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Volume 1, Issue 1

Version-of-Record articles in Volume 1, Issue 1, published continuously.

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Volume 1, Issue 1

Version-of-Record articles added continuously as they are published.

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Articles
9
Year
2026
Specialties
8
Article types
4
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Showing 9 of 9 published articles.

Original ArticleEmergency Medicine

Mountain Rescue Activity and Limitations of Accidental Hypothermia Surveillance in Spain: A Descriptive Analysis of Guardia Civil Data, 2018–2021

Guillermo Muñoz, Guillem Serra, Jesús Ceballos

Accidental hypothermia is a potentially life-threatening complication of cold exposure in mountain and wilderness environments. Reliable surveillance requires clinically specific field data, but administrative rescue datasets may group hypothermia with other medical problems. To describe mountain-rescue activity recorded by the Spanish Guardia Civil Mountain Service from 2018 through 2021 and assess whether publicly available administrative data can support estimation of accidental-hypothermia prevalence, severity, or clinical impact. We performed a retrospective descriptive secondary analysis of aggregate data from the Statistical Yearbooks of the Spanish Ministry of the Interior. Annual intervention totals were extracted for 2018–2021. Detailed 2021 data were summarized using separate denominators for rescue interventions and rescued persons, including activity, accident type, mountain massif, age, sex, and rescue status. Because the public data contain no hypothermia-specific count, core-temperature field, clinical stage, treatment data, or patient-level linkage, no hypothermia prevalence estimate or causal analysis was attempted. Across 2018–2021, 3,780 mountain-rescue interventions were recorded: 974 in 2018, 981 in 2019, 790 in 2020, and 1,035 in 2021. Interventions decreased by 19.5% from 2019 to 2020 and increased by 31.0% from 2020 to 2021. In 2021, 1,489 rescued persons were reported across 1,035 interventions; 102 were recorded as deceased, 654 as injured, and 733 as uninjured at rescue reporting. Men represented 62.9% of rescued persons, and the largest age group was 19–30 years (22.4%). Hiking accounted for 552/1,035 interventions (53.3%), the Aragonese Pyrenees for 402/1,035 (38.8%), and same-level trips/falls for 302/1,035 (29.2%). A broad “physical problems” category accounted for 127/1,035 interventions (12.3%) and included severe hypothermia together with other medical conditions; hypothermia-specific frequency could not be isolated. Guardia Civil data provide a useful description of mountain-rescue workload but do not support estimation of accidental-hypothermia prevalence, severity, or outcome. Future surveillance should separately record suspected or confirmed hypothermia, core temperature and measurement method, clinical severity, exposure context, treatment, and outcome using harmonized definitions across rescue services.

Emergency Medicine
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Original ArticleObstetrics & Gynecology

Clinical Characteristics and Maternal and Fetal-Neonatal Complications Among Patients With HELLP Syndrome: A Retrospective Single-Center Study

José Ángel Colmenarez Cordero, Marisjua Francyl Figueroa Ledezma, María Alejandra Gutiérrez Pérez

HELLP syndrome—hemolysis, elevated liver enzymes, and low platelet count—is a severe pregnancy complication associated with substantial maternal and perinatal morbidity. Published data from Venezuela remain limited, and historical hospital cohorts can provide useful descriptive information when their methodological limitations are explicitly recognized. To describe demographic and obstetric characteristics, clinical and laboratory features, and maternal and fetal-neonatal complications among patients with a chart-documented diagnosis of HELLP syndrome at a high-risk maternity service in Venezuela. We performed a retrospective, descriptive, single-center medical-record review of 106 patients treated at the Maternidad de Alto Riesgo Hugo Chávez, Ciudad Hospitalaria Dr. Enrique Tejera, Valencia, Venezuela, from May 2019 through May 2020. Eligible records had a chart-documented diagnosis of HELLP syndrome and available laboratory studies. Analyses were descriptive, and exact binomial 95% confidence intervals were calculated post hoc for key complication and mortality proportions. Among 106 patients, 74 (69.8%) were recorded in the preterm gestational-age category. Headache was documented in 76 (71.7%), nausea in 54 (50.9%), and epigastric pain in 45 (42.5%). Hemolysis was recorded in 74 (69.8%), elevated liver enzymes in 105 (99.1%), and thrombocytopenia in 79 (74.5%). At least one maternal complication occurred in 53 patients (50.0%; 95% CI, 40.1%–59.9%), while at least one fetal-neonatal complication occurred in 83 pregnancies (78.3%; 95% CI, 69.2%–85.7%). No maternal deaths were reported, and five fetal deaths were recorded. This historical single-center series demonstrates a substantial burden of maternal and fetal-neonatal complications among patients with a chart-documented HELLP diagnosis. Because the study lacked a comparator group, uniform patient-level diagnostic adjudication, and patient-level data for reanalysis, the findings should be interpreted as descriptive regional evidence rather than as estimates of causal associations or independent risk factors.

