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The Atoyac River is one of the most impacted freshwater systems in central Mexico due to sustained industrial, agricultural, and domestic discharges. Despite increasing concern regarding plastic contamination in rivers, information on polymer-related materials in this system remains limited. In this study, a qualitative and exploratory assessment of polymer-like spectral features in suspended matter was conducted along a 43-km section of the Atoyac River. Water samples were collected at six sites representing contrasting land use influences and analyzed directly by ATR-FTIR spectroscopy without chemical or enzymatic removal of organic matter. To improve interpretation of the complex spectra obtained from this highly polluted matrix, Gaussian deconvolution was applied to overlapping absorption regions. Recurrent infrared bands compatible with aliphatic, aromatic, ester, carbonate, and amide-containing structures were detected, showing spectral similarity to common synthetic polymers such as polyethylene-, polypropylene-, polyethylene terephthalate-, polystyrene-, polycarbonate-, and polyamide-like materials. A prominent absorption near 1121 cm⁻1, consistent with sulfonated functional groups commonly associated with textile dyes and other industrial sulfonated compounds, was observed at sites influenced by textile activity. Given the absence of organic matter digestion, the results are interpreted as indicative of polymer-like spectral signatures rather than definitive microplastic identification. This work demonstrates the potential of ATR-FTIR combined with spectral deconvolution as a rapid screening approach for polymer-related contamination in complex freshwater environments and provides a qualitative baseline for future studies employing standardized microplastic extraction and quantification protocols.

Neuropsychological tests must be adapted to local sociocultural realities. The Barcelona-2 test (TB-2) is a tool used in Spain and Hispanic America to perform a general neuropsychological assessment. The objective of this study was to develop versions of the TB-2 for 6 major dialects of Spanish-speaking Latin American countries, taking into account cross-cultural and cross-linguistic factors. Working documents consisting of sheets with 3 columns were established: original version, proposals for changes and justification of the proposals. The phonetic-prosodic aspect of the evaluation, which was controlled by local evaluators, was excluded. The documents were completed by at least two researchers for each dialect and subsequently agreed upon. The proposals were compared with the meanings of the Royal Spanish Academy and the Dictionary of Americanisms of the Association of Academies of the Spanish Language. The final versions were the subject of 6 acceptability studies. Versions have been established for 19 countries with 47 working documents for the Mexican, Caribbean, Central American, Andean, Austral, and Chilean TB-2 dialect varieties. For the first time a neuropsychological test, initially developed in Catalan and Spanish, is simultaneously adapted to the 6 major Hispanic American dialects. These versions will avoid local interpretations and improvisations when administering the test in any Spanish-speaking territory. Administration to broad populations without and with cognitive impairment should allow for completing or modifying some of the changes and, perhaps, adjusting the score ranges.

Most people with dementia live in LMICs, underscoring the need for LMIC-specific identification of high-risk individuals. This study aimed to develop and validate a simple dementia risk prediction model for these settings. Data from seven 10/66 Study sites were analyzed. Over 100 candidate predictors were screened based on existing models and the 2024 Lancet Commission, including LMIC-specific variables (eg, food insecurity and household assets). Predictors were selected using LASSO and modelled with the Fine-Gray method to generate a risk score. Predictive accuracy was pooled via meta-analysis. 11143 participants were included, among whom 1069 (9.6%) developed dementia during follow-up. A five-factor risk score comprising age, social engagement, physical activity, hypertension, and difficulty in handling money was developed. The pooled c-statistic was 0.75 (95% CI: 0.72-0.78), with good calibration across sites. Decision curve analysis showed a modest net benefit, with variation across countries. It is possible to predict incident dementia with reasonable accuracy using a simple model across different LMICs. Our findings support the use of context-specific risk assessment tools to identify individuals at elevated dementia risk in LMIC settings, which may inform resource allocation for dementia care services and public health planning.

