Medicina clinica (English ed.)最新文献

{"title":"Crescents and CKD progression in diabetic nephropathy","authors":"Xia Gu ,&nbsp;Danyang Zhang ,&nbsp;Shimin Jiang ,&nbsp;Wenge Li","doi":"10.1016/j.medcle.2024.11.018","DOIUrl":"10.1016/j.medcle.2024.11.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Crescents play important roles in the pathophysiology of patients with biopsy-proven diabetic nephropathy (DN). However, their relationship to disease severity and progression has not been fully clarified.</div></div><div><h3>Methods</h3><div>We assessed 142 participants in a retrospective cohort study of biopsy-proven DN. We determined associations of crescent formation with CKD progression event, defined as a sustained decrease from baseline of at least 40% in the eGFR or ESRD, using Cox proportional hazards models. A prognostic nomogram was constructed to predict 1-, 3-, and 5-year renal survival for patients with DN.</div></div><div><h3>Results</h3><div>Glomerular crescent formation negatively correlated with eGFR (Spearman's <em>ρ</em> <!-->=<!--> <!-->−0.33, <em>P</em> <!-->=<!--> <!-->0.01), whereas there was no significant correlation between crescents and 24-hour proteinuria, KW nodules, capillary microaneurysms, and C3 deposition. After adjustment for traditional risk factors (demographics, eGFR, proteinuria, and pathologic score), the crescents were independently associated with a CKD progression event (HR, 1.71; 95% CI, 1.07–2.76; <em>P</em> <!-->=<!--> <!-->0.024). Moreover, the risk of CKD progression events was greater with a higher proportion of crescents but reached a plateau when the crescent proportion was 20%.</div></div><div><h3>Conclusions</h3><div>In patients with DN, crescents were associated with CKD progression events independent of clinical and pathologic characteristics.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Pages 470-479"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900217","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":"Cognitive dysfunction in systemic lupus erythematosus: Its relationship with intracerebral volumes and antiphospholipid antibody profile. Case series","authors":"Julian A. Naranjo-Millán ,&nbsp;Alex Echeverri ,&nbsp;David Aguirre-Valencia ,&nbsp;Ana M. Granados-Sánchez ,&nbsp;Isabella Moreno-Arango ,&nbsp;Valentina Mejía-Quiñones ,&nbsp;Juan F. Orejuela-Zapata","doi":"10.1016/j.medcle.2024.11.019","DOIUrl":"10.1016/j.medcle.2024.11.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of cognitive compromise in systemic lupus erythematosus is variable; it presents early and is usually asymptomatic. Our study evaluated the frequency of cognitive impairment in patients without a previous diagnosis of neuropsychiatric lupus and compared the differences in intracerebral size in subgroups with cognitive alterations and positive autoantibodies.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study. Patients with systemic lupus erythematosus without a previous diagnosis of neuropsychiatric lupus treated between July 2018 and October 2019 were included. Neuropsychological tests and brain imaging were performed by magnetic resonance imaging (MRI) measuring brain volumes. The variables, including antiphospholipid syndrome (APS) antibodies, were compared between subgroups of patients with and without neuropsychological alterations.</div></div><div><h3>Results</h3><div>Six patients were included. Patients who tested positive in more than two abnormal neuropsychiatric assessments showed reduced brain volumes in the right (6.1 versus 5.31) and left (6.2 versus 5.38) frontal lobes, the right (0.66 versus 0.65) and left (0.67 versus 0.6) cingulate cortices, the right (3.63 versus 3.38) and left (3.67 versus 3.4) temporal lobes, the right (3.96 versus 3.8) and left (3.87 versus 3.7) parietal lobes, and the right (0.49 versus 0.41) and left (0.46 versus 0.42) insula. A comparison of median normalized brain volumes revealed that most patients testing positive for antiphospholipid antibodies had reduced brain volumes.</div></div><div><h3>Conclusions</h3><div>A relationship was observed between neurocognitive compromise, antiphospholipid antibodies and brain volumes measured by cerebral magnetic resonance. These findings occur in asymptomatic neuropsychiatric patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Pages 480-486"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900173","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":"Uncommon presentation of insulinoma in an elderly patient","authors":"Ángel López Montalbán ,&nbsp;Patricia Guirado Peláez ,&nbsp;José Ignacio Martínez Montoro","doi":"10.1016/j.medcle.2024.11.011","DOIUrl":"10.1016/j.medcle.2024.11.011","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 442-443"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860361","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":"Auricular chondritis","authors":"Sergio Prieto-González ,&nbsp;África Muxí","doi":"10.1016/j.medcle.2025.03.003","DOIUrl":"10.1016/j.medcle.2025.03.003","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 446-447"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860566","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":"Arrhythmic storm in a liver transplant recipient: Could bezlotoxumab be the trigger?","authors":"Maria Pascual ,&nbsp;Miguel Sogbe ,&nbsp;José Ramón Yuste","doi":"10.1016/j.medcle.2024.10.031","DOIUrl":"10.1016/j.medcle.2024.10.031","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 440-441"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860360","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":"Heavy metals screening model in primary care: Experience in the Sierra Minera de Cartagena (Spain)","authors":"Juan Antonio Ortega-García ,&nbsp;Francisco Díaz-Martínez ,&nbsp;Laura Rubio-Roca ,&nbsp;Isabel Martínez-Frutos ,&nbsp;Claudia Ortiz-Fernández ,&nbsp;Maria Luisa Gil-Del Castillo ,&nbsp;Francisco Pacheco-Martínez","doi":"10.1016/j.medcle.2024.10.030","DOIUrl":"10.1016/j.medcle.2024.10.