Erik Fernández Godínez

Cardiorenal syndrome associated with type 2 diabetes mellitus has emerged as a major global health challenge due to its increasing prevalence, complex pathophysiology, and significant impact on morbidity and mortality. The interaction between cardiovascular disease, chronic kidney disease, and metabolic dysfunction creates a bidirectional cycle of organ damage mediated by inflammation, oxidative stress, endothelial dysfunction, neurohormonal activation, and fibrosis. This review analyzes current evidence regarding the mechanisms linking diabetes with cardiovascular and renal deterioration, emphasizing the concept of the cardiorenal-metabolic continuum. A comprehensive review of contemporary literature was conducted using international scientific databases and clinical practice guidelines. The findings indicate that recent therapeutic advances, particularly sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists, have significantly improved cardiovascular and renal outcomes while reducing disease progression and hospitalization rates. Despite these advances, substantial challenges remain regarding early diagnosis, treatment accessibility, therapeutic implementation, and healthcare disparities. These challenges are especially relevant in Latin American countries, including Mexico, Colombia, and Ecuador, where the burden of diabetes and chronic kidney disease continues to rise. Current evidence supports the adoption of integrated multidisciplinary approaches focused on early detection, comprehensive risk assessment, and evidence-based therapeutic interventions. The transition from organ-centered management toward a cardiorenal-metabolic model represents a fundamental paradigm shift that may contribute to improved patient survival, preservation of organ function, and enhanced quality of life.

Cardiometabolic diseases, including obesity, type 2 diabetes mellitus, cardiovascular disease, and heart failure, represent a growing public health challenge throughout the Americas. The increasing prevalence of these conditions has generated interest in therapeutic strategies capable of simultaneously addressing multiple interconnected risk factors. This review aimed to analyze the current scientific evidence regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on heart failure and cardiometabolic risk. A structured literature review based on the Scientific Method was conducted using information obtained from PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, Cochrane Library, and major international clinical guidelines. Evidence from randomized controlled trials, systematic reviews, meta-analyses, and cardiovascular outcome studies was critically evaluated and synthesized. The findings demonstrated that GLP-1 receptor agonists consistently reduce major adverse cardiovascular events, promote significant body weight reduction, improve glycemic control, and contribute to favorable cardiometabolic outcomes. Recent studies also reported improvements in symptoms, functional capacity, and quality of life among patients with obesity-related heart failure with preserved ejection fraction. Additionally, emerging evidence suggests beneficial cardiorenal effects that further support their role within the cardiorenal-metabolic continuum. The clinical relevance of these findings is particularly important for countries such as Mexico, Colombia, and Ecuador, where obesity, diabetes, and cardiovascular disease continue to increase. In conclusion, GLP-1 receptor agonists represent an important advancement in contemporary cardiometabolic medicine and may contribute significantly to integrated prevention and management strategies aimed at reducing cardiovascular and metabolic disease burden across the Americas.

Perioperative systemic inflammation is a complex physiological response generated by surgical trauma and represents one of the principal determinants of postoperative outcomes in modern surgical practice. This review aimed to analyze the multisystem impact of perioperative inflammation, including its pathophysiological mechanisms, inflammatory biomarkers, organ dysfunction, and current perioperative management strategies. A structured narrative review was conducted using scientific literature obtained from international databases including PubMed, Scopus, ScienceDirect, and related peer-reviewed medical sources. The analyzed evidence demonstrated that perioperative inflammation involves coordinated activation of cytokines, neuroendocrine pathways, endothelial dysfunction, oxidative stress, and immune dysregulation. Elevated inflammatory markers such as interleukin-6, C-reactive protein, and neutrophil-to-lymphocyte ratio were consistently associated with postoperative complications including cardiovascular instability, pulmonary dysfunction, acute kidney injury, infectious complications, delayed gastrointestinal recovery, and prolonged hospitalization. Modern perioperative strategies such as Enhanced Recovery After Surgery protocols, minimally invasive surgery, multimodal analgesia, immunonutrition, and goal-directed physiological optimization demonstrated beneficial effects in reducing inflammatory burden and improving postoperative recovery. The findings emphasize that perioperative systemic inflammation should be understood as a multisystem process requiring multidisciplinary perioperative management. Continued research focused on personalized inflammatory profiling, biomarker-guided monitoring, and targeted immunomodulation may contribute to improved postoperative outcomes and more individualized surgical care in the future.

Olytrauma is a major cause of mortality, disability, and prolonged critical illness worldwide, particularly among young and economically active populations. Beyond the initial anatomical injury, severe trauma triggers a complex systemic response involving inflammatory activation, endothelial dysfunction, metabolic and endocrine alterations, coagulation abnormalities, immune dysregulation, and progressive organ failure. The objective of this review was to analyze current evidence regarding the inflammatory, metabolic, and organ dysfunction pathways associated with polytrauma from a multidisciplinary perspective integrating traumatology, orthopedics, internal medicine, endocrinology, and critical care medicine. A narrative and integrative literature review was conducted using scientific databases including PubMed/MEDLINE, Scopus, ScienceDirect, PMC, and Google Scholar. Peer-reviewed articles, clinical reviews, trauma guidelines, and observational studies related to systemic trauma physiology, trauma-induced coagulopathy, metabolic dysfunction, and multiple organ dysfunction syndrome were analyzed. The reviewed evidence demonstrated that inflammatory mediators such as interleukin-6, tumor necrosis factor-alpha, complement activation products, and oxidative stress pathways play fundamental roles in systemic deterioration after severe trauma. Simultaneously, hypercatabolism, stress hyperglycemia, insulin resistance, and prolonged endocrine activation contribute significantly to physiologic instability and delayed recovery. Trauma-induced coagulopathy emerged as a dynamic process strongly associated with endothelial injury, inflammatory signaling, hemorrhagic shock, and microvascular dysfunction. Pulmonary, cardiovascular, renal, hepatic, and neurological dysfunction represented the most frequent systemic complications identified during trauma progression.

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.

Population aging has significantly increased the number of elderly patients undergoing surgical procedures, challenging traditional models of perioperative risk assessment. Frailty has emerged as a multidimensional clinical syndrome that better reflects patient vulnerability than chronological age or comorbidities alone. This review aims to analyze the impact of frailty on surgical risk, perioperative decision-making, and postoperative outcomes, integrating current international evidence with a perspective relevant to healthcare systems in Mexico, Colombia, and Ecuador. A structured integrative review was conducted using major biomedical databases, including PubMed, Scopus, and Web of Science. Studies focusing on frailty in surgical settings, perioperative outcomes, and risk stratification were selected and analyzed. The evidence demonstrates that frailty is strongly associated with increased postoperative complications, higher mortality, and significant functional decline. Additionally, frailty-based assessment tools show superior predictive accuracy compared to traditional models based on age or comorbidities. The findings also highlight the effectiveness of interventions such as Comprehensive Geriatric Assessment and prehabilitation in improving surgical outcomes. These strategies support the concept that frailty is a modifiable condition and emphasize the importance of proactive perioperative management.