Portal venous thrombosis associated with acute cytomegalovirus infection

Ron Astudillo, Luigina Maureen; Pérez Stachowski, Javier; Pérez Aisa, Ángeles

doi:10.1016/j.medcle.2023.11.023

array:24 ["pii" => "S2387020624001499" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.11.023" "estado" => "S300" "fechaPublicacion" => "2024-05-17" "aid" => "6521" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:455-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775324000095" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.11.029" "estado" => "S300" "fechaPublicacion" => "2024-05-17" "aid" => "6521" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:455-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Trombosis venosa portal asociada a infección aguda por citomegalovirus" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "455" "paginaFinal" => "456" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Portal venous thrombosis associated with acute cytomegalovirus infection" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luigina Maureen Ron Astudillo, Javier Pérez Stachowski, Ángeles Pérez Aisa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luigina Maureen" "apellidos" => "Ron Astudillo" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Pérez Stachowski" ] 2 => array:2 [ "nombre" => "Ángeles" "apellidos" => "Pérez Aisa" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624001499" "doi" => "10.1016/j.medcle.2023.11.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624001499?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775324000095?idApp=UINPBA00004N" "url" => "/00257753/0000016200000009/v1_202405080526/S0025775324000095/v1_202405080526/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020624001505" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.11.024" "estado" => "S300" "fechaPublicacion" => "2024-05-17" "aid" => "6527" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:456-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Role of plasma exchange in myasthenia gravis in the shortage of immunoglublins" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "456" "paginaFinal" => "457" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel del recambio plasmástico en el abordaje de la miastenia gravis ante el desabastecimiento de inmunoglobulinas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ingrid Magnolia Parra Salinas, José Antonio García Erce" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Ingrid Magnolia" "apellidos" => "Parra Salinas" ] 1 => array:2 [ "nombre" => "José Antonio" "apellidos" => "García Erce" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775324000083" "doi" => "10.1016/j.medcli.2023.11.033" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775324000083?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624001505?idApp=UINPBA00004N" "url" => "/23870206/0000016200000009/v2_202405200151/S2387020624001505/v2_202405200151/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S238702062400144X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.10.027" "estado" => "S300" "fechaPublicacion" => "2024-05-17" "aid" => "6491" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2024;162:448-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "The value of vaccines in the 21st century" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "448" "paginaFinal" => "454" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El valor de las vacunas en el siglo XXI" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:9 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Author’s own." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2319 "Ancho" => 3452 "Tamanyo" => 467807 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Classical classification of vaccines." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irma Casas, Karen Colmenares, Beatriz Blanco, Julia Valera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Irma" "apellidos" => "Casas" ] 1 => array:2 [ "nombre" => "Karen" "apellidos" => "Colmenares" ] 2 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Blanco" ] 3 => array:2 [ "nombre" => "Julia" "apellidos" => "Valera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323007091" "doi" => "10.1016/j.medcli.2023.10.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323007091?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400144X?idApp=UINPBA00004N" "url" => "/23870206/0000016200000009/v2_202405200151/S238702062400144X/v2_202405200151/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Portal venous thrombosis associated with acute cytomegalovirus infection" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "455" "paginaFinal" => "456" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luigina Maureen Ron Astudillo, Javier Pérez Stachowski, Ángeles Pérez Aisa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Luigina Maureen" "apellidos" => "Ron Astudillo" "email" => array:1 [ 0 => "ronluigina@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Javier" "apellidos" => "Pérez Stachowski" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ángeles" "apellidos" => "Pérez Aisa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Costa del Sol, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Costa del Sol, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis venosa portal asociada a infección aguda por citomegalovirus" ] ] "textoCompleto" => "Cytomegalovirus (CMV) is a DNA virus that belongs to the Herpesviridae family. Can cause acute infection and remain latent in the host.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Seroprevalence is estimated at 83% varying by geographic area, race and age.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It is usually asymptomatic or causes a mononucleosis syndrome in immunocompetent individuals, whereas severe disseminated manifestations are more common in immunocompromised individuals.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>In the present case, venous thrombosis developed as an atypical manifestation associated with acute CMV infection. It has an incidence of 6.4% and, although infection is most common during childhood or young adulthood, thrombotic events are most prevalent between the ages of 25 and 55.