Describimos el caso de un paciente de sexo femenino de 42 años de edad que sufrió un accidente cerebrovascular isquémico criptogénico asociado a un foramen oval permeable (FOP). Durante el tratamiento de oclusión con dispositivos de FOP, se pone en evidencia trombo en el sistema de liberación distal al disco auricular izquierdo. Basados en el diseño de reconfiguración reversa cuyo disco izquierdo se pliega sobre su centro, se procede a recapturar el dispositivo absorbiendo el trombo protegido por el disco plegado, impidiendo su embolización.

Introducción: Las enfermedades cardiovasculares son la principal causa de muerte, siendo la hipertensión arterial (HA) su principal factor de riesgo. En nuestro país, 1 de cada 3 hipertensos desconoce su condición, con un menor conocimiento entre los jóvenes menores de 40 años. Además, hábitos no saludables, como el tabaquismo, la obesidad y el consumo excesivo de sal, se arraigan desde edades tempranas. La educación escolar sobre hábitos saludables podría impactar no solo en los niños, sino también en sus hogares. Este estudio tuvo como objetivo describir factores de riesgo, hábitos de vida y el nivel de conocimiento en alumnos de 5to grado. Métodos: Se realizó un estudio descriptivo de corte transversal en 133 alumnos de una escuela pública de La Plata. Se aplicaron encuestas sobre factores de riesgo y hábitos, seguidas de talleres interactivos dirigidos por estudiantes avanzados de Medicina y Biología. La PA fue medida con técnicas estandarizadas y se entregaron materiales educativos para su difusión en los hogares. Resultados: Ningún alumno conocía su valor de PA, y más del 60% creía que debía medirse a partir de los 14 años. Solo el 5% consumen frutas y verduras regularmente. El 40% de los alumnos reconoció que alguno de sus padres tiene HA, pero el 88% refirió que en sus hogares agregan sal al plato. El 74% no cree que la principal causa de muerte sea la cardiovascular. Conclusión: El bajo nivel de conocimiento sobre HA y hábitos saludables en preadolescentes evidencia una necesidad crítica de educación sanitaria desde edades tempranas. La intervención escolar podría ser una herramienta costo-eficaz para la prevención de ECV, impactando tanto en los niños como en sus familias.

Valvular heart diseases occur following different evitable and inevitable etiologies. Rheumatic valvular heart disease is among preventable etiologies and is almost disappeared in developed nations. In recent literature there are few low-quality evidences available about therapeutic efficacy of penicillin in maintaining and enhancing myocardial function in patients with rheumatic heart disease. In present study we aimed to investigate importance of penicillin in maintaining myocardial function indices within normal range.

In this retrospective descriptive-analytic study we enrolled a number of 682 consecutive patients with rheumatic heart disease. Information about history of treatment with penicillin and associated details along with left ventricular ejection fraction and right ventricular systolic function were collected in a questionnaire. Finally, all data were analyzed using SPSS ver.26 software.

The study population consist of 471 (69.1%) women and 211 (30.9%) men with mean age of 51.17±12.80 years, ranged between 17 and 87. We found that there is a statistically significant association between history of penicillin treatment (P-value=0.036) and left ventricular ejection fraction. Right ventricular systolic function was affected by history of penicillin treatment (P-value=0.040) and duration of treatment (P-value=0.002).

Rather than approved prophylactic effects of penicillin; we conclude that penicillin is also highly effective as a therapeutic agent in maintaining left ventricular ejection fraction and right ventricular systolic function within normal range in patients with rheumatic heart disease.

ObjectiveThe glucose-to-lymphocyte ratio (GLR) integrates metabolic stress and lymphocyte depletion, but its prognostic relevance in critically ill patients with mitral valve disease (MVD) is uncertain. We examined the association between early GLR and short-term all-cause mortality.MethodsWe used MIMIC-IV version 3.0 to identify adults with a documented MVD diagnosis and calculable GLR from the first valid glucose and absolute lymphocyte measurements within 24 hours of ICU admission. Primary analyses used a 24-hour landmark and modeled log2-transformed GLR continuously. Cox regression, restricted cubic splines, multiple imputation, timing and phenotype sensitivity analyses, paired DeLong tests, bootstrap-corrected C-index, calibration, and decision-curve analysis were performed.ResultsAmong 1,538 patients with calculable GLR, seven died by the 24-hour landmark, leaving 1,531 patients; 148 (9.7%) died by day 28 and 203 (13.3%) by day 90. In the primary complete-case model (n=1,245), each doubling of GLR was associated with higher 28-day mortality (HR 1.43, 95% CI 1.22-1.66) and 90-day mortality (HR 1.30, 95% CI 1.14-1.49; both P<0.001). Spline analyses showed no evidence of nonlinearity, and multiple-imputation and major sensitivity analyses were directionally consistent. GLR discriminated mortality better than glucose alone but not significantly better than lymphocyte count. Adding GLR to age, sex, SOFA, and CCI increased optimism-corrected C-index by 0.030 at 28 days and 0.023 at 90 days, with good calibration and modest net benefit.ConclusionsHigher early GLR was independently associated with 28-day and 90-day mortality in critically ill patients with documented MVD and provided modest adjunctive prognostic information.

