Medicina Clinica最新文献

{"title":"Postherpetic granuloma annulare: A Wolf's isotopic response.","authors":"Xin-Yu Liu, Cheng Tan","doi":"10.1016/j.medcli.2024.02.028","DOIUrl":"10.1016/j.medcli.2024.02.028","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"e109"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857115","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":"[Vaccine effectiveness in patients admitted for influenza during the 2023-2024 season].","authors":"Christian Ruzafa Martinez, Salvador Valero, Eva García Villalba, Cristina Tomás, Ángeles Muñoz, Antonia Alcaraz, Rodrigo Martínez-Rodríguez, María Dolores Hernández, María Isabel Martínez, María Rosario Vicente, Elena Guijarro Westermeyer, Román González Hipólito, Enrique Bernal","doi":"10.1016/j.medcli.2024.07.023","DOIUrl":"10.1016/j.medcli.2024.07.023","url":null,"abstract":"<p><strong>Background and goal: </strong>Vaccination against influenza is widespread worldwide, reducing complications associated with infection. However, the impact of vaccination on mortality/ICU admission in hospitalized patients has been little studied.</p><p><strong>Material and methods: </strong>A retrospective observational study was conducted on 238 patients hospitalized for influenza from October 2023 to January 2024 to evaluate the vaccine's effectiveness in terms of the combined event of ICU admission/mortality during hospitalization. Additionally, the characteristics of vaccinated patients and the existence of bacterial superinfection were analyzed. Cox regression was performed using the SPSS program and the free «R» software.</p><p><strong>Results: </strong>A total of 238 patients were included. Those vaccinated were older (78.2±8.8 vs 69.97±16.6years; P<.001) and were more likely to have hypertension (82.2% vs 56.2%; P<.001), cardiovascular disease (36.6% vs 24.1%; P=.05), chronic bronchopathy (25.7% vs 8.8%; P=.001), or chronic kidney disease (22.8% vs 8.8%; P=0.005). They had lower levels of CRP (8.39±9.55 vs 11.03±10.75mg/dl; P=.05), procalcitonin (0.62±1.74 vs 1.67±4.57ng/dl; P=.05), and SOFA scores (1.13±0.9 vs 1.39±0.97; P=0.033). 11 patients were admitted to ICU (4.6%) and 11 died (4.6%). Influenza vaccination was associated as a protective factor against ICU admission/mortality in the Cox regression (HR=0.216; 95%CI: 0.062-0.759, P=.017). The presence of bacterial superinfection was similar between vaccinated and unvaccinated patients (63.4% vs 67.9%; P=.556).</p><p><strong>Conclusions: </strong>Influenza vaccination may reduce the probability of ICU admission or death. This effect is likely due to better control of the immune response. We did not observe any relationship with the risk of presenting bacterial superinfection.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"589-594"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469876","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":"[Peritoneal infection by Streptococcus vestibularis].","authors":"Miguel Ángel González Martínez, María Peña Ortega, Vanesa García Chumillas","doi":"10.1016/j.medcli.2024.07.015","DOIUrl":"10.1016/j.medcli.2024.07.015","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"642-643"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375611","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":"[Hyperparathyroidism in patients with low bone mineral density treated with zoledronic acid or denosumab].","authors":"Carmen Riesco-Bárcena, José Ivorra-Cortés, Elena Grau-García, Luis González-Puig, Samuel Leal, Anderson Huaylla, José Román-Ivorra","doi":"10.1016/j.medcli.2024.07.020","DOIUrl":"10.1016/j.medcli.2024.07.020","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the prevalence of hyperparathyroidism in patients treated with zoledronic acid (ZA) or denosumab, its relationship with other parameters and how it affects on bone mineral density (BMD) evolution.</p><p><strong>Methods: </strong>Retrospective observational study in patients with osteoporosis or osteopenia and high risk of fracture, who have received denosumab or ZA for at least two years. Patients diagnosed with hyperparathyroidism or glomerular filtration rate <30ml/min at baseline visit were excluded from the study.</p><p><strong>Results: </strong>Ninety patients (ZA: 54.44%) were included. 18.36% of ZA-treated patients had elevated PTH levels at some time compared to 36.58% denosumab-treated patients (p>0.05). Patients with persistently elevated PTH were 6.13% in the AZ group and 19.51% in the denosumab group (p<0.04). We found a statistically significant inverse association between elevated PTH levels, glomerular filtration rate (p=0.007), and albumin-corrected calcium (p <0.001). We did not find an association between hyperparathyroidism and BMD evolution.