Fundación Valle del Lili

Introducción: el ataque cerebrovascular isquémico representa un gran desafío en salud pública por su alta carga de discapacidad y mortalidad. Los avances en Neuroimágenes y terapias de reperfusión, han transformado su manejo en la fase aguda Materiales y métodos: se realizó una búsqueda en bases de datos (PubMed, EMBASE, Lilac, SCOPUS) desde el año 2008 hasta noviembre de 2025, se seleccionaron fuentes que abordaban Neuroimágenes avanzadas y nuevas indicaciones de terapias de reperfusión en ventana extendida con el fin de sintetizar la información para su fácil lectura y actualizado con la última evidencia disponible. Resultados: las neuroimágenes avanzadas permiten decisiones terapéuticas, individualizadas, teniendo en cuenta un tiempo tisular, más que un tiempo cronológico. Cada vez se plantean más avances con criterios más amplios para la selección de pacientes candidatos a terapias de reperfusión. Discusión: la última evidencia cambia el paradigma del tratamiento agudo en ACV, permitiendo cada vez ampliar más la ventana e intervenir más pacientes con el fin de disminuir la mortalidad y discapacidad que genera esta patología Conclusiones: el manejo de la ACV en la fase aguda, ha evolucionado en los últimos años. Las nuevas terapias farmacológicas y endovasculares cada vez ofrecen mejores desenlaces incluso en pacientes con infartos extensos y de mayor tiempo de evolución.

Objetive: To compare the short (zone 1) and intermediate (zone 2) harvest zones of Flexor Hallucis Longus (FHL) tendon to a long harvest site at the interphalangeal joint of the hallux (zone 3). Methods: Fourteen fresh-frozen cadaveric lower limbs were used to measure the length of FHL tendon in zone 1, 2 and 3, tendon thickness, length of the calcaneal tunnel, percentage of tendon inside the tunnel, and relation between the base of the first metatarsal and medial plantar nerve. Results: In the short harvest, the mean length of the FHL tendon was 22.9 ± 4.5 mm with the ankle in neutral position, and 33.2 ± 4.1 mm with the ankle in 15 degrees of plantarflexion. Thickness of FHL was 6.2 ± 0.8 mm. The mean length of the calcaneus osseous tunnel was 44.1 ± 4.2 mm and the mean length of the tendon traversing the bone tunnel was 21 ± 3.2 mm, while covering on average 48.5% of tunnel length. The FHL length at the intermediate harvest was 48.9 ± 5.7 mm with a mean distance of 24 ± 4.8 mm between the base of the first metatarsal to the medial plantar nerve. The FHL length was the longest at the long harvest with 128.6 ± 7.1 mm. Conclusion: The short harvest provided FHL grafts that covered only 48.5% of the calcaneal tunnel. The long harvest provides longer FHL grafts that are suitable for large Achilles defects where augmentation with the remaining FHL tendon may be needed. Level of evidence V.

Repair of medium to large rotator cuff tears (RCTs) presents ongoing challenges, as the procedure may result in tendon retear and inadequate healing. Partial superior capsular reconstruction (pSCR) using the long head of the biceps tendon (LHBT) has emerged as a biomechanically robust and biologically advantageous technique for augmenting rotator cuff repairs. This study aims to evaluate the clinical and structural outcomes of arthroscopic rotator cuff repair augmented with pSCR using the LHBT combined with distal tenotomy in patients with medium to large reparable RCTs at two years postoperatively. A retrospective review was conducted on patients who underwent arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy between January 2014 and June 2017. Surgical indications were reparable supraspinatus tears, with or without infraspinatus involvement, accompanied by tendon retraction, high-grade fatty infiltration, and an intact or less than 50% partial tear of the LHBT. Exclusion criteria included prior shoulder surgery, shoulder infection, irreparable subscapularis tear, or incomplete follow-up. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and range of motion, while structural integrity was evaluated via ultrasonography at the 2-year follow-up. After excluding 10 patients, 45 patients (mean age: 67.2 ± 6.3 years) were included in the analysis. The VAS score improved significantly from 6.1 ± 1.3 to 1.7 ± 1.1, and the ASES score increased from 31.0 ± 7.9 to 77.2 ± 7.7 (both P < .001). Forward elevation improved from 95° to 156°, abduction from 78° to 142°, and external rotation from 33° to 50° (all P < .001). All patients met the minimal clinically important difference for both VAS and ASES scores. Ultrasonography at the 2-year follow-up demonstrated complete healing of the repair with the pSCR construct in 86.7% of patients, partial healing in 6.6%, and complete retear in 6.6%. No patients reported postoperative anterior shoulder pain. Subgroup analysis showed comparable outcomes between single-row repair with pSCR for medium-sized RCTs and double-row repair with pSCR for large-sized RCTs. Arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy resulted in significant improvements in pain and range of motion at the 2-year follow-up in patients with medium to large reparable RCTs. A high healing rate was observed with the pSCR construct, and no significant complications were reported.