Iatrogenic cerebral amyloid angiopathy (iCAA), likely caused by transmission of amyloid-beta by medical procedures, is a rare but distinct cerebral amyloid angiopathy (CAA) subtype, with rising numbers of patients identified globally. However, given its relatively recent recognition, data on long-term outcomes and prognosis are scarce. Therefore, we aimed to investigate the clinical disease progression in patients diagnosed with iCAA.

After a systematic literature search for larger case series of iCAA (n ≥ 5), we included patients from 4 European countries (Austria, Italy, The Netherlands, and the United Kingdom) meeting modified Queen Square criteria for possible or probable iCAA. Clinical outcomes of interest were symptomatic intracerebral hemorrhage (ICH), convexity subarachnoid hemorrhage (cSAH), cognitive status at last follow-up, and mortality. We used Cox regression to investigate clinical variables associated with those outcome events.

We included 82 patients (59.8% male, median age at presentation 50 years, median latency from exposure 39 years); 50% of patients initially presented with ICH and 32.9% with cSAH/transient focal neurologic episodes. During a median follow-up time of 3.8 years (IQR 1.8-5.9; total follow-up 385 patient-years), 74 symptomatic ICH occurred, corresponding to a rate of 19.2 per 100 patient-years after first presentation. Patients who initially presented with ICH had an increased rate of recurrent ICH compared with other presentations (hazard ratio 3.14, 95% CI 1.55-6.33, p = 0.001) with a recurrence rate of 24.6 per 100 patient-years (95% CI 18.2-32.6). Patients with spinal surgery as an exposure (n = 24) had a lower rate of ICH compared with brain surgery or embolization (hazard ratio 0.34, 95% CI 0.13-0.87, p = 0.02). Six patients (7.3%) died during the follow-up period (initial presentation with ICH in 3, cSAH in 3). Cognitive impairment at last available cognitive evaluation (median 1.9 years from first presentation) was recorded in 42 patients (51.2%).

Following a long latency from presumed exposure, patients diagnosed with iCAA have a high rate of subsequent symptomatic ICH (∼20% yearly risk), with recurrence risk being the highest among patients initially presenting with ICH and those exposed by brain rather than spinal surgery. The mortality rate was low despite the high frequency of ICH.

A 76-year-old White woman, with severe back pain, severe osteoporosis, rheumatoid arthritis, Parkinson's disease, and hypertension, presented with proximal junctional failure and progressive thoracic kyphosis and developed abrupt SpO2/EtCO2 decline, hypotension, bradycardia, and asystole immediately after cementing 20 pedicle screws. Prone CPR and 1 mg epinephrine achieved return of spontaneous circulation; ventricular tachycardia was cardioverted. TEE showed a hyperdynamic heart without RV dilation. CTA excluded major PE, revealing tiny polymethylmethacrylate deposits and perivertebral leak.

Findings suggest immunohumoral vasoplegia with relative preload loss triggering a Bezold-Jarisch reflex. Early recognition, prone CPR, and POCUS-guided, goal-directed resuscitation enabled neurologically intact survival.

Current methods lack high‑risk identification for acute kidney injury (AKI) after acute myocardial infarction (AMI). This study aimed to develop a metabolic‑biomarker‑based predictive system. 124 AMI patients (July 2023-October 2024) were enrolled prospectively. Logistic regression, ROC curves, and Pearson correlation were used to assess predictive values. Post-PCI kidney injury incidence was 19.39% (n = 19). The injury group showed higher LVEF, FFA, and Killip ≥ 2 rates (P < 0.05), but lower 5-MTP and UMOD (P < 0.05). FFA, 5-MTP, and UMOD were independent risk factors (P < 0.05), with combined AUC = 0.931 (superior to single markers, P < 0.05). BUN, UA, SCr, and eGFR correlated strongly with these metabolites (P < 0.05). LVEF, 5‑MTP, and UMOD are key metabolic indicators for early AKI risk identification. The integrated "biomarker+nursing" pathway improves early warning and outcomes in AMI patients.

Small (≤ 5 mm) intracranial aneurysms include both ruptured and unruptured lesions with markedly different early outcomes. Data on in-hospital mortality across this spectrum remain limited, particularly in Latin America. This study aimed to evaluate in-hospital mortality and identify factors associated with mortality in patients with small intracranial aneurysms, stratified by rupture status. This retrospective multicenter observational study included 1,519 patients with small (≤ 5 mm) intracranial aneurysms managed between 2017 and 2023 across eight centers in five Latin American countries. Patients were analyzed as an overall cohort and stratified by rupture status: 421 (28%) presented with aneurysmal subarachnoid hemorrhage and 1,098 (72%) had unruptured aneurysms. The primary outcome was in-hospital mortality. Clinical and treatment-related variables associated with in-hospital mortality were evaluated using Cox proportional hazards models. Overall in-hospital mortality was 7%, with a marked difference between patients with ruptured and unruptured aneurysms (18% vs. 3%). Management was endovascular in 69%, microsurgical in 11%, and conservative in 20%. In the overall cohort, factors independently associated with in-hospital mortality included age > 65 years, prior subarachnoid hemorrhage, rupture at presentation, treatment-related complications, and medical complications. In patients with ruptured aneurysms, mortality was primarily associated with hemorrhage severity and acute complications, whereas mortality in patients with unruptured aneurysms was low and was primarily associated with treatment-related factors. Differences in outcomes according to antiplatelet therapy were observed but should be interpreted cautiously because of potential confounding by indication. In-hospital mortality differed substantially according to rupture status in this multicenter Latin American cohort of patients with small intracranial aneurysms. Mortality in patients with ruptured aneurysms was primarily associated with hemorrhage severity and acute complications, whereas mortality in patients with unruptured aneurysms was lower and was primarily associated with treatment-related factors. These findings should be interpreted in the context of the retrospective observational design and potential treatment-selection bias.

