Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107201
Carlos Guillén-Astete , Esperanza Naredo
Musculoskeletal ultrasound is a safe and easily accessible imaging technique that allows the study of suspected infections of the musculoskeletal system. Although no finding is specific to these types of processes, certain synovial characteristics may suggest an infectious process rather than a non-infectious inflammatory condition. The role of ultrasound in this group of diseases is also to facilitate the extraction of synovial fluid for microbiological study. Ultrasound-guided synovial tissue biopsy is a minimally invasive, feasible, safe, and well-tolerated procedure that provides high-quality tissue samples, enhancing diagnostic capabilities in cases of suspected infectious arthritis, especially when synovial fluid analysis is negative or inconclusive.
{"title":"Ultrasound in the study of soft tissue infections","authors":"Carlos Guillén-Astete , Esperanza Naredo","doi":"10.1016/j.medcle.2025.107201","DOIUrl":"10.1016/j.medcle.2025.107201","url":null,"abstract":"<div><div>Musculoskeletal ultrasound is a safe and easily accessible imaging technique that allows the study of suspected infections of the musculoskeletal system. Although no finding is specific to these types of processes, certain synovial characteristics may suggest an infectious process rather than a non-infectious inflammatory condition. The role of ultrasound in this group of diseases is also to facilitate the extraction of synovial fluid for microbiological study. Ultrasound-guided synovial tissue biopsy is a minimally invasive, feasible, safe, and well-tolerated procedure that provides high-quality tissue samples, enhancing diagnostic capabilities in cases of suspected infectious arthritis, especially when synovial fluid analysis is negative or inconclusive.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107201"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697986","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.2025.107195
Esteban Fernando Noroña Vásconez , Andrea Viñas Barros , Alicia Viñas Barros
{"title":"Coexistence of primary central nervous system vasculitis and a heterozygous HTRA1 mutation associated with a CARASIL-related clinical entity","authors":"Esteban Fernando Noroña Vásconez , Andrea Viñas Barros , Alicia Viñas Barros","doi":"10.1016/j.medcle.2025.107195","DOIUrl":"10.1016/j.medcle.2025.107195","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107195"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697879","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.2025.107194
Jair Montenegro Pérez , Nashla Chalela Blanco , Juan Camilo Rodríguez
{"title":"Reversible posterior encephalopathy syndrome in a young patient with chronic kidney disease and a history of cocaine use","authors":"Jair Montenegro Pérez , Nashla Chalela Blanco , Juan Camilo Rodríguez","doi":"10.1016/j.medcle.2025.107194","DOIUrl":"10.1016/j.medcle.2025.107194","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697971","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107136
Lourdes Pérez , Annabel Blasi , Rosa Gutierrez , Marta Caballero , Jose Pérez , Iratxe Zarragoikoetxea , Julia Vidal , Patricia Salvador , Gorka Ojinaga , Patricia Duque , Andrea Bosca , Paula Isabel Carmona , Jordi Colmenero , Maria Jose Colomina , Sandra Llaurado , Antoni Sabate
Context
In liver transplantation (LT), anemia and transfusion of blood products have a negative impact on morbidity and mortality.
Methods
Multicenter, prospective observational study. The main objective was to assess whether correction of iron deficiency anemia with intravenous iron was feasible in LT candidates. Its efficacy and adverse effects were evaluated. Patients with Hb value <115 g/L and ferritin values <800 ng/mL were included. Based on the increase in Hb >10 g/L compared to its baseline level, the analysis of 76 patients was considered.
An anemia study was carried out, assigning to the study group those who met the criteria for iron deficiency anemia, which followed a protocol of administration of up to two doses of iron before LT.
Results
296 LT were performed during the study period, 48% of patients had an Hb value <115 g/L. 43 patients made up the study group, in 5 patients the first dose was not administered. The second dose was administered to 55% of patients. No patient presented serious adverse effects or alterations in liver function. Hemoglobin increased compared to baseline by a median of 11.22 g/L (6.47–15.97) after the first administration and 11.64 g/L (6.49–16.78) after the second.
Conclusions
The implementation of patient blood management in liver transplantation through the administration of intravenous iron is effective and safe. It is necessary to routinely characterize and treat the presence of iron deficiency anemia in these patients.
