Pérez Abad L, Aibar Arregui MÁ, Aramburu Llorente J
… +8 more, Ramón Y Cajal Calvo J, Andrés Gracia A, Revilla Martí P, Atienza Ayala S, Lahuerta Pueyo C, Campos Sáenz de Santamaría A, Ramos Ibañez E, Gracia Tello BDC
Med Clin (Barc)
· 2026 Feb · PMID 41547129
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BACKGROUND: Wild-type transthyretin amyloidosis (ATTRwt) is a serious condition. At early stages, symptoms resemble those of heart failure with preserved ejection fraction (HFpEF). Our aim was to perform software-support...BACKGROUND: Wild-type transthyretin amyloidosis (ATTRwt) is a serious condition. At early stages, symptoms resemble those of heart failure with preserved ejection fraction (HFpEF). Our aim was to perform software-supported nailfold videocapillaroscopy (NVC) analysis to identify hallmarks useful for diagnosis and build machine learning (ML)-based models to assess severity. METHODS: Thirty-two ATTRwt patients underwent NVC. Nineteen initiated TTR-stabilizing therapy and had a new NVC 12 months afterwards. Forty-one capillary-related variables were analyzed. Thirty NVCs were randomly chosen to train models to discriminate between poorer or less poor prognosis according to N-terminal pro-B-type natriuretic peptide (NT-proBNP) or Cheng score (cut-offs: 2000pg/mL and 4 points, respectively). The remaining 21 NVCs were used for validation purposes. A control population of 99 patients with heart failure with preserved ejection fraction (HFpEF) but without signs of amyloidosis was included. RESULTS: A profound disorganization in the nailfold capillary architecture was generally observed. The models achieved accuracies of 0.81 and 0.90, respectively, in predicting disease severity. An additional model designed to distinguish a profile suggestive of amyloidosis (vs. HFpEF controls) achieved an accuracy of 0.73. CONCLUSIONS: NVC-based ML models may contribute to early diagnosis and staging of ATTRwt.
Med Clin (Barc)
· 2026 Feb · PMID 41539079
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Hepatitis E, caused by the hepatitis E virus (HEV), represents an emerging global public health problem, constituting one of the main causes of acute viral hepatitis. Since its first description, it has been considered a...Hepatitis E, caused by the hepatitis E virus (HEV), represents an emerging global public health problem, constituting one of the main causes of acute viral hepatitis. Since its first description, it has been considered a disease with an epidemiological pattern linked to the consumption of contaminated water and food, and with a higher prevalence in geographical areas with poor socio-sanitary conditions. According to WHO estimates, around 2 billion people, representing a quarter of the world's population, live in areas where HEV is endemic and are therefore at risk of infection. Improvements in diagnostic techniques have provided the data necessary to demonstrate that in developed countries, HEV infection is common, indigenous and has a different epidemiological pattern, associated with contact with domestic animals, especially pigs. Another interesting aspect is that HEV can cause chronic hepatitis in transplant and immunocompromised patients.
de Santamaría AC, Godos-Gómez M, Crespo-Aznarez S
… +5 more, Esterellas-Sánchez LK, Sánchez-Marteles M, Garcés-Horna V, Giménez-López I, Rubio-Gracia J
Med Clin (Barc)
· 2026 Feb · PMID 41539078
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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...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.
