A narrative review assessed the utility of point-of-care ultrasound (POCUS) in evaluating suspected infective endocarditis (IE). MEDLINE, EMBASE, and Google Scholar were searched for studies published from January 1, 2010 to January 31, 2025. Data extraction was performed independently by three authors. Thirty-five studies involving 293 participants were included, the majority being case reports. For detecting valvular vegetations, POCUS demonstrated a sensitivity of 77% and a specificity of 94%. POCUS may serve as a useful adjunct to bedside physical examination, facilitating the detection of echocardiographic findings suggestive of IE and other endovascular infections. Nonetheless, the predominance of case reports, which represent the lowest level of clinical evidence, substantially limits the external validity and generalizability of these results. Further high-quality studies are warranted to confirm the diagnostic performance and clinical impact of POCUS in this setting. Overall, POCUS shows promise but evidence remains limited by study design.
{"title":"Point-of-care ultrasound in endocarditis and other endovascular infections: A narrative review","authors":"Serafín López Palmero , Patricia Martín Rico , Juan Torres Macho","doi":"10.1016/j.medcle.2025.107193","DOIUrl":"10.1016/j.medcle.2025.107193","url":null,"abstract":"<div><div>A narrative review assessed the utility of point-of-care ultrasound (POCUS) in evaluating suspected infective endocarditis (IE). MEDLINE, EMBASE, and Google Scholar were searched for studies published from January 1, 2010 to January 31, 2025. Data extraction was performed independently by three authors. Thirty-five studies involving 293 participants were included, the majority being case reports. For detecting valvular vegetations, POCUS demonstrated a sensitivity of 77% and a specificity of 94%. POCUS may serve as a useful adjunct to bedside physical examination, facilitating the detection of echocardiographic findings suggestive of IE and other endovascular infections. Nonetheless, the predominance of case reports, which represent the lowest level of clinical evidence, substantially limits the external validity and generalizability of these results. Further high-quality studies are warranted to confirm the diagnostic performance and clinical impact of POCUS in this setting. Overall, POCUS shows promise but evidence remains limited by study design.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697985","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}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107137
Antonio Chamorro Comesaña , Noa Piñeiro Fernández , Patricia Rodríguez Fernández , Natalia Fente García , Francisco Xosé Román Losada , M. del Carmen Quintela González , Agustín Nieto Vázquez , Ana Santamaría López , Judith Vázquez Álvarez , María del Carmen Albo López , Angela Prieto
Hematopoietic stem cell transplantation (HSCT) is a therapy used for the treatment of numerous pathologies, mainly oncohematological ones it is associated with the appearance of toxicities that can delay the patient's recovery.
Objective
To observe the effect of a therapeutic exercise (TE) program produces on the symptoms reported by patients undergoing HSCT 3 months after the transplant.
Patients and methods
Observational study in patients who underwent HSCT at the Álvaro Cunqueiro Hospital in Vigo between September 2020 and August 2021, with pre-admission assessment and 3 months post-transplant, using Edmonton Symptom Assessment System (ESAS) test. During their hospitalization, the patients followed the ET program based on the HSCT exercise guidelines from the Spanish Group for Transplantation and Cellular Therapy (GETH-TC).
Results
A total of 34 patients participated, and improvements were observed in fatigue, drowsiness, shortness of breath, mood, nervousness and feeling of well-being.
Conclusions
A therapeutic exercise program is safe, and may help reduce common symptoms in transplant patients. Exercise must be adapted to the specific situation of the patient throughout the transplant process.
