Medicina Clinica最新文献

{"title":"Diagnosis, follow-up, and management of patients with thrombotic thrombocytopenic purpura.","authors":"Javier de la Rubia, Inés Gómez-Seguí, Antonio Moscardó, Pilar Solves","doi":"10.1016/j.medcli.2026.107650","DOIUrl":"https://doi.org/10.1016/j.medcli.2026.107650","url":null,"abstract":"<p><p>Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy that significantly impacts patients' quality of life. In its immune and hereditary variants, it can affect any age group, and despite its low incidence, significant advances have been made in its diagnosis and treatment, considerably improving the prognosis. However, given the chronic nature of the disease, proper management requires long-term, multidisciplinary follow-up to minimize the development of complications, especially cardiovascular ones, and continuous treatment in the hereditary form, as well as timely but targeted intervention in the immune forms. The aim of this review is to provide an update on this microangiopathy, optimizing patient management through early diagnosis, updated therapy administration, and recommendations for appropriate follow-up and monitoring.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"107650"},"PeriodicalIF":2.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149287513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syphilis: clinical, diagnostic and therapeutic update.","authors":"Daniel Blaya Imbernón, Andrés Grau Echevarría, Esther Díez Recio, Pablo Hernández Bel","doi":"10.1016/j.medcli.2026.107623","DOIUrl":"https://doi.org/10.1016/j.medcli.2026.107623","url":null,"abstract":"<p><p>Syphilis remains a major global public health concern due to the sustained increase in incidence observed over recent decades, particularly among high-risk populations. Its broad clinical spectrum and ability to mimic numerous dermatological and systemic diseases continue to make it a relevant diagnostic challenge in dermatological practice. This review summarizes the main epidemiological, microbiological, clinical, diagnostic, and therapeutic aspects of Treponema pallidum infection, with special emphasis on mucocutaneous manifestations and recent advances in molecular diagnostic techniques. Current therapeutic strategies, clinical and serological follow-up, and special situations such as neurosyphilis, ocular syphilis, pregnancy, and HIV infection are also reviewed. Finally, emerging preventive challenges are discussed, including doxycycline post-exposure prophylaxis (DoxyPEP), antimicrobial resistance, and future perspectives in vaccine development.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"107623"},"PeriodicalIF":2.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149287627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic priapism: A rare complication of severe methanol intoxication","authors":"Tzu-Ching Sung,&nbsp;Tzu-Yuan Yang,&nbsp;Hsin-I. Shih,&nbsp;Hsiang-Chin Hsu","doi":"10.1016/j.medcli.2026.107467","DOIUrl":"10.1016/j.medcli.2026.107467","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 7","pages":"Article 107467"},"PeriodicalIF":2.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemangiomas linguales múltiples","authors":"Miguel Ángel Cuervo Pinna ,&nbsp;Belén Salgado Cardoso ,&nbsp;Montaña Julián Caballero","doi":"10.1016/j.medcli.2025.107302","DOIUrl":"10.1016/j.medcli.2025.107302","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 4","pages":"Article 107302"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La enfermedad por reflujo gastroesofágico en el siglo XXI","authors":"Antonio M. Caballero-Mateos ,&nbsp;Cristina Bailón-Gaona ,&nbsp;Guillermo A. Cañadas de la Fuente","doi":"10.1016/j.medcli.2025.107047","DOIUrl":"10.1016/j.medcli.2025.107047","url":null,"abstract":"<div><div>Gastroesophageal reflux disease (GERD) is a chronic disorder affecting a significant proportion of the global population, characterized by heartburn and regurgitation, and potentially associated with serious complications such as esophagitis, Barrett's esophagus, and adenocarcinoma. Its multifactorial pathophysiology includes alterations in the lower esophageal sphincter, motility, or visceral sensitivity. Diagnosis is based on a combination of clinical criteria and complementary tests such as endoscopy, pH monitoring, and impedance testing. Management includes non-pharmacological strategies like lifestyle and dietary changes, along with pharmacological therapy, with proton pump inhibitors being the cornerstone of treatment. Newer options, such as potassium-competitive acid blockers (vonoprazan), have shown promising benefits in refractory cases. This article synthesizes the most updated evidence on GERD, providing a comprehensive overview of its pathophysiology, diagnosis, and therapeutic options.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 4","pages":"Article 107047"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic diarrhea and infiltrative duodenal lesions caused by Chromobacterium violaceum in a kidney transplant recipient","authors":"Julya de Assis Sousa Morais ,&nbsp;Diogo Buarque Cordeiro Cabral ,&nbsp;Euclides Dias Martins Filho","doi":"10.1016/j.medcli.2025.107294","DOIUrl":"10.1016/j.medcli.2025.107294","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107294"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sitosterolemia heterocigota. Estudio de un caso","authors":"Antonio Moreno Tirado,&nbsp;Juan Jesús García González,&nbsp;Pilar Rodríguez Ortega","doi":"10.1016/j.medcli.2025.107348","DOIUrl":"10.1016/j.medcli.2025.107348","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107348"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound in tropical infections: Expanding frontline diagnostics","authors":"Fernando de la Calle-Prieto ,&nbsp;Patricia Martínez-Martín ,&nbsp;César Henríquez-Camacho","doi":"10.1016/j.medcli.2025.107310","DOIUrl":"10.1016/j.medcli.2025.107310","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in tropical