Medicina Clinica最新文献

{"title":"Artificial intelligence-based triage in emergency departments: A promising tool.","authors":"Francisco Miralles Linares, Alejandro Martín Quirós, Milagros Jaén Cañadas","doi":"10.1016/j.medcli.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.003","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770318","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":"Impact of the improvement in the etiological diagnosis of community pneumonia.","authors":"Santiago Roques, Pere Tudela, Eduard Clot, Sarah Dávila, Frank Abella, Josep Vega","doi":"10.1016/j.medcli.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Etiological diagnosis of community-acquired pneumonia (CAP) is only reached in 30-40% of cases, which frequently requires keeping empirical antibiotic regimens. The new nucleic acid amplification techniques (NAAT) in respiratory samples raise the possibility of improving this clinical practice. Our objective was to analyze TAANs contribution estimating both their costs and benefits.</p><p><strong>Patients and methods: </strong>The admitted CAPs were analyzed, in which, if the conventional diagnostic tests were negative, a NAAT was performed. If positive results was made, we assessed if antimicrobials were modified, a cost estimate, and isolation measures.</p><p><strong>Results: </strong>64 cases were documented. An etiological diagnosis was made in 65.6%: 10.9% were obtained by conventional techniques and the rest (54.7%) by TAAN. These tests' results led to antimicrobial regimen's modification in 88.9% of cases and isolations in 78.5% CONCLUSIONS: Compared to TAAN's economic cost, it is worth considering its contributions, such as antimicrobials' reduction, ecological pressure, and isolations' indications.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770340","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":"Carotid Plaque-Burden scale and outcomes: A real-life study.","authors":"Carmen Sánchez-Bacaicoa, Sergio Rico-Martin, Clara Costo-Muriel, Eduardo Ortega-Collazos, Marta Sánchez-Lozano, Marisol Sánchez-Bacaicoa, Javier Galán-González, Julián F Calderón-García, Juan Francisco Sánchez Muñoz-Torrero","doi":"10.1016/j.medcli.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.009","url":null,"abstract":"<p><strong>Background: </strong>The value of carotid ultrasound in real-world practice remains controversial. We investigated the outcomes of people with vascular risk factors according to an easy carotid-plaque burden scale (CPB-scale). Predictive yield of the addition CPB-scale to ESC-SCORE2 (CPB-SCORE2 table) was assessed.</p><p><strong>Methods: </strong>A cohort of participants without preexisting cardiovascular disease (CVD) was evaluated for clinical outcomes according to the number of plaques by segment. The usefulness of the CPB-SCORE2 table was investigated.</p><p><strong>Results: </strong>A total of 1004 patients were followed for a mean of 12.5 years for major adverse cardiovascular events (MACEs) and death. The CPB-scale was independently associated with MACEs; compared to those in the low-risk group, the corresponding adjusted hazard ratios (95% confidence intervals) for MACEs among the intermediate and high-risk groups were 13.1 (4.87-35.5) and 19.4 (7.27-51.9), respectively. Similarly, the risk of death was greater for participants stratified as high-risk than for those in the low-risk group (adjusted HR 3.36 [1.58-7.15]). According to our CPB-SCORE2 table, 149 of 178 (84%) CV events were detected in the high-risk group and exhibited greater sensitivity than did the SCORE2 Table, 84%; vs. 62%; but slightly less specificity, 62%; vs. 68%. Our table shows the improved performance of SCORE2; c-statistics: 0.74 vs. 0.68; p<0.001 for net reclassification index and integrated discrimination index.</p><p><strong>Conclusions: </strong>A simple prognostic CPB-scale was strongly associated with the long-term risk of developing a first MACE and all-cause death. Adding the CPB-scale to the SCORE2 may improve risk prediction with easy applicability in clinical practice.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770328","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":"Heparin-induced distant bullous hemorrhagic dermatosis.","authors":"Omar Alwattar-Ceballos, Marina Montero-García, Mónica Gómez-Manzanares, Marcos Carmona-Rodríguez","doi":"10.1016/j.medcli.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.008","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770335","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":"Use of intravenous calcium in emergencies to treat patients with hyperkalemia and digoxin poisoning and its impact on short-term outcome.","authors":"Pere Llorens, María Mataix, Matilde González Tejera, Leticia Serrano, Pablo Herrero-Puente, María Luisa López-Grima, Begoña Espinosa, Francisco Javier Lucas-Imbernón, María Pilar López-Díez, Javier Millán, Pilar Gallardo Rodríguez, Pablo Chico-Sánchez, Patricio Mas, Paula Lafuente, Cristina Calzón Blanco, Òscar Miró","doi":"10.1016/j.medcli.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.007","url":null,"abstract":"<p><strong>Objetives: </strong>Patients with digitalis intoxication (DI) and hyperkalaemia are frequently encountered in the emergency department (ED). This alteration may require intravenous (iv) calcium, but its administration has been considered to increase cardiotoxicity and mortality in patients with DI. We studied the effect of iv calcium on mortality and 30-day readmission in patients with hyperkalaemia and DI.</p><p><strong>Methods: </strong>A retrospective, multicentre, retrospective cohort study including all patients with DI and hyperkalaemia from 2004 to 2023 seen in 6 hospital emergency departments. Two cohorts were created according to iv calcium administration, and demographic, clinical, electrocardiographic and outcome variables (mortality, readmission and combined event at 30 days) were collected.