{"title":"Influence of therapeutic exercise on the symptomatology associated with hematopoietic stem cell transplantation","authors":"Antonio Chamorro Comesaña , Noa Piñeiro Fernández , Patricia Rodríguez Fernández , Natalia Fente García , Francisco Xosé Román Losada , M. del Carmen Quintela González , Agustín Nieto Vázquez , Ana Santamaría López , Judith Vázquez Álvarez , María del Carmen Albo López , Angela Prieto","doi":"10.1016/j.medcle.2025.107137","DOIUrl":"10.1016/j.medcle.2025.107137","url":null,"abstract":"<div><div>Hematopoietic stem cell transplantation (HSCT) is a therapy used for the treatment of numerous pathologies, mainly oncohematological ones it is associated with the appearance of toxicities that can delay the patient's recovery.</div></div><div><h3>Objective</h3><div>To observe the effect of a therapeutic exercise (TE) program produces on the symptoms reported by patients undergoing HSCT 3 months after the transplant.</div></div><div><h3>Patients and methods</h3><div>Observational study in patients who underwent HSCT at the Álvaro Cunqueiro Hospital in Vigo between September 2020 and August 2021, with pre-admission assessment and 3 months post-transplant, using Edmonton Symptom Assessment System (ESAS) test. During their hospitalization, the patients followed the ET program based on the HSCT exercise guidelines from the Spanish Group for Transplantation and Cellular Therapy (GETH-TC).</div></div><div><h3>Results</h3><div>A total of 34 patients participated, and improvements were observed in fatigue, drowsiness, shortness of breath, mood, nervousness and feeling of well-being.</div></div><div><h3>Conclusions</h3><div>A therapeutic exercise program is safe, and may help reduce common symptoms in transplant patients. Exercise must be adapted to the specific situation of the patient throughout the transplant process.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107137"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697997","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}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107169
Eva Cabrera César , Javier López Garcia , Miguel Benitez Cano Gamonoso , Cecilia López Ramirez , Beatriz Jiménez Rodriguez , Ana Dolores Romero Ortiz , Zulema Palacios Hidalgo , David Fole Vázquez , Patricia Guerrero Zamora , Natalia Mena Vázquez , Antonio Hidalgo Molina , Inés De La Cruz Morón , Francisco Espildora Hernández , Antonio Cruz Medina , Celia Lacarcel Bautista , Adriana Vegas Viñas , José Luis Velasco Garrido
Background
Patients with non-idiopathic interstitial lung diseases can develop progressive pulmonary fibrosis (PPF-ILD). The study objectives were to define the profile of patients with PPF-ILD treated with nintedanib and to assess the effectiveness and safety of this drug in a real-world setting.
Methods
This was a multicenter, prospective, observational study of adult patients with PPF-ILD that initiated treatment with nintedanib in ten Andalusian hospitals (Spain). Demographic data, smoking habit, underlying disease, and diagnosis criteria were recorded. Pulmonary function test results, the dyspnea scale score, and the number of hospitalizations related to PPF-ILD were evaluated at baseline and after 6 and 12 months. Adverse events were recorded.
Results
Between July 2021 and March 2023, a total of 145 patients entered the study and were followed up until March 2024; 55% were men and the mean age was 66.6 ± 11.5 years. PPF-ILD was diagnosed based on clinical, radiological and pulmonary function test findings in 97 patients (66.9%). The mean ± SD duration of nintedanib therapy was 13.3 ± 10.1 months. Dyspnea improved, although the difference was not statistically significant. FVC % and DLCO % stabilized. The number of hospitalizations related to PPF-ILD was reduced (p < 0.0001) after 12 months of therapy. Diarrhea was the most common adverse event.
Conclusions
In this real-world study, the profile of PPF-ILD patients treated with nintedanib was consistent with the approved therapeutic indications. Nintedanib reduced the decline in pulmonary function and the number of hospitalizations, and it was well tolerated. At 12 months, 75.1% of patients remained on treatment; treatment discontinuation occurred in 24.9% due to adverse events, death, or lung transplantation.
