Domingez-Riscart J, García-Zarzuela A, Romero-Sayago B
… +3 more, Ruiz-Ramos S, Lara-Barea A, Mateo-Gavira I
Med Clin (Barc)
· 2026 Mar · PMID 41643344
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INTRODUCTION: Transgender people show incongruence between the sex assigned at birth and the gender they identify with. Puberty generates hormonal changes that induce physical changes, with the development of secondary s...INTRODUCTION: Transgender people show incongruence between the sex assigned at birth and the gender they identify with. Puberty generates hormonal changes that induce physical changes, with the development of secondary sexual character, which cause great discomfort in the transgender individual. It is also a vital time when there is an increase in the rate of growth. The drug GnRHa stops puberty, slowing down the changes in the body and allowing the adolescent time to consider their gender identity. However, an expected side effect of these drugs is that growth velocity is affected. OBJECTIVE: To determine the growth velocity of adolescents and transgender children undergoing pubertal blocking therapies. MATERIAL AND METHODS: We conducted a longitudinal study using anthropometric and laboratory measurements every 6months, collected 1year before and 2years after blockade, to assess whether growth velocity and height are affected by pubertal blockade. The comparison was made using the standard deviations of the variables according to age, using the Wilcoxon signed-rank test in paired groups and the U-Mann Whitney test in independent groups. To obtain the data, we reviewed the medical records of the participants in our study. RESULTS: Fifty-five transgender adolescents initiating pubertal blocking with a median age of 11.8years are studied. It is observed that height measured in standard deviations (SD) and growth velocity, measured in centimetres and SD, decrease in accordance with increasing time in pubertal block. When comparing transgender boys and girls, transgender girls show a greater decrease in height SD. These differences are statistically significant for pre-blocking, 6 and 12months of BP therapy (P=.036, P=.005 and P=.042 respectively). In addition, it was also observed that growth velocity was more affected in trans girls than in boys, although these differences were not statistically significant. CONCLUSIONS: Height and growth velocity are decreased when puberty is blocked. This decrease is more striking in transgender girls than in transgender boys.
González-Cristóbal IR, Ferrera C, Carnero-Alcázar M
… +14 more, Carrero A, Del Toro E, Álvarez E, Alonso C, Ares TA, Viana-Tejedor A, Martínez I, Bustos A, Beltrao R, Noriega FJ, Tirado G, Cobiella J, Maroto L, Vilacosta I
Med Clin (Barc)
· 2026 Mar · PMID 41616510
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BACKGROUND AND OBJECTIVES: Type A-acute aortic syndrome (AAS-A) is associated with a high morbidity and mortality. The management of elderly patients with AAS-A is challenging. The aim of this study was to evaluate the c...BACKGROUND AND OBJECTIVES: Type A-acute aortic syndrome (AAS-A) is associated with a high morbidity and mortality. The management of elderly patients with AAS-A is challenging. The aim of this study was to evaluate the current prognosis of elderly patients with AAS-A, and to analyze the impact of surgery on a healthcare network. METHODS: Patients with AAS-A were prospectively and consecutively collected from 2019 to 2024 in a four-hospital network "Aorta Code" with a tertiary care referral centre for cardiac surgery. Patients were classified according to age into two groups: ≥75-year-old and under 75-year-old. Clinical, diagnostic, treatment and prognostic variables were analyzed. Primary outcomes included 30-day mortality, time from symptoms to diagnosis and time from diagnosis to surgery. RESULTS: A total of 102 patients were included. Of these, 36 were ≥75-year-old. Most patients (90%) had classical aortic dissection. The length of the aortic injury was shorter in the elder group. Older patients had more comorbidities, most were frail and mildly dependent, and took longer to be diagnosed. Complications at the time of diagnosis and time from diagnosis to surgery were similar in both groups. Preoperative mortality risk was higher in elderly patients and surgery was less extensive on them. Surgery was associated with a mortality reduction in both groups. CONCLUSIONS: Elderly patients with AAS-A have more comorbidities, are diagnosed later and have higher mortality than younger patients. Yet, in a dedicated healthcare network, surgery is associated with a reduction in mortality even in the older population.
