Medicina clinica (English ed.)最新文献

{"title":"In-hospital linagliptin for management simplification and hypoglycemia reduction in very old patients with type 2 diabetes","authors":"Miguel A. Pérez-Velasco ,&nbsp;Julio Osuna-Sánchez ,&nbsp;Mercedes Millán-Gómez ,&nbsp;Michele Ricci ,&nbsp;Almudena López-Sampalo ,&nbsp;María-Rosa Bernal-López ,&nbsp;Ricardo Gómez-Huelgas ,&nbsp;Luis M. Pérez-Belmonte","doi":"10.1016/j.medcle.2024.10.023","DOIUrl":"10.1016/j.medcle.2024.10.023","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The role of in-hospital dipeptidyl peptidase-4 inhibitors in very old patients has not been widely described. This work analyzes the simplification of in-hospital antihyperglycemic management (less insulin use) and reductions in hypoglycemia events using linagliptin in patients aged<!--> <!-->≥<!--> <!-->80 years with type 2 diabetes.</div></div><div><h3>Patients and methods</h3><div>This real-world observational study included hospitalized patients<!--> <!-->≥<!--> <!-->80 years with type 2 diabetes treated with an antihyperglycemic protocol of either basal-bolus insulin or linagliptin between January 2016 and December 2023. A 1:1 propensity score matching analysis was performed.</div></div><div><h3>Results</h3><div>Post-matching, 944 patients were included in each group. The total and basal insulin doses and number of daily injections were significantly lower in the linagliptin group than the basal-bolus insulin group with no differences in glycemic efficacy. Regarding safety, patients on the basal-bolus insulin regimen had more hypoglycemic events. The use of basal-bolus insulin regimen (odds ratio: 4.22; 95% confidence interval: 2.14–6.28; <em>p</em> <!-->&lt;<!--> <!-->0.001), a higher total insulin dose (odds ratio: 3.55; 95% confidence interval: 2.02–5.36; <em>p</em> <!-->&lt;<!--> <!-->0.001) and the number of insulin injections (odds ratio: 2.86; 95% confidence interval: 1.50–4.12; <em>p</em> <!-->=<!--> <!-->0.002) were associated with a greater risk of hypoglycemia. Other hypoglycemia risk factors were older age, moderate–severe functional dependence, moderate–severe dementia, polypharmacy, and complex health status.</div></div><div><h3>Conclusions</h3><div>The linagliptin regimen simplified in-hospital antihyperglycemic management and reduced hypoglycemia events compared to basal-bolus insulin regimen in patients with type 2 diabetes aged<!--> <!-->≥<!--> <!-->80 years. Basal-bolus insulin use and clinical factors were associated with hypoglycemia. The linagliptin regimen could be considered as standard of care for older adult type 2 diabetes patients in the hospital setting.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 350-357"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black hairy tongue","authors":"Julio C. Salas-Alanís ,&nbsp;Mauricio Salas-Garza ,&nbsp;María G. Moreno-Treviño ,&nbsp;Ma. G. Treviño-Alanís ,&nbsp;Gerardo Rivera-Silvac","doi":"10.1016/j.medcle.2024.10.021","DOIUrl":"10.1016/j.medcle.2024.10.021","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 386-387"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which patients need thromboprophylaxis for venous thromboembolism prevention after hospitalization due to COVID-19? A sub-analysis from the CV COVID-19 registry","authors":"Andrea Ruberti ,&nbsp;Luis Ortega-Paz ,&nbsp;Salvatore Brugaletta ,&nbsp;on behalf of the CV COVID-19 Registry Investigators","doi":"10.1016/j.medcle.2024.10.022","DOIUrl":"10.1016/j.medcle.2024.10.022","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 380-381"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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 ,&nbsp;Sergio Rico-Martin ,&nbsp;Clara Costo-Muriel ,&nbsp;Eduardo Ortega-Collazos ,&nbsp;Marta Sánchez-Lozano ,&nbsp;Marisol Sánchez-Bacaicoa ,&nbsp;Javier Galán-González ,&nbsp;Julián F. Calderón-García ,&nbsp;Juan Francisco Sánchez Muñoz-Torrero","doi":"10.1016/j.medcle.2024.10.020","DOIUrl":"10.1016/j.medcle.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>c</em>-statistics: 0.74 vs. 0.68; <em>p</em> <!-->&lt;<!--> <!-->0.001 for net reclassification index and integrated discrimination index.