Obstetrics & Gynecology
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Review ArticleRheumatology

Investigating the Diagnosis, Management, and Emerging Therapeutic Advances in Osteoarthritis: A Narrative Review

Syeda Alizay Fatima

Osteoarthritis (OA) is a degenerative joint disease and a major cause of chronic pain and disability worldwide, particularly among older adults. It is characterized by progressive articular cartilage degeneration and structural and biochemical changes in subchondral bone, synovium, ligaments, and periarticular muscles. OA is not simply a mechanical “wear-and-tear” disorder; it is now recognized as a multifactorial disease involving mechanical, genetic, metabolic, and low-grade inflammatory processes. Diagnosis is largely clinical and may be supported by imaging findings such as joint-space narrowing, osteophyte formation, and subchondral sclerosis, while laboratory testing is generally used to exclude inflammatory, infectious, or metabolic arthritides. Management is stepwise: non-pharmacological measures, including exercise and weight loss when appropriate, are foundational; pharmacological therapy may then be added, with topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) commonly used and opioids generally discouraged except in selected circumstances. Intra-articular corticosteroid injections may provide short-term symptom relief, and total joint replacement remains the most effective treatment for appropriately selected patients with end-stage disease. Emerging approaches, including platelet-rich plasma, mesenchymal stem-cell therapies, targeted molecular agents, and disease-modifying osteoarthritis drugs, remain investigational because evidence is inconsistent and disease modification has not been established. This narrative review summarizes current diagnostic approaches, established management strategies, and emerging therapeutic developments in OA, emphasizing the continued need for reliable biomarkers and effective disease-modifying therapies.

Rheumatology
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Original ArticleAnesthesiology

24-Hour Analgesic Outcomes After Ultrasound-Guided Bilateral Superficial Cervical Plexus Block With Perineural Dexamethasone for Thyroid Surgery: A Prospective Single-Center Case Series

Rachell Machado

Bilateral superficial cervical plexus block (BSCPB) is used within multimodal analgesia for thyroid surgery, and dexamethasone has been studied as an adjunct intended to prolong block-related analgesia. Because this study had no comparator group, its findings are interpreted as descriptive outcomes of a combined anesthetic and regional-analgesia protocol rather than as evidence of dexamethasone efficacy. To describe 24-hour postoperative pain, rescue-analgesic requirements, and reported block-related complications in adults undergoing thyroid surgery who received ultrasound-guided BSCPB with bupivacaine and perineural dexamethasone. This prospective single-center case series included 12 adults from a source population of 21 patients scheduled for thyroid surgery at Hospital Ana Francisca Pérez de León II between January and June 2025. All underwent general anesthesia followed by ultrasound-guided bilateral superficial cervical plexus block using a 10-mL preparation containing bupivacaine 25 mg (final concentration 0.25%) and dexamethasone 4 mg; the source thesis did not specify the exact volume injected per side. Pain was assessed on a 0–10 numerical rating scale at 30 minutes, 2 hours, 12 hours, and 24 hours. Protocol-defined analgesic failure was a score ≥4 at a scheduled assessment or a patient request for rescue medication; ketorolac 30 mg sublingually was the rescue regimen. All 12 patients were ASA physical status II. At 30 minutes and 2 hours, 1 patient (8.3%) reported no pain and 11 (91.7%) reported mild pain (scores 1–3). At 12 and 24 hours, all 12 patients (100%) had mild pain; no moderate or severe pain was reported at any scheduled assessment. No patient met the predefined failure criterion or required rescue analgesia (12/12; post hoc exact 95% CI, 73.5%–100%). No block-related complication was reported in the aggregated source results (0/12; post hoc exact 95% CI, 0%–26.5%). Favorable 24-hour pain and rescue-analgesia outcomes were observed after the combined general-anesthesia and BSCPB protocol. The small single-arm sample, systemic analgesic cointerventions, incomplete reporting of several planned outcomes, and absence of a comparator prevent causal attribution to perineural dexamethasone or definitive conclusions regarding safety.