Casafont-Solé I, Peralta-Garcia I, Centeno C
… +6 more, Martínez-Bujidos M, Millán-Billi P, Holgado S, Alcubilla P, Guasch I, Portillo K
Med Clin (Barc)
· 2026 Feb · PMID 41539076
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OBJECTIVES: To evaluate the utility of lung ultrasound (LUS) and serum KL-6 levels as screening tools for interstitial lung disease (ILD) in seropositive rheumatoid arthritis (RA) patients, as well as their correlation w...OBJECTIVES: To evaluate the utility of lung ultrasound (LUS) and serum KL-6 levels as screening tools for interstitial lung disease (ILD) in seropositive rheumatoid arthritis (RA) patients, as well as their correlation with ILD extent on high-resolution computed tomography (HRCT). METHODS: A single-center exploratory study including 20 seropositive RA patients with recent HRCT scans (<2 years) was conducted. Clinical data and pulmonary function tests were recorded. Patients were classified as RA-ILD (n=10) or RA-noILD (n=10). LUS assessed 14 intercostal spaces for B-lines and pleural abnormalities. Serum KL-6 was measured by chemiluminescence immunoassay. HRCT was evaluated by an expert radiologist to quantify ILD extent. RESULTS: KL-6 levels were higher in RA-ILD patients (p=0.028). More than 10 B-lines per LUS field were exclusively found in RA-ILD (p=0.003), and 5-10 B-lines per field were suggestive of ILD (p=0.002). Pleural thickening was more frequent in RA-ILD (p=0.035). Anterior lung fields were more specifically involved in RA-ILD. B-lines number correlated with ILD extent on HRCT (p=0.001). CONCLUSIONS: KL-6 and LUS are useful non-invasive screening tools for ILD in seropositive RA patients. A simplified LUS focusing on anterior fields may offer a rapid, reproducible method. Larger prospective studies are needed to establish cut-off values and validate clinical use.
González Muñoz B, Busca Arenzana C, Herrero-Martínez JM
Med Clin (Barc)
· 2026 Jan · PMID 41538905
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Point-of-care ultrasound (POCUS) has become an essential tool in the diagnosis and management of infections in immunocompromised patients, including those with HIV. Despite the existence of several ultrasound protocols,...Point-of-care ultrasound (POCUS) has become an essential tool in the diagnosis and management of infections in immunocompromised patients, including those with HIV. Despite the existence of several ultrasound protocols, an infection-specific protocol has not yet been developed. In immunocompromised patients, POCUS allows early identification of infectious processes. Ultrasound findings may not differ from those of the general population, but their interpretation does. They are more prone to infection by unusual microorganisms, involvement of unusual territories and formation of abscesses or masses of infectious origin. It is particularly useful for identifying signs of infection, such as consolidations and effusions. In immunocompromised patients, its usefulness varies according to the level of immunosuppression, being especially valuable in the identification of opportunistic infections. Including HIV, transplanted, hematological or autoimmune diseases patients, it facilitates a rapid and accurate assessment, guiding diagnostic and therapeutic procedures.
Tinoco Magalhães R, Valadas R, Cipriano P
… +1 more, Cruz D
Med Clin (Barc)
· 2026 Jan · PMID 41538904
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Gastrointestinal angiodysplasia (GIAD) is a common cause of obscure gastrointestinal bleeding. Pharmacological interventions assume significance in cases refractory to endoscopic management or in surgically inaccessible...Gastrointestinal angiodysplasia (GIAD) is a common cause of obscure gastrointestinal bleeding. Pharmacological interventions assume significance in cases refractory to endoscopic management or in surgically inaccessible locations. A comprehensive literature search was conducted to identify relevant studies on the pharmacological management of GIAD, focusing primarily on hormonal therapy, thalidomide, and octreotide. Of 325 references, 290 were screened, 85 full texts were assessed, and 59 publications were included. Hormonal therapy lacks consistent evidence of efficacy and has significant side effects. Thalidomide has potential, albeit with substantial adverse events. Octreotide, demonstrates efficacy with minimal side effects, with its long-acting formulation appearing advantageous. While both thalidomide and octreotide present promising avenues, further research is warranted to assess their efficacy and safety profiles. Comparative studies could also provide invaluable insights for clinical practice.