{"title":"Correction of iron deficiency anemia in liver transplantation. Preliminary study","authors":"Lourdes Pérez , Annabel Blasi , Rosa Gutierrez , Marta Caballero , Jose Pérez , Iratxe Zarragoikoetxea , Julia Vidal , Patricia Salvador , Gorka Ojinaga , Patricia Duque , Andrea Bosca , Paula Isabel Carmona , Jordi Colmenero , Maria Jose Colomina , Sandra Llaurado , Antoni Sabate","doi":"10.1016/j.medcle.2025.107136","DOIUrl":"10.1016/j.medcle.2025.107136","url":null,"abstract":"<div><h3>Context</h3><div>In liver transplantation (LT), anemia and transfusion of blood products have a negative impact on morbidity and mortality.</div></div><div><h3>Methods</h3><div>Multicenter, prospective observational study. The main objective was to assess whether correction of iron deficiency anemia with intravenous iron was feasible in LT candidates. Its efficacy and adverse effects were evaluated. Patients with Hb value <115 g/L and ferritin values <800 ng/mL were included. Based on the increase in Hb >10 g/L compared to its baseline level, the analysis of 76 patients was considered.</div><div>An anemia study was carried out, assigning to the study group those who met the criteria for iron deficiency anemia, which followed a protocol of administration of up to two doses of iron before LT.</div></div><div><h3>Results</h3><div>296 LT were performed during the study period, 48% of patients had an Hb value <115 g/L. 43 patients made up the study group, in 5 patients the first dose was not administered. The second dose was administered to 55% of patients. No patient presented serious adverse effects or alterations in liver function. Hemoglobin increased compared to baseline by a median of 11.22 g/L (6.47–15.97) after the first administration and 11.64 g/L (6.49–16.78) after the second.</div></div><div><h3>Conclusions</h3><div>The implementation of patient blood management in liver transplantation through the administration of intravenous iron is effective and safe. It is necessary to routinely characterize and treat the presence of iron deficiency anemia in these patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107136"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435556","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107143
Gloria Heredia-Campos , Rafael Gonzalez-Manzanares , Ana Rodríguez-Almodovar , Juan Antonio Moreno , Isabel Pozuelo , Jorge Perea , Ignacio Gallo , Luis Carlos Maestre , Francisco Hidalgo , Javier Suárez De Lezo , Miguel Romero , Dolores Mesa , Simona Espejo , Manuel Pan , Soledad Ojeda
Background
Transcatheter aortic valve implantation (TAVI) has become a cornerstone treatment for patients with severe aortic stenosis, especially those unsuitable for surgery. Intravascular haemolysis has been described in patients with aortic stenosis. This study aimed to assess the prevalence of haemolysis in patients with severe AS undergoing TAVI and its association with immediate and 30-day post-procedural outcomes.
Methods
The HEMO-TAVI study was a prospective, single-centre cohort study conducted at University Hospital Reina Sofía (Córdoba, Spain) from June 2020 to September 2023. Consecutive patients scheduled for TAVI were enrolled. Haemolysis was defined as LDH > 220 U/L plus ≥2 criteria (low haemoglobin, low haptoglobin, elevated reticulocytes, or schistocytes). The primary endpoint was a composite of peri-procedural and 30-day adverse events.
Results
Among 301 patients, pre-procedural haemolysis was identified in 18 (6.0%). Patients with haemolysis had higher interventricular septum thickness and transvalvular gradients. The composite endpoint occurred more frequently in the haemolysis group (44.4% vs 21.2%, ORadj 2.23, 95% CI 1.12–8.25, p = 0.025). Haemolysis was independently associated with a greater number of complications (ORadj 3.26, 95% CI 1.19–8.47, p = 0.016).
Conclusion
Pre-procedural haemolysis might be present in TAVI candidates and is associated with increased peri-procedural and 30-day complications. Pre-procedural haemolysis may serve as a marker of elevated procedural risk.