{"title":"Real-world use of nintedanib for the treatment of interstitial lung disease with progressive pulmonary fibrosis","authors":"Eva Cabrera César , Javier López Garcia , Miguel Benitez Cano Gamonoso , Cecilia López Ramirez , Beatriz Jiménez Rodriguez , Ana Dolores Romero Ortiz , Zulema Palacios Hidalgo , David Fole Vázquez , Patricia Guerrero Zamora , Natalia Mena Vázquez , Antonio Hidalgo Molina , Inés De La Cruz Morón , Francisco Espildora Hernández , Antonio Cruz Medina , Celia Lacarcel Bautista , Adriana Vegas Viñas , José Luis Velasco Garrido","doi":"10.1016/j.medcle.2025.107169","DOIUrl":"10.1016/j.medcle.2025.107169","url":null,"abstract":"<div><h3>Background</h3><div>Patients with non-idiopathic interstitial lung diseases can develop progressive pulmonary fibrosis (PPF-ILD). The study objectives were to define the profile of patients with PPF-ILD treated with nintedanib and to assess the effectiveness and safety of this drug in a real-world setting.</div></div><div><h3>Methods</h3><div>This was a multicenter, prospective, observational study of adult patients with PPF-ILD that initiated treatment with nintedanib in ten Andalusian hospitals (Spain). Demographic data, smoking habit, underlying disease, and diagnosis criteria were recorded. Pulmonary function test results, the dyspnea scale score, and the number of hospitalizations related to PPF-ILD were evaluated at baseline and after 6 and 12 months. Adverse events were recorded.</div></div><div><h3>Results</h3><div>Between July 2021 and March 2023, a total of 145 patients entered the study and were followed up until March 2024; 55% were men and the mean age was 66.6<!--> <!-->±<!--> <!-->11.5 years. PPF-ILD was diagnosed based on clinical, radiological and pulmonary function test findings in 97 patients (66.9%). The mean<!--> <!-->±<!--> <!-->SD duration of nintedanib therapy was 13.3<!--> <!-->±<!--> <!-->10.1 months. Dyspnea improved, although the difference was not statistically significant. FVC % and <em>D</em><sub>LCO</sub> % stabilized. The number of hospitalizations related to PPF-ILD was reduced (<em>p</em> <!--><<!--> <!-->0.0001) after 12 months of therapy. Diarrhea was the most common adverse event.</div></div><div><h3>Conclusions</h3><div>In this real-world study, the profile of PPF-ILD patients treated with nintedanib was consistent with the approved therapeutic indications. Nintedanib reduced the decline in pulmonary function and the number of hospitalizations, and it was well tolerated. At 12 months, 75.1% of patients remained on treatment; treatment discontinuation occurred in 24.9% due to adverse events, death, or lung transplantation.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107169"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697998","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}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107206
Na You , Xuan Cao , Hualing Nie , Tong Su , Hua Song , Ziyi Jin , Xiaoyan Xin , Dandan Wang , Lingyun Sun
Introduction and objectives
This study aimed to clarify whether quantitative high-resolution computed tomography (HRCT) analysis can assess the condition of interstitial lung disease (ILD) associated with anti-melanoma differentiation-associated gene 5 positive (anti MDA5+) dermatomyositis (DM) and investigate the efficacy of tofacitinib in the treatment of anti-MDA5+ DM.
Materials and methods
Seventy patients were included in this retrospective study: 39 in the tofacitinib group and 31 in the group without tofacitinib. Patients’ HRCT were uploaded to a deep learning system to assess ILD regression. Based on patients’ quantitative HRCT results, survival and glucocorticoids (GCs) usage, the efficacy of tofacitinib in the treatment of anti-MDA5+ DM were assessed. The safety was assessed by recording the incidence of adverse reactions. Data were analyzed using SPSS26.0 and R4.4.1.
Results
No significant differences for baseline characteristics were observed between the two groups of patients, except for cutaneous involvement. Tofacitinib group showed higher 3-year survival and it was an independent protective factor against mortality. Elevated serum ferritin (>1000 μg/L) increased the risk of death. Quantitative HRCT analysis showed a significant reduction in the percentage of whole-lung involvement in the tofacitinib group between the baseline and follow-up. The total lesion volume reduction in the whole lung after treatment was substantially higher in the tofacitinib group. The tofacitinib group had a shorter duration of GCs tapering and a higher risk of EBV infection.
Conclusions
Quantitative HRCT analysis can be used to assess the response of ILD to tofacitinib treatment. Tofacitinib is effective in patients with anti-MDA5+ DM-ILD but increases the risk of infection.
