Medicina Clinica最新文献

{"title":"Economic cost of long-term albumin treatment in cirrhotic patients with uncomplicated ascites based on the ANSWER trial: The Spanish healthcare system perspective","authors":"Javier Fernández ,&nbsp;Cristina Coll-Ortega ,&nbsp;Cristina Fuster ,&nbsp;Anne Davis ,&nbsp;Pablo Simó ,&nbsp;Susana Aceituno ,&nbsp;Maria Soler","doi":"10.1016/j.medcli.2025.107154","DOIUrl":"10.1016/j.medcli.2025.107154","url":null,"abstract":"<div><h3>Background and aims</h3><div>Cirrhosis represents the end-stage of chronic liver diseases. The ANSWER trial showed that long-term albumin (LTA) administration along with the standard medical treatment (SMT) improves survival and reduces complications in patients with decompensated cirrhosis and uncomplicated ascites. The present analysis compared the potential annual cost of treatment with LTA<!--> <!-->+<!--> <!-->SMT, following the ANSWER regimen, with respect to SMT alone in patients with decompensated cirrhosis and uncomplicated ascites from the Spanish healthcare system perspective.</div></div><div><h3>Methods</h3><div>Cost of illness for patients with cirrhosis and uncomplicated ascites, treated with SMT alone or LTA<!--> <!-->+<!--> <!-->SMT (ANSWER regimen), was estimated. The annual incidence of complications and treatment frequency were collected based on the findings from the ANSWER trial. Unit costs were obtained from published data and transformed to 2019 Euros. The incremental cost was the difference in annual cost per patient between LTA<!--> <!-->+<!--> <!-->SMT and SMT alone treatment groups. A univariate sensitivity analysis was performed to ensure the robustness of the analysis.</div></div><div><h3>Results</h3><div>The annual cost per patient of treatment and management of complications was estimated at €26,161 for patients treated with LTA<!--> <!-->+<!--> <!-->SMT, compared to €27,536 for those treated with SMT alone, representing saving costs of €1,375 per patient and year.</div></div><div><h3>Conclusions</h3><div>By translating the ANSWER trial results to the Spanish clinical setting, LTA<!--> <!-->+<!--> <!-->SMT could reduce the healthcare cost associated with the management of cirrhotic patients with uncomplicated ascites due to the reduction of costly complications, which counterbalance the cost of LTA.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107154"},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908709","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":"Papel de la inteligencia artificial en la reducción del estigma de la obesidad en la atención sanitaria","authors":"Ana Zugasti Murillo ,&nbsp;Javier Salvador Rodríguez","doi":"10.1016/j.medcli.2025.107157","DOIUrl":"10.1016/j.medcli.2025.107157","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107157"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902250","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":"Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y fibrilación auricular: Programa UMIPIC","authors":"José Luis García-Klepzig ,&nbsp;Manuel Méndez Bailón ,&nbsp;Manuel Montero-Pérez-Barquero ,&nbsp;Álvaro González-Franco ,&nbsp;José M. Cerqueiro ,&nbsp;José Pérez-Silvestre ,&nbsp;María Prado Salamanca-Bautista ,&nbsp;Sara Carrascosa-García ,&nbsp;Maria del Carmen Moreno-García ,&nbsp;Luis Manzano-Espinosa","doi":"10.1016/j.medcli.2025.107113","DOIUrl":"10.1016/j.medcli.2025.107113","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) and atrial fibrillation (AF) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and AF.</div></div><div><h3>Methods</h3><div>A total of 5644 patients were prospectively recruited, of which 3005 had a history of AF between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in the UMIPIC program (1142 patients) and another treated conventionally (1863 patients). Baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching. Admissions, mortality, incidence of stroke, intracranial hemorrhage and any other bleeding were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.