Daira Xadeny Robles Morales

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.

Acute abdomen remains one of the most challenging clinical conditions in emergency medicine and general surgery due to its heterogeneous etiologies, variable presentation, and high risk of rapid clinical deterioration. The objective of this review was to analyze acute abdomen as a multidisciplinary challenge through the integration of emergency medicine, radiological imaging, and clinical decision-making. A narrative review methodology based on scientific literature indexed in PubMed and Scopus was utilized, incorporating international guidelines, radiological recommendations, and evidence-based emergency surgery studies. The review evaluated major abdominal emergencies including appendicitis, intestinal obstruction, acute cholecystitis, pancreatitis, perforated viscus, mesenteric ischemia, and intra-abdominal infections. The findings demonstrated that early imaging integration, particularly computed tomography and ultrasonography, significantly improves diagnostic accuracy and therapeutic prioritization. Additionally, multidisciplinary collaboration between emergency physicians, radiologists, surgeons, intensivists, and anesthesiologists was identified as a key factor in reducing diagnostic delays and improving patient outcomes. The study also highlighted important healthcare system challenges affecting emergency abdominal care in Latin American countries such as Mexico, Colombia, and Ecuador, including limited imaging accessibility, emergency overcrowding, delayed specialist consultation, and interhospital transfer barriers. The evidence supports the implementation of structured multidisciplinary protocols and evidence-based diagnostic pathways to optimize emergency abdominal management. Acute abdomen should therefore be understood as a multidimensional emergency syndrome requiring coordinated interdisciplinary evaluation, rapid imaging utilization, and individualized therapeutic strategies to improve clinical outcomes and patient safety.

Metabolic optimization before surgery has become an essential component of contemporary perioperative medicine due to the increasing prevalence of obesity, diabetes mellitus, hypertension, metabolic syndrome, dyslipidemia, and cardiovascular disease among adult surgical populations worldwide. The present review aimed to analyze the endocrine and cardiovascular factors influencing perioperative surgical risk and to evaluate the impact of preoperative metabolic optimization on postoperative outcomes and surgical safety. A comprehensive narrative review methodology based on the Scientific Method and a Process-Based Methodology was employed using scientific literature indexed in PubMed, Scopus, Cochrane Library, and international clinical guidelines. The review analyzed evidence related to perioperative glycemic control, cardiovascular assessment, obesity-associated surgical complications, endocrine dysfunction, inflammatory mechanisms, pharmacological management, and multidisciplinary perioperative care models. The findings demonstrated that poor metabolic control is strongly associated with increased postoperative infection, cardiovascular instability, delayed wound healing, prolonged hospitalization, thromboembolic events, and intensive care admission. Hyperglycemia, insulin resistance, endothelial dysfunction, oxidative stress, systemic inflammation, and neurohormonal activation were identified as major mechanisms contributing to perioperative morbidity. Multidisciplinary optimization strategies integrating surgery, endocrinology, cardiology, anesthesiology, nutrition, and internal medicine consistently improved perioperative outcomes and reduced preventable complications. Additionally, the review highlighted the growing perioperative relevance of modern cardiometabolic therapies such as GLP-1 receptor agonists and SGLT2 inhibitors. The evidence supports the conclusion that structured preoperative metabolic and cardiovascular optimization significantly improves surgical safety and postoperative recovery in adult patients with cardiometabolic disease, particularly within healthcare systems experiencing increasing burdens of obesity and diabetes mellitus, including Mexico, Colombia, and Ecuador.