Anesthesiology
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Original ArticleAnesthesiology

Intravenous Dexmedetomidine as an Adjunct to Spinal Anesthesia for Lower-Extremity Orthopedic Surgery: A Randomized Controlled Study

Alfonso Gutierrez

Intravenous dexmedetomidine may prolong spinal anesthesia but can reduce heart rate and blood pressure. This study evaluated its effect on sensory and motor block characteristics and perioperative hemodynamics during lower-extremity orthopedic surgery. In this single-center randomized controlled study, 25 adults with American Society of Anesthesiologists physical status I-II undergoing lower-extremity surgery under spinal anesthesia were allocated by sealed-envelope selection to dexmedetomidine (Group D; n=12) or saline control (Group C; n=13). All patients received 10 mg intrathecal isobaric bupivacaine. Group D received intravenous dexmedetomidine 1 µg/kg over 10 minutes followed by 0.2 µg/kg/h; Group C received volume-matched 0.9% saline. Sensory block was assessed by pinprick, motor block by the Bromage scale, and heart rate and blood pressure at prespecified perioperative time points. Between-group comparisons used the Mann-Whitney U test. Median sensory block onset was 1.0 versus 1.2 minutes (p=0.040) and motor block onset was 2.0 versus 2.5 minutes (p=0.025) in Groups D and C, respectively. Sensory block duration was 125 versus 85 minutes (p<0.001), and motor block duration was 102.5 versus 65 minutes (p=0.002). Heart rate was lower in Group D after the spinal technique and at 15 minutes, 40 minutes, the end of infusion, and 40 minutes after infusion (all p<0.05). Between-group blood pressure differences did not meet the prespecified p<0.05 threshold. No severe hemodynamic events were reported in the source study. Intravenous dexmedetomidine was associated with longer sensory and motor block duration and modestly faster block onset, but also with lower perioperative heart rate. Given the small sample, absence of reported blinding, and multiple time-point comparisons, these findings should be confirmed in larger, prospectively registered trials.

Anesthesiology
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Original ArticleNeurosurgery

Modified Fisher Scale Distribution and In-Hospital Outcomes in Moderate and Severe Traumatic Brain Injury With Traumatic Subarachnoid Hemorrhage: A Retrospective Single-Center Study

Laura Perez Zabala, Helyhanna Paez, Luisciamni Molina et al.

Traumatic subarachnoid hemorrhage (tSAH) is a frequent imaging finding after traumatic brain injury (TBI) and has been associated with adverse clinical outcomes. The modified Fisher (mFisher) scale was developed for nontraumatic subarachnoid hemorrhage, and its descriptive distribution in patients with tSAH may help characterize radiographic injury burden. To describe the distribution of mFisher grades and in-hospital outcomes among patients with moderate and severe TBI and tSAH treated at a tertiary neurosurgical service. We conducted a retrospective, descriptive, single-center review of medical records from the Neurosurgery Service of Hospital Central de Maracay between 2015 and 2017. Of 205 records reviewed, 100 patients with documented moderate or severe TBI and tSAH comprised the analytic cohort. Demographic, clinical, imaging, treatment, and discharge-status variables were summarized using descriptive statistics. No inferential hypothesis testing or multivariable prognostic modeling was performed. Seventy-one patients had moderate TBI and 29 had severe TBI. The cohort was 87% male, with a mean age of 37.66 years. Overall mFisher grades were I in 48%, II in 13%, III in 34%, and IV in 5%. In the moderate-TBI group, grade I was most frequent (52.1%), whereas grade III was most frequent in the severe-TBI group (41.3%). Overall, 58% of patients were discharged alive and 42% died during hospitalization. Mortality was 26.8% among patients with moderate TBI and 79.3% among those with severe TBI. The Marshall CT classification was not documented in 60% of records. In this retrospective cohort, higher mFisher grades were proportionally more common among patients with severe TBI than among those with moderate TBI, and in-hospital mortality was substantially higher in the severe-TBI group. Because the analysis was descriptive and did not adjust for injury severity or other confounders, these findings should not be interpreted as demonstrating independent prognostic performance of the mFisher scale. Further studies using prespecified inferential and multivariable methods are needed to evaluate its prognostic utility in tSAH.