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Intracerebral hemorrhage (ICH) is a severe stroke subtype with high global mortality and morbidity. This study quantifies the global burden and time trend of ICH from 1990 to 2021, and constructs a predictive model for 2036. We focus on health disparities to inform targeted prevention and intervention. Utilizing Global Burden of Disease data, this study evaluated ICH incidence, prevalence, mortality, and disability-adjusted life years from 1990 to 2021. The study examined global, regional, and national levels. The estimated annual percentage change quantified trends. Frontier analysis examined variations by development. A Bayesian age-period-cohort model projected future burden. These methods provide a more comprehensive and actionable assessment than previous studies. The global burden of ICH increased substantially in absolute numbers from 1990 to 2021, with incident cases and deaths rising by 46.05% and 41.29%, respectively. In 2021, ICH caused 3,308,367 deaths [95% uncertainty interval (UI): 3,021,075-3,594,725]. However, age-standardized rates showed a consistent decline over time, with the age-standardized incidence rate was 40.83 (95% UI: 36.20-45.21) and the mortality rate was 39.09 (95% UI: 35.65-42.25) per 100,000, respectively. The burden of ICH was strongly associated with socio-demographic development. Lower Socio-demographic Index (SDI) regions bearing disproportionately higher mortality and DALY burdens. In contrast, higher SDI regions generally exhibited declining trends in age-standardized rates. ICH remains a critical global public health challenge. Although the overall age-standardized burden has decreased, pronounced disparities persist, especially in less developed regions. Focused public health action, equitable resource distribution, and stronger health systems are critical to closing these gaps.

Neuroworsening (NW) after traumatic brain injury (TBI) is a life-threatening complication affecting at least one in five patients. The current definition remains heterogeneous and does not integrate contemporary neuromonitoring tools that could help reduce this variability. Current diagnostic approaches are predominantly reactive, identifying deterioration only after brain herniation has occurred. To establish an expert consensus to update the definition of NW in TBI by proposing a stratified diagnostic framework aligned with precision and personalized medicine principles, aiming to shift a paradigm that has been in use for the past 50 years. A formal Delphi consensus process was conducted involving 25 experts from the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC). A pre-consensus systematic literature review was performed, followed by structured electronic surveys with Likert-scale and multiple-choice items. Consensus was predefined as ≥80% agreement for establishing a statement. A 95.2% response rate was achieved in the first Delphi round, with 100% of statements reaching the consensus threshold. The panel agreed on a stratified three phenotype NW framework: Established NW, Subclinical NW and High-Risk Phenotype, including patients with pre-existing anatomical or systemic conditions that affect cerebral compliance or oxygenation reserve. This consensus proposes integrating clinical, imaging, and multimodal neuromonitoring parameters to update the definition of NW, thereby reducing heterogeneity in the current concept. Seven statements were established with >80% agreement. The new definition promotes a preventive approach to this critical condition, in contrast to the traditional reactive model.

We describe the step-by-step microsurgical management of four right-sided incidental clustered ipsilateral anterior circulation aneurysms through a single extended minipterional approach. A 55-year-old woman with right-sided aneurysms involving the A1 segment, anterior choroidal artery, posterior communicating artery, and carotid terminus underwent clipping in a single-stage procedure. Her past medical history included two previously clipped aneurysms of the clinoidal segment of the right internal carotid artery (ICA). The patient was positioned supine with vertex-down tilt and contralateral head rotation to align the surgical corridor along the sphenoid ridge. A 4 × 5 cm craniotomy was performed following extradural sphenoid ridge drilling and anterior clinoidectomy to expose the distal dural ring and secure proximal internal carotid artery control. Sylvian fissure dissection from distal to proximal allowed cerebrospinal fluid drainage and brain relaxation. Aneurysms were clipped sequentially from proximal to distal: first the A1 aneurysm with preservation of perforators, followed by the posterior communicating artery aneurysm, the anterior choroidal artery aneurysm, and finally the carotid terminus aneurysm. Intraoperative fluorescein videoangiography confirmed aneurysm exclusion and patency of parent vessels and perforators. This stepwise proximal-to-distal strategy provided an unobstructed operative field, ensured vascular control, and allowed safe treatment of multiple lesions through a single surgical corridor.

