Brenda Mishell Ruiz Borja

Arrhythmias and sudden cardiac death represent major challenges in sports cardiology because they may occur in apparently healthy athletes and may be related to structural heart disease, inherited channelopathies, coronary abnormalities, myocarditis, or other arrhythmogenic substrates. This study analyzed the principal factors associated with sudden cardiac death in athletes, with emphasis on cardiovascular preparticipation evaluation, electrocardiographic interpretation, characterization of ventricular arrhythmias, and perioperative cardiovascular management. An integrative review and analytical synthesis of clinical guidelines, consensus statements, epidemiological studies, systematic reviews, and relevant observational investigations was performed using evidence from recognized scientific databases and international cardiovascular societies. The findings demonstrated that sudden cardiac death is uncommon overall but is heterogeneously distributed, with higher incidence reported in specific groups such as male athletes, Black athletes, and Division I male basketball players. Hypertrophic cardiomyopathy, congenital coronary artery anomalies, myocarditis, arrhythmogenic cardiomyopathy, and inherited electrical disorders were identified among the principal underlying conditions. Athlete-specific electrocardiographic criteria reduced abnormal classifications while preserving the detection of clinically significant cardiovascular disease. The analysis of ventricular ectopy showed that morphology, complexity, exercise response, symptoms, and the presence of structural abnormalities are more clinically informative than arrhythmic burden alone. In the perioperative setting, high functional capacity does not eliminate cardiovascular risk, particularly in athletes with known or suspected arrhythmogenic substrates. Electrolyte disturbances, autonomic fluctuations, anesthetic agents, hypoxemia, hemodynamic changes, and surgical stress may facilitate perioperative rhythm disturbances. The evidence supports an integrated and individualized strategy combining preparticipation screening, targeted diagnostic testing, arrhythmic risk stratification, shared decision-making, and perioperative planning. This approach may improve the identification of high-risk athletes while avoiding unnecessary restrictions and promoting safer participation in sport and surgical care.

Endocrine-metabolic disorders are increasingly recognized as major determinants of cardiovascular risk because their effects extend beyond alterations in glucose and lipid metabolism and involve inflammatory, vascular, and hemostatic pathways. This review analyzed the interaction between endocrine-metabolic abnormalities, the development of a prothrombotic state, and cardiovascular risk, with particular emphasis on obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, thyroid dysfunction, and hypercortisolism. A structured integrative review was conducted using scientific evidence from clinical guidelines, systematic reviews, meta-analyses, mechanistic studies, and epidemiological investigations. The findings showed that obesity, diabetes mellitus, and metabolic syndrome presented the greatest overlap of pathophysiological mechanisms, particularly chronic inflammation, oxidative stress, endothelial dysfunction, platelet hyperreactivity, coagulation activation, and impaired fibrinolysis. Coagulation activation was one of the most consistently identified pathways, while reduced fibrinolytic capacity, frequently associated with increased plasminogen activator inhibitor-1 activity, contributed to thrombus persistence. Diabetes was additionally associated with structural alterations of fibrin and increased platelet responsiveness, whereas visceral adiposity was linked to inflammatory and procoagulant signaling. Thyroid dysfunction and hypercortisolism also demonstrated relevant hemostatic alterations, supporting the broader relationship between endocrine regulation and thrombosis. Overall, the evidence indicates that cardiovascular risk in endocrine-metabolic disease results from an interconnected network in which metabolic dysfunction promotes inflammation and oxidative stress, followed by endothelial injury, platelet and coagulation activation, impaired fibrinolysis, and ultimately atherothrombotic events. The prothrombotic state therefore represents an important intermediate pathophysiological phenotype between endocrine-metabolic dysfunction and cardiovascular disease. These findings support comprehensive cardiovascular prevention and highlight the need for future studies evaluating integrated metabolic and hemostatic biomarkers for improved risk stratification.