</p><p><strong>Conclusions: </strong>A high incidence of hyperparathyroidism was observed in patients treated with AZ and especially denosumab. Hyperparathyroidism correlated inversely with glomerular filtration rate and albumin-corrected calcium. Elevated PTH does not appear to affect short-term bone mineral density evolution.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"595-599"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391767","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":"[Sublingual and buccal drug administration in medical emergencies].","authors":"Joan Ramon Roma, Pedro Castro Rebollo, Carla Bastida","doi":"10.1016/j.medcli.2024.05.008","DOIUrl":"10.1016/j.medcli.2024.05.008","url":null,"abstract":"<p><p>Drug administration is crucial to achieve effective therapeutic drug outcomes. In medical emergencies, it is particularly convenient to use drugs that could be administered as an alternative to traditional routes (as oral or intravenous routes), that are not always suitable in these situations. Thus, sublingual and buccal routes offer an alternative to traditional routes, when a rapid onset of action is required. The main objective of this narrative review is to summarize the evidence for the use of sublingual and buccal drug administration in medical emergencies. The evidence obtained has been divided into four common scenarios found in the emergency department and intensive care units: cardiovascular emergencies, acute pain, agitation, and epileptic status. Moreover, the main advantages and disadvantages of sublingual and buccal routes are presented, as the future perspectives in the drug delivery field to overcome the limitations of these routes.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"619-625"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616800","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":"Drug-induced hyponatraemia and possible related signals: Analysis of 659 cases reported to the Spanish Pharmacovigilance System and disproportionality analysis.","authors":"Lucía Estévez Asensio, Montserrat García, Zoraida Verde Rello, Verónica Velasco-González, Ana M Fernández-Araque, María Sainz-Gil","doi":"10.1016/j.medcli.2024.07.021","DOIUrl":"10.1016/j.medcli.2024.07.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Hyponatraemia has negative effects on cognitive function and gait stability and is a risk factor for osteoporosis, falls, fractures and hospital mortality. Acute hyponatraemia can lead to neurological dysfunction due to cerebral oedema. Its rapid correction can also be fatal, leading to osmotic demyelination syndrome. For some antiepileptics, thiazides, benzodiazepines or antidepressants this reaction is widely described. Knowing which drugs are most likely to cause hyponatraemia will allow early detection and prevention of its complications, as well as individualising the prescription of these drugs according to the patient's characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The main objectives are to identify potential new safety signals related to hyponatraemia and to analyse the cases of hyponatraemia reported to the Spanish Pharmacovigilance System for Medicines for Human Use (SEFV-H).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A disproportionality and a descriptive analysis of individual case safety reports (ICSR) was performed in the SEFV-H database (FEDRA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six hundred and fifty-nine cases of suspected drug-induced hyponatraemia were found (0.6% of the total database). Over the 5 years period studied, there was a 57% increase in the number of hyponatraemia reports in Spain. Most of the reported cases were serious (93%). Patients were most often women (63.7%) and elderly (71.9%). The time to onset ranged from 1 to 7030 days (median, 79 days) and approximately 70% of the total occurred within the first year of treatment. Five hundred and forty-six patients (82.9%) showed complete recovery after the withdrawal of the suspected medicine. Diuretics (reported in 57.7% of the cases), antidepressants (in 25%), drugs acting on renin angiotensin system (in 24%) and antiepileptics (in 20.2%) were the most frequent involved drugs. Disproportionate reporting has been found for almost all the substances most frequently reported, higher for amiloride and oxcarbazepine. Regarding new safety signals, the Reporting Odds Ratio (ROR) (95% CI) was found to be statistically significant for valsartan [7.7 (5.1-11.5)], olmesartan [7.3 (4.7-11.1)], amlodipine [3.4 (2.1-5.4)], pregabalin [2.5 (1.4-4.5)], irbesartan [18.6 (9.6-35.9)], paliperidone [2.7 (1.3-5.7)], ritonavir [2.4 (1.1-5.5)], atosiban [29.7 (8.6-102.2)], melphalan [9.7 (3.5-26.8)] and clozapine [4.4 (1.6-11.8)]. These active ingredients do not include this reaction on their SPC and comply with the EMA criteria for a safety signals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There are increasing reports of drug-induced hyponatraemia. It can be serious and seems