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.
BackgroundThe susceptibility vessel sign (SVS) on MRI has been linked to functional outcomes and reperfusion success after endovascular treatment (EVT), suggesting its potential as a prognostic marker. This updated systematic review and meta-analysis aimed to evaluate the prognostic and etiological significance of SVS in acute ischemic stroke (AIS).MethodsWe conducted a systematic search of PubMed, Embase, and Cochrane in May 2025. Eligible studies included post-hoc analyses of randomized controlled trials (RCTs) and observational studies of AIS patients treated with EVT and/or intravenous thrombolysis (IVT). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Primary outcome was successful reperfusion (mTICI 2b-3). Secondary outcomes included functional independence (modified Rankin Scale [mRS] score 0-2), mortality, stroke etiology, and time metrics.ResultsEighteen studies (n = 2602) were included. Overall, SVS was not associated with higher reperfusion rates (12 studies; n = 2083; RR: 1.01; 95% CI: 0.93-1.10; p = .832; I2 = 56.0%), except in the SWI subgroup (2 studies; RR: 1.17; 95% CI: 1.02-1.34; p = .022; I2 = 0.0%). SVS+ was linked to lower 90-day mortality in anterior circulation strokes (3 studies; n = 865; RR: 0.52; 95% CI: 0.36-0.74; p < .001; I2 = 0%), improved 90-day functional independence in Western populations (7 studies; n = 1481; RR: 1.22; 95% CI: 1.01-1.47, p = .039; I2 = 37.7%), and in cardioembolic stroke etiology using GRE (9 studies; n = 1058; RR: 1.29; 95% CI: 1.05-1.57; p = .014; I2 = 36.3%). The mean time from onset to treatment was 238.19 minutes ± 147.5.ConclusionsAlthough SVS+ did not predict reperfusion, it was associated with better functional outcomes in Western populations, particularly in cardioembolic stroke, and lower mortality, thereby reinforcing its prognostic value. MRI protocols did not delay treatment, but high heterogeneity limits certainty, highlighting the need for prospective studies.
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with up to 50
Introdução: A técnica de Hartmann baseia-se na ressecção do segmento afetado com sepultamento do coto distal e confecção de colostomia terminal, sendo amplamente empregada em emergências colorretais, porém associada à ocorrência de diversas complicações Objetivo: Avaliar a reconstrução do trânsito intestinal e as complicações da colostomia de Hartmann com base em um caso clínico e na literatura. Métodos: Realizou-se um relato de caso baseado em análise retrospectiva de prontuário, associado a uma revisão de literatura na base PubMed sobre complicações da colostomia de Hartmann. Discussão: Embora o procedimento de Hartmann esteja associado a elevadas taxas de morbidade, complicações locais e sistêmicas, dificuldades técnicas na reversão do trânsito intestinal e significativa proporção de estomas definitivos, ele permanece uma estratégia cirúrgica segura e amplamente empregada no manejo de emergências colorretais, especialmente em pacientes com diverticulite complicada, peritonite difusa, sepse, instabilidade hemodinâmica ou múltiplas comorbidades, nos quais o risco de falha anastomótica é elevado, enquanto a ressecção com anastomose primária, associada ou não a estoma de proteção, mostra-se preferível apenas em pacientes clinicamente estáveis e criteriosamente selecionados, conforme evidenciado por estudos recentes e diretrizes internacionais. Conclusão: A colostomia de Hartmann permanece indicada em pacientes selecionados, exigindo avaliação criteriosa para reconstrução do trânsito intestinal e manejo individualizado de suas complicações.
Introduction: Pericarditis is an inflammation of the pericardium that can be acute or chronic. The most common causes are viral and autoimmune, followed by bacterial infections, neoplasms, trauma and others. Clinical manifestations vary according to severity and etiology. We present a case of acute purulent pericarditis due to Streptococcus pneumoniae. Case description: A 54-year-old male, previously healthy, sought care on 06/12/25 with precordial pain and a syncopal episode after mild exertion. On examination, he was tachycardic, with no other abnormalities. ECG showed ST-segment elevation in V2 to V4. Coronary angiography revealed no obstructive lesions. Laboratory tests: leukocytosis (19,500), elevated troponin, normal renal function. Initial transthoracic echocardiogram (TTE) was unremarkable. On 06/14/25, he evolved with clinical and laboratory worsening, increased tachycardia and hypotension. A sepsis protocol was initiated, cultures were collected, and ceftriaxone plus azithromycin were started. TTE showed a moderate pericardial effusion. The patient underwent urgent pericardial drainage, with 450 mL of purulent fluid removed, which was sent for culture; vancomycin was added. Chest CT showed bilateral pleural effusion and bibasilar consolidations, and laboratory tests continued to show elevated inflammatory markers associated with respiratory worsening. Left thoracostomy was performed, with drainage of 400 mL of turbid fluid. Culture of pericardial fluid isolated Streptococcus pneumoniae; guided therapy with ceftriaxone was maintained, initially planned for 4 weeks. Analysis of pleural fluid revealed an exudate, with negative cultures. The patient experienced gradual clinical and laboratory improvement; after 3 weeks of treatment, TTE and cardiac MRI still showed pericardial thickening and a small loculated collection with purulent aspect. The cardiac surgery team decided on expectant management given the favorable evolution, and antibiotic therapy was extended. Comments: This case illustrates the diagnostic complexity of pericarditis, which may mimic myocardial infarction or pulmonary diseases. Diagnosis requires integration of clinical evaluation, laboratory tests and imaging (TTE and cardiac MRI). Treatment depends on etiology, ranging from anti-inflammatory drugs and colchicine to antibiotics and surgery. Culture of pericardial fluid was essential to guide management, highlighting the importance of etiologic diagnosis for a personalized and effective approach.
