Pub Date : 2026-01-29DOI: 10.1016/j.medcli.2025.107347
Thiago Martins Santos , Marta Rafael Marques , Ricardo Bañuelos-Huerta
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.
{"title":"Ultrasound guided procedures in infectious diseases","authors":"Thiago Martins Santos , Marta Rafael Marques , Ricardo Bañuelos-Huerta","doi":"10.1016/j.medcli.2025.107347","DOIUrl":"10.1016/j.medcli.2025.107347","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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107347"},"PeriodicalIF":2.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080351","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107310
Fernando de la Calle-Prieto , Patricia Martínez-Martín , César Henríquez-Camacho
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.
{"title":"Point-of-care ultrasound in tropical infections: Expanding frontline diagnostics","authors":"Fernando de la Calle-Prieto , Patricia Martínez-Martín , 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":"2026-01-27","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107236
Bibiana Quirant-Sánchez , Alba Herraiz Ruiz , Oriol Plans Galván , Regina Roig Pineda , Beatriz Catalán Eraso , David Mota Montané , Ester Lucas Varas , Maria Martínez Gonzalez , Eva Maria Martínez Cáceres , Fernando Arméstar Rodríguez
Background
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).
Methods
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.
Results
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 R2 of 0.0965 and p < 0.05. The robust linear regression between APACHE II and MFI HLA-DR obtained a coefficient of −40.5, with an R2 of 0.0679 and p < 0.05. In the analysis of the CRP value and % HLA-DR, a coefficient of −0.06092 was obtained, with an R2: 0.285 and p < 0.05.
Conclusion
The degree of immunosuppression is related to systemic inflammation and the severity of the patient.
{"title":"Role of severity and inflammation on the decrease of monocyte HLA-DR (MHLA-DR) in critically ill patients","authors":"Bibiana Quirant-Sánchez , Alba Herraiz Ruiz , Oriol Plans Galván , Regina Roig Pineda , Beatriz Catalán Eraso , David Mota Montané , Ester Lucas Varas , Maria Martínez Gonzalez , Eva Maria Martínez Cáceres , 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 (<sub>M</sub>HLA-DR). The aim of this study was to establish the factors associated with the low expression of <sub>M</sub>HLA-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><sup>2</sup> of 0.0965 and <em>p</em> <!--><<!--> <!-->0.05. The robust linear regression between APACHE II and MFI HLA-DR obtained a coefficient of −40.5, with an <em>R</em><sup>2</sup> of 0.0679 and <em>p</em> <!--><<!--> <!-->0.05. In the analysis of the CRP value and % HLA-DR, a coefficient of −0.06092 was obtained, with an <em>R</em><sup>2</sup>: 0.285 and <em>p</em> <!--><<!--> <!-->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":"2026-01-27","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107300
Francisco Epelde
{"title":"At the frontiers – and perils – of AI-text detectors in the screening of medical manuscripts","authors":"Francisco Epelde","doi":"10.1016/j.medcli.2025.107300","DOIUrl":"10.1016/j.medcli.2025.107300","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107300"},"PeriodicalIF":2.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080353","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107305
Jordi Reina
{"title":"¿Debería incluirse la neuraminidasa en las futuras vacunas de la gripe?","authors":"Jordi Reina","doi":"10.1016/j.medcli.2025.107305","DOIUrl":"10.1016/j.medcli.2025.107305","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107305"},"PeriodicalIF":2.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080346","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107307
Maria Teresa Reyes-Alvarez , Victoria Chávez Miñano , Boris Garro-Barrera , Neri Alvarez-Villalobos
Background and Objective
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.
Methods
a randomized, double-blind, phase 3 clinical trial was conducted across six centers in Peru. A total of 163 patients with chronic mechanical lower back pain were included and assigned to receive TPH plus NSAIDs (n = 81) or placebo plus NSAIDs (n = 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.
Results
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; p = 0,007). This effect remained significant after adjusting for BMI and albumin. Improvements were also observed in the Patient Global Assessment (PGA) and a favorable 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.
Conclusion
TPH as an adjunct to standard treatment was effective in reducing chronic low back pain and demonstrated an acceptable safety profile.
{"title":"Hidroxocobalamina, tiamina y piridoxina como complemento al tratamiento estándar en lumbalgia crónica: ensayo clínico aleatorizado","authors":"Maria Teresa Reyes-Alvarez , Victoria Chávez Miñano , Boris Garro-Barrera , Neri Alvarez-Villalobos","doi":"10.1016/j.medcli.2025.107307","DOIUrl":"10.1016/j.medcli.2025.107307","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 centers in Peru. A total of 163 patients with chronic mechanical lower back pain were included and assigned to receive TPH plus NSAIDs (n<!--> <!-->=<!--> <!-->81) or placebo plus NSAIDs (n<!--> <!-->=<!--> <!-->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; p<!--> <!-->=<!--> <!-->0,007). This effect remained significant after adjusting for BMI and albumin. Improvements were also observed in the Patient Global Assessment (PGA) and a favorable 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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107307"},"PeriodicalIF":2.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080455","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}
Pub Date : 2026-01-27DOI: 10.1016/j.medcli.2025.107309
Rafael Francisco Galiano Blancart, Lidia Vidal Mogort, Adrià Quesada Simó, Carmen María Sanchis Llopis, Francisco Domínguez Sanz, José Manuel Ferrer Casanova, Lamberto Landete Pascual
Introduction
Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. Stroke risk analysis (SRA) is an ECG monitoring system that allows the detection of AF and identifies patterns with high or low risk of suffering paroxysmal AF.
The objective of this study is to analyze the usefulness of SRA routine clinical practice for the search for AF in patients after cerebral ischemia.
Methods
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.
Results
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 auricular dilation, and a risk of AF development based on SRA findings. This group also suffered more strokes during the year of follow-up.
Conclusions
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.
{"title":"Utilidad del stroke risk analysis en práctica clínica habitual para predecir el riesgo de fibrilación auricular en pacientes con ictus isquémico o accidente isquémico transitorio","authors":"Rafael Francisco Galiano Blancart, Lidia Vidal Mogort, Adrià Quesada Simó, Carmen María Sanchis Llopis, Francisco Domínguez Sanz, José Manuel Ferrer Casanova, Lamberto Landete Pascual","doi":"10.1016/j.medcli.2025.107309","DOIUrl":"10.1016/j.medcli.2025.107309","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 analyze 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 auricular 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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107309"},"PeriodicalIF":2.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080453","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号