Segura Grau A, Martín-Borregón Bendito P, Segura Grau E
Med Clin (Barc)
· 2026 Mar · PMID 41616509
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Intra-abdominal infection is a potentially serious condition that requires early and accurate diagnosis. Point-of-care ultrasound (POCUS) has emerged as a key diagnostic tool due to its safety, availability, low cost, an...Intra-abdominal infection is a potentially serious condition that requires early and accurate diagnosis. Point-of-care ultrasound (POCUS) has emerged as a key diagnostic tool due to its safety, availability, low cost, and bedside applicability. It offers several advantages over other imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), although its diagnostic performance strongly depends on the operator's expertise. Ultrasound is particularly useful in diagnosing common conditions such as appendicitis, cholecystitis, cholangitis, liver abscesses, pyelonephritis, and complicated renal colic. In each of these scenarios, POCUS enables rapid assessment, guides therapeutic decisions, and may reduce complications, radiation exposure, and time to diagnosis. Multiple studies support its diagnostic reliability, reporting high sensitivity and specificity when performed by trained professionals. Despite its technical limitations, POCUS plays a fundamental role in emergency settings and in contexts with limited access to advanced imaging.
Med Clin (Barc)
· 2026 Mar · PMID 41616508
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Retained foci of infection can represent an additional risk for patients, as they may not respond to antibiotics and require specific procedures to control the focus. This manuscript provides a practical approach to perf...Retained foci of infection can represent an additional risk for patients, as they may not respond to antibiotics and require specific procedures to control the focus. This manuscript provides a practical approach to performing ultrasound-guided interventional procedures to recognise and drain infectious collections. The review details the main indications, technical steps, safety tips and clinical applications for five critical procedures: thoracentesis and chest drainage, paracentesis, arthrocentesis, pericardiocentesis and drainage of intra-abdominal abscesses (hepatic, splenic and renal). Ultrasound guidance offers several advantages, such as increased safety, precision and success rates by reducing complications such as pneumothorax, haemorrhage and organ damage, as well as improving diagnostic accuracy. By outlining evidence-based techniques, we also aimed to discuss the best techniques to provide safer and more effective care in the context of the infected patient.
Gastroesophageal reflux disease (GERD) is a chronic disorder affecting a significant proportion of the global population, characterized by heartburn and regurgitation, and potentially associated with serious complication...Gastroesophageal reflux disease (GERD) is a chronic disorder affecting a significant proportion of the global population, characterized by heartburn and regurgitation, and potentially associated with serious complications such as esophagitis, Barrett's esophagus, and adenocarcinoma. Its multifactorial pathophysiology includes alterations in the lower esophageal sphincter, motility, or visceral sensitivity. Diagnosis is based on a combination of clinical criteria and complementary tests such as endoscopy, pH monitoring, and impedance testing. Management includes non-pharmacological strategies like lifestyle and dietary changes, along with pharmacological therapy, with proton pump inhibitors being the cornerstone of treatment. Newer options, such as potassium-competitive acid blockers (vonoprazan), have shown promising benefits in refractory cases. This article synthesizes the most updated evidence on GERD, providing a comprehensive overview of its pathophysiology, diagnosis, and therapeutic options.
