Hospital Nuestra Señora de Alarcos

Infertility is defined as the inability of a sexually active couple, not using contraception, to achieve a spontaneous pregnancy within 12 months. It affects an estimated 8% to 12% of couples worldwide, with 30% to 50% of cases attributable, either primarily or in part, to male factors. Despite the increasing number of assisted reproductive technology (ART) procedures performed globally, improvements in fertilization and pregnancy outcomes have been limited. The need to improve diagnostic accuracy and therapeutic efficiency has driven the development of artificial intelligence (AI) in reproductive medicine. This narrative review aims to explore how AI is transforming the diagnosis and treatment of male infertility. AI technologies are nowadays being used to automate and refine semen analysis, providing more reliable assessments of sperm morphology, motility, and concentration. These innovations enable clinicians to improve the prediction of semen quality and to identify which patients might benefit most from specific interventions, such as sperm retrieval in cases of non-obstructive azoospermia or the selection of optimal sperm cells for reproductive techniques. Moreover, advanced AI algorithms—including support vector machines, deep neural networks, and decision trees—outperform traditional methods, offering greater precision and reducing subjectivity in laboratory evaluations. Additionally, AI is being utilized to estimate the chances of success with assisted reproductive techniques, assess sperm DNA fragmentation, and guide the selection of sperm. The integration of AI into clinical practice not only enables more accessible and personalized diagnoses but also opens new perspectives for the development of individualized treatments, optimizing reproductive outcomes. However, further multicenter validation of AI-based models, methodological standardization, and careful consideration of ethical and privacy issues are necessary before widespread clinical adoption.

Retrospective collection of preoperative and postoperative data for a series of patients undergoing en bloc resection for malignant tumors in the cervical spine. This study aims to share the long-term outcomes of en bloc resections for malignant cervical spine lesions-whether primary or solitary metastatic-from 2 centers, representing one of the largest multicenter series to date. En bloc resection is the mainstay of treatment for resectable malignant vertebral tumors, offering optimal outcomes for disease control and survival. However, in the cervical region, this procedure is challenging due to the proximity of critical structures, especially the vertebral arteries (VAs). Preoperative vertebral angiography and an intraoperative arterial block test can help ensure contralateral VA patency, allowing for safe VA management and favorable outcomes with an acceptable complications risk. Data were retrospectively recorded on patients who underwent total en bloc resection of malignant cervical spine lesions between 2005 and 2021. Each patient received a preoperative vertebral angiogram and intraoperative arterial block testing to confirm bilateral VA patency, allowing for the sacrifice of the affected VA when necessary. Details on the lesion characteristics, surgical approach used, oncological treatment, postoperative complications, and overall disease progression (recurrence or remission) were documented. Eleven patients were operated on and followed for a median of 13 years (range: 4-19). Three patients were treated using a single anterior approach, while 8 required a double approach. All patients achieved tumor-free margins, and all are currently disease-free. Four patients required reintervention due to disease recurrence (n=3) or VA bleeding (n=1). No patients have experienced long-term functional or neurological deficits from the procedure. Total en bloc resection of malignant cervical spine tumors, though technically challenging, is feasible and offers curative potential with manageable surgical risks. Level IV-case series.

Se expone el caso de una mujer de 88 años institucionalizada, con antecedentes cardiovasculares relevantes y multimorbilidad, que ingresa por disnea progresiva secundaria a un derrame pleural masivo izquierdo. El estudio clínico y de imagen descartó tromboembolismo pulmonar y neoplasia, identificando un hemotórax no traumático probablemente relacionado con anticoagulación oral directa. El análisis del líquido pleural reveló un exudado hemático no infeccioso. El manejo incluyó toracocentesis, drenaje pleural, tratamiento diurético y soporte funcional, con mejoría inicial. Durante la hospitalización, la paciente presentó complicaciones asociadas: infección respiratoria por COVID-19, descompensación de insuficiencia cardíaca, anemia microcítica, celulitis en extremidad inferior y episodios de delirio y ánimo depresivo. Estas condiciones se abordaron mediante terapia antiviral, antibióticos, transfusiones, hierro intravenoso, tratamiento neuropsiquiátrico y rehabilitación funcional. La evolución clínica permitió el alta con oxigenoterapia domiciliaria mínima de 15 horas diarias y suspensión definitiva de anticoagulación tras consenso familiar para prevenir recurrencias. Este caso refleja una complicación poco frecuente de la anticoagulación oral de acción directa, la complejidad diagnóstica y terapéutica en pacientes geriátricos frágiles expuestos a anticoagulantes, seguros en el paciente geriátrico, subrayando el balance riesgo-beneficio de la anticoagulación. La identificación precoz de complicaciones, la individualización del tratamiento y la coordinación entre niveles asistenciales son esenciales para optimizar la atención y priorizar la calidad de vida en este perfil de pacientes.

