Eduardo Garcia-Rico

Background: Emergency preparedness frameworks in Europe were largely organised around survival, hospital capacity and access to life-sustaining treatment during the first wave of COVID-19. In long-term care facilities, this focus left under-specified what health systems owed to residents when hospital transfer was withheld.Methods: We conducted a narrative policy analysis drawing on three evidence streams: published epidemiological and comparative studies on mortality and hospital transfer patterns; palliative care literature on symptom assessment and management; and policy documents and emergency guidance from the first wave of the pandemic. The Community of Madrid was used as a sentinel case, contextualised through evidence from Belgium, Italy, France and the United Kingdom.Results: Across European long-term care settings, mortality reporting was more visible than symptom burden, palliative escalation and end-of-life care quality. In Madrid, approximately 65% of transferred residents survived, challenging the assumption that non-transfer systematically reflected lack of potential clinical benefit. The analysis identifies a preparedness gap: non-transfer decisions were often visible administratively, while minimum obligations to relieve pain, dyspnoea and agitation remained weakly specified and poorly monitored.Conclusions: We propose avoidable suffering as a protected clinical and policy outcome in emergency preparedness for long-term care. Preparedness frameworks should prohibit categorical non-clinical exclusion criteria, require palliative escalation when non-transfer decisions are made, and incorporate symptom-burden indicators into crisis monitoring systems. This would make relief of suffering an auditable component of emergency governance rather than a residual aspiration.

This paper proposes a radical reconfiguration of medical ethics by placing suffering—not as a clinical symptom or ancillary datum, but as an ontological category—at the center of ethical deliberation. In the face of a fragmented and technified clinical practice, we argue that suffering is the only truly universal human experience, irreducible to cultural, linguistic, or ideological variations. As such, it offers a potent, immanent foundation for a non-relative ethics in medicine. Drawing on the philosophical contributions of Heidegger, Levinas, Jonas, Jaspers, Butler, and Schopenhauer, we develop a model of medical ethics rooted in the shared and asymmetrical vulnerability that suffering reveals. Rather than abstract principles or procedural deontology, this model emphasizes narrative, responsibility, and hospitality as structural dimensions of the clinical act. We contend that medicine must move from being a problem-solving technique to becoming a space of presence, attention, and recognition—where suffering is not erased but welcomed. The clinical encounter is thus reimagined as a site of ontological unveiling, where the physician’s role is not merely to diagnose or intervene, but to bear witness, to accompany, and to share in the exposure of the other. This ethics of suffering entails epistemological shifts (through narrative and phenomenology), spatial transformations (via architecture of care), and institutional reforms (integrating patients’ voices and lived experience). Ultimately, we propose suffering not as a failure of health, but as the ethical ground from which a truly human medicine must begin.

This article explores the relationship between human suffering and the limits of language, positing that suffering is not simply an experience of physical pain or emotional distress but a fracture in the capacity to articulate meaning. It clearly distinguishes between pain (a localised sensory experience that is potentially communicable) and suffering (an existential experience that involves a rupture of the symbolic order). It is argued that suffering appears when personal narrative is interrupted or becomes incoherent, provoking what is termed a ‘collapse of language’—moments when experience exceeds the expressive and symbolic capacity of the subject. This phenomenon is examined from multiple perspectives: the phenomenology of the body, philosophies of the limit (Lévinas, Derrida, Ricoeur) and clinical cases such as trauma, dementia and the diagnosis of serious illnesses. The text criticises the traditional definition of suffering proposed by Eric Cassell for presupposing a narrative self-consciousness, excluding prelinguistic or non-narrative forms of suffering. The text also tackles the issue of epistemic injustice in clinical contexts, where individuals discredit or lack conceptual resources to articulate their experiences of suffering. Finally, the article suggests an ethics of care that involves being open to what cannot be fully expressed, understanding that truly responding to suffering means not just trying to understand it completely or get rid of it, but being there in that difficult space where words fall short, while still providing human presence as support.

The intestinal microbiota and the human body are in a permanent interaction. There is a symbiotic relationship in which the microbiota plays a vitally important role in the performance of numerous functions, including digestion, metabolism, the development of lymphoid tissue, defensive functions, and other processes. It is a true metabolic organ essential for life and has potential involvement in various pathological states, including cancer and pathologies other than those of a digestive nature. A growing topic of great interest for its implications is the relationship between the microbiota and cancer. Dysbiosis plays a role in oncogenesis, tumor progression, and even the response to cancer treatment. The effect of the microbiota on tumor development goes beyond a local effect having a systemic effect. Another aspect of great interest regarding the intestinal microbiota is its relationship with drugs, modifying their activity. There is increasing evidence that the microbiota influences the therapeutic activity and side effects of antineoplastic drugs and also modulates the response of several tumors to antineoplastic therapy through immunological circuits. These data suggest the manipulation of the microbiota as a possible adjuvant to improve oncological treatment. Is it possible to manipulate the microbiota for therapeutic purposes?

