Medicina clinica (English ed.)最新文献

{"title":"Massive pulmonary thromboembolism and polyneuropathy in an adolescent laughing gas user","authors":"Carmen Solis-Ceballos , María Lopa-Aragón , Daniel García-Gil","doi":"10.1016/j.medcle.2026.107284","DOIUrl":"10.1016/j.medcle.2026.107284","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107284"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584735","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":"Giant lipoma causing carpal tunnel syndrome","authors":"Marco Colangeli , Paolo Spinnato , Francesca Agugiaro , Marco Fava , Marco Palmas","doi":"10.1016/j.medcle.2026.107331","DOIUrl":"10.1016/j.medcle.2026.107331","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107331"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584736","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 a healthcare network “Aorta Code” on outcomes of elderly patients with type A acute aortic syndrome","authors":"Inés Ramos González-Cristóbal ,&nbsp;Carlos Ferrera ,&nbsp;Manuel Carnero-Alcázar ,&nbsp;Ana Carrero ,&nbsp;Enrique del Toro ,&nbsp;Esther Álvarez ,&nbsp;Carlos Alonso ,&nbsp;Tirso Alonso Ares ,&nbsp;Ana Viana-Tejedor ,&nbsp;Isaac Martínez ,&nbsp;Ana Bustos ,&nbsp;Rosa Beltrao ,&nbsp;Francisco Javier Noriega ,&nbsp;Gabriela Tirado ,&nbsp;Javier Cobiella ,&nbsp;Luis Maroto ,&nbsp;Isidre Vilacosta","doi":"10.1016/j.medcle.2026.107306","DOIUrl":"10.1016/j.medcle.2026.107306","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Type A-acute aortic syndrome (AAS-A) is associated with a high morbidity and mortality. The management of elderly patients with AAS-A is challenging. The aim of this study was to evaluate the current prognosis of elderly patients with AAS-A, and to analyze the impact of surgery on a healthcare network.</div></div><div><h3>Methods</h3><div>Patients with AAS-A were prospectively and consecutively collected from 2019 to 2024 in a four-hospital network “Aorta Code” with a tertiary care referral centre for cardiac surgery. Patients were classified according to age into two groups: ≥75-year-old and under 75-year-old. Clinical, diagnostic, treatment and prognostic variables were analyzed. Primary outcomes included 30-day mortality, time from symptoms to diagnosis and time from diagnosis to surgery.</div></div><div><h3>Results</h3><div>A total of 102 patients were included. Of these, 36 were ≥75-year-old. Most patients (90%) had classical aortic dissection. The length of the aortic injury was shorter in the elder group. Older patients had more comorbidities, most were frail and mildly dependent, and took longer to be diagnosed. Complications at the time of diagnosis and time from diagnosis to surgery were similar in both groups. Preoperative mortality risk was higher in elderly patients and surgery was less extensive on them. Surgery was associated with a mortality reduction in both groups.</div></div><div><h3>Conclusions</h3><div>Elderly patients with AAS-A have more comorbidities, are diagnosed later and have higher mortality than younger patients. Yet, in a dedicated healthcare network, surgery is associated with a reduction in mortality even in the older population.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107306"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584744","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":"Ultrasound guided procedures in infectious diseases","authors":"Thiago Martins Santos ,&nbsp;Marta Rafael Marques ,&nbsp;Ricardo Bañuelos-Huerta","doi":"10.1016/j.medcle.2026.107347","DOIUrl":"10.1016/j.medcle.2026.107347","url":null,"abstract":"<div><div>Retained foci of infection can represent an additional risk for patients, as they may not respond to antibiotics and require specific procedures to control the focus. This manuscript provides a practical approach to performing ultrasound-guided interventional procedures to recognise and drain infectious collections. The review details the main indications, technical steps, safety tips and clinical applications for five critical procedures: thoracentesis and chest drainage, paracentesis, arthrocentesis, pericardiocentesis and drainage of intra-abdominal abscesses (hepatic, splenic and renal). Ultrasound guidance offers several advantages, such as increased safety, precision and success rates by reducing complications such as pneumothorax, haemorrhage and organ damage, as well as improving diagnostic accuracy. By outlining evidence-based techniques, we also aimed to discuss the best techniques to provide safer and more effective care in the context of the infected patient.