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Soils contaminated by heavy metals such as lead, cadmium, and arsenic represent a significant health risk. The Sierra Minera of Cartagena (Spain) is an area historically contaminated by mining activities. This study evaluates the exposure to heavy metals and proposes a clinical screening model for its management in primary care.</div></div><div><h3>Method</h3><div>Descriptive cross-sectional study conducted between 2017 and 2020 with volunteers from the Sierra Minera of Cartagena who provided blood and urine samples. Primary care health professionals were trained in sample collection and analysis, risk communication, and clinical protocols on heavy metals were implemented.</div></div><div><h3>Results</h3><div>203 participants, 66.5% women and 38 (18.7%) under 16 years old. The majority resided in Zone 0 (contaminated area). Mean blood lead level was 1.78<!--> <!-->μg/dl and 2.22<!--> <!-->μg/dl in those under 16 years old, with. Metal concentrations, particularly lead, increased with age, male sex, Arab ethnicity, and proximity to contaminated areas. Tobacco smoke was identified as a main source of lead exposure in children under 16 years. The primary care clinical screening model identified 12 (7%) and 22 (11%) participants exceeding 5<!--> <!-->μg/dl and 3.5<!--> <!-->μg/dl respectively, particularly six children and one pregnant woman, with significant levels that normalized within 2–3 months following PEHSU's clinical guidelines.</div></div><div><h3>Conclusions</h3><div>The implementation of clinical and analytical screening for heavy metals in primary care, supported by pediatric environmental health units (PEHSU), proved effective in screening and reducing in children blood lead levels in a short period. Training health professionals is crucial to adequately address environmental risks and protect the health of affected populations.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 410-417"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860419","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":"Unveiling spatial clusters of systemic sclerosis mortality in Spain: A comprehensive geographical analysis","authors":"Lucia Cayuela ,&nbsp;José-Juan Pereyra-Rodríguez ,&nbsp;Paz Collado Ramos ,&nbsp;Nuria Garvín Grande ,&nbsp;Aurelio Cayuela","doi":"10.1016/j.medcle.2024.10.029","DOIUrl":"10.1016/j.medcle.2024.10.029","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the spatial patterns of systemic sclerosis mortality in Spain from 2003 to 2022, identifying provincial-level clusters and sex-specific differences to explore potential underlying factors.</div></div><div><h3>Methods</h3><div>Mortality and population data (2003–2022) were sourced from the National Institute of Statistics. Age-standardized mortality rates were calculated, and spatial patterns were analyzed using standardized mortality ratios and smoothed relative risks via the Besag, York, and Mollié model, with statistical inference performed using the Integrated Nested Laplace Approximation (INLA) technique. Spatial clustering was assessed using Tango's and Kulldorff's tests.</div></div><div><h3>Results</h3><div>A total of 2016 SSc deaths were recorded, revealing a marked gender disparity. SSc mortality rates showed a consistent annual increase of 2.1% for both sexes, with women experiencing rates approximately 3.4 times higher than men. Age-specific analysis demonstrated higher mortality rates among women across all age groups, with an average sex ratio of 2.9, and rates increased with age for both sexes. Spatial analysis identified significant clusters of elevated SSc mortality in northwestern Spain, primarily in León and Asturias, with additional clusters extending to nearby provinces. These regions, characterized by silica mining and related industries, exhibited notable variations between men and women in the specific provinces affected.</div></div><div><h3>Conclusions</h3><div>This study identifies significant geographic and sex-based disparities in SSc mortality across Spain, with prominent clusters in the north. The results highlight the potential impact of environmental and occupational exposures on disease outcomes, emphasizing the need for targeted public health interventions in high-risk areas.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 403-409"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860356","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":"Patera syndrome in African migrants. An emerging clinical entity","authors":"Elena Pisos-Álamo ,&nbsp;José-Luis Pérez-Arellano","doi":"10.1016/j.medcle.2025.01.005","DOIUrl":"10.1016/j.medcle.2025.01.005","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 8","pages":"Pages 418-420"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859226","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":"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}