La pancreatitis aguda es una inflamación súbita del páncreas, de etiología multifactorial, con una evolución clínica que puede oscilar entre formas leves autolimitadas y presentaciones graves con fallo multiorgánico. El diagnóstico precoz, una estratificación adecuada de la gravedad y el abordaje terapéutico multidisciplinar son determinantes para reducir su morbimortalidad. Este artículo revisa los aspectos clínicos, fisiopatológicos y terapéuticos de la pancreatitis aguda, con especial énfasis en los cuidados de enfermería, desde una perspectiva actualizada y basada en la evidencia, aplicable al contexto hospitalario español.

Se presenta el caso de un varón de 92 años con antecedentes de degeneración macular bilateral, hipoacusia moderada, trastorno del sueño y enfermedad cardiovascular (HTA, BAV de primer y segundo grado), sin deterioro cognitivo significativo (MEC 28/35). Desde hace aproximadamente un año, el paciente refiere percepciones visuales de pequeños animales (“bichos”) que asocia con palomas o gallinas, así como sensaciones táctiles compatibles con formicación. Estas percepciones son interpretadas como infestación corporal, llegando a relacionarlas con la ingesta alimentaria o vía nasal. No se evidencian lesiones dérmicas ni signos objetivos de infestación. El uso de insecticida ha sido reforzador de la convicción delirante. La sintomatología se presenta en el contexto de pérdida visual severa, sin evidencia de psicosis activa ni trastorno del ánimo mayor, aunque se detecta componente afectivo reactivo vinculado al duelo prolongado por fallecimiento de su esposa. Se han considerado dos entidades clínicas como principales diagnósticos diferenciales: el síndrome de Charles Bonnet (alucinaciones visuales complejas secundarias a déficit visual, sin ideación delirante estructurada)1 y el síndrome de Ekbom o delirio de parasitosis (trastorno delirante somático caracterizado por creencia firme de infestación, frecuentemente acompañado de alucinaciones táctiles)2. Dado el contenido delirante persistente, la falta de crítica y la asociación con conductas compensatorias (uso de insecticida), el cuadro clínico se orienta hacia un síndrome de Ekbom con posible base sensorial y afectiva. Se recomienda intervención interdisciplinar con Psiquiatría para valorar inicio de tratamiento antipsicótico a dosis ajustadas a edad y comorbilidad, revisión de tratamiento psicotrópico (trazodona, zolpidem) y activación de redes de apoyo social. Este caso ilustra la complejidad diagnóstica de los trastornos perceptivos en el adulto mayor, así como la interacción entre déficits sensoriales, factores afectivos y creencias delirantes en el contexto geriátrico5.

El edema agudo de pulmón (EAP) es una emergencia médica grave que se define como el cuadro clínico secundario a una insuficiencia aguda del ventrículo izquierdo, provocando un aumento de la presión capilar pulmonar y la extravasación de líquido hacia los alvéolos y el intersticio pulmonar. Su etiología principal es la disfunción cardíaca, aunque también puede ser no cardiogénico. La sintomatología se caracteriza por disnea extrema, agitación, taquicardia y estertores pulmonares. El diagnóstico se basa en la evaluación clínica, la radiografía de tórax, la medición de biomarcadores como el BNP y pruebas complementarias. El tratamiento es urgente y se centra en la estabilización del paciente mediante oxigenoterapia, diuréticos, vasodilatadores y, si es necesario, asistencia ventilatoria. El papel de la enfermería es fundamental en la monitorización, la administración de tratamientos y la educación del paciente para prevenir futuras descompensaciones.

Backgroundthis study aims to assess the real-world efficacy and safety of one shot of intraarticular (IA) hyaluronic acid (HA) in patients with advanced knee osteoarthritis (OA), in accordance with the requirement of the new EU Regulation on medical devices to monitor the safety and efficacy of throughout their life cycle.Methodsobservational, cross-sectional and retrospective study in a cohort of patients with advanced knee OA treated in a Pain Unit with a single injection of IA HA between January 2021 and December 2022. Efficacy was assessed at 6 months using the Visual Analogue Scale (VAS) for pain, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness and function. The Research Ethics Committee of the Autonomous Community of Aragon (CEICA) approved the study. Patient’s data were pseudonymized.Resultsthe study included a cohort of 30 patients (mean age 73.1, 63.3% female, 66.7% retired). At 6 months, patients showed 51.3% and 52.2% reduction in pain (VAS and WOMAC, respectively), 44.9% improvement in function and 60% improvement in stiffness. In addition, 83.3% of patients showed improvement ≥ 20% according to VAS and 80% of patients according to total WOMAC. No adverse events were informed.Conclusionthe results support the use of IA HA as an effective and safe treatment for advanced knee OA, providing significant improvements in pain, stiffness, and function over six months. Future research should include larger populations.

