Importance:Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives:To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants:This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure:A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures:The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results:The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance:This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.
Neurocardiogenic syncope (NCS), particularly cardioinhibitory and mixed subtypes, remains a clinical challenge when refractory to conventional therapy. Cardioneuroablation (CNA) targeting the parasympathetic ganglionated plexi has emerged as a novel interventional option. This study evaluates the efficacy of biatrial CNA with extracardiac vagal stimulation (ECVS) validation in preventing recurrence and modulating cardiac autonomic regulation. A single-center combined retrospective–prospective cohort study was conducted at a fourth-level institution in Colombia, including patients with cardioinhibitory or mixed-type NCS refractory to conventional treatment. CNA was performed targeting both atria with three-dimensional mapping, followed by ECVS via the internal jugular vein for pre/post validation. Primary outcome was the recurrence of syncope. Secondary outcomes included changes in heart rate variability (HRV) and quality of life (QoL) as assessed by 24-hour Holter monitoring and the SF-36 questionnaire, respectively. Mean follow-up was 24 months. Statistical analysis was performed using SPSS Statistics 28.0.0.0. Fifty-three patients (mean age 42.8 ± 10.1 years, 70 Cardioneuroablation significantly reduced syncope recurrence in patients with refractory cardioinhibitory and mixed-type neurocardiogenic syncope. Extracardiac vagal stimulation enabled reliable intraoperative confirmation of successful vagal denervation. Heart rate variability indices (SDNN, RMSSD, pNN50) showed significant parasympathetic suppression after cardioneuroablation. Patients experienced substantial improvement in health-related quality of life following the procedure.
Tennis leg is a common cause of acute posteromedial calf pain and encompasses a spectrum of injuries involving the posterior calf. Although initially described as rupture of the plantaris tendon, clinical, surgical, and imaging evidence indicates that injury to the medial head of the gastrocnemius at the distal myotendinous junction is the most frequent cause. Less commonly, the lateral gastrocnemius, the soleus, or the plantaris may be affected. Clinical presentation is often nonspecific and overlaps with important alternative diagnoses, including Achilles tendon rupture, deep vein thrombosis, and ruptured Baker cyst, making imaging helpful for accurate diagnosis. Sonography (US) and magnetic resonance imaging (MRI) are the principal imaging modalities used in assessment. US is well suited for initial evaluation due to its wide availability, dynamic capability, and high spatial resolution for superficial tissues. It enables panoramic assessment of the posterior calf, allowing detection of muscle fiber disruption, myoaponeurotic injury, and intermuscular hematoma, while also facilitating exclusion of common mimics. MRI provides superior characterization of deep or subtle myoconnective tissue injuries and allows comprehensive assessment of injury extent and associated findings. In addition, MRI supports standardized grading using established muscle injury classification systems, which is valuable for prognosis and return-to-play decision-making. Emerging imaging techniques like quantitative MRI and artificial intelligence–based analysis may improve injury prognostication and individualized return-to-play assessment. This review summarizes the relevant anatomy, definitions, mechanisms of injury, and characteristic US and MRI features of tennis leg. Current classification systems are outlined, and key differential diagnoses and potential complications are also discussed.
Tricuspid regurgitation is often underdiagnosed and carries a poor prognosis when severe, while conventional surgery poses high risk in elderly patients with comorbidities. We report the case of a 72-year-old man with Chagas disease, permanent pacemaker, cardiac resynchronization therapy, and heart failure with reduced ejection fraction, who presented with NYHA class IV symptoms and recurrent hospitalizations for edema and ascites. Given the elevated surgical risk, an endovascular TricValve procedure was performed. The patient improved to NYHA class I in the early postoperative period and remained clinically stable without rehospitalizations at 8-month follow-up. The TricValve system is emerging as a therapeutic option for high-risk surgical candidates, improving quality of life and reducing admissions. To the authors knowledge, this is first case of TricValve implantation in a patient with multiple pacemaker leads. This case underscores the growing role of transcatheter therapies as effective alternatives.