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>A 34-year-old male, immunocompetent and with no relevant personal history, presented with a fever of 39.5 °C, mostly in the evenings, accompanied by profuse sweating of 2 week’s duration. It did not improve despite the use of antipyretics and after seven days of treatment with cefuroxime. He had been experiencing discontinuous abdominal pain for four months, mainly in the right iliac fossa, with periods of three or four diarrhoeal stools per day without pathological products. He had not started new medication and had not had any recent surgery. Nor had she travelled abroad or remembered any insect bites.On physical examination he was conscious, oriented, well hydrated and perfused. No palpation of cervical, supraclavicular, axillary or inguinal lymph nodes. No pathological findings on cardiopulmonary auscultation. The abdomen was soft with discomfort on palpation in the epigastrium and right iliac fossa. No masses, lymphadenopathy, limb oedema or skin lesions were detected. He exhibited preserved mobility and overall strength.Blood tests showed glutamate oxaloacetate transaminase (GOT) 95 U/L, glutamate pyruvate transaminase (GPT) 153 U/L, alkaline phosphatase 91 U/L, lactate dehydrogenase 423 U/L, total bilirubin 0.7 mg/dL, procalcitonin 0.28 ng/mL and C-reactive protein 55 mg/L. The CBC showed 6550 WBCs/μL, (32.8% lymphocytes/μL), 166,000 platelets/μL y 15 g/dL haemoglobin. The coagulation and hypercoagulability study (antiphospholipid antibodies, proteins C and S, antithrombin and factor II mutation) was normal. His immunoglobulin M (IgM) levels were 236 mg/dL (normal 40–230 mg/dL) and beta-2-microglobulin 7.16 mg/L (normal 0.7–1.8 mg/L). The study of tumour markers (including carcinoembryonic antigen [CEA], cancer antigens 15.3 [CA15.3], 125 [CA125] and 19.9 [CA19.9], prostate-specific antigen [PSA] and alpha-fetoprotein [AFP]), autoimmunity (anti-nuclear antibodies, anti-DNA, anti-mitochondrial, anti-smooth muscle [ASMA], antibodies against liver and kidney microsomes (LKM), parietal cell antibodies), and serology for Coxiella, Brucella, Rickettsia, Bartonella, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) were negative. He showed immunoglobulin G (IgG) antibodies to Epstein–Barr virus and IgM antibodies to CMV at a titre higher than 1:8, so serum viral load was determined (1733 IU/mL). Blood cultures, urine cultures and stool cultures on different days were negative. An abdominal ultrasound was performed showing a diffuse increase in hepatic echogenicity, low doppler uptake in the right portal vein and splenomegaly with a major axis of 16 cm. Upper and lower gastrointestinal endoscopy and echocardiography were performed without findings of interest. Abdominal computed tomography (CT) confirmed right portal branch thrombosis and positron emission tomography (PET/CT) showed increased splenic reactive uptake, with no other pathological findings.Rivaroxaban was prescribed at a dose of 15 mg every 12 h for 21 days and thereafter 20 mg daily until completion of six months of treatment. Within two weeks of hospital discharge, symptoms had subsided, and acute phase reactants and liver profile returned to normal. A follow-up abdominal CT scan at 3 months showed resolution of the thrombosis.CMV promotes a procoagulant state by inducing the release of von Willebrand factor at the endothelial level, increasing tissue factor expression on the cell surface, and inhibiting antithrombin III and fibrinolysis. Phospholipids in its envelope trigger an immune response that reduces Factor Xa clotting time by directly activating thrombin.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>A systematic review of 115 cases found that the most common sites were the pulmonary arteries (25.7%), portal (23.4%), splenic (13.9%) and superior mesenteric (13.5%) veins.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The risk increases when other factors coexist such as thrombophilia (antiphospholipid antibodies; mutation of factor V Leiden, factor II, VIII or mutation of the methylenetetrahydrofolate reductase gene [MTHFR]; protein C and S deficiencies, and hyperhomocysteinemia), advanced age, pregnancy, oestrogen therapy, prolonged immobilisation, previous episodes or neoplastic disease.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Antiviral treatment has only been shown to be cost-effective in immunocompromised individuals and, although there is no consensus on anticoagulation, it is recommended for at least three months in the absence of other risk factors.<a class="elsevierStyleCrossRefs" href="#bib0015">3,5</a>FundingThis work has not received any funding.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytomegalovirus-associated thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.I.M. Neppelenbroek" 1 => "P.A. Rootjes" 2 => "L. Boxhoorn" 3 => "J.F.P. Wagenaar" 4 => "S. Simsek" 5 => "F. Stam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neth J Med" "fecha" => "2018" "volumen" => "76" "paginaInicial" => "251" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30019682" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimation of the worldwide seroprevalence of cytomegalovirus: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Zuhair" 1 => "G.S.A. Smit" 2 => "G. Wallis" 3 => "F. Jabbar" 4 => "C. Smith" 5 => "B. Devleesschauwer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/rmv.2034" "Revista" => array:5 [ "tituloSerie" => "Rev Med Virol" "fecha" => "2019" "volumen" => "29" "paginaInicial" => "e2034" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30706584" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytomegalovirus (CMV)-associated portal vein thrombosis in a healthy, immunocompetent man" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Burkey" 1 => "C. Teng" 2 => "K.I. Hussein" 3 => "J. Sabetta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2020-238645" "Revista" => array:5 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "e238645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33372022" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors of venous thrombo-embolism during cytomegalovirus infection in immunocompetent individuals. A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ceccarelli" 1 => "E. Venanzi Rullo" 2 => "G. Nunnari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10096-018-3185-y" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "381" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29344839" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytomegalovirus-associated venous and arterial thrombotic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.H. Kelkar" 1 => "B.L. Loc" 2 => "M.D. Tarantino" 3 => "A. Rajasekhar" 4 => "H. Wang" 5 => "M. Kelkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.12161" "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "e12161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33489573" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000009/v2_202405200151/S2387020624001499/v2_202405200151/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000009/v2_202405200151/S2387020624001499/v2_202405200151/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624001499?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 162. Issue 9.

Pages 455-456 (May 2024)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Free access articles

Early cortical atrophy in REM sleep behavior...

Med Clin. 2024;163:70-3

Disability degree assessment: A comprehensive approach...

Med Clin. 2024;163:e3-e7

Inappropriate hospitalization: Measurement...

Med Clin. 2024;163:91-7

Medicina Clínica (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter