Medicina clinica (English ed.)最新文献

{"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.medcle.2026.107236","DOIUrl":"10.1016/j.medcle.2026.107236","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":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107236"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular adrenal rest tumors and congenital adrenal hyperplasia","authors":"Marc Martín Hernández,&nbsp;Álex Gil Ordoñez,&nbsp;Daniel Vas","doi":"10.1016/j.medcle.2026.107296","DOIUrl":"10.1016/j.medcle.2026.107296","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107296"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulminant emphysematous hepatitis","authors":"Inés Alonso Envid ,&nbsp;Ángel Lafuente los Arcos ,&nbsp;José Enrique Alonso Formento ,&nbsp;Carlos Pardillos Marín ,&nbsp;María del Carmen Orts Cansino ,&nbsp;Elisa Simó Gaztambide","doi":"10.1016/j.medcle.2026.107295","DOIUrl":"10.1016/j.medcle.2026.107295","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107295"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and gender disparities in ischemic heart disease: The role of social and clinical factors in long-term outcomes from the RECORVAL registry","authors":"Miriam Rodríguez de Rivera ,&nbsp;Jon Zubiaur ,&nbsp;Itziar Cucurull Ortega ,&nbsp;Elton Carreiro Da Cunha ,&nbsp;Raquel Pérez Barquín ,&nbsp;Adrian Margarida de Castro ,&nbsp;Andrea Teira Calderón ,&nbsp;Fermín Sáinz Laso ,&nbsp;Dae-Hyun Lee Hwang ,&nbsp;Tamara García-Camarero ,&nbsp;Gabriela Veiga ,&nbsp;Aritz Gil Ongay ,&nbsp;Celia Garilleti ,&nbsp;Rigoberto Hernández ,&nbsp;Sergio Barrera ,&nbsp;Víctor Fradejas ,&nbsp;Cristina Obregón ,&nbsp;Jose María De la Torre Hernández","doi":"10.1016/j.medcle.2026.107335","DOIUrl":"10.1016/j.medcle.2026.107335","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Ischemic heart disease remains a leading cause of mortality, with women facing unique social and clinical challenges that impact outcomes. This study aimed to examine sex and gender specific differences in social and clinical predictors of long-term outcomes in coronary artery disease.</div></div><div><h3>Materials and methods</h3><div>This prospective cohort study used the RECORVAL registry, including patients with coronary artery disease undergoing coronary angiography. Clinical data were extracted from electronic health records, and social determinants were collected via a structured questionnaire. Outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, revascularization, stroke, major bleeding and a composite endpoint (cardiovascular death, myocardial infarction or revascularization). Sex-stratified Kaplan–Meier curves, Fine–Gray competing risk models, and multivariate Cox regression models adjusted for social and clinical variables were used.</div></div><div><h3>Results</h3><div>Among 2219 patients (23.4% women) followed for a median of 2421 days, women were older (68.5 vs. 64.3 years) and had greater social disadvantages, including lower education, employment, and internet access. Percutaneous intervention rates were similar, but coronary artery bypass grafting was less frequent in women (3.5% vs. 6.0%). No significant differences were observed in all-cause or cardiovascular mortality (aHR 0.80; 95% CI 0.51–1.24). Women showed a non-significant trend toward lower composite endpoint risk (aHR 0.81; 95% CI 0.64–1.04), lower myocardial infarction and revascularization risk, and higher major bleeding (aHR 1.39; 95% CI 0.92–2.11).</div></div><div><h3>Conclusions</h3><div>Women face significant social disadvantages requiring personalized prevention addressing gender-specific risks. Similar mortality rates suggest improving equity, while differing ischemic–haemorrhagic profiles call for sex-tailored therapy to improve outcomes.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107335"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of symptomatic atrial fibrillation recurrence and all-cause mortality at 12 months in obese and non-obese patients","authors":"Shyla Gupta ,&nbsp;Rohan Kalasipudi ,&nbsp;Praveen Tharusha Gurusinghe ,&nbsp;Ayush Gautam ,&nbsp;Ken Huang ,&nbsp;Edward Dababneh ,&nbsp;Prithviraj Dhonde ,&nbsp;María Gabriela Matta","doi":"10.1016/j.medcle.2026.107290","DOIUrl":"10.1016/j.medcle.2026.107290","url":null,"abstract":"<div><h3>Background and objective</h3><div>Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics and 12-month outcomes between obese and non-obese patients with AF and to identify predictors of recurrence and mortality.