Neurosurgery
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Review ArticlePulmonology

Pulmonary Carcinoid Tumors as an Asthma Mimic: Diagnostic Challenges, Clinical Presentation, and Management Strategies

Syeda Alizay Fatima

Asthma is a common chronic respiratory disease; however, some patients continue to have symptoms despite appropriate guideline-directed therapy. Pulmonary carcinoids are rare, well-differentiated neuroendocrine neoplasms that may cause cough, wheeze, dyspnea, hemoptysis, and recurrent infection through focal airway obstruction, thereby mimicking asthma. This review summarizes the pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, and management of pulmonary carcinoid tumors presenting as an asthma mimic and highlights clinical features that should prompt reconsideration of an asthma diagnosis. This is a narrative, non-systematic review. A structured search and screening process was used specifically to identify the case-level literature summarized in Table 1, but this does not constitute a systematic review: only one database was searched, no protocol was registered or pre-published, and findings are synthesized narratively rather than through meta-analysis. The search strategy used combinations of the terms “pulmonary carcinoid,” “bronchial carcinoid,” “asthma mimic,” “endobronchial tumor,” “refractory asthma,” and “unilateral wheezing” to identify 14 English-language case-level reports of carcinoid tumors presenting with or mimicking asthma; seven of these are included in the present review (Table 1), while seven others were excluded (four for an irrelevant clinical scenario, two for an alternative diagnosis of adenoid cystic carcinoma, and one for carcinoid syndrome without asthma-like features in a patient with COPD). Inclusion/exclusion followed a priori eligibility criteria established prospectively, before screening began. Screening was performed by a single reviewer, with a second-pass re-screening of all records by the same reviewer to check consistency, since no second, independent screener was available; there were no discrepancies between the two passes. A PRISMA flow diagram was not produced, consistent with the narrative, non-systematic design of this review. The included case reports were assessed using four of the CARE reporting domains (demographics, work-up, treatment, outcome/follow-up) as a means of appraisal of reporting quality rather than formal risk-of-bias assessment; results of this informal appraisal are described rather than pooled. Pulmonary carcinoid tumors are usually indolent neuroendocrine neoplasms, but centrally located lesions can narrow a major airway and cause wheeze, cough, dyspnea, hemoptysis, and post-obstructive infection. Because this presentation can resemble asthma, diagnosis may be delayed despite escalating inhaled therapy or consideration of biologic treatment. Features that should raise suspicion for a focal endobronchial lesion include localized or unilateral wheeze, adult-onset or atypical symptoms, poor or incomplete response to appropriate asthma therapy, recurrent infection in the same lung segment, hemoptysis, asymmetric breath sounds, or unexpected imaging findings. Chest CT and bronchoscopy, followed by histopathology and neuroendocrine immunohistochemistry when tissue sampling is appropriate, are central to diagnosis and to distinguishing typical from atypical carcinoids. Complete surgical resection remains the preferred treatment for most localized, resectable pulmonary carcinoid tumors. Bronchoscopic/endoscopic treatments, including Nd:YAG laser photoresection, electrocautery or snare resection, cryotherapy, and rigid bronchoscopic debulking, may be considered as parenchyma-sparing approaches in carefully selected patients with strictly intraluminal typical carcinoids; available evidence is largely retrospective and direct comparative evidence against surgery remains limited. For unresectable or metastatic disease, treatment may include somatostatin analogues, peptide receptor radionuclide therapy, targeted therapy, and other individualized systemic options. Pulmonary carcinoid should be considered in patients with persistent or atypical asthma-like symptoms that do not respond as expected to guideline-directed therapy. Early recognition permits timely CT imaging, bronchoscopic evaluation, histopathologic confirmation, and definitive management; surgical resection remains standard for most localized resectable tumors, while selected strictly intraluminal typical carcinoids may be considered for bronchoscopic treatment.