medicine, particularly in settings with limited access to advanced imaging. Its portability, non-invasiveness, and ability to provide real-time information make it especially valuable for evaluating infectious diseases endemic to tropical and subtropical regions. In conditions such as malaria, visceral and cutaneous leishmaniasis, and Chagas disease, POCUS can aid in the detection of complications including hepatosplenomegaly, effusions, cardiac involvement, and raised intracranial pressure. It also aids in the assessment of cutaneous parasitic infections and secondary bacterial complications. Beyond diagnosis, ultrasound has demonstrated utility in monitoring treatment response and identifying patients at higher risk of adverse outcomes. This review summarizes the most relevant ultrasonographic findings across major tropical infections, offering a practical approach for clinicians working in endemic areas. As an extension of the physical examination, POCUS enhances clinical decision-making and represents a feasible, impactful tool in resource-limited settings.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107310"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of severity and inflammation on the decrease of monocyte HLA-DR (MHLA-DR) in critically ill patients","authors":"Bibiana Quirant-Sánchez ,&nbsp;Alba Herraiz Ruiz ,&nbsp;Oriol Plans Galván ,&nbsp;Regina Roig Pineda ,&nbsp;Beatriz Catalán Eraso ,&nbsp;David Mota Montané ,&nbsp;Ester Lucas Varas ,&nbsp;Maria Martínez Gonzalez ,&nbsp;Eva Maria Martínez Cáceres ,&nbsp;Fernando Arméstar Rodríguez","doi":"10.1016/j.medcli.2025.107236","DOIUrl":"10.1016/j.medcli.2025.107236","url":null,"abstract":"<div><h3>Background</h3><div>The critically ill patient has unique characteristics that make him part of a very delimited group of patients. One example is the transient immunosuppression that appears during their stay at ICU. One of the parameters in which this alteration is observed is the membrane expression of HLA-DR on monocytes (_MHLA-DR). The aim of this study was to establish the factors associated with the low expression of _MHLA-DR, as measured by the percentage of monocytes expressing HLA-DR (% HLA-DR) and the quantification of HLA-DR molecules per monocyte (MFI HLA-DR).</div></div><div><h3>Methods</h3><div>The study included 84 critically ill patients without infection at admission and without previous pathology conditioning immunosuppression. To assess severity and inflammation, we used the APACHE II and CRP variables, respectively, quantified at the time of admission.</div></div><div><h3>Results</h3><div>We found that the higher the APACHE II and CRP values, the lower the % HLA-DR and MFI HLA-DR values. In the analysis of the robust linear regression between APACHE II and % HLA-DR, a coefficient of −0.588 was obtained, with an <em>R</em>² of 0.0965 and <em>p</em> <!-->&lt;<!--> <!-->0.05. The robust linear regression between APACHE II and MFI HLA-DR obtained a coefficient of −40.5, with an <em>R</em>² of 0.0679 and <em>p</em> <!-->&lt;<!--> <!-->0.05. In the analysis of the CRP value and % HLA-DR, a coefficient of −0.06092 was obtained, with an <em>R</em>²: 0.285 and <em>p</em> <!-->&lt;<!--> <!-->0.05.</div></div><div><h3>Conclusion</h3><div>The degree of immunosuppression is related to systemic inflammation and the severity of the patient.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107236"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound training in infectious diseases: Educational models, challenges, and multi-sectoral roles","authors":"Samuel García-Rubio ,&nbsp;Suean Pascoe ,&nbsp;Yale Tung-Chen","doi":"10.1016/j.medcli.2025.107341","DOIUrl":"10.1016/j.medcli.2025.107341","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) has become an essential diagnostic and procedural adjunct in infectious disease practice, providing real-time bedside evaluation that improves patient outcomes. Despite its clinical relevance, broad implementation faces educational challenges, including limited access to hands-on training, inconsistent curricular integration, and lack of standardized certification pathways across all stages of medical education.</div><div>This review frames POCUS education as a longitudinal, progressive pathway starting with foundational exposure in undergraduate medical curricula and advancing through competency-based postgraduate training, continuing professional development, and formal credentialing. Key educational frameworks such as G.O.O.S.E. and I-AIM structure the acquisition of both technical imaging skills and clinical integration, fostering critical ultrasound competence.</div><div>Various stakeholders contribute to this continuum: medical schools form the foundational base; private sector programs fill training gaps using innovative educational approaches including immersive workshops, simulation, blended learning, and small-group pathology-focused sessions; and scientific societies provide leadership by defining standards, supporting collaborative research, and advocating for formalized training and certification.</div><div>These innovative training modalities enable flexible, practical skill acquisition tailored to evolving clinical needs and diverse practice environments, accelerating learners’ progression toward competent, autonomous ultrasound use. Such approaches are especially valuable in resource-limited settings or where traditional academic resources are constrained.</div><div>Sustained multisectoral collaboration among academic institutions, private educators, scientific societies, and regulatory bodies is vital to ensure accessible, effective, and equitable POCUS training worldwide. By outlining this comprehensive educational roadmap and recognizing ongoing innovations, this review aims to guide the integration of POCUS into infectious disease care, ultimately improving global patient outcomes.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107341"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}