</div></div><div><h3>Results</h3><div>The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for any cause (35.6% vs. 44.8%, respectively; hazard ratio [HR]<!--> <!-->=<!--> <!-->0.82; 95% confidence interval [95% CI]: 0.74-0.92; <em>P</em>&lt;.001) and lower rate of admissions for HF (18.3% vs 29.6, respectively; HR<!--> <!-->=<!--> <!-->0.74; 95% confidence interval [95% CI]: 0.66-0.83; <em>P</em>&lt;.001). Mortality was lower in the UMIPIC group (23.2% vs. 31%, respectively; HR<!--> <!-->=<!--> <!-->0.82; 95% CI: 0.73-0.92; <em>P</em>=.001). No differences were found in the incidence of ischemic stroke group (1.2 vs. 0.5%, respectively; HR<!--> <!-->=<!--> <!-->0.71; 95% CI: 0.5-1.03; <em>P</em>=.714).</div></div><div><h3>Conclusions</h3><div>The implementation of the UMIPIC care program for patients with HF and a history of AF, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up without differences in ischemic stroke incidence.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107113"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894963","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":"Deterioro en el lenguaje médico","authors":"Carlos Romero Gómez","doi":"10.1016/j.medcli.2025.107146","DOIUrl":"10.1016/j.medcli.2025.107146","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107146"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895008","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":"Absceso hepático primario por Klebsiella pneumoniae","authors":"Kattia Gassely Torres Gil ,&nbsp;Aina Martí-Carretero","doi":"10.1016/j.medcli.2025.107142","DOIUrl":"10.1016/j.medcli.2025.107142","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107142"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895009","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":"Weight management treatment in obesity","authors":"Miguel A. Rubio-Herrera ,&nbsp;Sara Mera-Carreiro","doi":"10.1016/j.medcli.2025.107152","DOIUrl":"10.1016/j.medcli.2025.107152","url":null,"abstract":"<div><div>Obesity is a chronic and relapsing disease associated with medical complications and mortality. Our improved understanding of the relevance of the gut–brain axis in regulating appetite and body weight has encouraged research into nutrient-stimulated gastroenteropancreatic hormones as a new therapeutic arsenal for the treatment of people living with obesity. Beyond the necessary lifestyle changes, this new era with second-generation drugs has been able to achieve weight loss of 15–25%, close to that of bariatric surgery. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), used as weekly injectable monotherapy or daily oral (semaglutide), achieve weight loss of 15–17%, with a good safety profile. The synergistic combination with other hormones (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, or amylin) will allow to increase weight loss, as well as improve cardiometabolic variables. Tirzepatide (a dual GLP-1/GIP receptor agonist) achieves weight loss of up to 22.5% at the highest doses. In this same range of weight loss, it is expected that it can be achieved with the combination of Cagrisema (cagrilintide 2.4<!--> <!-->mg plus semaglutide 2.4<!--> <!-->mg), combinations of GLP-1 RAs – glucagon agonists or with the triple combination of GLP-1 RAs-GIP-Glucagon (Retatrutide). In this review, we will examine the efficacy and safety of the drugs marketed and others under ongoing clinical trials for the treatment of persons with obesity, as well as the main challenges faced by both healthcare professionals and patients in maintaining long-term treatment.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107152"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895013","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":"Corrección de la anemia ferropénica en el trasplante hepático. Estudio preliminar","authors":"Lourdes Pérez ,&nbsp;Annabel Blasi ,&nbsp;Rosa Gutierrez ,&nbsp;Marta Caballero ,&nbsp;Jose Pérez ,&nbsp;Iratxe Zarragoikoetxea ,&nbsp;Julia Vidal ,&nbsp;Patricia Salvador ,&nbsp;Gorka Ojinaga ,&nbsp;Patricia Duque ,&nbsp;Andrea Bosca ,&nbsp;Paula Isabel Carmona ,&nbsp;Jordi Colmenero ,&nbsp;Maria Jose Colomina ,&nbsp;Sandra Llaurado ,&nbsp;Antoni Sabate","doi":"10.1016/j.medcli.2025.107136","DOIUrl":"10.1016/j.medcli.2025.107136","url":null,"abstract":"<div><h3>Context</h3><div>In liver transplantation (LT), anemia and transfusion of blood products have a negative impact on morbidity and mortality.