Hospitalized patients with COVID-19 are at increased risk of thrombosis, acute respiratory distress syndrome and death. The optimal dosage of thromboprophylaxis is unknown. The aim was to evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate, and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia. PROTHROMCOVID is a randomized, unblinded, controlled, multicenter trial enrolling non-critical, hospitalized adult patients with COVID-19 pneumonia. Patients were randomized to prophylactic (4500 IU), intermediate (100 IU/kg), or therapeutic (175 IU/kg) groups. All tinzaparin doses were administered once daily during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non-invasive mechanical ventilation, or death within 30 days. The main safety outcome was major bleeding at 30 days. Of the 311 subjects randomized, 300 were included in the prespecified interim analysis (mean [SD] age, 56.7 [14.6] years; males, 182 [60.7%]). The composite endpoint at 30 days from randomization occurred in 58 patients (19.3%) of the total population; 19 (17.1 %) in the prophylactic group, 20 (22.1%) in the intermediate group, and 19 (18.5%) in the therapeutic dose group (p = 0.72). No major bleeding event was reported; non-major bleeding was observed in 3.7% of patients, with no intergroup differences. Due to these results and the futility analysis, the trial was stopped. In non-critically ill COVID-19 patients, intermediate or full-dose tinzaparin compared to standard prophylactic doses did not appear to affect the risk of thrombotic event, non-invasive ventilation, or mechanical ventilation or death. Trial Registration ClinicalTrials.gov Identifier (NCT04730856). Edura-CT registration number: 2020-004279-42.

The study aimed to assess the clinical and economic impact of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli bacteraemic UTIs (Ec-BUTI) and to evaluate the possibility of developing antimicrobial stewardship interventions. Retrospective single-centre cohort study included all consecutive episodes of Ec-BUTI requiring hospitalisation from September 2020 to February 2023. clinical failure. hospital resource consumption, length of stay, 30-d recurrence and mortality and 90-d readmissions. Antimicrobial stewardship interventions were evaluated. A propensity score matching analysis was performed. Three hundred ten E. coli-BUTI episodes were included; 86 caused by ESBL-producing strains. The ESBL group had greater comorbidity burden than the non-ESBL group (median Charlson index 4 [IQR 2-6] vs. 2 [IQR 1-4]; P < 0.001) and more frequent inappropriate empirical therapy (40.7% vs. 3.6%; P < 0.001). Overall, an intravenous-to-oral switch was made within the first week in 172 (55.5%) episodes. In the ESBL group, an oral switch was made in 17 patients (19.7%), while no oral option was available in 48 (55.8%) based on susceptibility results. After adjustment, ESBL was not significantly associated with clinical failure (aOR 1.85, 95% CI 0.33-10.48), recurrence (aOR 1.98, 95% CI 0.70-5.62) or mortality (aHR 2.12, 95% CI 0.43-10.38). However, ESBL-producing Ec-BUTI was associated with longer stays (P = 0.014), higher pharmacy costs (P < 0.001) and independently increased overall hospitalisation costs by a median of €1493 (P = 0.022). ESBL-producing Ec-BUTI was associated with greater healthcare resource consumption and costs, though not with worse clinical outcomes. These findings highlight the economic impact of antimicrobial resistance and support antimicrobial stewardship.

Introduction: Large language model-based AI systems are increasingly used in medical education, but their educational value in multilingual, high-stakes examination settings remains insufficiently defined. Objective: To assess the accuracy of latest-generation AI systems on the official 2026 Spanish Médico Interno Residente (MIR) examination and compare their performance with the Healthcademia chatbot, AMIR faculty experts, and average candidates. Materials and Methods: A cross-sectional quantitative evaluation analyzed all 200 valid questions from the official MIR 2026 Version 0 booklet. Performance was assessed using automated pipelines for text-only items and manual multimodal input for the 24 image-associated questions. Two instruction conditions, neutral and expert-role, were tested, with additional effort-level stratification for GPT-5.2. Accuracy was measured against the final official answer key. Human comparison groups included AMIR faculty experts and the average MIR candidate. Results: Several latest-generation AI systems showed very high accuracy on the MIR 2026 examination. The highest-performing configuration, GPT-5.2 high effort without expert-role instruction, achieved 199/200 correct answers (99.5%). Gemini 3 Flash with expert-role instruction achieved 198/200 (99.0%). AMIR faculty experts achieved 194/200 (97.0%), whereas the average candidate achieved 131/200 (65.7%). On image-associated questions, several multimodal configurations achieved 24/24 correct answers when the corresponding image was provided. Conclusions: Under the conditions evaluated in this study, several AI configurations achieved near-perfect accuracy on a complete, high-stakes national medical licensing examination. These findings support licensing-style examinations as benchmarks for educational AI and suggest potential use in supervised feedback and self-assessment. Performance on multiple-choice items should not be interpreted as evidence of autonomous clinical reasoning.

The largest outbreak of human leishmaniasis in Europe took place in Fuenlabrada, Spain, between 2009 and 2017. The University Hospital “12 de Octubre” in Madrid serves the population residing in three districts of Madrid located just north of the outbreak area (Villaverde, Usera, and Carabanchel). Villaverde and Usera are connected by rail to the outbreak area, unlike Carabanchel. We performed a retrospective study including all cases of leishmaniasis diagnosed between 2011 and 2020. Fifty-one cases were documented. In the districts connected by rail to the outbreak area, a higher-than-expected incidence was observed (13.45–15.55 versus 5.2 per 100,000 inhabitants). Apart from the linear distance from the place of residence to the railway tracks, no differences in terms of demographics or risk factors were detected between the populations of the districts. We hypothesize that the direct connection with the outbreak area by rail could explain the higher incidence observed in Villaverde and Usera.