经导管主动脉瓣植入术（TAVI）已成为严重主动脉瓣狭窄患者，尤其是不适合手术的患者的基础治疗方法。血管内溶血已被描述为主动脉狭窄患者。本研究旨在评估严重AS患者接受TAVI时溶血的发生率及其与即刻和术后30天预后的关系。方法HEMO-TAVI研究是一项前瞻性单中心队列研究，于2020年6月至2023年9月在雷纳大学医院Sofía （Córdoba，西班牙）进行。入选了计划接受TAVI治疗的连续患者。溶血定义为LDH≤220 U/L，加上≥2项标准（低血红蛋白、低接触珠蛋白、网织红细胞或血吸虫细胞升高）。主要终点是手术期间和30天不良事件的综合。结果301例患者中，18例（6.0%）存在术前溶血。溶血患者有较高的室间隔厚度和跨瓣梯度。溶血组出现复合终点的频率更高（44.4% vs 21.2%, ORadj 2.23, 95% CI 1.12-8.25, p = 0.025）。溶血与更多的并发症独立相关（ORadj 3.26, 95% CI 1.19-8.47, p = 0.016）。结论TAVI患者术前可能存在溶血，且与术中并发症和术后30天并发症增加有关。手术前溶血可作为手术风险升高的标志。
{"title":"Association between subclinical haemolysis and periprocedural outcomes in patients undergoing transcatheter aortic valve replacement","authors":"Gloria Heredia-Campos , Rafael Gonzalez-Manzanares , Ana Rodríguez-Almodovar , Juan Antonio Moreno , Isabel Pozuelo , Jorge Perea , Ignacio Gallo , Luis Carlos Maestre , Francisco Hidalgo , Javier Suárez De Lezo , Miguel Romero , Dolores Mesa , Simona Espejo , Manuel Pan , Soledad Ojeda","doi":"10.1016/j.medcle.2025.107143","DOIUrl":"10.1016/j.medcle.2025.107143","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) has become a cornerstone treatment for patients with severe aortic stenosis, especially those unsuitable for surgery. Intravascular haemolysis has been described in patients with aortic stenosis. This study aimed to assess the prevalence of haemolysis in patients with severe AS undergoing TAVI and its association with immediate and 30-day post-procedural outcomes.</div></div><div><h3>Methods</h3><div>The HEMO-TAVI study was a prospective, single-centre cohort study conducted at University Hospital Reina Sofía (Córdoba, Spain) from June 2020 to September 2023. Consecutive patients scheduled for TAVI were enrolled. Haemolysis was defined as LDH<!--> <!-->><!--> <!-->220<!--> <!-->U/L plus ≥2 criteria (low haemoglobin, low haptoglobin, elevated reticulocytes, or schistocytes). The primary endpoint was a composite of peri-procedural and 30-day adverse events.</div></div><div><h3>Results</h3><div>Among 301 patients, pre-procedural haemolysis was identified in 18 (6.0%). Patients with haemolysis had higher interventricular septum thickness and transvalvular gradients. The composite endpoint occurred more frequently in the haemolysis group (44.4% vs 21.2%, OR<sub>adj</sub> 2.23, 95% CI 1.12–8.25, <em>p</em> <!-->=<!--> <!-->0.025). Haemolysis was independently associated with a greater number of complications (OR<sub>adj</sub> 3.26, 95% CI 1.19–8.47, <em>p</em> <!-->=<!--> <!-->0.016).</div></div><div><h3>Conclusion</h3><div>Pre-procedural haemolysis might be present in TAVI candidates and is associated with increased peri-procedural and 30-day complications. Pre-procedural haemolysis may serve as a marker of elevated procedural risk.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107143"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435562","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":"Eagle syndrome as an uncommon cause of dysphagia in older people","authors":"Yanira Aranda Rubio , Natalia Loren Lázaro , María Asenjo Cambra","doi":"10.1016/j.medcle.2025.107171","DOIUrl":"10.1016/j.medcle.2025.107171","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107171"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435594","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107065
Ying Zhao , Xiaoying Zhang , Yongsheng Li , Jinhua He , Zeping Han
Objective
Enterocolic lymphocytic phlebitis (ELP) is a rare venous-specific gastrointestinal inflammation with challenging preoperative diagnosis. We aimed to characterize its clinicopathological spectrum.
Patients and methods
This narrative review synthesizes evidence from 85 published cases (9–81 years) from 50 articles to characterize ELP's clinicopathological features and diagnostic pitfalls, along with its differentiation from other vasculitides, such as Behcet's disease, systemic lupus erythematosus, mesenteric inflammatory veno-occlusive disease, idiopathic myointimal hyperplasia of the mesenteric veins and IgG4-related diseases.
Results
ELP has a wide range of clinical and histological presentations, it predominantly affects the right colon/small bowel, mimicking acute abdomen. Diagnosis relies on postoperative histopathology showing venular lymphocytic infiltration.
Conclusion
ELP represents a underdiagnosed clinicopatologic entity, a diagnosis of ELP is predominantly made after histological resection.
