Background: Cardiac involvement in dengue has been increasingly recognized, yet the true burden and spectrum of arrhythmias remain uncertain due to heterogeneous and fragmented evidence. We conducted a systematic review and meta-analysis to estimate the proportion of cardiac arrhythmias in patients with dengue and to describe the distribution of major arrhythmia subtypes. Methods: We searched PubMed/MEDLINE, EMBASE, LILACS, Global Index Medicus, and Google Scholar from inception to November 2025 without language restrictions. Observational studies reporting the number of dengue patients evaluated for arrhythmias and the number with at least one rhythm disturbance were included. Random-effects generalized linear mixed models with a logit transformation were used to estimate pooled proportion with 95% confidence intervals (CIs). Subgroup analyses were performed by age group. Risk of bias was assessed using the Joanna Briggs Institute tool, and certainty of evidence was evaluated with GRADE. Results: Thirty-five studies, including 6948 patients, were analyzed. The pooled proportion of any arrhythmia was 24.48% (95% CI 17.54–33.07), with a higher proportion in adults (30.00%) than in children (10.73%). Sinus bradycardia (11.84%) and sinus tachycardia (10.63%) were the most frequent abnormalities. Atrioventricular block was uncommon (1.33%). Between-study heterogeneity was high for most outcomes. No significant small-study effects were detected. Conclusions: Cardiac arrhythmias occur in approximately one in four patients with dengue, predominantly as sinus rate abnormalities. While often transient, these findings support the role of baseline and risk-based ECG monitoring, particularly in hospitalized adults and patients with severe disease.

We sincerely thank Iqhrammullah and Rampengan for their thoughtful and valuable Comment

Background/Objective: The management of acute ischemic stroke (AIS) has evolved from rigid time-based treatment paradigms toward tissue-based selection guided by advanced neuroimaging, thereby expanding eligibility for reperfusion therapies. To provide an updated narrative review of acute ischemic stroke (AIS) classification and management, with emphasis on extended therapeutic windows for intravenous thrombolysis (IVT) and endovascular therapy (EVT), bridging strategies, posterior circulation stroke, and implementation challenges in Latin America and other resource-constrained settings. Methods: A structured narrative review was conducted using the PubMed/MEDLINE, Embase, Scopus, and LILACS databases, covering the period from 2013 to 2025. Results: Sixty-three studies were selected from 412 records and categorized into etiologic classification, extended-window thrombolysis, EVT and bridging therapy, and posterior circulation stroke. Current evidence supports imaging-guided IVT beyond 4.5 h and EVT up to 24 h in selected patients with salvageable brain tissue, including some individuals with large infarct cores. Recent trials also support EVT for basilar artery occlusion. Tenecteplase offers practical workflow advantages in many centers, particularly where transfer delays and limited access to advanced imaging constrain timely reperfusion decisions. Conclusions: Contemporary AIS management is increasingly guided by pathophysiology and imaging rather than strict time thresholds. However, improving outcomes in middle- and low-income settings requires the implementation of adapted clinical algorithms, strengthening of stroke care networks, and optimization of referral pathways.