Posterior fossa surgery requires precise anatomic orientation within a restricted operative corridor. The trochlear nerve [cranial nerve (CN) IV], although small and often overlooked, has distinctive cisternal relationships that may serve as a reproducible landmark. This study characterizes CN IV anatomy and highlights its role in guiding safe microsurgical approaches. Five alcohol-fixed, silicone-injected adult cadaveric heads were dissected under ×10 to ×40 magnification after suboccipital craniotomy. The cisternal course of CN IV was traced from its dorsal brainstem exit to the tentorial edge, with attention to quadrigeminal, cerebellomesencephalic, and ambient portions. Four clinical cases of posterior fossa lesions treated via supracerebellar infratentorial approaches were reviewed to correlate anatomic findings with operative utility. CN IV consistently emerged dorsally below the inferior colliculus, marking the midbrain-pons transition and aqueduct-fourth ventricle boundary. Its cisternal trajectory divided adjacent sulci and venous channels into 4 quadrants, providing reproducible orientation within the cerebellomesencephalic fissure. In the ambient cistern, CN IV coursed between the posterior cerebral and superior cerebellar arteries. In all clinical cases, intraoperative identification of CN IV facilitated orientation and complete lesion resection without new neurological deficits. The trochlear nerve is a reliable intraoperative landmark in posterior fossa surgery. Recognition of its cisternal relationships enhances orientation, improves dissection accuracy, and reduces risk in approaches to deep-seated posterior fossa lesions.

Limb-girdle muscular dystrophies (LGMD) exhibit a wide range of disease severity, affecting various parts of the skeletal muscle to varying degrees. This may be associated with differences in the degeneration and regeneration processes in different muscles. We previously reported that muscles with different metabolic characteristics showed distinct levels of proteins involved in the muscle regeneration process in δ-sarcoglycan-deficient mice, a model for LGMDR6. These phenomena may be relevant to test potential therapeutic compounds in myopathies. In this study, we analyzed the effect of (-)-epicatechin (Epi), a flavanol enriched in cacao that has shown beneficial effects in skeletal muscle, in different muscles of the δ-sarcoglycan-deficient mice. Histochemical analysis showed that dystrophic triceps and gastrocnemius had a higher level of fibrosis than plantaris, and Epi reduced this. In addition, Epi increased the cross-sectional area of dystrophic triceps fibers, which was associated with a higher fusion index. In contrast, Epi reduced the index fusion in dystrophic plantaris. Western blot analysis demonstrates that Epi increases protein levels of Pax7, β-catenin, and myogenin in the dystrophic triceps and increases protein levels of β-catenin and myogenin in the gastrocnemius. In contrast, in the plantaris, none of the protein levels was modified. All these results suggest that muscles with different metabolic characteristics and physiological demands could respond differentially to pharmacological therapies in dystrophic muscles.