{"title":"Quantitative analysis of chest CT with deep learning to assess the efficacy of tofacitinib in the treatment of anti-MDA5+ dermatomyositis","authors":"Na You , Xuan Cao , Hualing Nie , Tong Su , Hua Song , Ziyi Jin , Xiaoyan Xin , Dandan Wang , Lingyun Sun","doi":"10.1016/j.medcle.2025.107206","DOIUrl":"10.1016/j.medcle.2025.107206","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>This study aimed to clarify whether quantitative high-resolution computed tomography (HRCT) analysis can assess the condition of interstitial lung disease (ILD) associated with anti-melanoma differentiation-associated gene 5 positive (anti MDA5+) dermatomyositis (DM) and investigate the efficacy of tofacitinib in the treatment of anti-MDA5+ DM.</div></div><div><h3>Materials and methods</h3><div>Seventy patients were included in this retrospective study: 39 in the tofacitinib group and 31 in the group without tofacitinib. Patients’ HRCT were uploaded to a deep learning system to assess ILD regression. Based on patients’ quantitative HRCT results, survival and glucocorticoids (GCs) usage, the efficacy of tofacitinib in the treatment of anti-MDA5+ DM were assessed. The safety was assessed by recording the incidence of adverse reactions. Data were analyzed using SPSS26.0 and R4.4.1.</div></div><div><h3>Results</h3><div>No significant differences for baseline characteristics were observed between the two groups of patients, except for cutaneous involvement. Tofacitinib group showed higher 3-year survival and it was an independent protective factor against mortality. Elevated serum ferritin (>1000<!--> <!-->μg/L) increased the risk of death. Quantitative HRCT analysis showed a significant reduction in the percentage of whole-lung involvement in the tofacitinib group between the baseline and follow-up. The total lesion volume reduction in the whole lung after treatment was substantially higher in the tofacitinib group. The tofacitinib group had a shorter duration of GCs tapering and a higher risk of EBV infection.</div></div><div><h3>Conclusions</h3><div>Quantitative HRCT analysis can be used to assess the response of ILD to tofacitinib treatment. Tofacitinib is effective in patients with anti-MDA5+ DM-ILD but increases the risk of infection.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107206"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698083","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}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107210
Maria de los Angeles Fernandez-Rodriguez , Belén Prieto-García , María Pilar López Díez , Pere Llorens , Francisco Javier Martín-Sánchez , Víctor Gil , Javier Jacob , Lluís Llauger , Òscar Miró , Pablo Avanzas , Pablo Herrero-Puente , on behalf of the ICA-SEMES Group
Introduction and objective
There are no data on the effect of oral anticoagulant treatment on the prognosis of patients with acute heart failure (AHF). This study aimed to evaluate the effect of oral anticoagulant treatment on the short- and long-term prognosis of patients with an episode of AHF requiring hospital emergency department (ED) care.
Method
This was a prospective, multicentre, observational study with cohort follow-up. Basal and clinical data of the episode of patients diagnosed with AHF in the EDs of 41 Spanish hospitals were collected. Propensity score matching was performed and the crude and adjusted association of oral anticoagulant treatment with mortality was analysed at 30 days (primary objective) and at one year.
Results
A total of 17,635 patients were included, 42.9% of whom were previously receiving oral anticoagulants. Compared with non-anticoagulated patients, anticoagulated patients had a higher mean age (80.6 vs 80.3, p = 0.02), were predominantly female (56.5 vs 54.9; p = 0.035), had a high prevalence of risk factors and cardiovascular disease, and had a higher thrombotic risk. The 30-day [adjusted HR: 0.75 (95% CI: 0.63–0.89); p < 0.001] and 1-year [adjusted HR: 0.81 (95% CI: 0.73–0.89); p < 0.001] prognosis was better in patients in the anticoagulated group. After propensity score matching, the results did not differ at 30 days [HR: 0.73 (95% CI: 0.59–0.90); p < 0.001] and at 1 year [HR: 0.82 (95% CI: 0.72–0.92); p < 0.001].
Conclusions
Oral anticoagulation may be beneficial in patients with heart failure, regardless of the presence of AF. However, more randomized studies are needed to evaluate this hypothesis.