Abstract Background Atrial fibrillation (AF) is a prevalent and sustained arrhythmia in adults, with an estimated global prevalence of 37.5 million cases in 2017. While it primarily affects elderly individuals with structural heart disease (prevalence &amp;gt;10% after age 80), it can also occur in younger individuals, albeit with a much lower prevalence (&amp;lt;1% in those aged &amp;lt;40 years). Increasing knowledge about the pathophysiology of AF shows that in every patient there may be an underlying cause, which, although it cannot be discovered in all patients, should be explored, especially in young patients without risk factors. Case Summary We present a case of paroxysmal atrial fibrillation (PAF) in a 37-year-old female patient with no cardiovascular risk factors. The PAF was likely associated with an atypically located thymic cyst over the left atrium, which was incidentally discovered during an intracardiac echocardiogram (ICE) performed for pulmonary vein isolation. Subsequently, surgical cyst extraction was performed, resulting in improved episodes of atrial fibrillation. Discussion This case underscores the importance of considering uncommon anatomical variations when evaluating and managing AF. It also highlights the need for further research and understanding of Non-valvular AF, particularly in cases associated with thymic abnormalities, to better inform clinical decision-making and enhance patient outcomes.

Abstract The aging population is growing, with a prevalence of cognitive decline (CD) expected to increase over the next decade, mainly affecting Latin America countries (LAC). The lack of appropriate context-based tools to detect cognitive decline (CD) may be a source of misinterpretation. The Montreal Cognitive Assessment (MoCA) is a recommended screening test to detect CD; however, it has commonly been used with a proposed cut off &gt; 26. Our aim was to propose normative values based on a large sample from LAC to improve the detection of CD in our population. We collected data from Argentina, Brazil, Colombia, and Mexico participants who were classified as controls from the LARGE-PD consortium. A total of 781 individuals (38.54% male; mean age 55.2 ± 16.6 years), with a mean of 13.5 ± 5 years of education and a mean MoCA score of 24.2士4.1, were stratified by age and educational level (EL). DSM-V criteria were used to determine absence of CD. MoCA test v.7 was administered using a pen-and-paper format. ANOVA was used to detect differences in age and EL among countries. MoCA scores were compared using the Kruskal-Wallis test. Normative values for detecting CD were established as -1 standard deviation (SD) below the mean within each stratified group. The prevalence of CD was calculated by country and for the entire sample. Our proposed normative values adjusted for age and educational level demonstrated that the prevalence of CD decreased to 12%, compared with the 53.8% when using the cut-off of 26. Consequently, normal cognition increased to 88%. This finding improves the detection of cognitive decline through a more appropriate interpretation of MoCA score, considering the diversity of population of LAC. Working with normative values may enhance the allocation of resources to follow-up, monitoring and management in resource-limited settings.

BackgroundStillbirth (SB) remains a significant public health problem worldwide, with disparities across regions and socioeconomic strata, and studies have reported inconsistent findings regarding its incidence before and during the pandemic. The aims of this study were twofold: (1) To describe the changes in the incidence of SB before and during the COVID-19 pandemic; (2) To determine whether any changes observed before and during the pandemic differed by geographic location and health insurance.MethodsWe compared cross-sectional data from pregnancies resulting in either live births or SBs in Colombia before the onset of the pandemic (from January 1st to December 31st, 2019), and during the pandemic (from January 1st to December 31st, 2021). The main socioeconomic determinants considered were, area of residence, place of birth and health insurance coverage. Risk differences (RD) and incident rate ratio (IRR) from Poisson regression models with robust variance were used as measures of absolute and relative inequalities.ResultsSB incidence per 1000 births was 5.53(95%CI:5.35–5.71) in 2019 and 5.94(5.75–6.13) in 2021, RD: 0.41(0.68 − 0.14), IRR adjusted: 1.05 (1-1.10). In both 2019 and 2021, women living and those giving birth in towns and rural areas, as well as women who are uninsured or have subsidized health insurance, were at the highest risk of experiencing SB compared to their respective reference categories. SB incidence among residents of towns and those with subsidized insurance increased significantly in 2021 (RD = 1.32 and 0.53, respectively), whereas no changes in inequalities were observed among rural residents or unaffiliated women. In 2021, both absolute (RD = − 9.15) and relative inequalities (IRR = 3.78 vs. 1.99, p-value for interaction < 0.001) decreased significantly for rural delivery places compared with urban areas.ConclusionsThe increase in SB incidence during the pandemic was largely explained by changes in socioeconomic, obstetric, and demographic factors. Our results highlight persistent inequalities in Colombia, with heterogeneous patterns between 2019 and 2021: some disparities increased, others remained stable, and some decreased.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-026-26646-4.