Pituitary adenomas are the third most common intracranial tumor. Due to their growth, they may cause endocrine disturbances, compression, and visual deficits, particularly visual field defects. The Visual Field Index (VFI) is an objective parameter that accurately quantifies visual improvement or deterioration. Transsphenoidal resection is the first-line treatment; therefore, pre- and postoperative visual assessment is essential for follow-up and prognosis. To correlate pre- and postoperative VFI in patients with pituitary adenomas who underwent microscopic transsphenoidal surgery at the Centro Médico Nacional de Occidente. A retrospective study of patients operated on between January 2020 and January 2024 was conducted, including those with pre- and postoperative automated perimetry. Both sexes and all ages were included, provided they had complete medical records, magnetic resonance imaging, and visual field testing. VFI values were compared using descriptive and correlational analyses. Thirty-two patients were analyzed (mean age 54 years); 29 had comorbidities, with hypothyroidism being the most common (56%). The most frequent visual deficit was bitemporal hemianopia (60%). In the right eye, the mean VFI increased from 50.1% to 56.1% (p = 0.002); the median increased from 55% to 68.5% (p = 0.001). In the left eye, the mean changed from 54.6% to 56.7% (p = 0.472); the median from 55.5% to 64.5% (p = 0.537). A greater proportion of improvement was observed in the right eye. In diabetic patients, a reduction in left-eye VFI was noted. Postoperative VFI showed an overall increase following microscopic transsphenoidal resection, supporting its usefulness as a practical and objective parameter for evaluating visual function. los adenomas hipofisarios son el tercer tumor intracraneal más frecuente. Por su crecimiento pueden causar alteraciones endocrinas, compresión y déficit visual, especialmente campimétrico. El índice de campo visual (VFI) es un parámetro objetivo que cuantifica con precisión la mejoría o deterioro visual. La resección transesfenoidal es el tratamiento de primera línea, por lo que la evaluación visual pre y posoperatoria es clave para el seguimiento y pronóstico. asociar el VFI pre y posoperatorio en pacientes con adenomas hipofisarios intervenidos mediante abordaje transesfenoidal microscópico en el Centro Médico Nacional de Occidente. estudio retrospectivo de pacientes operados entre enero de 2020 y enero de 2024, con campimetría digital pre y posquirúrgica. Se incluyeron ambos sexos y todas las edades con expediente completo, resonancia magnética y campimetría. Se compararon valores de VFI mediante análisis descriptivo y correlacional. se analizaron 32 pacientes (edad promedio 54 años); 29 presentaban comorbilidades, predominando hipotiroidismo (56%). El déficit visual más frecuente fue hemianopsia bitemporal (60%). En el ojo derecho, el VFI promedio aumentó de 50.1% a 56.1% (p = 0.002); mediana de 55% a 68.5% (p = 0.001). En el izquierdo, el promedio pasó de 54.6% a 56.7% (p = 0.472); mediana de 55.5% a 64.5% (p = 0.537). Se observó mayor proporción de mejoría en el ojo derecho. En pacientes diabéticos hubo reducción del VFI izquierdo. el VFI posoperatorio mostró incremento global tras resección transesfenoidal microscópica, siendo un parámetro útil y práctico para evaluar la función visual.

Introduction: Humanized care is a core indicator of nursing quality, yet its prevalence and determinants among Spanish undergraduates remain unclear. Methods: A cross-sectional survey was administered to fourth-year nursing students from public and private universities. Instruments included the Health Professional's Humanization Scale (HUMAS), the Communication Styles Inventory-Revised (CSI-R) and a sociodemographic questionnaire that captured prior training: completion of ≥6 h role-playing seminars in patient-family communication. Results: Mean scores were 3.62 ± 0.48 for HUMAS and 2.50 ± 0.52 for CSI-R. Women exceeded men on HUMAS total (p = 0.025) and on Sociability, Emotional Understanding, Dispositional Optimism and Self-Efficacy (all p ≤ 0.013), but not on Affect-Regulation or CSI-R. Age correlated weakly with Optimism (r = 0.24) and Self-Efficacy (r = 0.21). Students who had completed the role-playing seminars recorded higher HUMAS totals (d = 0.50; p = 0.001) and sub-scores, with only a modest gain in Affect-Regulation, and showed a trend towards better CSI-R performance (p = 0.06). No differences emerged by university type. HUMAS and CSI-R correlated moderately (r = 0.32; p = 0.001). In multivariate analysis, training (β = 0.36; p = 0.001) and CSI-R (β = 0.26; p = 0.001) jointly explained 27.9% of humanization variance; male sex exerted a small negative effect (β = -0.19; p = 0.001), whereas age was nonsignificant. Conclusions: Structured communication seminars are a key factor associated with higher levels of humanization in senior nursing students, whereas sociodemographic influences are modest. Embedding longitudinal, simulation-rich modules in communication and emotional intelligence is therefore recommended to cultivate truly person-centered nurses and to narrow observed sex disparities.