</div></div><div><h3>Methods</h3><div>Multicenter, prospective observational study. The main objective was to assess whether correction of iron deficiency anemia with intravenous iron was feasible in LT candidates. Its efficacy and adverse effects were evaluated. Patients with Hb value &lt;<!--> <!-->115<!--> <!-->g/l and ferritin values &lt;<!--> <!-->800<!--> <!-->ng/ml were included. Based on the increase in Hb<!--> <!-->&gt;<!--> <!-->10<!--> <!-->g/l compared to its baseline level, the analysis of 76 patients was considered.</div><div>An anemia study was carried out, assigning to the study group those who met the criteria for iron deficiency anemia, which followed a protocol of administration of up to two doses of iron before LT.</div></div><div><h3>Results</h3><div>Two hundred ninety-six LT were performed during the study period, 48% of patients had an Hb value &lt;<!--> <!-->115<!--> <!-->g/l. Forty-three patients made up the study group, in 5 patients the first dose was not administered. The second dose was administered to 55% of patients. No patient presented serious adverse effects or alterations in liver function. Hemoglobin increased compared to baseline by a median of 11.22<!--> <!-->g/l (6.47-15.97) after the first administration and 11.64<!--> <!-->g/l (6.49-16.78) after the second.</div></div><div><h3>Conclusions</h3><div>The implementation of patient blood management in LT through the administration of intravenous iron is effective and safe. It is necessary to routinely characterize and treat the presence of iron deficiency anemia in these patients.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107136"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895114","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 subclinical haemolysis and periprocedural outcomes in patients undergoing transcatheter aortic valve replacement","authors":"Gloria Heredia-Campos ,&nbsp;Rafael Gonzalez-Manzanares ,&nbsp;Ana Rodríguez-Almodovar ,&nbsp;Juan Antonio Moreno ,&nbsp;Isabel Pozuelo ,&nbsp;Jorge Perea ,&nbsp;Ignacio Gallo ,&nbsp;Luis Carlos Maestre ,&nbsp;Francisco Hidalgo ,&nbsp;Javier Suárez De Lezo ,&nbsp;Miguel Romero ,&nbsp;Dolores Mesa ,&nbsp;Simona Espejo ,&nbsp;Manuel Pan ,&nbsp;Soledad Ojeda","doi":"10.1016/j.medcli.2025.107143","DOIUrl":"10.1016/j.medcli.2025.107143","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) has become a cornerstone treatment for patients with severe aortic stenosis, especially those unsuitable for surgery. Intravascular haemolysis has been described in patients with aortic stenosis. This study aimed to assess the prevalence of haemolysis in patients with severe AS undergoing TAVI and its association with immediate and 30-day post-procedural outcomes.</div></div><div><h3>Methods</h3><div>The HEMO-TAVI study was a prospective, single-centre cohort study conducted at University Hospital Reina Sofía (Córdoba, Spain) from June 2020 to September 2023. Consecutive patients scheduled for TAVI were enrolled. Haemolysis was defined as LDH<!--> <!-->&gt;<!--> <!-->220<!--> <!-->U/L plus ≥2 criteria (low haemoglobin, low haptoglobin, elevated reticulocytes, or schistocytes). The primary endpoint was a composite of peri-procedural and 30-day adverse events.</div></div><div><h3>Results</h3><div>Among 301 patients, pre-procedural haemolysis was identified in 18 (6.0%). Patients with haemolysis had higher interventricular septum thickness and transvalvular gradients. The composite endpoint occurred more frequently in the haemolysis group (44.4% vs 21.2%, OR_adj 2.23, 95% CI 1.12–8.25, <em>p</em> <!-->=<!--> <!