Medicina Clinica最新文献

{"title":"Amiloidosis cardiaca y red flags: historia natural e impacto en la morbimortalidad","authors":"Emilio Blanco-López ,&nbsp;Jorge Martínez-del Río ,&nbsp;Alba López-Calles ,&nbsp;Martín Negreira-Caamaño ,&nbsp;Daniel Águila-Gordo ,&nbsp;Pablo Soto-Martín ,&nbsp;Maria Maeve Soto-Pérez ,&nbsp;Andrez Felipe Cubides-Novoa ,&nbsp;Maria Gonzalez-Barderas ,&nbsp;Ignacio Sánchez-Pérez ,&nbsp;Jesús Piqueras-Flores","doi":"10.1016/j.medcli.2024.08.006","DOIUrl":"10.1016/j.medcli.2024.08.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Red flags (RF) are typical cardiac and extracardiac manifestations that may precede the definitive diagnosis of cardiac amiloidosis (CA) by several years, playing a pivotal role in the early diagnosis of the disease. The principal aim of the research was to determine the chronology of onset of RF throughout the natural history of CA as well as its prognostic influence.</div></div><div><h3>Patients and methods</h3><div>Observational, retrospective inquiry of consecutive patients with a definitive diagnosis of CA in a terciary hospital centre in Ciudad Real (Spain) between February 2016 and December 2023. We defined 21 RF and 3 adverse clinical events, establishing the date of occurrence of each of them.</div></div><div><h3>Results</h3><div>102 patients (81.6<!--> <!-->±<!--> <!-->7.7 years; 84,3% males) with a diagnosis of CA (89.2% TTR; 10,8% AL) were included. The prevalence of RF was very high (8.4<!--> <!-->±<!--> <!-->2.3). In the natural history, the first to appear were integumentary, with the most specific cardiological ones being the closest to diagnosis. The 2-year mortality was 49%, with biomarker RFs and the presence of ≥<!--> <!-->10 RFs being associated with higher mortality.</div></div><div><h3>Conclusions</h3><div>RFs proved highly prevalent among patients with CA and substantially preceded disease diagnosis. RF burden was associated with prognosis in the follow-up of ATTR patients.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 61-68"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemangioma suprarrenal: presentación de 3 casos","authors":"Verónica Vallejo Herrera ,&nbsp;María José Vallejo Herrera ,&nbsp;Félix Serrano Puche","doi":"10.1016/j.medcli.2024.07.025","DOIUrl":"10.1016/j.medcli.2024.07.025","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 101-103"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waardenburg syndrome","authors":"Mar Luque-Luna ,&nbsp;Mar Borregan-Prats ,&nbsp;Javier Gil Lianes ,&nbsp;Carolina Prat-Torres","doi":"10.1016/j.medcli.2024.04.011","DOIUrl":"10.1016/j.medcli.2024.04.011","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 105-106"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Síndrome de piernas inquietas. Fisiopatología, diagnóstico y tratamiento","authors":"Federico Castillo-Álvarez,&nbsp;María Eugenia Marzo-Sola","doi":"10.1016/j.medcli.2024.05.026","DOIUrl":"10.1016/j.medcli.2024.05.026","url":null,"abstract":"<div><div>Restless legs syndrome is the most prevalent sleep-related movement disorder, affecting 5-10% of the population, characterized by an urge to move that appears during rest or is exacerbated by rest, primarily in the lower extremities, that occurs in the evening or night and that disappears during movement or is improved by movement. Restless legs syndrome significantly impacts sleep, mood, and quality of life.</div><div>Its pathophysiology involves a complex interplay of genetic and environmental factors, as well as comorbidities, leading to alterations in brain iron resulting in dysfunction in dopaminergic, adenosine, and glutamatergic pathways.</div><div>Treatment typically includes iron supplementation and symptomatic therapy, traditionally utilizing dopamine agonists. However, their long-term use may exacerbate symptoms, relegating them to second-line treatment after ligands α2δ of calcium channels.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 84-90"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of antifungal drugs for the treatment of oral candidiasis in HIV-positive patients: A Bayesian network meta-analysis","authors":"Jiong Lin,&nbsp;Cai-xia Peng,&nbsp;Wei-man Huang","doi":"10.1016/j.medcli.2024.05.018","DOIUrl":"10.1016/j.medcli.2024.05.018","url":null,"abstract":"<div><div>Oral candidiasis infection is particularly prevalent among individuals in HIV-positive patients. Antifungal drugs have shown promising therapeutic effects in treating oral candidiasis in HIV-positive patients. However, the selection of specific antifungal drugs for the treatment of oral candidiasis in HIV-positive patients lacks evidence-based guidelines. This study aims to address this gap by conducting a comprehensive review of relevant randomized controlled trials (RCTs) and performing a network meta-analysis to assess the efficacy of different antifungal drugs in treating oral candidiasis in HIV-positive patients. A systematic search was conducted in databases including EMBASE, Web of Science, Medline, and Cochrane databases to identify relevant articles. Additionally, key pertinent sources in the literatures were also reviewed. All studies published prior to August 2023 were eligible