D. Alonso Castronuño, S. Romero Rodríguez, M. J. Terol Castera, and N. C. Gutiérrez equally contributing author. Background: Central nervous system (CNS) infiltration by diffuse large B-cell lymphoma (DLBCL), whether primary (PCNSL) or secondary (SCNSL), is associated with poor prognosis. Bruton’s tyrosine kinase inhibitors (BTKi) have demonstrated efficacy in lymphomas with B-cell receptor and Toll-like receptor signaling alterations pathways, such as lymphomas of immune-privileged sites, including PCNSL. Aims: To assess the real-world efficacy and safety of BTKi in patients with PCNSL and SCNSL. Desing: We conducted a retrospective, observational, multicenter study within the Spanish Lymphoma Group (GELTAMO). Patients diagnosed with PCNSL or SCNSL with DLBCL histology who received BTKi for the treatment of CNS infiltration were included. Prognostic factors and survival were analyzed using Chi-square and Kaplan-Meier models. Results: A total of 65 patients were analyzed. The median age was 60 (range 27–81) years. The diagnosis of PCNSL was more frequent (43/65, 66%) than that of SCNSL (22/65, 34%). Most cases (86%) exhibited a non-germinal center B-cell phenotype (non-GC-Ph). All GC-Ph were SCNSL. Population characteristics are summarized in Table 1. The overall and complete response rates were 54% and 24%, respectively. The diagnosis of PCNSL, a non-GC-Ph, MYD88 mutations and ECOG < 2 were associated with higher response rates (p < 0.05). After a median follow-up for surviving patients of 30 (3 to 93) months, the median progression-free survival (PFS) after BTKi was 3 months and PFS at 2-years was 26%. Median PFS was significantly longer for patients diagnosed with PCNSL compared to those diagnosed with SCNSL (7 vs. 2 months, p = 0.003), and for non-GC-Ph compared to CG-Ph (3 vs. 1 months (p = 0.001). At the time of the last follow-up, 66% of patients had died, 84% due to disease progression. The median overall survival (OS) was 6 months, and OS at 2-years was 36%. Median OS was higher in patients with PCNSL compared to those with SCNSL diagnosis (8 vs. 5 months, p = 0.017), and in patients with non-GC-Ph (6 vs. 1 month, p < 0.001), with normal LDH at the onset of BTKi (8 vs. 2 months, p = 0.009) and with ECOG < 2 at the onset of BTKi (not-reached vs. 6 months, p = 0.002) compared to the opposite alternative. Consolidation therapy (Table 1) after BTKi was associated with longer OS at 5-years with respect to patients without consolidation therapy (90% vs. 16%, p < 0.001). Half of the patients experienced BTKi-related toxicity (Table 1), requiring discontinuation in 22% of cases. The rate of febrile neutropenia was 9% and 12% of patients died due to infection. No fungal infections were reported. Less than 10% of patients presented cardiovascular toxicity. Conclusions: BTKi were effective in treating DLBCL involving CNS, particularly in PCNSL. Ibrutinib yielded a significant response in many patients; however, these responses were not durable. Consolidation treatment following ibrutinib significantly improved outcomes. Safety profile was as expected for this population. Keywords: aggressive B-cell non-Hodgkin lymphoma; molecular targeted therapies; extranodal non-Hodgkin lymphoma No potential sources of conflict of interest.

Chronic lymphocytic leukemia (CLL) is a clinically and genetically heterogenous disease. Recent next-generation sequencing (NGS) studies have uncovered numerous low-frequency mutated genes in CLL patients, with SAMHD1 emerging as a candidate driver gene. However, the biological and clinical implications of SAMHD1 mutations remain unclear. Using CRISPR/Cas9, we generated CLL models to investigate the impact of SAMHD1 deficiency on pathogenesis and explore therapeutic strategies. Moreover, we performed NGS in treatment-naïve CLL patients to characterize SAMHD1 mutations and employed RNA-sequencing to evaluate their clinical significance. Our study shows that SAMHD1 inactivation impairs the DNA damage response by reducing homologous recombination efficiency through BRCA1 and RAD51 dysregulation. Importantly, SAMHD1 colocalizes with BRCA1 at DNA damage sites in CLL cells. This research also identifies that SAMHD1-mutated cells are more sensitive to PARP inhibition. Clinically, SAMHD1 dysfunction negatively impacts clinical outcome of CLL cases: SAMHD1 mutations reduce failure-free survival (median 46 vs 57 months, p = 0.033), while low SAMHD1 expression associates with shorter time to first treatment (median 47 vs 77 months; p = 0.00073). Overall, this study elucidates that SAMHD1 dysfunction compromises DNA damage response mechanisms, potentially contributing to unfavorable clinical outcomes in CLL, and proposes PARP-inhibitors as a potential therapeutic approach for SAMHD1-mutated CLL cells.