Complejo Hospitalario Torrecárdenas

Cardiac organ damage (OD) is associated with increased risk of cardiovascular disease. However, limited knowledge exists on cardiac OD in young patients with cryptogenic ischaemic stroke (CIS). To explore prevalence and covariates of cardiac OD in patients with CIS compared to controls participating in the SECRETO study. We analysed data from 427 patients with CIS aged <50 years and 361 age- and sex-matched controls. OD was defined as presence of abnormal left ventricular (LV) geometry (LV hypertrophy or concentric remodelling) or left atrial enlargement (LAE) assessed by echocardiography, using sex-specific threshold values. Compared to controls, patients had higher prevalences of obesity and tobacco smoking, patent foramen ovale (PFO) (52% vs. 25%) and abnormal LV geometry (12% vs. 7%, all p < 0.01), while presence of LAE did not differ. In multivariable analyses, CIS was associated with presence of abnormal LV geometry (odds ratio 1.86 [95% confidence interval 1.09-3.20], p=0.024). In separate multivariable analyses in patients only, obesity was associated with both abnormal LV geometry and LAE (both p < 0.01), and higher systolic blood pressure only with presence of abnormal LV geometry (p < 0.001). No significant association with PFO was found. In young patients with CIS participating in the SECRETO study, abnormal LV geometry was more prevalent compared to age- and sex-matched controls and associated with presence of higher blood pressure and obesity. The results point to the importance of blood pressure and weight control in CIS to prevent progression of cardiac OD and recurrent cardiovascular events.

Introduction: The clinical outcome of switching to levodopa-entacapone-carbidopa intestinal gel (LECIG) after failure of subcutaneous foslevodopa/foscarbidopa (fLD/fCD) is unknown. We analyze it in people with Parkinson's disease (PwP) treated in Spain. Methods: Retrospective analysis of PwP who had previously received fLD/fCD but dropped out for different reasons and started before this LECIG in Spain up to 30 November 2025. Non-parametric tests were applied to evaluate the changes between the pre- (Vpre) and post-treatment (Vpost) (LECIG) periods. Results: Data about 14 patients (57.1% males; 66.6 ± 8.6 years old) from 12 hospitals out of a total of 15 who were treated with LECIG were included. The mean time with fLD/fCD was 98.6 ± 92.3 days, with 92.9% and 57.1% experiencing side effects and lack of response, respectively. Specifically, significant subcutaneous nodules were reported in up to 64.3% of the patients. LECIG was a direct switch from fLD/fCD in 35.7% of the patients. LECIG was well tolerated, with only one dropout due to complications related to dementia. Adverse events were reported in 28.6% and 35.7% of the patients in the optimization and final follow-up evaluation (mean follow-up of 233.7 ± 157.4 days) phases, respectively. From Vpre to Vpost, "Off" time was reduced in 2.9 ± 1.9 h (p = 0.002) and motor symptoms burden improved significantly (p = 0.013), whereas a trend of significance was found for non-motor symptoms burden (p = 0.050) and quality of life (p = 0.126). Conclusions: LECIG could be an alternative therapeutic option in PwP who failed fLD/fCD.

This quasi-experimental study assessed the impact of a postpartum educational programme on health care utilization and maternal stress in mothers of infants with colic. A total of 84 mothers took part in 2 individual sessions, 15 days apart. Maternal stress was measured at baseline and again at 3 months using Perceived Stress Questionnaire; colic severity was evaluated with Infant Colic Questionnaire Severity. Analyses included the Wilcoxon test, repeated-measures analysis and Spearman correlation. Maternal stress levels were not significantly related to colic severity, feeding type, childbirth type or the number of paediatric or emergency visits. However, we observed a statistically significant reduction in health care visits for excessive crying during the intervention period (<i>P</i> < .01). Although the programme did not reduce maternal stress directly, mothers rated it highly satisfactory, and it effectively lowered unnecessary health care use. Early postpartum education and support programmes may enhance care quality and optimize health care resource utilization in primary care.Trial Registration: Clinicaltrials.gov NCT03326297.

