgG4-RD, and early diagnosis with imaging studies and serum IgG4 measurement is essential to initiate timely immunosuppressive therapy and reduce associated morbidity and mortality.

Introduction: Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a prevalent autoimmune condition marked by diverse neuropsychiatric symptoms, primarily impacting young females (Alzghoul et al., 2024). Approximately 38-40% of cases exhibit a paraneoplastic relationship, with ovarian teratomas being the most commonly associated malignancy (94% of tumor cases) (Vervloet Sollero et al., 2024; Alzghoul et al., 2024). The association between anti-NMDAr encephalitis and renal carcinoma is extremely rare, with isolated cases reported in the literature (Yang et al., 2020; Vervloet Sollero et al., 2024). Brugada syndrome is a cardiac channelopathy that predisposes to malignant ventricular arrhythmias and can be triggered by drugs, including those used in the management of encephalitis (Brugada et al., 2002). Objective: To synthesize the available evidence on anti-NMDA autoimmune encephalitis associated with renal adenocarcinoma and drug-induced Brugada syndrome. Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 2000 and 2026 on anti-NMDA encephalitis, renal carcinoma and drug-induced Brugada syndrome. Results: Seven relevant studies documenting the association between anti-NMDA encephalitis and renal carcinoma were identified. Cases of young patients (20-54 years) with anti-NMDA encephalitis presenting clear cell renal carcinoma as underlying tumor were reported (Yang et al., 2020; Vervloet Sollero et al., 2024). Diagnosis was made through detection of anti-NMDAr antibodies in serum and CSF, and imaging studies revealing renal masses (Yang et al., 2020). Management included tumor resection, immunotherapy (corticosteroids, rituximab, cyclophosphamide) and plasmapheresis, with variable improvement of symptoms (Vervloet Sollero et al., 2024). The association with drug-induced Brugada syndrome has not been documented in the reviewed literature, but represents a potentially fatal complication requiring close electrocardiographic monitoring during immunosuppressive treatment (Brugada et al., 2002). Conclusion: Anti-NMDA encephalitis associated with renal carcinoma is an exceptional entity that requires a high index of suspicion and multidisciplinary management. Early diagnosis with imaging studies and antibody detection is essential to initiate timely immunosuppressive therapy and tumor resection. Electrocardiographic monitoring during treatment is essential to detect and manage drug-induced Brugada syndrome.

Introducción: Las malformaciones linfáticas cervicales (MLC) son anomalías vasculares congénitas que causan obstrucción de la vía aérea y disfagia grave neonatal. El tratamiento prenatal es un desafío por limitaciones de visualización y precisión. Objetivo: Realizar una revisión sistemática sobre MLC cervicales y desarrollar un modelo conceptual (in silico) no validado para generar hipótesis sobre la posible aplicación de realidad aumentada (RA) en cirugía fetal. Métodos: Revisión sistemática PRISMA 2020 (PubMed, EMBASE, Cochrane, Scopus; 2015-2026) y modelo conceptual in silico (no validado experimentalmente) de fetoscopia con navegación RA, presentado exclusivamente como herramienta generadora de hipótesis. Resultados: La revisión (18 estudios, n=324 fetos/neonatos) mostró que MLC >4 cm se asocian a obstrucción crítica de vía aérea en el 78% (IC95%:71-85%) y disfagia severa en el 65% (IC95%:57-73%). El modelo conceptual no validado sugirió hipotéticamente que la RA podría lograr reducciones volumétricas en rangos del 80-90% y precisiones de ablación <1 mm, con reducciones potenciales de la morbilidad post-natal del 80-90%. Conclusiones: La evidencia actual muestra alta morbilidad del manejo postnatal de MLC grandes. El modelo conceptual presentado genera hipótesis prometedoras, pero requiere validación experimental en modelos animales antes de cualquier aplicación clínica.

Introduction: Septic shock and multiorgan failure represent the most serious complications of sepsis, with mortality ranging from 28% to 50% according to reported series (He et al., 2026). Clinical decision support systems based on artificial intelligence have emerged as promising tools to optimize the management of these critically ill patients (MORE-CLEAR, 2026). Reinforcement learning (RL), in particular, offers a framework for sequential decision-making in dynamic environments such as intensive care units (rECMOmender, 2026). Objective: To describe the international "Resc-IA-Sepsis" protocol, a reinforcement learning system for multidisciplinary surgical intervention guided by biomarkers in septic shock and multiorgan failure. Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 2020 and 2026 on reinforcement learning systems in sepsis, organ failure predictive models, and biomarkers in septic shock. Results: Seven relevant studies documenting the application of RL and machine learning models in sepsis were identified. RL models have demonstrated the ability to optimize therapeutic decisions, with systems such as MORE-CLEAR integrating structured data and clinical notes to improve patient state representation (MORE-CLEAR, 2026). Machine learning-based predictive models have shown AUCs of up to 0.95 for heart failure prediction and 0.93 for liver failure in septic patients (He et al., 2026). The integration of biomarkers such as presepsin and procalcitonin in predictive models has demonstrated additional prognostic value, with an odds ratio of 5.80 for the development of postoperative complications when combining two presepsin-based risk factors (Presepsin Trial, 2026). Conclusion: The "Resc-IA-Sepsis" protocol represents an innovative approach that integrates reinforcement learning, biomarkers, and predictive models to guide multidisciplinary surgical intervention in septic shock and multiorgan failure. Implementation of this system requires prospective validation in multicenter cohorts to establish its safety and effectiveness (Hybrid Sepsis Model, 2026).

