Medicina clinica (English ed.)最新文献

{"title":"Prevalence of human papillomavirus in the oropharynx of women with persistent genital infection","authors":"María Soledad Sánchez Torices,&nbsp;Javier Modesto García Fernández,&nbsp;Pilar Gómez Gallego,&nbsp;María de Alharilla Montilla Ibáñez,&nbsp;Rafael Lomas Vega,&nbsp;Jesús Joaquín Hijona Elósegui","doi":"10.1016/j.medcle.2026.107529","DOIUrl":"10.1016/j.medcle.2026.107529","url":null,"abstract":"<div><h3>Introduction</h3><div>The study of oropharyngeal infection with Human Papillomavirus (HPV) has become increasingly relevant in recent years due to its association with oropharyngeal carcinomas. Unlike genital infection, the natural history of oropharyngeal infection remains poorly understood, and no population-based screening programs are currently available. In the search for potential risk groups, this study aimed to evaluate the prevalence of oropharyngeal HPV infection in women with persistent genital HPV infection.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional study was conducted in 135 women with persistent genital HPV infection. Patients with genital lesions and immunosuppression were excluded. Gynecological and oropharyngeal samples were collected from each participant by brushing and analyzed with PCR and hybrid capture for viral detection and genotyping. Clinical, immunological, and sexual behavior variables were also recorded.</div></div><div><h3>Results</h3><div>The prevalence of oropharyngeal HPV infection was 1.48% (2/135). The genotypes detected were HPV 52 and HPV 66. The mean age was 44.3 years. Single genotype genital infection was identified in 62.2% of cases. Orogenital intercourses were reported by 77.8% of participants, with limited use of barrier protection methods. Additionally, 57.1% had received HPV vaccination.</div></div><div><h3>Conclusion</h3><div>The low prevalence observed contrasts with previous studies conducted in the general population, suggesting that women with persistent genital HPV infection do not appear to be more susceptible to oropharyngeal infection. However, further studies are needed to confirm these findings.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107529"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861632","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":"Glucocorticoid monotherapy versus combination with methotrexate or tocilizumab in giant cell arteritis: efficacy and safety at 78 weeks in a retrospective cohort study","authors":"Javier Gamazo-Herrero,&nbsp;Alejandra Vela-Martín,&nbsp;Laura Rodríguez-Delgado,&nbsp;Sara Gómez-García,&nbsp;Miguel Martín-Asenjo,&nbsp;Ivan Cusacovich,&nbsp;Roberto González-Fuentes","doi":"10.1016/j.medcle.2026.107497","DOIUrl":"10.1016/j.medcle.2026.107497","url":null,"abstract":"<div><h3>Background and objective</h3><div>The classic treatment for giant cell arteritis (GCA) is based on glucocorticoids (GC), whose prolonged use causes adverse effects. Therefore, GC-sparing drugs are used, although few direct comparative studies exist. We assessed the efficacy and safety of GC monotherapy (GC_mono), GC with methotrexate (GC + MTX), and GC with tocilizumab (GC + TCZ).</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients with GCA. A composite endpoint (REACT-G) was defined that included relapses, serious infections, and GC-related adverse events at 78 weeks, and the cumulative dose of GC was analyzed.</div></div><div><h3>Results</h3><div>A total of 52 patients were included; 15 received GC_mono, 30 received GC + MTX, and 7 received GC + TCZ. The REACT-G endpoint occurred in 27 patients, mainly due to relapses. GC + TCZ was associated with a lower REACT-G rate (14%) than GC_mono (67%) and GC + MTX (53%) (p = 0.082). In the GC + MTX group, the REACT-G was lower with higher doses of MTX (p = 0.009). In the multivariate analysis, the use of GC + TCZ was the only independent protective factor against REACT-G (p = 0.038). The cumulative GC dose at 78 weeks was higher in the GC_mono group (7143.7 ± 2977.7 mg) than in GC + MTX group (5273.2 ± 1745.3 mg; p = 0.032) and GC + TCZ group (3733.9 ± 2286.8 mg; p = 0.005). In the multivariate analysis, only the GC + TCZ group accumulated significantly lower GC doses (p = 0.034).</div></div><div><h3>Conclusions</h3><div>Compared with GC_mono, GC + TCZ combination was associated with a significant reduction in REACT-G events in the multivariate analysis and a lower cumulative dose of GC at 78 weeks. The benefit of GC + MTX was moderate and, like the prevention of REACT-G events, appears to be dose-dependent.