Stroke remains a leading cause of death and disability throughout the Americas, disproportionately impacting low-and middle-income countries and underserved populations. In this review, we examine the status of stroke prevention in the Americas. Prevention is essential, yet unequal access to healthcare has led to major disparities - especially among rural populations, ethnic minorities, and lower socioeconomic status. Models like the WHO HEARTS Program demonstrate that evidence-based programs can be tailored to local contexts. Telehealth and digital tools play a critical role in empowering patients, educating communities, and supporting healthcare workers. Despite growing efforts, challenges persist due to health inequities, gaps between policy and implementation, and underinvestment. Strengthening prevention will support countries in achieving the United Nations Sustainable Development Goals, targeting a one-third reduction in premature deaths from non-communicable diseases by 2030. This paper outlines effective strategies for implementing stroke prevention, emphasizing healthy lifestyles, early detection of risk factors, and system-level interventions.
Gallstone disease affects individuals of different ages, yet age-related variations in stone morphology, histology, and chemical composition remain insufficiently defined. Understanding these patterns may clarify pathogenic mechanisms and their potential links to clinical or metabolic profiles. This study investigated age-related differences in gallstone characteristics. Thirty-seven gallstones were analyzed and grouped into three age categories (<20, 21-30, and 31-40 years), with additional stratification by sex. Morphological classification was performed macroscopically and by scanning electron microscopy, while composition was assessed using energy-dispersive spectroscopy. Histological evaluation of the gallbladder wall focused on chronic inflammation, Rokitansky-Aschoff sinuses, fibrosis, and metaplasia. Female predominance was observed in all groups, reaching 100% in the 31-40-year category. Patients under 20 years presented heterogeneous stones, including pigmented and amorphous patterns, early structural changes, and chemically diverse profiles containing Calcium (Ca), Sodium (Na), Phosphorus (P), and Magnesium (Mg). Individuals aged 21-30 years showed mostly cholesterol stones, moderate histological alterations, and frequent Ca and Na incorporation with reduced elemental variability. In contrast, the 31-40-year group exhibited exclusively cholesterol stones with milder but consistent chronic changes and a homogeneous chemical composition mainly comprising Carbon (C) and Oxygen (O). These results demonstrate age-related transitions in gallstone morphology, chemistry, and associated gallbladder alterations.