Background/Objectives: Chronic nonspecific neck pain is a common global health problem that diminishes people's quality of life and functionality. Strengthening and mobility exercises are a fundamental tool in managing this condition. Combined treatment with electrotherapy appears to have promising results; however, the evidence is limited. The aim of this review was to compare the effectiveness of therapeutic exercise combined with electrotherapy versus the McKenzie method alone in improving pain and disability in adults. Methods: A systematic review and meta-analysis of randomized clinical trials was conducted following the PRISMA guidelines. Studies published up to June 2025 were extracted from major scientific databases. High-quality studies evaluating therapeutic exercise with or without electrostimulation and studies evaluating the McKenzie method alone were analyzed, measuring short-term pain and disability through meta-analysis using random-effects models. The risk of bias of the included studies was assessed using the Cochrane Collaboration tool. Results: Seven studies were included (N = 441). The combination of therapeutic exercise with electrotherapy showed a significant reduction in pain (SMD -0.76 [-1.36, -0.16] (p = 0.01; 95% CI)), without additional benefits for disability (SMD -0.94 [-2.08, 0.20] (p = 0.1; 95% CI)) compared to exercise alone. Similarly, the McKenzie method presented statistically significant differences compared to other active interventions in reducing pain (SMD -0.61 [-1.01, -0.21] (p = 0.003; 95% CI)), while no significant differences were found for disability (SMD -0.31 [-1.78, 1.15] (p = 0.67; 95% CI)). Heterogeneity among studies was generally high. The results show short-term effects measured after completion of the intervention. Conclusions: Electrotherapy combined with exercise may provide short-term relief of nonspecific chronic neck pain, although the certainty of evidence is very low. Interferential current plus exercise and isolated McKenzie exercises showed short-term pain improvements, with no consistent benefits for disability. The methodological limitations, heterogeneity, small samples, and short follow-up warrant cautious interpretation. High-quality trials with standardized protocols and longer follow-up are needed.

<title>Abstract</title> Primary gastric T-cell lymphoma is a rare and aggressive neoplasm with nonspecific clinical presentation. We report the case of a 75-year-old patient who presented with upper gastrointestinal bleeding secondary to a gastric mass, with histological analysis confirming a high-grade T-cell lymphoma. This case highlights the importance of considering this entity in the differential diagnosis of hemorrhagic gastric lesions.

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Abstract Background There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of embolic event prevention after a severe bleeding (SB) in anticoagulated patients with atrial fibrillation (AF). Purpose Our main objective was to investigate the frequency of LAAC in anticoagulated AF patients surviving a SB event and to describe the differential features of these patients versus those medically managed in Andalusia (South of Spain). Methods All consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after an intracranial or gastrointestinal severe haemorrhage, who were previously anticoagulated for AF, in all public Andalusian hospitals with LAAC program, and who could be eligible either for LAAC or direct anticoagulant treatment were included in a retrospective, multicentre study. The frequency of a percutaneous LAAC strategy in the follow-up was registered. A comparative analysis of baseline features between those patients treated with LAAC and those medically managed was performed. Results Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study. Median age was 81 years [p25-75, 76-87 years] with 51.6% male patients. A LAAC procedure was performed in 114 patients (8.13%) at a median time of 5 [2-10] months after discharge. After adjusting for confounding variables in a logistic regression model, LAAC closure was independently associated with intracranial hemorrhage (ICH), previous bleeding events, at least moderate valvular disease, leukemia and aspirin use at admission; and was more infrequently performed in patients aged &amp;gt;80 years, with dementia, uncontrolled blood pressure, vitamin K antagonist use at admission and interventional treatment of the bleeding event (Table). Variables with univariate association with LAAC (p&amp;lt;0.10) but excluded in backward stepwise regression after showing no significant independent association were hypercholesterolemia (rate of LAAC 9.5% vs 6.5% in non-hypercholesterolemia, p=0.04), diabetes mellitus (9.6% vs 7.2%, p=0.096), ischemic heart disease (11.9% vs 7.4%, p=0.02), heart failure or left ventricular dysfunction (9.9% vs 7.1%, p=0.06), connective tissue disease (0.0% vs 8.3%, p=0.09), chronic obstructive pulmonary disease (5.3% vs 8.7%, p=0.08), peptic ulcer disease (11.9% vs 7.7%, p=0.09), baseline heart rate (70[64-80] vs 75[66-87] bpm, p=0.003) and platelet count (201[158-244] vs 212[166-269]/nL, p=0.08). Conclusions In anticoagulated patients with AF who survived a SB event in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with DOAC, only 8.13% were managed with a LAAC strategy. Several baseline features were independently associated with higher or lower frequency of this approach.Table