Los trastornos de personalidad representan una categoría compleja y heterogénea de condiciones psicológicas que afectan significativamente la vida emocional, social y funcional de quienes los padecen. En las últimas décadas, los avances en el diagnóstico y tratamiento han permitido una comprensión más profunda de estas alteraciones, destacando la importancia de enfoques integrales y personalizados. La inclusión de criterios más claros en manuales diagnósticos como el DSM-5 y el CIE-11 ha facilitado una identificación más precisa de los distintos trastornos, mientras que herramientas como la evaluación dimensional han complementado las clasificaciones tradicionales. En cuanto al tratamiento, las terapias basadas en evidencia, como la terapia dialéctico-conductual (TDC) y la terapia centrada en esquemas, han mostrado eficacia en el manejo de trastornos como el límite de la personalidad. Asimismo, los avances en farmacoterapia han contribuido a abordar síntomas específicos, aunque su uso sigue siendo complementario a la intervención psicoterapéutica. Este artículo revisa críticamente los progresos recientes en esta área, subrayando la necesidad de un enfoque multidisciplinario que combine investigación, práctica clínica y apoyo psicosocial. Finalmente, se plantean desafíos actuales y futuras direcciones para optimizar la atención a pacientes con trastornos de personalidad, promoviendo su bienestar y funcionalidad a largo plazo.

Skin manifestations frequently represent visible indicators of systemic disease and may provide important diagnostic clues during clinical evaluation. The objective of this review was to analyze the diagnostic value of dermatological manifestations associated with systemic disorders within the fields of internal medicine and endocrinology. A narrative review methodology based on the scientific method was utilized through the analysis of peer-reviewed literature indexed in PubMed, Scopus, ScienceDirect, and related biomedical databases. The review included studies focused on endocrine, metabolic, autoimmune, renal, hepatic, infectious, vascular, inflammatory, and neoplastic diseases associated with cutaneous findings. The analyzed evidence demonstrated that endocrine-metabolic disorders represented the most frequent group associated with dermatological manifestations, particularly diabetes mellitus, obesity, metabolic syndrome, thyroid dysfunction, and hyperandrogenic states. Common findings included acanthosis nigricans, xerosis, pigmentation changes, inflammatory rashes, vascular lesions, ulcers, and paraneoplastic dermatoses. Autoimmune diseases such as systemic lupus erythematosus and dermatomyositis also exhibited characteristic cutaneous patterns strongly associated with systemic inflammatory activity. Renal and hepatic diseases frequently presented with xerosis, chronic pruritus, jaundice, and vascular skin lesions, while paraneoplastic dermatoses demonstrated considerable relevance as potential indicators of occult malignancy. The review additionally highlighted the educational and interdisciplinary importance of dermatological examination in medical practice. Recognition of skin findings may improve diagnostic suspicion, facilitate earlier intervention, strengthen interdisciplinary collaboration, and support comprehensive patient-centered care. The findings reinforce the concept that the skin functions as a clinically meaningful reflection of systemic disease and should be considered an essential component of physical examination within internal medicine and endocrinology.

Metabolic syndrome is currently recognized as a major multisystem disorder associated with significant cardiovascular, renal, endocrine, and inflammatory complications. The present review aimed to analyze the pathophysiological mechanisms, epidemiological characteristics, cardiovascular and renal outcomes, and current therapeutic perspectives associated with metabolic syndrome through an integrative analysis of recent scientific literature. A narrative and integrative review methodology based on the Scientific Method and a Process-Based Approach was employed using peer-reviewed publications indexed in PubMed, Scopus, and internationally recognized medical journals. The analyzed evidence demonstrated that insulin resistance, visceral obesity, chronic low-grade inflammation, oxidative stress, endothelial dysfunction, and neurohormonal activation constitute the principal mechanisms underlying multisystem deterioration in metabolic syndrome. Cardiovascular complications including coronary artery disease, heart failure, hypertension, and cerebrovascular disease were strongly associated with metabolic dysfunction. Additionally, chronic kidney disease progression appeared closely linked to glomerular hyperfiltration, fibrosis, inflammatory injury, and endothelial impairment. Epidemiological findings from Mexico, Colombia, and Ecuador revealed increasing prevalence patterns associated with obesity, sedentary lifestyles, nutritional transition, and socioeconomic disparities. The review also identified the importance of multidisciplinary therapeutic strategies involving lifestyle modification, cardiovascular risk reduction, glycemic control, renal protection, and emerging pharmacological therapies such as GLP-1 receptor agonists and SGLT2 inhibitors. Overall, metabolic syndrome should be understood as a systemic cardiometabolic disorder requiring comprehensive clinical management, preventive medicine strategies, and continued scientific investigation to reduce long-term morbidity and mortality.