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis was conducted on 225 patients hospitalized for AF, classified according to obesity (BMI ≥30<!--> <!-->kg/m²). The primary outcome was AF-related rehospitalization within 12 months, and the secondary outcome was all-cause mortality. Clinical, biochemical, and sociodemographic data were collected.</div></div><div><h3>Results</h3><div>Obesity was present in 43% of patients and was associated with younger age, a higher prevalence of sleep apnea, and hypertriglyceridemia. At 12 months, 24.9% of patients were rehospitalized and 14.0% experienced AF recurrence. Obesity (OR 2.84; 95% CI 1.17–6.90; <em>p</em> <!-->=<!--> <!-->0.021) and excessive alcohol consumption (OR 3.49; 95% CI 1.07–11.41; <em>p</em> <!-->=<!--> <!-->0.039) independently predicted AF recurrence. Advanced age, low socioeconomic status, and hypokalaemia were associated with higher mortality, whereas obesity was linked to a lower risk (OR 0.38; 95% CI 0.16–0.95; <em>p</em> <!-->=<!--> <!-->0.038).</div></div><div><h3>Conclusions</h3><div>In this cohort, obesity was associated with increased AF recurrence but reduced mortality, supporting the “obesity paradox.” Excessive alcohol intake and low socioeconomic status also influenced outcomes, underscoring the need for individualized management strategies.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107290"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth after pubertal block in trans adolescents","authors":"Jesus Domingez-Riscart ,&nbsp;Ana García-Zarzuela ,&nbsp;Blanca Romero-Sayago ,&nbsp;Sandra Ruiz-Ramos ,&nbsp;Almudena Lara-Barea ,&nbsp;Isabel Mateo-Gavira","doi":"10.1016/j.medcle.2026.107343","DOIUrl":"10.1016/j.medcle.2026.107343","url":null,"abstract":"<div><h3>Introduction</h3><div>Transgender people show incongruence between the sex assigned at birth and the gender they identify with. Puberty generates hormonal changes that induce physical changes, with the development of secondary sexual character, which cause great discomfort in the transgender individual. It is also a vital time when there is an increase in the rate of growth. The drug GnRHa stops puberty, slowing down the changes in the body and allowing the adolescent time to consider their gender identity. However, an expected side effect of these drugs is that growth velocity is affected.</div></div><div><h3>Objective</h3><div>To determine the growth velocity of adolescents and transgender children undergoing pubertal blocking therapies.</div></div><div><h3>Material and methods</h3><div>We conducted a longitudinal study using anthropometric and laboratory measurements every 6 months, collected 1 year before and 2 years after blockade, to assess whether growth velocity and height are affected by pubertal blockade. The comparison was made using the standard deviations of the variables according to age, using the Wilcoxon signed-rank test in paired groups and the <em>U</em>-Mann Whitney test in independent groups. To obtain the data, we reviewed the medical records of the participants in our study.</div></div><div><h3>Results</h3><div>Fifty-five transgender adolescents initiating pubertal blocking with a median age of 11,8 years are studied. It is observed that height measured in standard deviations (SD) and growth velocity, measured in centimetres and SD, decrease in accordance with increasing time in pubertal block. When comparing transgender boys and girls, transgender girls show a greater decrease in height SD. These differences are statistically significant for pre-blocking, 6 and 12 months of BP therapy (<em>P</em> = ,036, <em>P</em> = ,005 and <em>P</em> = ,042 respectively). In addition, it was also observed that growth velocity was more affected in trans girls than in boys, although these differences were not statistically significant.</div></div><div><h3>Conclusions</h3><div>Height and growth velocity are decreased when puberty is blocked. This decrease is more striking in transgender girls than in transgender boys.