Introduction: Pancreatic pseudocysts are enzyme-rich fluid collections that form as a complication of acute or chronic pancreatitis, with an incidence of 5-16% and 20-40% respectively. Spontaneous rupture of a pancreatic pseudocyst is an exceptional complication, occurring in only 3-5% of cases. When rupture occurs toward adjacent structures, it can give rise to internal fistulas, including pancreaticopericardial fistulas (PPF), an extraordinarily rare entity with only 15 cases documented over a 40-year period. PPF can manifest with cardiac tamponade, heart failure, and shock. Sweet syndrome or febrile neutrophilic dermatosis is a rare inflammatory dermatosis that has been associated with neoplastic processes and, exceptionally, with pancreatic pathology. Objective: To synthesize the available evidence on spontaneous rupture of pancreatic pseudocyst into the pericardial cavity, gastro-pericardial fistula, and its association with febrile neutrophilic dermatosis (Sweet syndrome). Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 2000 and 2026 on pancreaticopericardial fistulas, cardiac tamponade secondary to pancreatic pathology, and Sweet syndrome associated with pancreatic disease. Results: Eight relevant studies documenting the association between pancreatic pseudocysts and pericardial complications were identified. Pancreaticopericardial fistula is an extremely rare complication of chronic pancreatitis, with an unknown incidence but with only 15 cases reported in 40 years. Cardiac tamponade was present in most cases, with dyspnea as the main symptom (78%), followed by hypotension (53%), chest pain (50%), and fever (43%). Management includes pericardiocentesis, percutaneous or endoscopic drainage, and octreotide therapy, with surgery reserved for refractory cases. Sweet syndrome associated with pancreatic neoplasm is exceptional, with only one documented case of association with intraductal papillary mucinous neoplasm (IPMN). Conclusion: Rupture of pancreatic pseudocyst into the pericardial cavity is an exceptional but potentially lethal complication that requires a high index of suspicion. The association with Sweet syndrome is extremely rare and suggests a possible common pathophysiological mechanism related to systemic inflammation and neutrophilic response. Multidisciplinary management and early diagnosis are essential to reduce associated morbidity and mortality.

Interacciones Endocrinas en la Enfermedad Cardiovascular es una obra académica que explora la estrecha relación entre el sistema endocrino y las patologías cardiovasculares, abordando los mecanismos fisiopatológicos, diagnósticos y terapéuticos que conectan ambas áreas. A través de un enfoque actualizado y multidisciplinario, el libro analiza el impacto de trastornos hormonales como la diabetes, disfunciones tiroideas, obesidad y alteraciones metabólicas en la salud cardiovascular. Dirigido a médicos, especialistas y estudiantes de ciencias de la salud, constituye una herramienta de consulta integral para comprender los desafíos clínicos contemporáneos en endocrinología y cardiología

Intersecciones Cardiovasculares: Manejo del Paciente Complejo es una obra que aborda los retos diagnósticos y terapéuticos del paciente cardiovascular con comorbilidades y condiciones clínicas multisistémicas. Mediante un enfoque integral y basado en la evidencia, el libro reúne temas relacionados con cardiología, medicina interna, cuidados críticos y enfermedades metabólicas, ofreciendo estrategias prácticas para la toma de decisiones en escenarios clínicos complejos. Dirigido a profesionales de la salud y médicos en formación, esta obra constituye una guía actualizada para el abordaje multidisciplinario del paciente cardiovascular contemporáneo.

Introducción: La enfermedad cardiovascular aterosclerótica (ASCVD) es la principal causa de morbimortalidad a nivel mundial. Clásicamente, factores de riesgo como la hipertensión y la hipercolesterolemia han monopolizado las estrategias de prevención. Sin embargo, la resistencia a la insulina (RI), incluso en ausencia de diabetes mellitus tipo 2 (DM2), ha emergido como un potente predictor independiente del desarrollo y progresión de la aterosclerosis a través de mecanismos moleculares que promueven la disfunción endotelial, la inflamación sistémica y la aterogénesis. Objetivo:Analizar y sintetizar la evidencia científica actual sobre la resistencia a la insulina como predictor de enfermedad cardiovascular aterosclerótica, detallando su fisiopatología, métodos diagnósticos e implicaciones terapéuticas. Método: Se realizó una revisión narrativa exhaustiva de la literatura publicada entre 1990 y 2025. La búsqueda bibliográfica se ejecutó en bases de datos biomédicas (PubMed/MEDLINE, Scopus, Web of Science y Google Scholar) utilizando términos MeSH específicos. Resultados: La evidencia demuestra que la RI precede a la hiperglucemia franca por décadas y desencadena un estado proaterogénico y protrombótico. La hiperinsulinemia compensatoria estimula la proliferación de células musculares lisas vasculares y exacerba el estrés oxidativo. Las herramientas diagnósticas como el índice HOMA-IR, aunque útiles epidemiológicamente, presentan limitaciones en la práctica clínica diaria. Las intervenciones tempranas con modificaciones del estilo de vida y agentes farmacológicos con beneficios cardiovasculares demostrados (como los inhibidores de SGLT2 y los agonistas del receptor GLP-1) modifican favorablemente el pronóstico. Conclusiones: La resistencia a la insulina no es solo un trastorno metabólico, sino un determinante clave en la patogenia de la ASCVD. Su identificación temprana y abordaje terapéutico integral son fundamentales para la prevención primaria y secundaria de eventos cardiovasculares.