前言与目的口服抗凝治疗对急性心力衰竭（AHF）患者预后的影响尚无相关研究数据。本研究旨在评估口服抗凝治疗对AHF患者短期和长期预后的影响，这些患者需要医院急诊治疗。方法前瞻性、多中心、观察性研究，采用队列随访。收集了西班牙41家医院急诊科诊断为AHF患者的基础和临床资料。进行倾向评分匹配，并在30天（主要目标）和一年内分析口服抗凝治疗与死亡率的粗相关性和调整相关性。结果共纳入17635例患者，其中42.9%的患者曾接受过口服抗凝药物治疗。与非抗凝患者相比，抗凝患者的平均年龄更高（80.6 vs 80.3, p = 0.02），以女性为主（56.5 vs 54.9, p = 0.035），危险因素和心血管疾病患病率高，血栓形成风险更高。30天[调整后HR: 0.75 (95% CI: 0.63-0.89)；p <； 0.001]和1年[调整后风险比：0.81 (95% CI: 0.73-0.89)；P <； 0.001]抗凝治疗组预后较好。倾向评分匹配后，30天的结果没有差异[HR: 0.73 (95% CI: 0.59-0.90)；p & lt; 0.001), 1年(人力资源:0.82(95%置信区间:0.72—-0.92);p < 0.001]。结论：无论是否存在房颤，口腔抗凝可能对心力衰竭患者有益。然而，需要更多的随机研究来评估这一假设。
{"title":"Effect of oral anticoagulant treatment on mortality in patients with acute heart failure: Propensity score analysis. TAO-ICA study","authors":"Maria de los Angeles Fernandez-Rodriguez , Belén Prieto-García , María Pilar López Díez , Pere Llorens , Francisco Javier Martín-Sánchez , Víctor Gil , Javier Jacob , Lluís Llauger , Òscar Miró , Pablo Avanzas , Pablo Herrero-Puente , on behalf of the ICA-SEMES Group","doi":"10.1016/j.medcle.2025.107210","DOIUrl":"10.1016/j.medcle.2025.107210","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>There are no data on the effect of oral anticoagulant treatment on the prognosis of patients with acute heart failure (AHF). This study aimed to evaluate the effect of oral anticoagulant treatment on the short- and long-term prognosis of patients with an episode of AHF requiring hospital emergency department (ED) care.</div></div><div><h3>Method</h3><div>This was a prospective, multicentre, observational study with cohort follow-up. Basal and clinical data of the episode of patients diagnosed with AHF in the EDs of 41 Spanish hospitals were collected. Propensity score matching was performed and the crude and adjusted association of oral anticoagulant treatment with mortality was analysed at 30 days (primary objective) and at one year.</div></div><div><h3>Results</h3><div>A total of 17,635 patients were included, 42.9% of whom were previously receiving oral anticoagulants. Compared with non-anticoagulated patients, anticoagulated patients had a higher mean age (80.6 vs 80.3, <em>p</em> = 0.02), were predominantly female (56.5 vs 54.9; <em>p</em> = 0.035), had a high prevalence of risk factors and cardiovascular disease, and had a higher thrombotic risk. The 30-day [adjusted HR: 0.75 (95% CI: 0.63–0.89); <em>p</em> < 0.001] and 1-year [adjusted HR: 0.81 (95% CI: 0.73–0.89); <em>p</em> < 0.001] prognosis was better in patients in the anticoagulated group. After propensity score matching, the results did not differ at 30 days [HR: 0.73 (95% CI: 0.59–0.90); <em>p</em> < 0.001] and at 1 year [HR: 0.82 (95% CI: 0.72–0.92); <em>p</em> < 0.001].</div></div><div><h3>Conclusions</h3><div>Oral anticoagulation may be beneficial in patients with heart failure, regardless of the presence of AF. However, more randomized studies are needed to evaluate this hypothesis.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107210"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698084","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}
Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107187
Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola
{"title":"Ribavirin as a treatment for severe acute hepatitis E on chronic liver disease: Clinical experience","authors":"Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola","doi":"10.1016/j.medcle.2025.107187","DOIUrl":"10.1016/j.medcle.2025.107187","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107187"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697877","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}
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