Med Clin (Barc)
· 2026 Feb · PMID 41604869
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Infectious diseases remain a leading cause of pediatric consultations despite significant advances in their prevention and treatment. Clinical ultrasound has emerged as a valuable diagnostic tool in the pediatric setting...Infectious diseases remain a leading cause of pediatric consultations despite significant advances in their prevention and treatment. Clinical ultrasound has emerged as a valuable diagnostic tool in the pediatric setting due to its non-ionizing nature, the absence of need for sedation, its feasibility at the point of care, and its safety, reproducibility, and current availability. In this article, we review pediatric infectious conditions in which clinical ultrasound contributes significantly to diagnosis, follow-up, and clinical decision-making. This is a narrative review based on both the available evidence and clinical experience regarding the role of ultrasound in pediatric infectious pathology. Ultrasound is useful in the vast majority of pediatric infectious diseases, including respiratory infections (pneumonia, bronchiolitis), cutaneous and musculoskeletal infections (cellulitis, myositis, abscesses, osteomyelitis, arthritis), abdominal infections (appendicitis, mesenteric adenitis, intra-abdominal abscesses), urinary tract infections (pyelonephritis, renal abscess), cervical infections (adenitis, deep neck abscesses, parotitis), and genital infections (epididymitis, orchitis, scrotal abscesses). It allows the identification of characteristic findings in each condition, with good clinical and radiological correlation. Ultrasound also aids in drainage procedures, helps avoid unnecessary invasive interventions, and facilitates the monitoring of patient progress. Point-of-care ultrasound (POCUS) has become a key tool in the diagnosis, management, and follow-up of pediatric infections.
Reyes-Alvarez MT, Chávez Miñano V, Garro-Barrera B
… +1 more, Alvarez-Villalobos N
Med Clin (Barc)
· 2026 Mar · PMID 41604864
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BACKGROUND AND OBJECTIVE: Chronic low back pain is one of the leading causes of disability. Current therapies offer limited efficacy and carry potential adverse risks. Vitamins B1, B6, and B12 have shown promise in the a...BACKGROUND AND OBJECTIVE: Chronic low back pain is one of the leading causes of disability. Current therapies offer limited efficacy and carry potential adverse risks. Vitamins B1, B6, and B12 have shown promise in the amelioration of musculoskeletal pain. The aim of this study was to evaluate the efficacy and safety of a combined injectable formulation of hydroxocobalamin (B12), thiamine hydrochloride (B1), and pyridoxine hydrochloride (B6) (TPH) as an adjunct treatment for chronic low back pain. METHODS: a randomized, double-blind, phase 3 clinical trial was conducted across six centers in Peru. A total of 163 patients with chronic mechanical lower back pain were included and assigned to receive TPH plus NSAIDs (n=81) or placebo plus NSAIDs (n=82). The primary outcome was the proportion of patients achieving ≥30% reduction in the NRS-11 score by day 28. Analyses were performed using an intention-to-treat approach and models adjusted for covariates. RESULTS: In the treatment group, 84% of participants achieved ≥30% reduction in the NRS-11 score compared to 64% in the control group (RR=1,31; 95% CI: 1,08-1,59; p=0,007). This effect remained significant after adjusting for BMI and albumin. Improvements were also observed in the Patient Global Assessment (PGA) and a favorable trend in the Oswestry Disability Index. The incidence of adverse events was higher in the treatment group, but no significant differences in serious events were found. CONCLUSION: TPH as an adjunct to standard treatment was effective in reducing chronic low back pain and demonstrated an acceptable safety profile.
de la Calle-Prieto F, Martínez-Martín P, Henríquez-Camacho C
Med Clin (Barc)
· 2026 Mar · PMID 41604863
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Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in tropical medicine, particularly in settings with limited access to advanced imaging. Its portability, non-invasiveness, and abi...Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in tropical medicine, particularly in settings with limited access to advanced imaging. Its portability, non-invasiveness, and ability to provide real-time information make it especially valuable for evaluating infectious diseases endemic to tropical and subtropical regions. In conditions such as malaria, visceral and cutaneous leishmaniasis, and Chagas disease, POCUS can aid in the detection of complications including hepatosplenomegaly, effusions, cardiac involvement, and raised intracranial pressure. It also aids in the assessment of cutaneous parasitic infections and secondary bacterial complications. Beyond diagnosis, ultrasound has demonstrated utility in monitoring treatment response and identifying patients at higher risk of adverse outcomes. This review summarizes the most relevant ultrasonographic findings across major tropical infections, offering a practical approach for clinicians working in endemic areas. As an extension of the physical examination, POCUS enhances clinical decision-making and represents a feasible, impactful tool in resource-limited settings.
