María Alejandra Galindo Van Strahlen

Pharmacogenomic variability represents an increasingly relevant determinant of therapeutic response, drug toxicity, and treatment failure in emergency and internal medicine. This study analyzed the clinical applicability of actionable gene–drug interactions associated with acute pharmacological decision-making, severe adverse drug reactions, and the potential integration of genomic information into emergency-care workflows. A structured integrative review based on the Scientific Method was conducted using pharmacogenomic guidelines, implementation studies, regulatory resources, and clinically oriented evidence. Particular attention was given to associations involving CYP2D6, CYP2C19, CYP2C9, VKORC1, G6PD, RYR1, CACNA1S, HLA-B, SLCO1B1, TPMT, and NUDT15. The evidence demonstrated that pharmacogenomic-guided prescribing can be associated with measurable differences in medication safety. In the PREPARE study, clinically relevant adverse drug reactions occurred in 21.0% of patients managed with genotype-guided treatment compared with 27.7% receiving standard care. In an emergency department cohort, actionable pharmacogenomic variants were identified in 99% of patients, while clinically relevant gene–drug pairs were detected in 53%. The analyzed interactions were mainly associated with altered drug metabolism, modified pharmacological sensitivity, severe genetically mediated adverse reactions, and delayed toxicities capable of producing acute-care presentations. Pharmacogenomic information showed potential utility for medication selection, dose modification, drug avoidance, risk stratification, and prevention of recurrent adverse events. Nevertheless, its clinical value depends on integration with renal and hepatic function, comorbidities, drug interactions, disease severity, and conventional emergency assessment. Preemptive testing integrated into electronic health records appears to be one of the most feasible models for emergency implementation because it allows actionable results to be available before time-sensitive treatment decisions. Pharmacogenomics may therefore contribute to a more preventive, individualized, and precise approach to medication safety in acute care, although prospective emergency-specific studies, interoperable systems, population-diverse validation, and equitable access remain necessary for broader implementation.

Multivisceral pelvic surgery represents a complex therapeutic strategy for patients with locally advanced or recurrent pelvic malignancies in whom conventional organ-specific resection may be insufficient to achieve adequate oncological clearance. This study aimed to analyze the relationship between surgical radicality, urinary tract preservation or reconstruction, postoperative morbidity, oncological control, and quality of life. An integrative review guided by the Scientific Method was conducted using evidence from PubMed/MEDLINE, Scopus, Web of Science, and Embase, focusing on contemporary studies published between 2015 and 2026. The analysis incorporated oncological, urological, surgical, and patient-centered outcomes. Contemporary PelvEx data demonstrated an increase in R0 resection rates from 79.8% to 84.8% in locally advanced rectal cancer and from 55.4% to 71.7% in locally recurrent disease, despite a greater frequency of extended resections. Major complication rates decreased from 37.8% to 23.1% in locally advanced disease and from 32.1% to 23.9% in recurrent disease. Urinary reconstruction remained heterogeneous, and comparative evidence showed similar rates of grade III–IV complications between continent and non-continent diversion, at 42.9% and 42.3%, respectively, with urinary complication rates of 15.9% and 16.7%. Longitudinal quality-of-life data showed early postoperative deterioration in some functional domains followed by progressive recovery, with overall quality-of-life scores returning toward or exceeding baseline during follow-up in many patients. These findings indicate that contemporary multivisceral pelvic surgery can achieve high rates of complete oncological resection while maintaining acceptable functional outcomes when performed in appropriately selected patients within specialized multidisciplinary centers. Surgical success should therefore be defined through the integrated assessment of R0 resection, urinary preservation or individualized reconstruction, perioperative safety, and long-term quality of life.

Inadvertent ureteral injury is an uncommon but potentially severe complication of abdominopelvic surgery, particularly in complex colorectal, gynecological, oncological, and retroperitoneal procedures. Its clinical impact is strongly influenced by the timing of recognition, since delayed diagnosis may lead to urinary extravasation, urinoma, obstruction, infection, fistula formation, ureteral stricture, prolonged hospitalization, and loss of renal function. This study analyzed current evidence on intraoperative prevention, radiological diagnosis, and early therapeutic management of iatrogenic ureteral injury through a structured review of the literature. The findings showed that intraoperative recognition was associated with fewer secondary procedures, hospital readmissions, and hospitalization days compared with delayed diagnosis. Routine prophylactic ureteral stenting did not demonstrate a consistent reduction in ureteral injury rates, although it may facilitate anatomical identification in selected high-risk procedures. Fluorescence-guided visualization with indocyanine green significantly improved intraoperative ureteral identification, but current evidence has not confirmed a definitive reduction in injury incidence. Computed tomography urography with delayed excretory-phase acquisition was identified as a key diagnostic tool, particularly for demonstrating contrast extravasation, urinoma, hydronephrosis, and incomplete ureteral opacification. Management depended on injury location, severity, tissue viability, and timing of diagnosis. Endoscopic stenting and nephrostomy were useful in selected cases, while complete transection, devascularization, or extensive tissue loss generally required reconstructive surgery. Overall, the evidence supports a multidisciplinary approach integrating risk stratification, careful intraoperative identification, early imaging, prompt urinary diversion, and anatomy-adapted reconstruction to reduce morbidity and preserve renal function.