Cancer is currently recognized as a systemic and multifactorial disease involving complex interactions between metabolism, immunity, endocrinology, inflammation, and the tumor microenvironment. The objective of this review was to analyze the metabolic and immune interactions involved in tumor progression from an integrative systemic perspective. A narrative review methodology was employed using scientific literature indexed in PubMed, Scopus, Web of Science, and ScienceDirect between 2020 and 2025. The analyzed evidence demonstrated that tumor progression depends not only on genetic alterations but also on metabolic reprogramming, chronic inflammatory signaling, endocrine dysfunction, immune suppression, and adaptive modifications within the tumor microenvironment. Malignant cells exhibit metabolic flexibility characterized by increased glycolysis, glutamine dependency, altered lipid metabolism, and mitochondrial adaptations that promote survival under hypoxic and nutrient-deprived conditions. Simultaneously, metabolic competition and accumulation of immunosuppressive metabolites impair cytotoxic immune responses and favor immune evasion. Obesity, insulin resistance, hyperinsulinemia, adipokine imbalance, and chronic low-grade inflammation were identified as important systemic contributors to carcinogenesis and tumor dissemination. The review additionally highlighted the relevance of cancer-associated cachexia, chronic inflammation, and therapeutic resistance as systemic manifestations of malignant disease. Current evidence supports the development of integrated therapeutic strategies combining metabolic modulation, immunotherapy, endocrine intervention, and anti-inflammatory approaches. Overall, this review reinforces the concept that cancer progression results from continuous communication between malignant cells and host physiology, emphasizing the importance of multidisciplinary and systemic perspectives in contemporary oncology.

Cardiometabolic diseases currently represent one of the leading causes of morbidity and mortality worldwide. The growing coexistence of obesity, insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, and cardiovascular disease has contributed to the development of the cardiometabolic continuum concept, which describes the progressive interaction between metabolic and cardiovascular dysfunction. The objective of this review was to analyze the current scientific evidence regarding the integration of cardiovascular and endocrine risk factors within contemporary clinical practice, emphasizing pathophysiological mechanisms, epidemiological impact, preventive strategies, and therapeutic approaches associated with cardiometabolic disease. A narrative and analytical literature review was conducted using scientific databases including PubMed, Scopus, ScienceDirect, and major international medical journals. Priority was given to clinical guidelines, randomized clinical trials, systematic reviews, and epidemiological studies published in recent years. The analysis focused on the relationship between obesity, inflammation, endothelial dysfunction, insulin resistance, atherosclerosis, cardiovascular disease, and chronic kidney disease, with particular attention to Latin American populations from Mexico, Colombia, and Ecuador. The reviewed evidence demonstrated that cardiometabolic diseases evolve through interconnected inflammatory, metabolic, vascular, and renal mechanisms rather than isolated pathological processes. Obesity and insulin resistance were identified as major contributors to systemic inflammation, endothelial injury, oxidative stress, and accelerated cardiovascular deterioration. Major clinical trials evaluating sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists showed significant reductions in cardiovascular events, heart failure hospitalization, renal disease progression, and cardiometabolic complications.