Aging results from the gradual accumulation of molecular and cellular damage, and it is a risk factor for neurodegenerative disease. The aryl hydrocarbon receptor (AhR) is increasingly recognized as a key in the regulatory molecular mechanisms that drive aging. AhR is a cytoplasmic receptor activated by diverse endogenous and exogenous ligands. It modulates cell proliferation and differentiation in development and the adult brain. Besides, AhR participates in multiple physiological mechanisms that become dysregulated with age, including neuroinflammation, gut dysbiosis, stem cell maintenance, genomic stability, lipid metabolism, and mitochondrial function, contributing to the onset of neurodegeneration. These interconnected physiological processes lead to cumulative damage that ultimately impairs physical and cognitive function in older individuals. Activation of AhR by selective ligands has been shown to dampen neuroinflammatory responses and support cognitive integrity, underscoring its regulatory role in central nervous system (CNS) homeostasis. This review plumbs current evidence on how AhR influences the molecular mechanisms of aging and explores its potential as a therapeutic target to preserve brain health and mitigate age-related neurological decline.

Pediatric stroke (PS) may be ischemic or hemorrhagic and affects patients from birth to 18 years. Although its incidence is low, it carries significant morbidity and mortality. Diagnosis is frequently delayed due to low clinical suspicion and age-dependent symptoms, making early recognition essential for better outcomes. Neuroimaging, particularly magnetic resonance imaging (MRI) and computed tomography (CT), is fundamental for confirmation. For ischemic PS, reperfusion therapies such as thrombolysis and mechanical thrombectomy are treatment options in selected cases. Hospital mortality ranges from 3 % to 6 % for ischemic stroke and is higher for hemorrhagic forms. Long-term complications include epilepsy and persistent neurological deficits. Improving care requires educational tools and multidisciplinary training for prehospital and hospital teams, along with institution-specific protocols. Implementing these measures does not demand additional resources but rather adaptation and professional education to ensure timely diagnosis and treatment. El accidente cerebrovascular (ACV) pediátrico, isquémico o hemorrágico, afecta a niños desde el nacimiento hasta los 18 años. Aunque su incidencia es baja, genera alta morbimortalidad y secuelas. El diagnóstico suele retrasarse por baja sospecha clínica y síntomas variables según la edad, por lo que la detección precoz es esencial para mejorar resultados. Las neuroimágenes, especialmente resonancia magnética (RM) y tomografía computada (TC), son fundamentales. En el ACV isquémico, la trombólisis y la trombectomía mecánica son opciones terapéuticas en casos seleccionados. La mortalidad hospitalaria oscila entre el 3 % y el 6 % en el ACV isquémico y es mayor en el hemorrágico; la epilepsia constituye un riesgo a largo plazo. Se requiere capacitación multidisciplinaria y protocolos adaptados a cada institución para optimizar la atención. Estas recomendaciones no implican recursos adicionales, sino educación y organización para garantizar una respuesta rápida y eficaz.

Interoceptive awareness (IA) supports emotional processing and may be affected in people with Parkinson's disease (PwP), where depression and anxiety are common. We examined associations between IA, neuropsychiatric symptoms, cognition, and disease severity in PwP. In a case-control study, 50 PwP and 25 controls completed the MAIA, HDRS, HARS, MoCA, and MDS-UPDRS. IA did not differ between groups. In PwP, lower MAIA Not-Worrying and Self-Regulation scores correlated with depression, anxiety, and disease severity. In addition, lower MAIA Self-Regulation scores correlated with higher orthostatic hypotension symptoms. Reduced interoceptive confidence in PwP is associated with neuropsychiatric burden and perceived autonomic symptom burden.