The clinical management of small, unruptured intracranial aneurysms, particularly those measuring less than 5 mm, represents a significant area of debate in neurovascular surgery. The decision to pursue invasive treatment versus conservative surveillance is often guided by limited and sometimes conflicting evidence, leaving a critical gap in clinical decision-making. This study aimed to meticulously characterize the five-year natural history and morphological evolution of a cohort of patients with untreated small intracranial aneurysms (defined as < 5 mm), managed conservatively with serial angiographic surveillance. We conducted a longitudinal cohort study at a single tertiary academic center, enrolling 113 patients (101 female, 89.4%; 12 male, 10.6%; mean age 59 years) with at least one unruptured intracranial aneurysm measuring < 5 mm, diagnosed by digital subtraction angiography (DSA). All patients were managed with a conservative "watch-and-wait" protocol, which included a follow-up DSA at five years. The primary endpoints were morphological changes, including dimensional growth, shrinkage, complete resolution, de novo formation of new aneurysms, and the incidence of aneurysmal subarachnoid hemorrhage (SAH). Over the cumulative 565 patient-years of follow-up, no instances of aneurysmal rupture or SAH were observed. Most aneurysms were located in the anterior circulation (92.2%). The vast majority of aneurysms (n = 87; 77.0%) demonstrated complete morphological stability. A small subset of aneurysms exhibited dynamic changes: 12 (10.6%) demonstrated minor growth but remained within the < 5 mm size category, 6 (5.3%) decreased in size, and 5 (4.4%) underwent complete spontaneous resolution. De novo aneurysm formation was identified in 3 patients (2.7%). While traditional vascular risk factors like hypertension and oral contraceptive use showed no significant correlation with aneurysm behavior, a paradoxical and statistically significant association was found with smoking, which correlated with a higher likelihood of aneurysm resolution (p = 0.016). This study supports that a conservative management strategy with planned imaging surveillance is a safe and viable option for patients with unruptured intracranial aneurysms smaller than 5 mm. The absence of rupture over five years, coupled with the low rate of significant growth, suggests that these lesions have a very low observed risk of rupture and morphological progression over five years. These findings support conservative management for most patients with UIAs < 5 mm, although treatment decisions should remain individualized according to patient- and aneurysm-specific risk factors.

Children with complex congenital heart disease (CHD) are at high risk of brain lesions both before and after cardiac surgery. Preoperative brain injury reflects foetal and perinatal brain development and represents an independent predictor of neurodevelopmental outcome. This study aimed to characterize preoperative brain lesions and their correlation with clinical course and neurodevelopmental outcomes in children with complex CHD. The secondary objective was to compare findings between syndromic and non-syndromic patients, as preoperative brain injury in syndromic children remains underreported. A single-centre cohort study was performed at the University of Padova, Italy, involving children with complex CHD who underwent preoperative brain MRI between January 2020 and October 2024. Patients were categorized based on the presence or absence of a known or suspected genetic syndrome. Neurological and neurodevelopmental evaluations were conducted pre- and postoperatively, and at 6- and 18-months follow-up. Among 54 enrolled patients, 21 (39%) had a suspected or confirmed genetic syndrome. Preoperative brain lesions were present in 24 children (44%), including 16/33 (48%) non-syndromic and 8/21 (38%) syndromic patients (OR 0.65 [0.21-1.94], p = 0.5708). Arterial ischemic stroke was the most common lesion (20%), followed by subdural haemorrhage (11%), cerebral sinovenous thrombosis (9%), and white matter injury (6%). Despite similar lesion rates, syndromic children showed more complicated perinatal histories and greater neurodevelopmental impairment, particularly in motor and language domains.

 Syndromic children with CHD do not have higher rates of preoperative brain injury but remain at greater neurodevelopmental risk. Further studies are warranted to confirm these findings.

• Children with complex congenital heart disease (CHD) are at high risk for preoperative brain injury and neurodevelopmental impairment. • Syndromic children with CHD are often excluded from neurodevelopmental studies.

• Preoperative brain lesions (44%), mainly arterial ischemic stroke (20%), are frequent in our cohort of syndromic and non-syndromic children with complex CHD. • Syndromic children with CHD do not show increased rates of preoperative brain injury compared to non-syndromic children, but remain a population at higher neurodevelopmental risk.