Medicina Clinica最新文献

{"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":"2026-03-01","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}

{"title":"Hepatitis enfisematosa fulminante","authors":"Inés Alonso Envid , Ángel Lafuente los Arcos , José Enrique Alonso Formento , Carlos Pardillos Marín , María del Carmen Orts Cansino , Elisa Simó Gaztambide","doi":"10.1016/j.medcli.2025.107295","DOIUrl":"10.1016/j.medcli.2025.107295","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107295"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080451","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":"Hidroxocobalamina, tiamina y piridoxina como complemento al tratamiento estándar en lumbalgia crónica: ensayo clínico aleatorizado","authors":"Maria Teresa Reyes-Alvarez ,&nbsp;Victoria Chávez Miñano ,&nbsp;Boris Garro-Barrera ,&nbsp;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":"2026-03-01","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}

{"title":"Hypokalemic periodic paralysis type 1 with respiratory involvement: A case report and critical review of the diagnostic and therapeutic approach","authors":"Rocío Fernández Gavira,&nbsp;Roberto Pertusa Mataix,&nbsp;José Salvador García Morillo","doi":"10.1016/j.medcli.2025.107339","DOIUrl":"10.1016/j.medcli.2025.107339","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107339"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036914","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":"Nódulo azulado solitario umbilical asociado a dolor cíclico","authors":"Omar Alwattar-Ceballos ,&nbsp;Araceli Jiménez-Lara ,&nbsp;Mónica Gómez-Manzanares ,&nbsp;Marina Montero-García","doi":"10.1016/j.medcli.2025.107293","DOIUrl":"10.1016/j.medcli.2025.107293","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107293"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080348","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":"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,&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.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":"2026-03-01","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}

{"title":"Inhibidores de SGLT2 en insuficiencia cardiaca aguda: estrato 8 intermedio de filtrado glomerular, sesgos potenciales y aplicabilidad en urgencias","authors":"Ivan Agra Montava,&nbsp;Antoni Moline Pareja,&nbsp;Meritxell Motos Bescos","doi":"10.1016/j.medcli.2025.107332","DOIUrl":"10.1016/j.medcli.2025.107332","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107332"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080352","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":"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.medcli.2025.107306","DOIUrl":"10.1016/j.medcli.2025.107306","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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107306"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080454","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":"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.medcli.2025.107290","DOIUrl":"10.1016/j.medcli.2025.107290","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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107290"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030003","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":"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.medcli.2025.107335","DOIUrl":"10.1016/j.medcli.2025.107335","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":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107335"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030035","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}