Medicina clinica (English ed.)最新文献

{"title":"Rational use of immunoglobulins","authors":"José Antonio García Erce , Ingrid Magnolia Parra Salinas","doi":"10.1016/j.medcle.2026.107260","DOIUrl":"10.1016/j.medcle.2026.107260","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107260"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394960","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":"Coxitis in relapsing polychondritis: An uncommon case","authors":"Angelo Nigro","doi":"10.1016/j.medcle.2026.107238","DOIUrl":"10.1016/j.medcle.2026.107238","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107238"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147395254","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":"Ash-grey skin lesions in atypical dermatosis – Ashy dermatosis","authors":"Luis Luque Caraballo , Ana Massé Palomo , José Salvador García Morillo","doi":"10.1016/j.medcle.2026.107239","DOIUrl":"10.1016/j.medcle.2026.107239","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107239"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147395255","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":"Paracentesis-related bleeding complications and associated risk factors in patients with liver cirrhosis","authors":"Eduard Brunet Mas ,&nbsp;Jordi Vives Moreno ,&nbsp;Cristina Solé Martí ,&nbsp;Gemma Sole Enrich ,&nbsp;Mertixell Casas Rodrigo ,&nbsp;Mireia Miquel Planas ,&nbsp;Jordi Sánchez-Delgado ,&nbsp;José Ferrusquía-Acosta ,&nbsp;Oliver Valero Coppin ,&nbsp;Xavier Calvet Calvo ,&nbsp;Mercedes Vergara Gómez","doi":"10.1016/j.medcle.2026.107229","DOIUrl":"10.1016/j.medcle.2026.107229","url":null,"abstract":"<div><h3>Background</h3><div>Ascites is the most frequent complication in liver cirrhosis and often requires paracentesis. The aim of this study was to evaluate the rate of paracentesis-related bleeding complications and the associated risk factors.</div></div><div><h3>Patients and methods</h3><div>An observational, unicentric, retrospective study to analyze paracentesis-related bleeding complications in the 7 days after the procedure. All paracentesis procedures performed at our centre from January 1998 to December 2018 were analyzed. A propensity score matching was performed. Data were obtained from patients’ clinical records.</div></div><div><h3>Results</h3><div>1137 patients with a total of 11,043 paracentesis procedures were analyzed. Patients were on antiplatelet treatment for 316 procedures (2.9%) and on anticoagulant treatment for 585 (5.3%). Thirty-six paracentesis procedures (0.3%) had a major bleeding complication, with a mortality rate of 0.01%. The group with paracentesis-related bleeding had an international normalized ratio (INR) and prothrombin time and more impaired liver function than those without bleeding. No differences were observed in bleeding events according to anticoagulant and antiplatelet treatment. Anticoagulant and antiplatelet treatments seem not to increase the risk of bleeding complications after paracentesis.</div></div><div><h3>Conclusion</h3><div>Paracentesis is a safe procedure, even in patients on antiplatelet and anticoagulant treatment. The risk factors associated with bleeding complications were number of previous paracentesis, increased INR and liver impairment.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107229"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409304","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":"Prognostic factors and predictive models for outcomes in organophosphate poisoning: A retrospective analysis","authors":"Liang Sun ,&nbsp;Buhe Bao ,&nbsp;Yu-hua Zhang ,&nbsp;Zhenhua Du","doi":"10.1016/j.medcle.2026.107329","DOIUrl":"10.1016/j.medcle.2026.107329","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to identify prognostic factors and develop a predictive model for patients with organophosphate poisoning.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 108 cases was conducted, collecting demographic, clinical, and laboratory data including age, sex, time to treatment, plasma organophosphate (OP) levels, arterial lactate (LAC), aspartate aminotransferase (AST), creatinine (Cr), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Patients were categorized into survivor and non-survivor groups. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent prognostic factors and assess their predictive value.