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107347"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584730","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":"Hydroxocobalamin, thiamine, and pyridoxine as an adjunct to standard treatment in chronic low back pain: A randomized clinical trial","authors":"Maria Teresa Reyes-Alvarez ,&nbsp;Victoria Chávez Miñano ,&nbsp;Boris Garro-Barrera ,&nbsp;Neri Alvarez-Villalobos","doi":"10.1016/j.medcle.2026.107307","DOIUrl":"10.1016/j.medcle.2026.107307","url":null,"abstract":"<div><h3>Background and objective</h3><div>Chronic low back pain is one of the leading causes of disability. Current therapies offer limited efficacy and carry potential adverse risks. Vitamins B1, B6, and B12 have shown promise in the amelioration of musculoskeletal pain. The aim of this study was to evaluate the efficacy and safety of a combined injectable formulation of hydroxocobalamin (B12), thiamine hydrochloride (B1), and pyridoxine hydrochloride (B6) (TPH) as an adjunct treatment for chronic low back pain.</div></div><div><h3>Methods</h3><div>A randomized, double-blind, phase 3 clinical trial was conducted across six centres in Peru. A total of 163 patients with chronic mechanical lower back pain were included and assigned to receive TPH plus NSAIDs (<em>n</em> = 81) or placebo plus NSAIDs (<em>n</em> = 82). The primary outcome was the proportion of patients achieving ≥30% reduction in the NRS-11 score by day 28. Analyses were performed using an intention-to-treat approach and models adjusted for covariates.</div></div><div><h3>Results</h3><div>In the treatment group, 84% of participants achieved ≥30% reduction in the NRS-11 score compared to 64% in the control group (RR = 1.31; 95% CI: 1.08–1.59; <em>p</em> = 0.007). This effect remained significant after adjusting for BMI and albumin. Improvements were also observed in the Patient Global Assessment (PGA) and a favourable trend in the Oswestry Disability Index. The incidence of adverse events was higher in the treatment group, but no significant differences in serious events were found.</div></div><div><h3>Conclusion</h3><div>TPH as an adjunct to standard treatment was effective in reducing chronic low back pain and demonstrated an acceptable safety profile.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107307"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584734","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":"Heterozygous sitosterolemia. A case study","authors":"Antonio Moreno Tirado,&nbsp;Juan Jesús García González,&nbsp;Pilar Rodríguez Ortega","doi":"10.1016/j.medcle.2026.107348","DOIUrl":"10.1016/j.medcle.2026.107348","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107348"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584741","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":"Umbilical nodule associated to cyclic pain","authors":"Omar Alwattar-Ceballos ,&nbsp;Araceli Jiménez-Lara ,&nbsp;Mónica Gómez-Manzanares ,&nbsp;Marina Montero-García","doi":"10.1016/j.medcle.2026.107293","DOIUrl":"10.1016/j.medcle.2026.107293","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107293"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584747","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":"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.medcle.2026.107310","DOIUrl":"10.1016/j.medcle.2026.107310","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":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107310"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584798","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":"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.medcle.2026.107341","DOIUrl":"10.1016/j.medcle.2026.107341","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":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107341"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584799","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":"Toxic hepatitis due to use of levonorgestrel subcutaneous contraceptive: Case report","authors":"Senith Marcela Beleño Rodríguez ,&nbsp;Dadier Antonio Arroyo Monterroza ,&nbsp;Martha Lucia Fontalvo Muñoz","doi":"10.1016/j.medcle.2026.107320","DOIUrl":"10.1016/j.medcle.2026.107320","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 3","pages":"Article 107320"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584740","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}