Pub Date : 2026-02-01Epub Date: 2026-01-13DOI: 10.1016/j.medcli.2025.107291
Paula Mula , Marco Tomasino , Aitor Uribarri
Takotsubo syndrome (TTS) is an acute and transient cardiomyopathy characterised by left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Although its clinical presentation frequently resembles acute myocardial infarction, TTS is driven by distinct pathophysiological mechanisms involving sympathetic hyperactivation, catecholamine surge, coronary microvascular dysfunction, and imbalance within the brain–heart axis. Once considered a benign condition, it is now recognized to carry a significant burden of adverse events—including cardiogenic shock, malignant arrhythmias, and thromboembolic complications—with short- and long-term mortality rates comparable to those of acute coronary syndromes. Diagnosis requires the integration of clinical assessment, cardiac biomarkers, characteristic electrocardiographic changes, and advanced imaging techniques, particularly echocardiography and cardiac magnetic resonance. Management is primarily supportive and should be adapted to the predominant haemodynamic phenotype. This review provides an updated and comprehensive synthesis of the epidemiology, pathophysiology, diagnostic strategies, complications, treatment approaches, and prognosis of TTS, while highlighting current evidence gaps that warrant ongoing and future clinical trials.
{"title":"Síndrome de Takotsubo: de la fisiopatología a la práctica clínica","authors":"Paula Mula , Marco Tomasino , Aitor Uribarri","doi":"10.1016/j.medcli.2025.107291","DOIUrl":"10.1016/j.medcli.2025.107291","url":null,"abstract":"<div><div>Takotsubo syndrome (TTS) is an acute and transient cardiomyopathy characterised by left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Although its clinical presentation frequently resembles acute myocardial infarction, TTS is driven by distinct pathophysiological mechanisms involving sympathetic hyperactivation, catecholamine surge, coronary microvascular dysfunction, and imbalance within the brain–heart axis. Once considered a benign condition, it is now recognized to carry a significant burden of adverse events—including cardiogenic <em>shock</em>, malignant arrhythmias, and thromboembolic complications—with short- and long-term mortality rates comparable to those of acute coronary syndromes. Diagnosis requires the integration of clinical assessment, cardiac biomarkers, characteristic electrocardiographic changes, and advanced imaging techniques, particularly echocardiography and cardiac magnetic resonance. Management is primarily supportive and should be adapted to the predominant haemodynamic phenotype. This review provides an updated and comprehensive synthesis of the epidemiology, pathophysiology, diagnostic strategies, complications, treatment approaches, and prognosis of TTS, while highlighting current evidence gaps that warrant ongoing and future clinical trials.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107291"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980346","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":"Asociación entre la obstrucción al flujo aéreo y la mortalidad en una cohorte de pacientes con insuficiencia cardíaca","authors":"Nerea Alonso Suárez , Aida Muñoz Ferrer , Evelyn Santiago-Vacas , Ignasi Garcia-Olivé","doi":"10.1016/j.medcli.2025.107337","DOIUrl":"10.1016/j.medcli.2025.107337","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107337"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023982","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 : 2026-02-01Epub Date: 2026-01-13DOI: 10.1016/j.medcli.2025.107297
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Reassessing the economic evaluation of long-term albumin therapy in cirrhotic ascites","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.medcli.2025.107297","DOIUrl":"10.1016/j.medcli.2025.107297","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107297"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973281","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 : 2026-02-01Epub Date: 2026-01-13DOI: 10.1016/j.medcli.2025.107289
Miguel Jiménez-Gómez
Chronic cough (CC) has traditionally been attributed to asthma, rhinosinusitis, and gastroesophageal reflux disease. Yet in many patients, symptoms persist despite targeted treatment, revealing a mismatch between clinical need and current strategies.
A new paradigm has emerged: refractory and unexplained CC are increasingly recognized as manifestations of cough hypersensitivity syndrome. Diagnosis should follow a lean pathway emphasizing focused history, exclusion of red flags, essential baseline tests, and addressing treatable traits. Recognition of hypersensitivity features (allotussia, hypertussia, laryngeal paresthesia) is supported by validated tools such as the CHQ and TOPIC. Severity assessment requires integrating objective cough counts with robust patient-reported outcomes (MCSQ, CSD, LCQ, CQLQ), which capture clinical burden and guide referral.
