Medicina clinica (English ed.)最新文献

{"title":"Independent predictors of functional loss and refractures in patients with femur fracture: Follow-up at 6 and 18 months in a Fracture Liaison Service","authors":"Teresa Casanova Querol ,&nbsp;Dacia Cerdà Gabaroi ,&nbsp;José María Santiago Bautista ,&nbsp;Joan Girós Torres ,&nbsp;Ramon Miralles Basseda ,&nbsp;Montse Martín-Baranera","doi":"10.1016/j.medcle.2024.11.017","DOIUrl":"10.1016/j.medcle.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>In elderly patients hospitalized for a femur fracture, this study aimed to evaluate the functional evolution, and to estimate the incidence of second fractures at 6 and 18 months after hospital discharge.</div></div><div><h3>Patients and methods</h3><div>A longitudinal prospective study was designed at an Orthogeriatric Unit after implementing a Fracture Liaison Service (FLS). The variables collected included the baseline demographic and clinical characteristics of the patients, and the outcome variables on discharge, at 6 and 18 months of follow-up. Logistic regressions models were applied to identify independent predictors of functional evolution.</div></div><div><h3>Results</h3><div>478 patients were admitted. Independent predictors of functional loss at follow-up were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarction, GFR<!--> <!-->&lt;<!--> <!-->30<!--> <!-->ml/min/1.73<!--> <!-->m² and not receiving treatment for osteoporosis on discharge. Patients attending follow-up appointments presented improved compliance with osteoporosis treatment both at 6 and 18 months. A lower number of 2nd fractures were recorded at 18 months for patients who attended their appointments (4.8% vs 12.1%, <em>p</em> <!-->=<!--> <!-->0.01). At 6 and 18 months follow-up, a lower rate of readmission was recorded (7% vs 15.3%, <em>p</em> <!-->=<!--> <!-->0.006), (9.6% vs 25.6%, <em>p</em> <!-->&lt;<!--> <!-->0.0001), respectively.</div></div><div><h3>Conclusions</h3><div>The independent predictors of functional loss at 6 and 18 months were institutionalisation, severe dependence either prior to and on discharge, delirium, protein malnutrition, prior acute myocardial infarct, GFR<!--> <!-->&lt;<!--> <!-->30<!--> <!-->ml/min/1.73<!--> <!-->m² and not receiving treatment for osteoporosis on discharge. A lower incidence of refractures, a lower readmission rate and a better treatment compliance were observed in patients attending follow-up visits.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Pages 451-460"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900215","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":"18F-FDG PET/CT in systemic autoimmune diseases and related disorders","authors":"Ricardo Blanco ,&nbsp;Javier Loricera","doi":"10.1016/j.medcle.2025.01.006","DOIUrl":"10.1016/j.medcle.2025.01.006","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Pages 487-490"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900310","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":"Hepatic phenomena associated with SARS-CoV-2: Acute liver injury, autoimmune hepatitis and post-vaccination","authors":"Roberto Pertusa Mataix ,&nbsp;José Salvador García Morillo ,&nbsp;José Manuel Sousa Martín","doi":"10.1016/j.medcle.2024.12.007","DOIUrl":"10.1016/j.medcle.2024.12.007","url":null,"abstract":"<div><div>The infection with SARS-CoV-2, primarily recognized for its respiratory effects, reveals itself as a multifaceted clinical phenomenon, extending beyond the pulmonary realm. Accompanied by gastrointestinal, neurological, thromboembolic, cardiovascular, and immune-related manifestations, the complexity of the systemic repercussions of the disease becomes apparent. Genetic predisposition is a significant factor in the development of autoimmune hepatitis, as both viruses, such as SARS-CoV-2, and drugs, including vaccines, can act as triggers in genetically susceptible individuals. A profound understanding of these mechanisms is essential to effectively address the clinical complexity of SARS-CoV-2 infection.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Pages 491-498"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900174","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":"Giant pulmonary hydatid cyst","authors":"Yener Aydin,&nbsp;Ali Bilal Ulas,&nbsp;Atilla Eroglu","doi":"10.1016/j.medcle.2024.11.020","DOIUrl":"10.1016/j.medcle.2024.11.020","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 9","pages":"Page 513"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900307","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":"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}