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Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Although medical management remains the cornerstone of treatment, selected patients may benefit from surgical or neuromodulatory interventions. The role of surgery in SRSE remains incompletely defined, and the available evidence is largely limited to case reports, case series, and recent systematic reviews. We conducted a structured narrative review of the literature using PubMed, ScienceDirect, SciELO, and Google Scholar. Articles published in English or Spanish after 2000 addressing surgical or neuromodulatory treatment strategies for SRSE were included. Evidence related to refractory status epilepticus (RSE) was considered when relevant to timing of intervention, patient selection, or progression toward SRSE. Both resective/disconnective procedures and neuromodulation techniques (VNS, RNS, DBS) were evaluated. Methodological quality was assessed using the CARE checklist for case reports and AMSTAR-2 for systematic reviews. Thirty-three studies were included, comprising case reports and systematic reviews involving both adult and pediatric populations. Resective and disconnective procedures appeared to provide the most rapid and consistent SRSE termination in patients with well-defined epileptogenic lesions and were frequently associated with rapid termination of SRSE. Neuromodulation techniques demonstrated more variable and delayed responses but provided meaningful clinical benefit in selected patients with diffuse or poorly localized epileptogenic networks. Vagus nerve stimulation was the most frequently reported neuromodulation strategy, while responsive neurostimulation and deep brain stimulation showed promising results in focal and network-related epilepsies. Across studies, favorable long-term seizure outcomes were reported in a substantial proportion of surviving patients, although interpretation is limited by study heterogeneity, publication bias, and inconsistent outcome reporting. The current evidence, although limited by the low overall quality of the available studies and heterogeneity of the populations, suggests that surgical intervention may represent a valuable therapeutic option in carefully selected patients with SRSE, particularly when a focal epileptogenic lesion can be identified. Neuromodulation may serve as a rescue or palliative strategy in diffuse or non-resectable cases. Early multidisciplinary evaluation in specialized epilepsy surgery centers may be critical for optimizing outcomes. Surgical and neuromodulatory interventions may play an important role in selected patients with SRSE refractory to medical therapy. However, the available evidence remains limited and heterogeneous. Further multicenter prospective studies are needed to better define patient selection, timing of intervention, and long-term outcomes.

Stroke remains a leading cause of death and disability across the Americas, disproportionately affecting low- and middle-income countries. According to the 2023 Global Burden of Disease (GBD) Study, the Americas recorded approximately 1.2 million incident strokes and 15.7 million prevalent cases. This narrative review synthesizes epidemiological evidence on stroke trends in the Americas, with emphasis on disparities in healthcare access. We integrated estimates from the GBD, peer-reviewed studies and national surveillance systems. Although age-standardized stroke rates declined after 1990, recent analyses demonstrate a concerning resurgence, particularly among younger adults. Stroke incidence, prevalence, and disability burden vary widely across countries. Latin America and the Caribbean show higher incidence but lower prevalence than high-income settings, reflecting limited access to acute care and higher case fatality. Socioeconomic and racial inequities drive delayed treatment and poorer functional outcomes. Over 75% of stroke burden is attributable to modifiable risk factors. Urgent system-level action is needed. O acidente vascular cerebral (AVC) permanece como uma das principais causas de morte e incapacidade nas Américas, afetando de forma desproporcional os países de baixa e média renda. De acordo com o estudo Global Burden of Disease (GBD) 2023, as Américas registraram aproximadamente 1.2 milhão de casos incidentes de AVC e 15.7 milhões de casos prevalentes. Esta revisão narrativa sintetiza evidências epidemiológicas sobre as tendências do AVC nas Américas, com ênfase nas desigualdades no acesso à assistência em saúde. Foram integradas estimativas do GBD, estudos revisados por pares e sistemas nacionais de vigilância. Embora as taxas de AVC padronizadas por idade tenham diminuído após 1990, análises recentes demonstram uma preocupante retomada do aumento, particularmente entre adultos mais jovens. A incidência, prevalência e carga de incapacidade por AVC variam amplamente entre os países. A América Latina e o Caribe apresentam maior incidência, porém menor prevalência em comparação com países de alta renda, refletindo acesso limitado ao cuidado agudo e maior letalidade. Desigualdades socioeconômicas e raciais contribuem para atrasos no tratamento e piores desfechos funcionais. Mais de 75% da carga de AVC é atribuível a fatores de risco modificáveis, ressaltando a necessidade urgente de ações em nível de sistema de saúde. El accidente cerebrovascular (ictus) sigue siendo una de las principales causas de mortalidad y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos. Según el estudio Global Burden of Disease (GBD) 2023, las Américas registraron aproximadamente 1.2 millones de casos incidentes de ictus y 15.7 millones de casos prevalentes. Esta revisión narrativa sintetiza la evidencia epidemiológica sobre las tendencias del ictus en las Américas, con énfasis en las desigualdades en el acceso a la atención sanitaria. Se integraron estimaciones del GBD, estudios revisados por pares y sistemas nacionales de vigilancia. Aunque las tasas de ictus ajustadas por edad disminuyeron después de 1990, análisis recientes muestran una preocupante reaparición del aumento, particularmente entre adultos más jóvenes. La incidencia, la prevalencia y la carga de discapacidad por ictus varían ampliamente entre los países. América Latina y el Caribe presentan una mayor incidencia, pero una menor prevalencia en comparación con los países de altos ingresos, lo que refleja un acceso limitado a la atención aguda y una mayor letalidad. Las desigualdades socioeconómicas y raciales contribuyen a retrasos en el tratamiento y a peores resultados funcionales. Más del 75% de la carga del ictus es atribuible a factores de riesgo modificables, lo que subraya la necesidad urgente de acciones a nivel de los sistemas de salud.