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 325-333"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening ECG for cardiovascular prevention","authors":"José Luis Hernández Hernández,&nbsp;Marta Martín Millán","doi":"10.1016/j.medcle.2025.01.004","DOIUrl":"10.1016/j.medcle.2025.01.004","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 358-360"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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 ,&nbsp;María Mataix ,&nbsp;Matilde González Tejera ,&nbsp;Leticia Serrano ,&nbsp;Pablo Herrero-Puente ,&nbsp;María Luisa López-Grima ,&nbsp;Begoña Espinosa ,&nbsp;Francisco Javier Lucas-Imbernón ,&nbsp;María Pilar López-Díez ,&nbsp;Javier Millán ,&nbsp;Pilar Gallardo Rodríguez ,&nbsp;Pablo Chico-Sánchez ,&nbsp;Patricio Mas ,&nbsp;Paula Lafuente ,&nbsp;Cristina Calzón Blanco ,&nbsp;Òscar Miró","doi":"10.1016/j.medcle.2024.10.015","DOIUrl":"10.1016/j.medcle.2024.10.015","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>117 patients with ID and hyperkalaemia were collected and 29% were administered iv calcium. Seventy-eight point six percent 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 = 0.007), arrhythmias (97.1% vs 81.9%, p = 0.037), and higher levels of creatinine (70.6% vs 42.2%, p = 0.005) and serum potassium (94.1% vs 31.3%, p &lt; 0.001) 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).</div></div><div><h3>Conclusion</h3><div>Calcium administration in hyperkalaemia and ID is not associated with short-term mortality.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 334-340"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors of mortality in very old patients visited in Emergency Department and admitted for infection","authors":"Míriam Carbó Díez,&nbsp;Gina Osorio Quispe,&nbsp;Lourdes Artajona García,&nbsp;Marie Anette Arce Marañón,&nbsp;Natalia Miota Hernández,&nbsp;Dora Sempertegui Gutiérrez,&nbsp;Milagrosa Perea Gainza,&nbsp;María del Mar Ortega Romero","doi":"10.1016/j.medcle.2024.10.018","DOIUrl":"10.1016/j.medcle.2024.10.018","url":null,"abstract":"<div><h3>Objective</h3><div>To describe mortality predictive factors in patients 80 years or older with infection who were visited at the emergency department and were admitted to hospital.</div></div><div><h3>Methods</h3><div>Retrospective observational study. Patients ≥ 80 years old who visited the emergency department (January 1st to December 31st, 2022), whose main diagnosis was infection and required admission, were included. Factors associated with mortality at the end of the episode were determined.</div></div><div><h3>Results</h3><div>987 patients were included (mean age 87 years, 53% women). Mortality at the end of the episode was 13% (<em>n</em> = 127). Median survival of the series was 52 days (95% CI: 44–60). The independent factors related to mortality were: age (HR: 1.07; 95% CI: 1.03–1.11; <em>p</em> &lt; 0.001), frailty (Clinical Frailty Scale, CFS) (HR: 1.51; 95% CI: 1.15–1.97; <em>p</em> = 0.003), qSOFA (HR: 1.35; 95% CI: 1.07–1.70; <em>p</em> = 0.01), SOFA (HR: 1.23; 95% CI: 1.15–1.38; <em>p</em> &lt; 0.001), leukocyte count (HR: 1.04; 95% CI: 1.02–1.06; <em>p</em> &lt; 0.001) and criteria for sepsis and/or septic shock (HR: 2.52; 95% CI: 1.63–3.87; <em>p</em> &lt; 0.001). On the contrary, any type of microbiological isolation was associated with lower mortality (HR: 0.44; 95% CI: 0.29 – 0.64; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>qSOFA and SOFA scores, the sepsis and septic shock criteria, as well as frailty are predictive factors of poor prognosis in very elderly patients who come to the emergency room due to infection. Knowing frailty would allow us to adapt the treatment and therapeutic effort to the patient's characteristics.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 341-349"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic adventitial disease of the popliteal artery","authors":"Bernat Morist-Beltrán,&nbsp;Vicente López-Pérez,&nbsp;Gloria Pedemonte-Parramón","doi":"10.1016/j.medcle.2024.09.034","DOIUrl":"10.1016/j.medcle.2024.09.034","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 376-377"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contamination by Mycobacterium lentiflavum in the bronchoscope washing water","authors":"Concepción Prados-Sánchez,&nbsp;Alberto Mangas-Moro,&nbsp;Grupo de trabajo de Contaminación por M. lentiflavum","doi":"10.1016/j.medcle.2024.09.033","DOIUrl":"10.1016/j.medcle.2024.09.033","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 374-375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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,&nbsp;Marina Montero-García,&nbsp;Mónica Gómez-Manzanares,&nbsp;Marcos Carmona-Rodríguez","doi":"10.1016/j.medcle.2024.10.016","DOIUrl":"10.1016/j.medcle.2024.10.016","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 7","pages":"Pages 384-385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}