Med Clin (Barc)
· 2026 Jan · PMID 41538903
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PURPOSE: This study aimed to identify prognostic factors and develop a predictive model for patients with organophosphate poisoning. METHODS: A retrospective analysis of 108 cases was conducted, collecting demographic, c...PURPOSE: This study aimed to identify prognostic factors and develop a predictive model for patients with organophosphate poisoning. METHODS: A retrospective analysis of 108 cases was conducted, collecting demographic, clinical, and laboratory data including age, sex, time to treatment, plasma organophosphate (OP) levels, arterial lactate (LAC), aspartate aminotransferase (AST), creatinine (Cr), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Patients were categorized into survivor and non-survivor groups. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent prognostic factors and assess their predictive value. RESULTS: The overall mortality rate was 23.15%. Non-survivors had higher age, LAC, AST, Cr, and APACHE II scores, and lower AChE levels compared to survivors. Multivariate logistic regression identified age (OR: 1.12, 95% CI: 1.05-1.22) and AST (OR: 1.03, 95% CI: 1.01-1.05) as independent prognostic factors. ROC analysis validated a model combining age, AChE, and AST, showing an excellent discriminative ability with an AUC of 0.95 (95% CI: 0.91-0.99), sensitivity of 1.00, and specificity of 0.90. CONCLUSIONS: Age and AST are significant prognostic factors for organophosphate poisoning. Combining these factors enhances predictive accuracy, aiding clinical decision-making and emphasizing early aggressive management to improve survival rates.
Mozas P, Quintela D, Serna Á
… +1 more, en representación de Nexo en LLC
Med Clin (Barc)
· 2026 Jan · PMID 41538902
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Despite its typically indolent course in most patients, chronic lymphocytic leukemia (CLL) can relapse or become refractory to the two main classes of drugs commonly used: covalent BTK inhibitors and BCL2 inhibitors. Thi...Despite its typically indolent course in most patients, chronic lymphocytic leukemia (CLL) can relapse or become refractory to the two main classes of drugs commonly used: covalent BTK inhibitors and BCL2 inhibitors. This review outlines the potential reasons for discontinuation of these drug classes, defines the concepts of double exposure (DE) and double refractoriness (DR), delineates the possible treatment sequences leading to DR, summarizes the poor prognosis of this patient subgroup, and describes the approved, investigational, and less optimal therapeutic alternatives for the management of this population. Finally, three illustrative clinical vignettes of patients with DE/DR CLL are presented, including case analysis and practical management recommendations, as well as teaching points.
Florencia Pilia M, Sansano I, Varona D
… +6 more, Sánchez M, Espejo D, Culebras M, Muñoz X, Ojanguren I, Ramón Y Cajal S
Med Clin (Barc)
· 2026 Jan · PMID 41538901
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BACKGROUND: In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain po...BACKGROUND: In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to evaluate the prognostic value of histopathological patterns, cellular senescence, and lymphatic proliferation in patients with post-COVID-19 ILD. METHODS: This prospective observational study of patients hospitalized at Vall d'Hebron University Hospital due to COVID-19 pneumonia and presenting respiratory symptoms, radiological alterations, and pulmonary function test impairment during the 3-month follow-up visit after discharge. Lung cryobiopsies were performed, and the histopathological findings and expression of senescence and lymphatic proliferation (P16 and D2-40) were analyzed. RESULTS: Between March 2020 and February 2021, 4332 patients were hospitalized at Vall d'Hebron University Hospital due to COVID-19 pneumonia, and 1403 were visited in the Respiratory Clinic 3 months after discharge. The first 66 patients presenting with respiratory symptoms, radiological alterations, and decreased pulmonary function tests during the post hospitalization follow-up underwent cryobiopsy for diagnostic purposes. Multivariate regression showed that Masson bodies in the 3-month cryobiopsy were related to a higher forced vital capacity at 6 months whereas higher expression of senescence and lymphatic proliferation markers, such as P-16 and D2-40, in the histological samples were related to decreased carbon monoxide transfer test values at 6 months. CONCLUSION: Cellular senescence and lymphatic proliferation in lung tissue are associated with impaired gas exchange in mid-term follow-up, suggesting their potential as prognostic markers in post-COVID-19 ILD.