Management should be mechanism-based: early access to multimodal speech therapy, judicious neuromodulators, and emerging peripherally targeted therapies such as P2X3 antagonists.
Establishing CC as a disease entity is essential to align research, regulation, and care with patient suffering.
{"title":"Chronic cough as a disease: A mechanism-based framework for diagnosis and management","authors":"Miguel Jiménez-Gómez","doi":"10.1016/j.medcli.2025.107289","DOIUrl":"10.1016/j.medcli.2025.107289","url":null,"abstract":"<div><div>Chronic cough (CC) has traditionally been attributed to asthma, rhinosinusitis, and gastroesophageal reflux disease. Yet in many patients, symptoms persist despite targeted treatment, revealing a mismatch between clinical need and current strategies.</div><div>A new paradigm has emerged: refractory and unexplained CC are increasingly recognized as manifestations of cough hypersensitivity syndrome. Diagnosis should follow a lean pathway emphasizing focused history, exclusion of red flags, essential baseline tests, and addressing treatable traits. Recognition of hypersensitivity features (allotussia, hypertussia, laryngeal paresthesia) is supported by validated tools such as the CHQ and TOPIC. Severity assessment requires integrating objective cough counts with robust patient-reported outcomes (MCSQ, CSD, LCQ, CQLQ), which capture clinical burden and guide referral.</div><div>Management should be mechanism-based: early access to multimodal speech therapy, judicious neuromodulators, and emerging peripherally targeted therapies such as P2X3 antagonists.</div><div>Establishing CC as a disease entity is essential to align research, regulation, and care with patient suffering.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107289"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980108","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 : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107257
José Berciano
{"title":"Hypertrophy of great auricular nerve in Charcot-Marie-Tooth disease type 1A","authors":"José Berciano","doi":"10.1016/j.medcli.2025.107257","DOIUrl":"10.1016/j.medcli.2025.107257","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107257"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980276","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 : 2026-02-01Epub Date: 2026-01-18DOI: 10.1016/j.medcli.2025.107344
Mario Álvarez-Díez , María Varela , Adolfo Suárez , Sabino Riestra
{"title":"Indicaciones basadas en la evidencia del uso de prebióticos y probióticos en enfermedades gastrointestinales","authors":"Mario Álvarez-Díez , María Varela , Adolfo Suárez , Sabino Riestra","doi":"10.1016/j.medcli.2025.107344","DOIUrl":"10.1016/j.medcli.2025.107344","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107344"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003778","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":"Opportunistic Pneumocystis jirovecii infection in a COPD patient on anti-IL5 biologic treatment with benralizumab. A case report","authors":"Xavier Pomares, Daniella Yamunaque, Concepción Montón","doi":"10.1016/j.medcli.2025.107319","DOIUrl":"10.1016/j.medcli.2025.107319","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107319"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979939","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 : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107274
Juan Francisco García Granado , Yesica Miranda Bacallado , Jesús de la Nuez González , Marta González Vega , Ayoze Nauzet González Hernández
{"title":"Rhino-orbito-cerebral mucormycosis","authors":"Juan Francisco García Granado , Yesica Miranda Bacallado , Jesús de la Nuez González , Marta González Vega , Ayoze Nauzet González Hernández","doi":"10.1016/j.medcli.2025.107274","DOIUrl":"10.1016/j.medcli.2025.107274","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107274"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980277","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 : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107327
Amelia Campos-Saenz de Santamaría , Marc Godos-Gómez , Silvia Crespo-Aznarez , Laura Karla Esterellas-Sánchez , Marta Sánchez-Marteles , Vanesa Garcés-Horna , Ignacio Giménez-López , Jorge Rubio-Gracia
Background
The BAN-ADHF score integrates clinical, biomarker, and diuretic data to predict low diuretic efficiency and adverse events, offering a tool for individualized risk stratification. However, its performance in real-world settings remains understudied. No previous studies analyzed its usefulness across left ventricular ejection fraction (LVEF) phenotypes.