</div></div><div><h3>Results</h3><div>The overall mortality rate was 23.15%. Non-survivors had higher age, LAC, AST, Cr, and APACHE II scores, and lower AChE levels compared to survivors. Multivariate logistic regression identified age (OR: 1.12, 95% CI: 1.05–1.22) and AST (OR: 1.03, 95% CI: 1.01–1.05) as independent prognostic factors. ROC analysis validated a model combining age, AChE, and AST, showing an excellent discriminative ability with an AUC of 0.95 (95% CI: 0.91–0.99), sensitivity of 1.00, and specificity of 0.90.</div></div><div><h3>Conclusions</h3><div>Age and AST are significant prognostic factors for organophosphate poisoning. Combining these factors enhances predictive accuracy, aiding clinical decision-making and emphasizing early aggressive management to improve survival rates.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107329"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409344","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":"Recurrent respiratory papillomatosis treated with combined erlotinib and celecoxib: A retrospective study","authors":"Thais Lizondo López ,&nbsp;Belén López García ,&nbsp;Neus Basté ,&nbsp;Isabel Vilaseca ,&nbsp;Juan José Grau ,&nbsp;Esther Carcelero San Martín","doi":"10.1016/j.medcle.2026.107251","DOIUrl":"10.1016/j.medcle.2026.107251","url":null,"abstract":"<div><h3>Introduction</h3><div>Recurrent respiratory papillomatosis is a rare benign airway disease caused by human papillomavirus, typically types 6 and 11. Management is often difficult due to high recurrence rates and lack of effective pharmacologic options. Recent studies suggest that EGFR and COX-2 pathways play a role in the pathogenesis of human papillomavirus-related lesions.</div></div><div><h3>Patients and methods</h3><div>We present an observational retrospective study of three patients with PCR confirmed human papillomavirus DNA associated to recurrent respiratory papillomatosis treated with erlotinib and celecoxib at a tertiary hospital between 2017 and 2024. Inclusion criteria were histological diagnosis, prior failure to conventional therapies, and complete clinical follow-up.</div></div><div><h3>Results</h3><div>Two patients exhibited sustained improvement in symptoms and lesion burden, with no significant adverse events. In one case, treatment was well tolerated over six years. A third patient discontinued therapy due to disease progression, treated with immunotherapy afterwards.</div></div><div><h3>Conclusion</h3><div>Combined EGFR and COX-2 inhibition may be a promising treatment strategy for recurrent respiratory papillomatosis refractory to standard therapy. These preliminary observations support further prospective investigation in selected patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107251"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409495","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":"Initiation and titration of guideline-directed medical therapy during hospitalization for acute decompensation of heart failure with reduced ejection fraction","authors":"Sandra Valdivielso Moré ,&nbsp;Núria Farré ,&nbsp;Neus Badosa ,&nbsp;Núria Rodríguez de Francisco ,&nbsp;Laia Carla Belarte-Tornero ,&nbsp;Ronald O. Morales Murillo ,&nbsp;Joan Vime-Jubany ,&nbsp;Miren Vicente Elcano ,&nbsp;Juan Jose Ochoa Segarra ,&nbsp;Pilar Ruiz-Rodriguez ,&nbsp;Ana María Linás-Alonso ,&nbsp;Felicidad Martinez-Medina ,&nbsp;Beatriz Vaquerizo Montilla ,&nbsp;Sonia Ruiz-Bustillo","doi":"10.1016/j.medcle.2026.107247","DOIUrl":"10.1016/j.medcle.2026.107247","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).</div></div><div><h3>Methods</h3><div>We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.</div></div><div><h3>Results</h3><div>One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.</div></div><div><h3>Conclusions</h3><div>Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107247"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409720","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":"Treatment of aspergillosis in a hematologic patient with intraventricular amphotericin B","authors":"Cristina Cremades Artacho,&nbsp;Inés Monge-Escartín,&nbsp;Esther Carcelero San Martín","doi":"10.1016/j.medcle.2026.107264","DOIUrl":"10.1016/j.medcle.2026.107264","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107264"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394965","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":"Impact of an integrated transitional care programme for older patients with multimorbidity and repeated emergency department visits","authors":"Antonio San-José ,&nbsp;María