García Ortiz MC, Sanchez Casado M, Morán Gallego FJ
… +4 more, García Benassi JM, Marina Martinez L, Calle Flores A, Sánchez Carretero MJ
Med Clin (Barc)
· 2026 Jun · PMID 41936788
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OBJECTIVE: To analyze the presentation characteristics of idiopathic subarachnoid hemorrhage (SAHi), its characteristics and its long-term evolution. PATIENTS AND METHODS: Descriptive follow-up study. ICU in Hospital of...OBJECTIVE: To analyze the presentation characteristics of idiopathic subarachnoid hemorrhage (SAHi), its characteristics and its long-term evolution. PATIENTS AND METHODS: Descriptive follow-up study. ICU in Hospital of III level. SAH admitted to the ICU with negative admission arteriography during the years 2007-2022. The main variables of interest were demographic data, prognostic and severity scales, ICU evolution data, radiological results, exitus and GOSE scale (Glasgow Outcome Scale Extended) until the last observation. RESULTS: Seven hundred thirty-threepatients with SAH were admitted to the ICU, 149 with initial negative arteriography. After the verification test starting at 3 weeks, 114 patients (16.1%) remained without underlying lesion. 58.8% were male and the age was 57.1±12.8 years. If we compare SAH with vs without underlying lesion (SAHi), we observed differences in the male sex (38.7% vs 58.8%), Hunt-Hess [2 (2-4) vs 2 (1-2)], Fisher [4 (3-4) vs 3 (2-4)], mechanical ventilation (86.8% vs 21.1%), tracheostomy (24.9% vs 1.8%), ICU stay days [10 (5-21) vs 3 (2-5)] and ICU deaths (20.9% vs 1%). We followed up on SAHi: 70,5 (33-109) months, with mortality of 11.4% (13 patients), none to related causes. There has been no rebleeding or late brain injury. In survivors, the GOSE was 7 (7-8), with 82.3% of patients with GOSE between 5-8. 44.7% of the patients had perimesencephalic SAH, with a mortality in the follow-up period of 7.8% and GOSE 7 (6-8). CONCLUSIONS: SAH without underlying vascular lesion presents good results in terms of morbidity and mortality and long-term functional status, improving if it is a perimensencephalic SAH.
Minetto J, Pacho Calvo S, Cerri G
… +1 more, Espeche W
Med Clin (Barc)
· 2026 Jun · PMID 41936787
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While hypertension remains the leading modifiable cardiovascular risk factor, the opposite end of the spectrum-hypotension, particularly during sleep-has received limited attention. This narrative review synthesizes curr...While hypertension remains the leading modifiable cardiovascular risk factor, the opposite end of the spectrum-hypotension, particularly during sleep-has received limited attention. This narrative review synthesizes current evidence on nocturnal hypotension as assessed by ambulatory blood pressure monitoring (ABPM), including its pathophysiological mechanisms, epidemiology, and clinical consequences. Definitions varied markedly, from absolute nocturnal blood pressure (BP) thresholds (<90/50mmHg) to relative declines (>20% from daytime BP). Excessive nocturnal BP reduction has been associated with cardiovascular events, optic neuropathies-particularly normal-tension glaucoma-cognitive decline, and increased fall risk in older adults. Antihypertensive therapy, especially intensive or bedtime dosing, may accentuate these effects in vulnerable populations. Recognition of nocturnal hypotension as a distinct and clinically relevant phenomenon underscores the value of ambulatory BP monitoring to detect excessive nocturnal declines and balance cardiovascular protection with the prevention of hypoperfusion-related damage. Standardized definitions and prospective studies are urgently needed to clarify its prognostic significance.
Fumanal Idocin L, Dieste Grañena I, López de Turiso Giner P
… +3 more, Fumanal Idocin J, Moreno Díaz J, Velilla Marco J
Med Clin (Barc)
· 2026 Jun · PMID 41903274
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BACKGROUND AND OBJECTIVE: Interstitial lung disease (ILD) is a frequent and severe complication of systemic autoimmune diseases (SADs). Its early diagnosis, based on periodic high-resolution computed tomography (HRCT), i...BACKGROUND AND OBJECTIVE: Interstitial lung disease (ILD) is a frequent and severe complication of systemic autoimmune diseases (SADs). Its early diagnosis, based on periodic high-resolution computed tomography (HRCT), involves radiation exposure. Lung ultrasound (LUS) has shown good performance in ILD detection. The aim of this study was to design a new simplified lung ultrasound scoring scale based on the quantification of B-lines and pleural irregularities (LUNA score) for ILD detection using a point-of-care ultrasound device. PATIENTS AND METHODS: Between November 2020 and December 2021, HRCT and LUS (using a Butterfly iQ® device and a 14-zone scanning protocol) were performed in 88 patients with SADs, 69 of whom met criteria for systemic sclerosis. The LUNA score, which combines B-line counts and pleural irregularities to detect ILD, was constructed using logistic regression. Diagnostic performance was evaluated through ROC analysis, 10-fold cross-validation, and inter-observer reliability. RESULTS: The LUNA score showed excellent inter-observer agreement (κ=0.810) and utility for ILD diagnosis, with an area under the curve (AUC) of 0.968 (95% CI: 0.926-1.0). The optimal cut-off point (≥38 points) demonstrated a sensitivity of 97.2% and a specificity of 92.3% (Youden index 0.895). Cross-validation yielded an average AUC of 0.963. CONCLUSIONS: The LUNA score is a simple scale based on objective items that are easily identifiable via LUS. In this study, it demonstrated excellent performance for ILD detection in patients with SADs, supporting its potential incorporation into diagnostic algorithms and the reduction of unnecessary HRCT scans.
Med Clin (Barc)
· 2026 Jun · PMID 41855950
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Circulating biomarkers may enhance risk stratification and guide treatment in diseases with heterogeneous prognosis, namely in moderate and asymptomatic severe aortic stenosis (AS). Therefore, this study aims to assess t...Circulating biomarkers may enhance risk stratification and guide treatment in diseases with heterogeneous prognosis, namely in moderate and asymptomatic severe aortic stenosis (AS). Therefore, this study aims to assess the association between biomarkers and mortality in patients with these diseases. MEDLINE, Web of Science, and Scopus were searched from inception up to January 2025. Cohort studies evaluating BNP, NT-proBNP, troponin, galectin-3 or ST2, before aortic valve replacement, and reporting mortality outcomes, were eligible. Two independent reviewers performed screening, data extraction and quality assessment. A total of ten studies were included: five focused on BNP and the other five on NT-proBNP. Despite methodological heterogeneity and a high risk of bias in most studies, a positive association was observed between high levels of these biomarkers and mortality. Further research should ascertain biomarkers' standardized thresholds, as well as the prognostic role of other biomarkers in this population.
Lakhwani S, Díaz-López M, Cabello-García D
… +5 more, De Bonis-Braun C, José Rodríguez-Salazar M, Pérez-Pinilla B, Martín-Martín A, Hernández MT
Med Clin (Barc)
· 2026 May · PMID 41855930
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BACKGROUND: Interim positron emission tomography-computed tomography (iPET) has shown prognostic value in high-avidity lymphomas, like diffuse large B-cell lymphoma and Hodgkin lymphoma. However, its role in follicular l...BACKGROUND: Interim positron emission tomography-computed tomography (iPET) has shown prognostic value in high-avidity lymphomas, like diffuse large B-cell lymphoma and Hodgkin lymphoma. However, its role in follicular lymphoma (FL) remains unclear. METHODS: We conducted a retrospective observational study including patients with grades 1-3a FL treated with frontline chemoimmunotherapy between 2012 and 2014 at our institution, who underwent iPET after the fourth treatment cycle. All PET-CT were re-evaluated to assign Deauville 5-point scale (D5PS) and we considered complete metabolic response (CMR) when D5PS was 1-3. Primary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS: Of the 38 patients included, 63.2% (24/38) achieved CMR on iPET. All the patients who were in CMR on iPET, were also in CMR at the end of treatment PET-CT. However, among the 14 patients without CMR on iPET, only 4 patients achieved CMR at end of treatment PET-CT and 5 patients had progressive disease. After a median follow-up of 87.6 months (range 11.0-129.8), achieving CMR was associated with longer PFS (p<0.001; HR 0.08; 95% CI 0.03-0.24) and longer OS (p=0.012; HR 0.24; 95% CI 0.07-0.80). CONCLUSIONS: In this single-center study with long follow-up, iPET evaluated by D5PS predicted PFS and OS in FL.
Nogué-Xarau S, Ríos-Guillermo J, Saavedra C
… +3 more, Amigó-Tadín M, en representación del Grupo de Trabajo de Toxicología (SoCMUETox), de la Sociedad Catalana de Medicina de Urgencias y Emergencias
Med Clin (Barc)
· 2026 May · PMID 41855929
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INTRODUCTION: Acute heart failure (AHF) is a leading cause of hospitalization among older adults, associated with high mortality and frequent readmissions. Prealbumin has been proposed as a marker of nutritional status a...INTRODUCTION: Acute heart failure (AHF) is a leading cause of hospitalization among older adults, associated with high mortality and frequent readmissions. Prealbumin has been proposed as a marker of nutritional status and systemic inflammation, while the PROFUND index stratifies long-term risk in multimorbid patients. However, the combined prognostic utility of both tools in AHF remains poorly defined. OBJECTIVE: To assess the individual and combined prognostic value of prealbumin levels and the PROFUND index in predicting 12-month mortality and hospital readmissions in elderly patients admitted for AHF. METHODS: We conducted a retrospective, observational study using data from the National RICA Registry. Patients aged≥65 years hospitalized for AHF with available prealbumin levels and PROFUND index at admission were included. Associations with 12-month mortality and readmission rates were analyzed using multivariate models, ROC curve analysis, and Kaplan-Meier survival estimates. RESULTS: A total of 609 patients were included (median age 80 years, 61% female). Low prealbumin levels (<18mg/dL) were observed in 51% of patients. One-year mortality was significantly higher in the low prealbumin group (55.8 vs. 38.0%; p<0.001). The PROFUND index showed a progressive association with mortality risk (p<0.001). The combination of low prealbumin and high PROFUND index improved the prediction of all-cause mortality (AUC=0.685), but did not significantly impact readmission risk. CONCLUSIONS: Both prealbumin levels and the PROFUND index independently predict mortality in elderly patients hospitalized for AHF. Their combined assessment may enhance risk stratification, identifying vulnerable subgroups with higher short-term mortality. Their predictive value for hospital readmissions appears limited.
Villalobos-Sánchez L, Garrote-Corral S, Amil Casas I
… +10 more, Briones-Figueroa A, Morán-Alvarez P, García-Fernández A, Carrasco Sayalero Á, Tejada Velarde A, Lorente-Ros Á, Avendaño-Ortiz J, Camino López A, Jiménez Mena M, García-Villanueva MJ
Med Clin (Barc)
· 2026 May · PMID 41833202
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OBJECTIVE: To determine the frequency of criterion and non-criterion antiphospholipid antibody (aPL) titers in young patients with acute coronary syndrome (ACS). METHOD: A descriptive, prospective study with 12 weeks of...OBJECTIVE: To determine the frequency of criterion and non-criterion antiphospholipid antibody (aPL) titers in young patients with acute coronary syndrome (ACS). METHOD: A descriptive, prospective study with 12 weeks of follow-up was conducted in ACS patients under 55 years of age admitted to a tertiary hospital in Spain. The frequency of criterion and non-criterion aPL positivity was described in two determinations: at the time of diagnosis and at 12 weeks. A descriptive analysis of sociodemographic and clinical variables was performed, and the frequency of criterion and non-criterion aPL and antiphospholipid syndrome (APS) was estimated in these patients. RESULTS: A total of 52 patients with ACS were included. aPL positivity was found in 23% of the ACS patients; 3 patients met the Sydney criteria, and none met the new ACR criteria. CONCLUSIONS: Antiphospholipid antibody positivity is common in patients with ACS.