Methods
Observational and retrospective study carried out at the Internal Medicine Ward of a tertiary hospital between 2018 and 2024. Patients were classified into low (<12) and high-risk (≥12) groups. The primary endpoint was all-cause mortality and/or rehospitalization for heart failure (HF) at 180 days.
Results
A total of 472 patients were eligible. The mean age was 79.6 ± 9.4 years with 47.8% female and 64.6% of HF with preserved LVEF. Based on the BAN-ADHF score, 77.1% were categorized as “low-risk”, while 22.9% were classified as “high-risk”. High-risk patients were older (p = 0.019), more frequently male (p < 0.001), and had a higher comorbidity burden. At 180 days, the composite endpoint occurred in 30% of low-risk versus 64% of high-risk patients (p < 0.001). Mortality was 13.5% versus 41% (p < 0.001), and HF rehospitalization 42% versus 76% (p < 0.001). At one year, the combined outcome was 45% versus 76% (p < 0.001). High-risk status remained an independent predictor of adverse events (HR 2.8, 95% CI 2.1–3.8, p < 0.001). The BAN-ADHF score demonstrated acceptable predictive capacity (C-index 0.65).
Conclusions
The BAN-ADHF score reliably identifies high-risk patients with a significantly greater incidence of adverse events, independently including readmission, mortality, and their composite at 180 days in a real-world cohort regardless LVEF. Its integration into routine care may help guide early therapeutic strategies and resource allocation.
{"title":"Outcome prediction in acute decompensated heart failure using the BAN-ADHF score across LVEF: Analysis in an internal medicine cohort","authors":"Amelia Campos-Saenz de Santamaría , Marc Godos-Gómez , Silvia Crespo-Aznarez , Laura Karla Esterellas-Sánchez , Marta Sánchez-Marteles , Vanesa Garcés-Horna , Ignacio Giménez-López , Jorge Rubio-Gracia","doi":"10.1016/j.medcli.2025.107327","DOIUrl":"10.1016/j.medcli.2025.107327","url":null,"abstract":"<div><h3>Background</h3><div>The BAN-ADHF score integrates clinical, biomarker, and diuretic data to predict low diuretic efficiency and adverse events, offering a tool for individualized risk stratification. However, its performance in real-world settings remains understudied. No previous studies analyzed its usefulness across left ventricular ejection fraction (LVEF) phenotypes.</div></div><div><h3>Methods</h3><div>Observational and retrospective study carried out at the Internal Medicine Ward of a tertiary hospital between 2018 and 2024. Patients were classified into low (<12) and high-risk (≥12) groups. The primary endpoint was all-cause mortality and/or rehospitalization for heart failure (HF) at 180 days.</div></div><div><h3>Results</h3><div>A total of 472 patients were eligible. The mean age was 79.6<!--> <!-->±<!--> <!-->9.4 years with 47.8% female and 64.6% of HF with preserved LVEF. Based on the BAN-ADHF score, 77.1% were categorized as “low-risk”, while 22.9% were classified as “high-risk”. High-risk patients were older (<em>p</em> <!-->=<!--> <!-->0.019), more frequently male (<em>p</em> <!--><<!--> <!-->0.001), and had a higher comorbidity burden. At 180 days, the composite endpoint occurred in 30% of low-risk versus 64% of high-risk patients (<em>p</em> <!--><<!--> <!-->0.001). Mortality was 13.5% versus 41% (<em>p</em> <!--><<!--> <!-->0.001), and HF rehospitalization 42% versus 76% (<em>p</em> <!--><<!--> <!-->0.001). At one year, the combined outcome was 45% versus 76% (<em>p</em> <!--><<!--> <!-->0.001). High-risk status remained an independent predictor of adverse events (HR 2.8, 95% CI 2.1–3.8, <em>p</em> <!--><<!--> <!-->0.001). The BAN-ADHF score demonstrated acceptable predictive capacity (C-index 0.65).</div></div><div><h3>Conclusions</h3><div>The BAN-ADHF score reliably identifies high-risk patients with a significantly greater incidence of adverse events, independently including readmission, mortality, and their composite at 180 days in a real-world cohort regardless LVEF. Its integration into routine care may help guide early therapeutic strategies and resource allocation.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107327"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980280","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}
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