Adverse social conditions across the life course influence brain aging and dementia, yet their compounded impact on clinical phenotypes remains underexplored, particularly in Latin America, where social inequality and dementia burden are high. We studied 3941 individuals from six Latin American countries, including cognitively unimpaired controls (CU), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). A life-course questionnaire captured eight domains of social vulnerability, used to derive a social vulnerability index and latent vulnerability profiles. Brain health was characterized across 37 cognitive, functional, mental health, and dementia severity indicators. Higher vulnerability was mostly associated with executive and memory deficits in CU, cognitive and functional impairment in AD, and social cognition and neuropsychiatric symptoms in FTLD. Multidimensional brain health was affected across groups. Compounded social vulnerability is a key determinant of clinical expression in aging and dementia, underscoring the need for life-course-informed and equity-oriented dementia models.

Low back pain is a common pathology in the general population. In people over 60 years of age, it is associated with degenerative changes that cause narrowing of the vertebral canal. Its treatment includes conservative measures and even surgery with decompression and fusion. In those patients with moderate symptoms, the use of interspinous spacers emerged as a minimally invasive therapeutic option. This scoping review seeks to map the existing literature on the use of interspinous spacers and identify knowledge gaps to clarify their real position in the stepwise approach to low back pain. This study as a scoping review, conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. The type of synthesis chosen was descriptive and mapping-based, allowing for the inclusion of diverse study designs (randomized controlled trials, observational studies, case series, clinical guidelines, and relevant reviews) to capture a comprehensive overview of the field. This approach was selected because the existing literature is heterogeneous in terms of intervention protocols, clinical outcomes, and follow-up duration, and the effectiveness and indications for interspinous spacers (ISD) remain controversial. The search was extended from the inception of the databases until November 2025. The program "Rayyan" was used to collect the information and facilitate the analysis process. Each of the authors independently reviewed the summary of all the articles found and applied the following inclusion criteria: systematic review, clinical trials, observational studies, and case series. articles in cadavers or made in the laboratory. A total of 522 articles were found in the databases consulted, of which 95 duplicate articles were eliminated. The criteria (Inclusion/Exclusion) were applied to the 427 identified articles based on the independent reading of the abstracts by each of the authors in the Rayyan platform, and 110 articles were excluded. The 317 selected articles were reviewed completely by each of the authors to finally obtain 101 articles included in the review. The use of ISD in the treatment of moderate LSS may be controversial. Although the clinical results seem conclusive about the usefulness in controlling symptoms, more studies are needed to compare these technologies with new surgical procedures and especially new biomechanical concepts. The efforts made to treat patients with moderate LSS appropriately should continue to be channeled into optimizing techniques.