{"title":"Enterocolic lymphocytic phlebitis: Clinical insights from a literature review","authors":"Ying Zhao , Xiaoying Zhang , Yongsheng Li , Jinhua He , Zeping Han","doi":"10.1016/j.medcle.2025.107065","DOIUrl":"10.1016/j.medcle.2025.107065","url":null,"abstract":"<div><h3>Objective</h3><div>Enterocolic lymphocytic phlebitis (ELP) is a rare venous-specific gastrointestinal inflammation with challenging preoperative diagnosis. We aimed to characterize its clinicopathological spectrum.</div></div><div><h3>Patients and methods</h3><div>This narrative review synthesizes evidence from 85 published cases (9–81 years) from 50 articles to characterize ELP's clinicopathological features and diagnostic pitfalls, along with its differentiation from other vasculitides, such as Behcet's disease, systemic lupus erythematosus, mesenteric inflammatory veno-occlusive disease, idiopathic myointimal hyperplasia of the mesenteric veins and IgG4-related diseases.</div></div><div><h3>Results</h3><div>ELP has a wide range of clinical and histological presentations, it predominantly affects the right colon/small bowel, mimicking acute abdomen. Diagnosis relies on postoperative histopathology showing venular lymphocytic infiltration.</div></div><div><h3>Conclusion</h3><div>ELP represents a underdiagnosed clinicopatologic entity, a diagnosis of ELP is predominantly made after histological resection.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107065"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435245","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107154
Javier Fernández , Cristina Coll-Ortega , Cristina Fuster , Anne Davis , Pablo Simó , Susana Aceituno , Maria Soler
Background and aims
Cirrhosis represents the end-stage of chronic liver diseases. The ANSWER trial showed that long-term albumin (LTA) administration along with the standard medical treatment (SMT) improves survival and reduces complications in patients with decompensated cirrhosis and uncomplicated ascites. The present analysis compared the potential annual cost of treatment with LTA + SMT, following the ANSWER regimen, with respect to SMT alone in patients with decompensated cirrhosis and uncomplicated ascites from the Spanish healthcare system perspective.
Methods
Cost of illness for patients with cirrhosis and uncomplicated ascites, treated with SMT alone or LTA + SMT (ANSWER regimen), was estimated. The annual incidence of complications and treatment frequency were collected based on the findings from the ANSWER trial. Unit costs were obtained from published data and transformed to 2019 Euros. The incremental cost was the difference in annual cost per patient between LTA + SMT and SMT alone treatment groups. A univariate sensitivity analysis was performed to ensure the robustness of the analysis.
Results
The annual cost per patient of treatment and management of complications was estimated at €26,161 for patients treated with LTA + SMT, compared to €27,536 for those treated with SMT alone, representing saving costs of €1,375 per patient and year.
Conclusions
By translating the ANSWER trial results to the Spanish clinical setting, LTA + SMT could reduce the healthcare cost associated with the management of cirrhotic patients with uncomplicated ascites due to the reduction of costly complications, which counterbalance the cost of LTA.
{"title":"Economic cost of long-term albumin treatment in cirrhotic patients with uncomplicated ascites based on the ANSWER trial: The Spanish healthcare system perspective","authors":"Javier Fernández , Cristina Coll-Ortega , Cristina Fuster , Anne Davis , Pablo Simó , Susana Aceituno , Maria Soler","doi":"10.1016/j.medcle.2025.107154","DOIUrl":"10.1016/j.medcle.2025.107154","url":null,"abstract":"<div><h3>Background and aims</h3><div>Cirrhosis represents the end-stage of chronic liver diseases. The ANSWER trial showed that long-term albumin (LTA) administration along with the standard medical treatment (SMT) improves survival and reduces complications in patients with decompensated cirrhosis and uncomplicated ascites. The present analysis compared the potential annual cost of treatment with LTA<!--> <!-->+<!--> <!-->SMT, following the ANSWER regimen, with respect to SMT alone in patients with decompensated cirrhosis and uncomplicated ascites from the Spanish healthcare system perspective.</div></div><div><h3>Methods</h3><div>Cost of illness for patients with cirrhosis and uncomplicated ascites, treated with SMT alone or LTA<!--> <!-->+<!--> <!-->SMT (ANSWER regimen), was estimated. The annual incidence of complications and treatment frequency were collected based on the findings from the ANSWER trial. Unit costs were obtained from published data and transformed to 2019 Euros. The incremental cost was the difference in annual cost per patient between LTA<!--> <!-->+<!--> <!-->SMT and SMT alone treatment groups. A univariate sensitivity analysis was performed to ensure the robustness of the analysis.</div></div><div><h3>Results</h3><div>The annual cost per patient of treatment and management of complications was estimated at €26,161 for patients treated with LTA<!--> <!-->+<!--> <!-->SMT, compared to €27,536 for those treated with SMT alone, representing saving costs of €1,375 per patient and year.</div></div><div><h3>Conclusions</h3><div>By translating the ANSWER trial results to the Spanish clinical setting, LTA<!--> <!-->+<!--> <!-->SMT could reduce the healthcare cost associated with the management of cirrhotic patients with uncomplicated ascites due to the reduction of costly complications, which counterbalance the cost of LTA.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107154"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435294","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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