for inclusion. Two researchers independently conducted the screening of literature, extraction of data, and evaluation of quality. Pairwise and network meta-analysis were then performed to assess the primary outcomes of the randomized controlled trials (RCTs) included. The protocol was registered on the PROSPERO database (CRD42024513912). Twenty-six RCTs were included in this meta-analysis, involving a total of 3145 patients and evaluating seven interventions (placebo, fluconazole, itraconazole, nystatin, clotrimazole, ketoconazole, miconazole). Pairwise meta-analysis and network meta-analysis showed fluconazole was significantly efficacy in increasing mycological cure rates when compared with placebo, clotrimazole, and nystatin. Ketoconazole and miconazole were significantly efficacy in increasing mycological cure rates when compared with nystatin. Network meta-analysis also suggested the efficacy of the seven interventions in increasing mycological cure rates was ranked as follows: placebo (35.3%), fluconazole (95.2%), itraconazole (61.6%), nystatin (17.0%), clotrimazole (52.7%), ketoconazole (69.2%), miconazole (69.1%). The available evidence indicates that fluconazole had the greatest possibility to increase mycological cure rates in HIV-positive patients, while, nystatin was the least effective antifungal drug in increasing mycological cure rates in HIV-positive patients.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 76-83"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurofibromatosis type 1","authors":"Miguel Mansilla-Polo","doi":"10.1016/j.medcli.2024.04.012","DOIUrl":"10.1016/j.medcli.2024.04.012","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 107-108"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalización a domicilio en la asistencia de los pacientes con enfermedad aguda","authors":"Sheila Romero-Ruperto ,&nbsp;Jordi Llaneras Artigues ,&nbsp;Mariajosé Mosquera-Brea ,&nbsp;Francesc Xavier Jiménez-Moreno","doi":"10.1016/j.medcli.2024.07.002","DOIUrl":"10.1016/j.medcli.2024.07.002","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 91-96"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety profiles in the use of immune checkpoint inhibitors by patients with cancer and pre-existing autoimmune diseases","authors":"Júlia de Almeida Santos Freitas ,&nbsp;Marinho Marques da Silva Neto ,&nbsp;Cleverton Kleiton Freitas de Lima ,&nbsp;Ney Cristian Amaral Boa Sorte ,&nbsp;Maria Teresita Bendicho ,&nbsp;Aníbal de Freitas Santos Júnior","doi":"10.1016/j.medcli.2024.08.003","DOIUrl":"10.1016/j.medcli.2024.08.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment of cancer when associated with autoimmune diseases (AID) has been the subject of immunotherapy investigation, especially with the use of immune checkpoint inhibitors (ICI). Clinical studies have restricted the evaluation of its use in special populations such as patients with AID, leaving a gap regarding the safety of using immunotherapy.</div></div><div><h3>Objective</h3><div>Discuss the safety of using ICI in patients with cancer and AID, in specialized oncology units, in the cities of Bahia, Brazil.</div></div><div><h3>Methods</h3><div>Retrospective and quantitative cross-sectional study on immune-related adverse events (IRAE) to the use of ICI in patients with cancer and AID.</div></div><div><h3>Results</h3><div>Patients (39 with cancer, and 14 with AID and cancer) were studied. Men (between 30 and 95 years old), melanoma and lung cancer and Hashimoto's thyroiditis were predominance. Pembrolizumab and Nivolumab (anti-PDL-1) were drugs most used. In general, patients using anti-PDL-1 with AID had IRAE with greater frequency and severity: Grade 1 (57%) and 3/4 grades (43%) reactions. The gastrointestinal system presented a greater IRAE in both groups, however in patients with AID more severe reactions were found (0% <em>versus</em> 60%). Patients with cancer and AID had higher rates of IRAE compared to patients without AID, respectively, of discontinuation (50% <em>versus</em> 18%) and interruption (85% <em>versus</em> 20%) of treatment.</div></div><div><h3>Conclusion</h3><div>IRAE increased in patients using ICI with cancer and AID. This suggests that the presence of IAD, in cancer patients, can increase the severity of IRAE. Therefore, the adoption of more appropriate therapeutic strategies is essential for better therapeutic results.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 53-60"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El sistema MIR a sus 50 años, un valor necesitado de cambios pendientes","authors":"Ramon Pujol Farriols","doi":"10.1016/j.medcli.2024.09.002","DOIUrl":"10.1016/j.medcli.2024.09.002","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 73-75"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lupus eritematoso sistémico y compromiso neurológico: una manifestación heterogénea","authors":"Paula Cabestre Pinilla ,&nbsp;Ángela Fernández García ,&nbsp;María Díaz del Valle","doi":"10.1016/j.medcli.2024.07.018","DOIUrl":"10.1016/j.medcli.2024.07.018","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"164 2","pages":"Pages 98-99"},"PeriodicalIF":2.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}