The Hospital Universitario San Ignacio is a 4th level[clarification needed] university hospital in Bogotá, Colombia. It is located within campus of the Pontificia Universidad Javeriana and is home to this school's faculties of Medicine, Nursing and Dentistry. The hospital serves nearly all fields in medical expertise and has been home to several recognised physicians including neurologist Rodolfo Llinás and anesthesiologist Alejandro Jadad. Its ample resources and serving the Downtown and northeast areas of the capital city make it an important referral centre in all fields.
The safety of same day discharge after atrial fibrillation ablation remains uncertain because prior evidence relied mainly on heterogeneous observational studies with limited control of confounding. This systematic review and meta-analysis compared structured same day discharge with overnight stay. We searched MEDLINE, Embase, Web of Science, Scopus, CENTRAL, Epistemonikos and LILACS from 1994 to May 2025 for randomized and nonrandomized controlled studies of adults undergoing atrial fibrillation ablation with pulmonary vein isolation. Comparisons were protocolized same day discharge versus overnight hospitalization. Outcomes were all-cause mortality, short term (30-day) unplanned medical contact (readmissions or emergency visits), and procedural complications. Random-effects models generated pooled odds ratios (ORs) with 95
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.
Background Stereotactic radiosurgery (SRS) is an established treatment option for selected patients with brain arteriovenous malformations (bAVMs), particularly for lesions not amenable to microsurgical resection or located in surgically high-risk areas. SRS can be delivered through different platforms, including Gamma Knife, CyberKnife, and linear accelerator (LINAC)-based systems. This retrospective single-institution study evaluated outcomes of patients with bAVMs treated with LINAC-based SRS at a quaternary care center in Bogotá, Colombia. Materials and methods We conducted a retrospective observational study of patients with bAVMs treated with LINAC-based SRS guided by triple-fusion imaging between 2011 and 2017. Clinical, treatment, and imaging data were collected from medical records. Telephone interviews were used only to supplement clinical follow-up and were not used to determine radiological obliteration. The primary outcome was radiological obliteration during the available follow-up period, assessed by follow-up imaging. Actuarial obliteration rates were estimated using Kaplan-Meier analysis and interpreted as exploratory because of limited follow-up and censoring. Univariable Cox proportional hazards analyses were performed as exploratory analyses to evaluate factors associated with obliteration. Results Eighty-two patients were included. At presentation, 36 patients (44.0%) had ruptured bAVMs, 61 (74.4%) had lesions in eloquent areas, and most had Spetzler-Martin grade III malformations. Prior embolization was performed in 47 patients (57.3%). Complete radiological obliteration was documented in 27 patients (33.0%) during available follow-up. The median follow-up was 16.3 months, and 46 patients (56.1%) were lost to follow-up before completing three years of institutional follow-up. Actuarial obliteration estimates at later time points should therefore be interpreted cautiously. In exploratory univariable Cox analysis, radiosurgery dose >20 Gy was associated with a shorter time to obliteration. Conclusions This single-institution retrospective study describes radiological and clinical outcomes after LINAC-based SRS for bAVMs in a Latin American quaternary care center. The findings suggest that LINAC-based SRS is a feasible treatment approach when appropriate technology, planning expertise, and quality assurance are available. However, the short median follow-up, substantial loss to follow-up, and lack of a comparator group limit conclusions regarding effectiveness. Future prospective studies with standardized long-term imaging follow-up are needed.
Introduction: Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disorder caused by the accumulation of misfolded prion proteins. Molecular classification, based on PRNP codon 129 polymorphisms and the protease-resistant PrPsc fragment, has refined recognition of subtypes and their correlation with specific neuroimaging patterns. Case presentation: We report a 60-year-old patient presenting with progressive instability, lateral propulsion, generalized polymyoclonus, tremors, paranoid delusions, and vivid hallucinations. Prominent cerebellar signs and gait disturbance were dominant, configuring an ataxic phenotype accompanied by cognitive decline. An extensive workup excluded alternative diagnoses, and the detection of 14-3-3 protein in cerebrospinal fluid, along with positive RT-QuIC and diffusion-weighted magnetic resonance imaging (MRI) findings, were compatible with probable sporadic CJD. Remarkably, the MRI revealed an atypical pattern with predominant basal ganglia involvement rather than the common cortical changes, raising MV2K as a radiological hypothesis and underscoring the clinical-radiological heterogeneity of the ataxic presentation. Discussion: CJD has diverse phenotypic variants. Molecular classification and advanced MRI techniques, particularly diffusion-weighted imaging (DWI), are crucial for distinguishing between sporadic subtypes. Identifying atypical presentations, such as ataxic variants with basal ganglia predominance, improves premortem diagnostic certainty in resource-limited settings where molecular subtyping is not widely available. Conclusion: Molecular and neuroimaging-based approaches have substantially deepened the understanding of CJD heterogeneity. This case emphasizes the value of DWI/MRI in identifying atypical ataxic variants and reinforces the importance of integrating biomarker-supported diagnosis and clinical-radiological correlation when approaching this disease.
Las válvulas protésicas mecánicas en la posición pulmonar se utilizan en contadas ocasiones, y su disfunción, aunque poco frecuente, reviste importancia clínica. Se presenta el caso de una mujer de 34 años, con displasia congénita de la válvula pulmonar, a quien se le realizó un reemplazo valvular mecánico de doble disco y dos años después acudió con signos de insuficiencia cardíaca derecha. Las pruebas de imagen revelaron estenosis significativa y regurgitación intraprotésica moderada debida a un disco inmóvil, asociada a niveles de INR subterapéuticos. La exploración quirúrgica identificó un pannus y un trombo crónico. La limpieza de la prótesis restableció la movilidad completa y mejoró el estado clínico. Este caso subraya la importancia del control de la anticoagulación, el papel de las técnicas de imagen multimodales y la intervención oportuna en el manejo de la disfunción de las válvulas mecánicas en la posición pulmonar.