</p><p><strong>Results: </strong>117 patients with ID and hyperkalaemia were collected and 29% were administered iv calcium. Seventy-eight point 6percent were women, with a median age of 82.8 years. Cardiological symptoms were present in 57.3%, 47% digestive and 37.6% neurological. Cardiac arrhythmia was present in 86.3%, the most frequent type being slow supraventricular arrhythmia in 76.1%. The presence of cardiological symptoms (76.5% vs. 49.4, P=.007), arrhythmias (97.1% vs. 81.9%, P=.037), and higher levels of creatinine (70.6% vs. 42.2%, P=.005) and serum potassium (94.1% vs. 31.3%, P<.001) was more frequent in the group receiving iv calcium. An association was found between the administration of iv calcium An association was found between calcium administration and the combined event at 30 days (ORa 3.11, 95% CI:1.02-9.53), but this increase was at the expense of more readmissions (ORa 3.58, 95% CI, 1.04-12,33), with no relationship found with mortality at 30 days (ORa 0,75, 95% CI: 0.18-3.09).</p><p><strong>Conclusion: </strong>Calcium administration in hyperkalaemia and ID is not associated with short-term mortality.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770402","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":"It's time to properly classify dengue.","authors":"Marta Díaz-Menéndez, Marta Arsuaga","doi":"10.1016/j.medcli.2024.09.034","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.09.034","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770353","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":"Institutional or personal e-mail address in manuscripts submitted to biomedical journals.","authors":"Marta Pulido","doi":"10.1016/j.medcli.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.09.035","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770347","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":"New treatments in Alzheimer's disease.","authors":"Alberto Lleó","doi":"10.1016/j.medcli.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.10.011","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770355","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":"Effect of pentoxifylline on hepcidin and iron profile in hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial.","authors":"Hadeer Zakaria, Noha Alaa Hamdy, Nagy A H Sayed-Ahmed, Ahmed El-Mallah","doi":"10.1016/j.medcli.2024.09.032","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.09.032","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis (HD) patients often have elevated levels of hepcidin hormone, which is a key regulator of systemic iron homeostasis. While pentoxifylline (PTX) has been demonstrated to have anti-inflammatory properties, it is unclear if these effects would also have an inhibitory effect on hepcidin. This study aimed to examine the potential role of PTX on hepcidin and its consequent effects on iron profile and anemia in HD patients.</p><p><strong>Methods: </strong>Eighty HD patients were randomly assigned 1:1 to the pentoxifylline group, receiving a daily dose of PTX (800mg), or the placebo group, receiving placebo capsules for 6-months. Different laboratory parameters, including hepcidin, hemoglobin (Hb), red blood cells (RBCs), hypoxia-inducible factor-2 alpha (HIF-2α), serum iron, total iron-binding capacity (TIBC), ferritin, transferrin saturation (TSAT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs.CRP), were used for evaluation the patients' response.</p><p><strong>Results: </strong>In the PTX-treated patients, the hepcidin levels reduced significantly (p=0.001) from 628.03 (334.4-800.85)ng/ml to 235.25 (192.8-508.76)ng/ml, and this reduction was also statistically significant as compared to the placebo group (p<0.001). Also, there were significant changes (p<0.001) regarding other iron hemostasis parameters including Hb, RBCs, serum iron, TIBC, TSAT, and HIF-2α. Levels of IL-6 and hs.CRP, as a reflection of inflammatory status, decreased significantly (p=0.002 and p=0.003, respectively) in the pentoxifylline group, and the percent reduction in these parameters was also statistically significant compared to the placebo group (p<0.001).</p><p><strong>Conclusions: </strong>This study reveals that PTX reduces hepcidin levels and consequently provides an improvement in the iron profile and anemia in HD patients.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755304","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":"Association between cigarette smoking, genetic polymorphism and myelodysplasia: a multicentric case-control study.","authors":"Natalia de Las Heras Rodríguez, Marta Megido Lahera, José Ramón González Porras, Sonia Sánchez Campos, Raquel Díez Láiz, Marta Fuertes Núñez, Fernando Ramos Ortega","doi":"10.1016/j.medcli.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.09.017","url":null,"abstract":"<p><strong>Background: </strong>Both cigarette smoking (CGS), through its role as a benzene source, and some metabolic detoxyfiying enzymes (EDTOX) polymorphisms that hamper its inactivation, are considered as risk factors for the development of myelodysplastic neoplasms (MDS) and related disorders. This study aims to confirm such associations.</p><p><strong>Patients and methods: </strong>We recruited 61 patients diagnosed with MDS following FAB Group criteria and 180 adults without peripheral blood cytopenia, and we analyzed: i) the crude odds-ratio (OR) for MDS between smokers and non-smokers, ii) the crude OR for MDS between homozygous individuals for the mutation NQO1⁶⁰⁹C-T, or harboring deletions in the genes codyfing for GSTM1 y GSTT1, and those who did not show such genotypes, and iii) the OR for MDS between smokers and non-smokers, adjusted for other potential risk factors.</p><p><strong>Results: </strong>Our data confirm the association between MDS with a 28 pack-year or greater CGS history (OR 3.10; IC 95% 1.38-6.96). Conversely, we did not observe any association between MDS diagnosis and the EDTOX genotypes analyzed.</p><p><strong>Conclusions: </strong>Cigarette smoking history is more relevant than EDTOX genotype in MDS etiopathogenesis.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755303","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}