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107343"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 inhibitors in acute heart failure: Intermediate eGFR stratum, potential biases, and applicability in the Emergency Department","authors":"Ivan Agra Montava,&nbsp;Antoni Moline Pareja,&nbsp;Meritxell Motos Bescos","doi":"10.1016/j.medcle.2026.107332","DOIUrl":"10.1016/j.medcle.2026.107332","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107332"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of the stroke risk analysis in routine clinical practice for predicting risk of atrial fibrilation in patients with acute stroke or transient ischemic attack","authors":"Rafael Francisco Galiano Blancart,&nbsp;Lidia Vidal Mogort,&nbsp;Adrià Quesada Simó,&nbsp;Carmen María Sanchis Llopis,&nbsp;Francisco Domínguez Sanz,&nbsp;José Manuel Ferrer Casanova,&nbsp;Lamberto Landete Pascual","doi":"10.1016/j.medcle.2026.107309","DOIUrl":"10.1016/j.medcle.2026.107309","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. <em>Stroke risk analysis</em> (SRA) is an ECG monitoring system that allows the detection of AF and identifies patterns with high or low risk of suffering paroxysmal AF.</div><div>The objective of this study is to analyse the usefulness of SRA routine clinical practice for the search for AF in patients after cerebral ischemia.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study that includes patients with transient ischemic attack (TIA) or recent ischemic stroke in whom the search for AF was initially negative. Vascular risk factors were recorded together with the clinical and neuroimaging characteristics of stroke. The presence of AF in the low- and high-risk groups was reassessed over a one-year follow-up period.</div></div><div><h3>Results</h3><div>We enrolled 708 patients (58% male, median age 73,0, IQR 62,0-82,0) among whom 576 suffered a stroke (81%) and 132 (19%) a TIA. The registry indicated a low risk of AF in 537 (76%), while 171 (24%) displayed an elevated risk. One year later, follow-up was conducted on 693 patients, revealing that 32 individuals had developed AF, accounting for 5.1% of the total cohort; 23/171 (13%) of patients classified as high risk versus 9/537 (1,7%) of those classified as low risk. Patients diagnosed with AF were older, had a higher frequency of Embolic Stroke of Undetermined Source (ESUS), greater left atrial dilation, and a risk of AF development based on SRA findings. This group also suffered more strokes during the year of follow-up.</div></div><div><h3>Conclusions</h3><div>In routine clinical practice, the Holter-SRA emerges as a valuable instrument that, combined with other clinical data and complementary tests, can help prioritize the search for paroxysmal AF following cerebral ischemic events.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107309"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ultrasound in the diagnosis of intraabdominal infections","authors":"Ana Segura Grau ,&nbsp;Paula Martín-Borregón Bendito ,&nbsp;Elena Segura Grau","doi":"10.1016/j.medcle.2026.107334","DOIUrl":"10.1016/j.medcle.2026.107334","url":null,"abstract":"<div><div>Intra-abdominal infection is a potentially serious condition that requires early and accurate diagnosis. Point-of-care ultrasound (POCUS) has emerged as a key diagnostic tool due to its safety, availability, low cost, and bedside applicability. It offers several advantages over other imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), although its diagnostic performance strongly depends on the operator's expertise. Ultrasound is particularly useful in diagnosing common conditions such as appendicitis, cholecystitis, cholangitis, liver abscesses, pyelonephritis, and complicated renal colic. In each of these scenarios, POCUS enables rapid assessment, guides therapeutic decisions, and may reduce complications, radiation exposure, and time to diagnosis. Multiple studies support its diagnostic reliability, reporting high sensitivity and specificity when performed by trained professionals. Despite its technical limitations, POCUS plays a fundamental role in emergency settings and in contexts with limited access to advanced imaging.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107334"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At the frontiers – and perils – of AI-text detectors in the screening of medical manuscripts","authors":"Francisco Epelde","doi":"10.1016/j.medcle.2026.107300","DOIUrl":"10.1016/j.medcle.2026.107300","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107300"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}