Background: Psychological distress is a predictor of future health and disease data, with consequent implications for both the patient and the healthcare system. Taking advantage of the unprecedented situation caused by the COVID-19 pandemic we aimed to assess whether the type of medical care received by patients during the initial months of the pandemic influenced their evolution, particularly at the psychological level. Additionally, we investigated whether allostatic load was associated not only with physical but also psychological alterations. Methods: All the patients diagnosed with COVID-19 infection at HM Madrid Hospital during the month of March 2020 were studied, both those hospitalized (110) and those treated on an outpatient basis (46). They were psychologically evaluated using the Profile of Mood States (POMS) test. We calculated the allostatic load using different laboratory parameters. Results: Outpatient patients had significantly higher scores than hospitalized ones in Tension-Anxiety (52 ± 19.3 vs. 38 ± 4.3; p < 0.001). So, 36.9% of the outpatient patients exhibited anxiety. Allostatic load has not been correlated with patients’ psychological alterations. Conclusions: Psychological distress of outpatient patients should be taken into account in their management to improve mental health planning. This knowledge could provide comprehensive care to patients including their mental health, in the face of subsequent epidemics/pandemics.

Neck lymphangiomas are rare, benign congenital malformations that predominate in childhood. Most present before the age of two. There are no risk factors related to sex, ethnic origin or predominance on either side, and they can occur in any anatomical location, although the most frequent is in the head and neck. The clinical presentation depends on its location. The most frequent symptom is the existence of a painless mass that grows slowly. Available therapeutic tools include surgery, systemic treatment, and injection of sclerosing agents.

Primary systemic treatment (PST) downsizes the tumor and improves pathological response. The aim of this study is to analyze the feasibility and tolerance of primary concurrent radio–chemotherapy (PCRT) in breast cancer patients. Patients with localized TN/HER2+ tumors were enrolled in this prospective study. Radiation was delivered concomitantly during the first 3 weeks of chemotherapy, and it was based on a 15 fractions scheme, 40.5 Gy/2.7 Gy per fraction to whole breast and nodal levels I-IV. Chemotherapy (CT) was based on Pertuzumab–Trastuzumab–Paclitaxel followed by anthracyclines in HER2+ and CBDCA-Paclitaxel followed by anthracyclines in TN breast cancers patients. A total of 58 patients were enrolled; 25 patients (43%) were TN and 33 patients HER2+ (57%). With a median follow-up of 24.2 months, 56 patients completed PCRT and surgery. A total of 35 patients (87.5%) achieved >90% loss of invasive carcinoma cells in the surgical specimen. The 70.8% and the 53.1% of patients with TN and HER-2+ subtype, respectively, achieved complete pathological response (pCR). This is the first study of concurrent neoadjuvant treatment in breast cancer in which three strategies were applied simultaneously: fractionation of RT (radiotherapy) in 15 sessions, adjustment of CT to tumor phenotype and local planning by PET. The pCR rates are encouraging.

Primary systemic treatment (PST) downsizes the tumor and improves pathological response. The aim of this study is to analyze the feasibility and tolerance of primary concurrent radio-chemotherapy (PCRT) in breast cancer patients. Patients with localized TN/HER2+ tumors were enrolled in this prospective study. Radiation is delivered concomitantly during the first 3 weeks of chemotherapy, and it is based on a 15 fractions scheme (40.5Gy/2.7Gy per fraction to whole breast and nodal levels I-IV. Chemotherapy is based on Pertuzumab-Trastuzumab-Paclitaxel followed by anthracyclines in HER2+ and CBDCA-Paclitaxel followed by anthracyclines in TN breast cancers patients. 58 patients were enrolled, 25 patients (43%) were TN and 33 patients HER2+ (57%). With a median follow-up of 24.2 months, 56 patients completed PCRT and surgery. A total of 35 patients (87.5%) achieved >90% loss of invasive carcinoma cell in the surgical specimen. The 70.8% and the 53.1% of patients with TN and HER-2+ subtype respectively achieved complete pathological response (pCR). This is the first study of concurrent neoadjuvant treatment in breast cancer in which three strategies are applied simultaneously: fractionation of RT in 15 sessions, adjustment of CT to tumor phenotype and local planning by PET. The pCR rates are encouraging.

Exosomes are emerging as one of the most intriguing cancer biomarkers in modern oncology for early cancer diagnosis, prognosis and treatment monitoring. Concurrently, several nanoplasmonic methods have been applied and developed to tackle the challenging task of enabling the rapid, sensitive, affordable analysis of exosomes. In this review, we specifically focus our attention on the application of plasmonic devices exploiting surface-enhanced Raman spectroscopy (SERS) as the optosensing technique for the structural interrogation and characterization of the heterogeneous nature of exosomes. We summarized the current state-of-art of this field while illustrating the main strategic approaches and discuss their advantages and limitations.