Quirant-Sánchez B, Herraiz Ruiz A, Plans Galván O
… +7 more, Roig Pineda R, Catalán Eraso B, Mota Montané D, Lucas Varas E, Martínez Gonzalez M, Martínez Cáceres EM, Arméstar Rodríguez F
Med Clin (Barc)
· 2026 Mar · PMID 41604860
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BACKGROUND: The critically ill patient has unique characteristics that make him part of a very delimited group of patients. One example is the transient immunosuppression that appears during their stay at ICU. One of the...BACKGROUND: The critically ill patient has unique characteristics that make him part of a very delimited group of patients. One example is the transient immunosuppression that appears during their stay at ICU. One of the parameters in which this alteration is observed is the membrane expression of HLA-DR on monocytes (HLA-DR). The aim of this study was to establish the factors associated with the low expression of HLA-DR, as measured by the percentage of monocytes expressing HLA-DR (% HLA-DR) and the quantification of HLA-DR molecules per monocyte (MFI HLA-DR). METHODS: The study included 84 critically ill patients without infection at admission and without previous pathology conditioning immunosuppression. To assess severity and inflammation, we used the APACHE II and CRP variables, respectively, quantified at the time of admission. RESULTS: We found that the higher the APACHE II and CRP values, the lower the % HLA-DR and MFI HLA-DR values. In the analysis of the robust linear regression between APACHE II and % HLA-DR, a coefficient of -0.588 was obtained, with an R of 0.0965 and p<0.05. The robust linear regression between APACHE II and MFI HLA-DR obtained a coefficient of -40.5, with an R of 0.0679 and p<0.05. In the analysis of the CRP value and % HLA-DR, a coefficient of -0.06092 was obtained, with an R: 0.285 and p<0.05. CONCLUSION: The degree of immunosuppression is related to systemic inflammation and the severity of the patient.
Galiano Blancart RF, Vidal Mogort L, Quesada Simó A
… +4 more, Sanchis Llopis CM, Domínguez Sanz F, Ferrer Casanova JM, Landete Pascual L
Med Clin (Barc)
· 2026 Mar · PMID 41604858
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INTRODUCTION: Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. Stroke risk analysis (SRA) is an ECG monitoring system...INTRODUCTION: Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. Stroke risk analysis (SRA) is an ECG monitoring system that allows the detection of AF and identifies patterns with high or low risk of suffering paroxysmal AF. The objective of this study is to analyze the usefulness of SRA routine clinical practice for the search for AF in patients after cerebral ischemia. METHODS: We conducted a single-center retrospective study that includes patients with transient ischemic attack (TIA) or recent ischemic stroke in whom the search for AF was initially negative. Vascular risk factors were recorded together with the clinical and neuroimaging characteristics of stroke. The presence of AF in the low- and high-risk groups was reassessed over a one-year follow-up period. RESULTS: We enrolled 708 patients (58% male, median age 73,0, IQR 62,0-82,0) among whom 576 suffered a stroke (81%) and 132 (19%) a TIA. The registry indicated a low risk of AF in 537 (76%), while 171 (24%) displayed an elevated risk. One year later, follow-up was conducted on 693 patients, revealing that 32 individuals had developed AF, accounting for 5.1% of the total cohort; 23/171 (13%) of patients classified as high risk versus 9/537 (1,7%) of those classified as low risk. Patients diagnosed with AF were older, had a higher frequency of Embolic Stroke of Undetermined Source (ESUS), greater left auricular dilation, and a risk of AF development based on SRA findings. This group also suffered more strokes during the year of follow-up. CONCLUSIONS: In routine clinical practice, the Holter-SRA emerges as a valuable instrument that, combined with other clinical data and complementary tests, can help prioritize the search for paroxysmal AF following cerebral ischemic events.