-->0.025). Haemolysis was independently associated with a greater number of complications (OR_adj 3.26, 95% CI 1.19–8.47, <em>p</em> <!-->=<!--> <!-->0.016).</div></div><div><h3>Conclusion</h3><div>Pre-procedural haemolysis might be present in TAVI candidates and is associated with increased peri-procedural and 30-day complications. Pre-procedural haemolysis may serve as a marker of elevated procedural risk.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 5","pages":"Article 107143"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902251","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":"Efectividad de los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) en función del filtrado glomerular en los pacientes ancianos pluripatológicos con insuficiencia cardíaca aguda. Registro PROFUND-IC","authors":"Alicia Guzmán-Carreras ,&nbsp;Sahar Okab ,&nbsp;Irene Ruiz-Torrubia ,&nbsp;Rafael Sánchez-del Hoyo ,&nbsp;Mateo Paz-Cabezas ,&nbsp;Beatriz Sánchez-Sauce ,&nbsp;Noel Lorenzo-Villalba ,&nbsp;Manuel Méndez-Bailón ,&nbsp;en representación de todos los colaboradores del registro PROFUND-IC","doi":"10.1016/j.medcli.2025.107139","DOIUrl":"10.1016/j.medcli.2025.107139","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure is a prevalent disease causing high morbidity and mortality. It is associated with comorbidities like renal impairment that worsen its prognosis.</div></div><div><h3>Aims</h3><div>To analyse whether renal function influences the effectiveness of SGLT2 inhibitors in reducing readmissions or mortality in elderly pluripathological patients with acute heart failure (AHF).</div></div><div><h3>Materials and methods</h3><div>Retrospective study of 913 pluripathological patients with AHF from the PROFUND-IC registry. The sample was divided into three groups by glomerular filtration rate (GFR): ≤25^th percentile (GFR≤30.41<!--> <!-->ml/min/1.73m²; N<!--> <!-->=<!--> <!-->229), 25^th-75^th percentile (GFR: 30.41-65.14; N<!--> <!-->=<!--> <!-->456), and ≥75^th percentile (GFR≥65.14; N<!--> <!-->=<!--> <!-->228). Group differences were analyzed using chi-square test for qualitative variables and ANOVA for quantitative ones, with Fisher and Kruskal-Wallis tests applied when indicated. Kaplan-Meier curves evaluated survival and readmissions according to treatment with iSGLT2.</div></div><div><h3>Results</h3><div>Nine hundred thirteen patients were included, with mean GFR of 49<!--> <!-->ml/min/1.73m² and mean creatinine of 1.4<!--> <!-->mg/dl. The 58.2% were women, with a mean age of 84 years, and mean left ventricular ejection fraction of 51.45%. Patients with lower GFR were older (<em>p</em> <!-->&lt;<!--> <!-->.001), had more diabetes mellitus (<em>p</em> <!-->&lt;<!--> <!-->.001), and worse functional class (<em>p</em> <!-->=<!--> <!-->.038). Mortality and readmission rates did not differ across GFR categories. SGLT2 inhibitors use was associated with reduced readmissions in all groups, although significant differences in mortality (<em>p</em> <!-->=<!--> <!-->.0068) and readmissions (<em>p</em> <!-->=<!--> <!-->.021) were only observed in patients with GFR between 30.41 and 65.14<!--> <!-->ml/min/1.73m<span><span>²</span></span>^.</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitors significantly reduced readmissions and mortality in elderly pluripathological patients with AHF and GFR between 30.41 and 65.14<!--> <!-->ml/min/1.73m².</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 6","pages":"Article 107139"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902397","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":"Osteomielitis crónica recurrente multifocal en adultos: un desafío diagnóstico","authors":"Clara Beatriz Palacios Morenilla,&nbsp;Mónica Zamora Pasadas,&nbsp;Blanca Sánchez Checa","doi":"10.1016/j.medcli.2025.107125","DOIUrl":"10.1016/j.medcli.2025.107125","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 4","pages":"Article 107125"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902308","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}