José Abadías ,&nbsp;Emmanuel Giménez ,&nbsp;Marta Losada ,&nbsp;Carmen Pérez-Bocanegra ,&nbsp;María Gabriela Carrizo ,&nbsp;María Arranz ,&nbsp;Jordi Acezat ,&nbsp;Jordi Ibáñez ,&nbsp;Miriam Barrecheguren ,&nbsp;Ana Belén Méndez ,&nbsp;Neus Gual","doi":"10.1016/j.medcle.2026.107232","DOIUrl":"10.1016/j.medcle.2026.107232","url":null,"abstract":"<div><h3>Background</h3><div>With an ageing population, the prevalence of multimorbidity is increasing. This leads to increasing frailty and repeated Emergency Department (ED) visits. This study aim was to evaluate the impact of an integrated transitional care programme on ED revisits and Health-Related-Quality-of-Life (HRQoL) in older patients with multimorbidity.</div></div><div><h3>Methods</h3><div>Prospective intervention pre-post study comparing the programme impact 6 months before and 6 after launching (from November-2022 to June-2023). The programme involved automated daily lists, a patient distribution protocol and a specialized case – manager nurse. Patients included had two or more ED visits in the 6 months prior due to Heart Failure (HF) decompensation or Chronic Obstructive Pulmonary Disease (COPD) exacerbation with multimorbidity. The programme involved the tertiary, intermediate and primary care centres of an integrated care health area of a Spanish city.</div></div><div><h3>Results</h3><div>In 126 older patients with multimorbidity and repeated ED visits (91 HF, 29 COPD, 6 both), an integrated transitional care programme resulted in a significant 33% reduction in ED visits after six months. The reduction was higher among women (39.6% reduction vs 27.6% in men) and patients experiencing HF (38.7% vs 17.2% in COPD). Most participants (68.2%) reported an improvement or maintenance of quality of life.</div></div><div><h3>Conclusion</h3><div>A combined intervention between automated lists, territorial consensus, and a specialized case-manager nurse is efficacious to achieve ED re-visits decreases with a majority of patients having maintained or improved HRQoL.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107232"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409612","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":"Clinical presentation and prognosis of transthyretin cardiac amyloidosis according to gender. Analysis of the Galician registry of cardiac amyloidosis (AMIGAL)","authors":"Daniel Enríquez-Vázquez ,&nbsp;Gonzalo Barge-Caballero ,&nbsp;Mario Porto-Souto ,&nbsp;Manuel López-Pérez ,&nbsp;Andrea López-López ,&nbsp;Eva González-Babarro ,&nbsp;Mario Gutiérrez-Feijoo ,&nbsp;Raquel Bilbao-Quesada ,&nbsp;Inés Gómez-Otero ,&nbsp;Alfonso Varela-Román ,&nbsp;María G. Crespo-Leiro ,&nbsp;Eduardo Barge-Caballero","doi":"10.1016/j.medcle.2026.107242","DOIUrl":"10.1016/j.medcle.2026.107242","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Sex differences in clinical presentation of ATTR-CA have been described, although published information is scarce. We aimed to compare baseline characteristics and outcomes between women and men with ATTR-CA.</div></div><div><h3>Methods</h3><div>We evaluated all patients with ATTR-CA included in the Galician registry of cardiac amyloidosis (AMIGAL) between January 1st, 2018 and September 30th, 2023.</div></div><div><h3>Results</h3><div>We included 385 patients with ATTR-CA - 95 women (24.7%) and 290 men (75.3%), with a median age of 82.5 years. Female sex presented more frequently NYHA class ≥ III (36.8% vs. 25.2%, <em>P</em> = .028) and had higher LVEF (56.0% vs. 52.6%, <em>P</em> = .003) and indexed left ventricular maximum thickness (10.2 mm/m² vs. 9.2 mm/m², <em>P</em> = .001). Women received more thiazide diuretics (18.9% vs. 10.3%, <em>P</em> = .028) and less SGLT2i (15.8% vs. 27.2%, <em>P</em> = .024) and tafamidis (15.8% vs. 26.6%, <em>P</em> = .033). Incidence of HF hospitalizations was lower in female sex (IR 167.39 vs. 245.61, <em>P</em> = .033). There was no differences in mean survival, which was 4.1 years in both sexes.</div></div><div><h3>Conclusions</h3><div>Women with AC-ATTR presented with worse functional class, higher LVEF and higher left ventricular thicknesses than men. Female patients received less frequently SGLT2i and tafamidis, and were admitted to hospital for HF less frequently compared to male patients, while survival was similar.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107242"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409613","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}