to most often affect women over 65 years of age who take more than 1 medication. The time to onset varies and can be very long, so patient monitoring should be continuous throughout treatment. Hydrochlorothiazide is the drug with the highest number of reported cases in our setting. In terms of disp","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"600-608"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469865","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":"Caring for patients with multiple chronic conditions: Moving from morbidities to person needs.","authors":"Miquel Àngel Mas","doi":"10.1016/j.medcli.2024.06.010","DOIUrl":"10.1016/j.medcli.2024.06.010","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"617-618"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036282","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":"Liver Cirrhosis: ancient disease, new challenge.","authors":"Adrià Juanola, Elisa Pose, Pere Ginès","doi":"10.1016/j.medcli.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.11.002","url":null,"abstract":"<p><p>Liver cirrhosis is a common cause of morbidity and mortality worldwide. Excessive alcohol consumption and metabolic associated steatotic liver disease are the most common etiological factors of cirrhosis in our region. Cirrhosis occurs in two well-differentiated phases, compensated and decompensated, depending on the absence or presence of complications, respectively. Current therapeutic strategies are aimed at controlling these complications (such as ascites, hepatic encephalopathy, bacterial infections, or digestive hemorrhage, among others) or performing a liver transplant if there are no contraindications. However, it is important to eliminate the etiological factor responsible for the disease, as this can lead to the disappearance of complications, a state known as recompensation. This article proposes an updated review of the epidemiology of cirrhosis and its main causes, and offers an overview of the clinical features and treatment of the disease's complications, in addition to outlining future lines of research in this field.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896121","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":"Prediction model of hepatocellular carcinoma development in chronic hepatitis B virus infection in a Spanish cohort.","authors":"Paula Gavilán, Juan-Carlos Gavilán, Rocío Arnedo, Encarnación Clavijo, Isabel Viciana, José-Antonio González-Correa","doi":"10.1016/j.medcli.2024.07.022","DOIUrl":"10.1016/j.medcli.2024.07.022","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>To identify risk factors associated with the development of hepatocellular carcinoma (HCC) in an unselected cohort of patients with chronic B virus infection (CHB) in Spain. A predictive model was developed to assess the risk of HCC.</p><p><strong>Material and methods: </strong>A prospective open-cohort study recruited 446 unselected patients with chronic hepatitis B infection from two hospitals in Málaga (Spain). The follow-up time ranged from 0.5 to 31.5 years (mean: 13.8; SD: 9.5; median: 11.4 years). We used a Cox proportional hazard model to estimate the multivariable-adjusted hazard ratios of risk factors associated with the development of liver cancer and developed a clinical score, (HCCB score) to determine the risk of liver cancer, that categories patients into two risk levels for the development of HCC. We compared the diagnostic accuracy of our model with other previously published.</p><p><strong>Results: </strong>During the follow-up period, 4.80% of the patients developed liver cancer (21 out of 437), 0.33 cases per 100 patient-years. Multivariate Cox regression analysis revealed that age >45 years, male gender, hepatitis C coinfection, alkaline phosphatase >147IU/L, Child score >5 points, glucose >126mg/dL, and a viral load >4.3 log₁₀ IU/mL were independent risk factors. A risk score has been developed with a high predictive capacity for identifying patients at high risk of developing hepatocellular carcinoma. AUROC 0.87 (95% CI: 0.79-0.95).</p><p><strong>Conclusions: </strong>An HCCB score greater than 5.42 points identifies a subgroup of chronic hepatitis B patients at high risk of developing liver cancer, who could benefit from screening measures for the early diagnosis of HCC.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"609-616"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469870","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":"A rare case of LGI1 antibody-positive Morvan syndrome with myasthenia gravis.","authors":"Chunge Xie, Chizhong He, Tengyun Ma","doi":"10.1016/j.medcli.2024.07.011","DOIUrl":"10.1016/j.medcli.2024.07.011","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":"639-641"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349876","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}