Pulmonology
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Case ReportNeurology

Sporadic Creutzfeldt-Jakob Disease: Case Series of Refractory Convulsive Status Epilepticus and Ataxic Variant in a Health Care Provider

Enzo M. Fortuny, Laura Alejandra Ochoa Torrico, Mario Camargo Villarreal et al.

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, rapidly progressive, and fatal prion disease characterized by cognitive decline, myoclonus, cerebellar dysfunction, and characteristic neuroimaging abnormalities. Seizures are uncommon, and refractory convulsive status epilepticus represents a particularly rare complication. Case Presentations: The first case involved a 35-year-old man with several months of behavioral changes, sleep disturbances, gait instability, ataxia, dysarthria, and generalized myoclonus. Brain MRI demonstrated bilateral caudate and basal ganglia diffusion abnormalities with cortical involvement, and CSF 14-3-3 testing provided supportive evidence for probable sCJD. On hospital day 3, he developed recurrent generalized tonic-clonic seizures progressing to refractory convulsive status epilepticus requiring intubation, continuous EEG monitoring, levetiracetam, phenobarbital, midazolam, and propofol for seizure control. The second case involved a 50-year-old man with progressive sleep and behavioral disturbances followed by dysarthria and profound ataxia. MRI demonstrated bilateral caudate and lenticular hyperintensities with pulvinar and medial thalamic involvement producing a hockey-stick pattern. CSF 14-3-3 was positive, supporting a clinical suspicion of sCJD, although RT-QuIC and neuropathological confirmation were unavailable. These cases illustrate two clinically suspected presentations of sCJD, including one complicated by refractory convulsive status epilepticus and another with an ataxic-predominant phenotype. Acute deterioration, new seizure activity, or worsening myoclonus in patients with suspected sCJD should prompt EEG evaluation because status epilepticus, although rare, may require aggressive neurocritical care management.

Neurology
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Clinical StudyPediatricse0007

Association Between Kramer Visual Jaundice Grade and Total Serum Bilirubin in Neonates: A Cross-Sectional Study From Venezuela

Andrés Efraín de San José Betancourt Sosa, Juan Jesús Arvelo C., Rodolfo Moreno

Kramer visual staging is a rapid bedside method for estimating the cephalocaudal extent of neonatal jaundice, but visual assessment is imprecise and should not substitute for objective bilirubin measurement. This study evaluated the association between Kramer grade and total serum bilirubin (TSB) in neonates with jaundice at a Venezuelan maternity hospital. This single-center cross-sectional clinical study prospectively collected data from 80 neonates with clinically recognized jaundice at Hospital Materno Infantil Dr. José María Vargas, Valencia, Venezuela, from January through June 2020. Kramer grade and TSB were recorded using a standardized study form. Mean TSB across Kramer grades was compared using one-way analysis of variance (ANOVA), and the monotonic association between Kramer grade and TSB was assessed using Spearman rank correlation. Kramer grade 2 was most frequent (32/80, 40.0%), followed by grades 1 (28.8%), 3 (20.0%), and 4 (11.3%); no infant was classified as grade 5. Overall mean TSB was 10.69 ± 0.37 mg/dL (mean ± standard error). Mean TSB increased from 9.43 mg/dL at grade 1 to 14.06 mg/dL at grade 4, with a significant overall between-grade difference (ANOVA P = 0.0019). Kramer grade showed a moderate positive correlation with TSB (Spearman ρ = 0.42; P = 0.0006). Higher Kramer grade was associated with higher TSB, but the association was only moderate and bilirubin ranges overlapped across grades. Kramer staging may provide a preliminary bedside cue in resource-constrained settings, but quantitative transcutaneous or serum bilirubin measurement remains necessary for risk stratification and treatment decisions.

Pediatrics
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