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 8","pages":"Article 107497"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861633","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":"Bullous systemic lupus erythematosus presenting with a ‘string of pearls’ pattern mimicking linear IgA bullous dermatosis","authors":"Alejandra Méndez Valdés,&nbsp;María Castellanos González,&nbsp;José Luis López Estebaranz","doi":"10.1016/j.medcle.2026.107468","DOIUrl":"10.1016/j.medcle.2026.107468","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107468"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148634673","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":"Cocaine- and levamisole-induced vasculitis","authors":"Carlos Gonzalezrubio-Altamar,&nbsp;Eloy De Jesús Franco Sánchez,&nbsp;Agustín Rafael Fabregas Esmeral","doi":"10.1016/j.medcle.2026.107475","DOIUrl":"10.1016/j.medcle.2026.107475","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107475"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148640746","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 ISGLT2 in kidney transplant recipients without diabetes mellitus","authors":"Pilar Fraile Gómez,&nbsp;Marina López Cano,&nbsp;Elena Villanueva Sánchez,&nbsp;Alexandra Lizarazo Suarez,&nbsp;Silvia Sánchez-Montero,&nbsp;Fernanda Lorenzo Gómez","doi":"10.1016/j.medcle.2026.107449","DOIUrl":"10.1016/j.medcle.2026.107449","url":null,"abstract":"<div><h3>Introduction</h3><div>Kidney transplant (KT) recipients have a very high cardiovascular and renal risk. Sodium–glucose cotransporter-2 inhibitors (iSGLT2) have demonstrated cardiorenal benefits in non-transplanted populations with chronic kidney disease, both diabetic and non-diabetic, but evidence in KT recipients remains scarce. There is an unmet clinical need for additional nephroprotective and cardiometabolic interventions in KT without diabetes mellitus (DM). We aimed to assess safety, renal function and metabolic effects of SGLT2i in non-diabetic KT recipients.</div></div><div><h3>Methods</h3><div>Retrospective single-centre observational study including 28 non-diabetic KT recipients (no pre-existing DM or post-transplant DM) from the University Hospital of Salamanca treated with SGLT2i (2023–2025). We analysed renal function trajectories (serum creatinine, eGFR CKD-EPI, urine protein/creatinine ratio [PCR] and urine albumin/creatinine ratio [ACR), lipid profile, electrolytes, HbA1c, immunosuppression, adverse events and acute rejection, with follow-up at 1, 6 and 12 months.</div></div><div><h3>Results</h3><div>Mean age at SGLT2i initiation was 57 ± 13 years; 89,3% were men. The main indication was non-nephrotic proteinuria. After an initial eGFR decline, renal function subsequently stabilised. PCR and ACR decreased significantly at one year. Body mass index and total cholesterol also declined. There were no clinically relevant changes in immunosuppressant levels and no increase in rejection episodes. Diarrhoea and urinary tract infections (7%) were the most frequent adverse events, without euglycaemic ketoacidosis.</div></div><div><h3>Conclusions</h3><div>SGLT2i therapy showed acceptable safety and a possible reno-metabolic benefit in non-diabetic KT recipients. Controlled trials with longer follow-up are required to determine the robustness of this indication.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107449"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148640751","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":"Value of renal biopsy in patients with renal dysfunction and ANCA positivity with anti-MPO and anti-PR3 specificity","authors":"Sergio Barroso Hernández,&nbsp;Enrique Matallana Encinas,&nbsp;José María Romero León,&nbsp;Andrea Guerrero Fernández,&nbsp;María Inmaculada Alcalá Peña,&nbsp;Jorge Alberto Rodríguez Sabillón,&nbsp;Álvaro Álvarez López,&nbsp;Isis Cerezo Arias,&nbsp;Nicolás Roberto Robles-Pérez Monteoliva","doi":"10.1016/j.medcle.2026.107455","DOIUrl":"10.1016/j.medcle.2026.107455","url":null,"abstract":"<div><h3>Introduction</h3><div>ANCA-associated vasculitides with anti-MPO or anti-PR3 specificity cause inflammation of the glomerular capillary, leading to deterioration of renal function and potentially resulting in advanced kidney disease. Histological findings are overlapping for both subtypes; however, the genetic background differs, which may lead to differences in disease progression or response to treatment.</div></div><div><h3>Objectives</h3><div>To evaluate the differences between both subtypes in the progression of renal function and in the responses to treatments administered in real-world clinical practice at a single center.</div></div><div><h3>Materials and methods</h3><div>Patients with impaired renal function and ANCA positivity with anti-MPO or anti-PR3 specificity who had undergone a renal biopsy were included.</div></div><div><h3>Results</h3><div>A total of 113 patients were included, of whom 36% had histological findings different from those expected in the context of renal involvement due to vasculitis. No significant differences were found in the progression of renal function after treatment, nor between the different types of treatments administered. The determinants of renal survival were baseline creatinine levels, the presence of anti-GBM antibodies, and elevated levels of complement factor C4. A baseline creatinine level above 4 mg/dL was associated with poorer renal survival.</div></div><div><h3>Conclusions</h3><div>In patients with impaired renal function and anti-MPO or PR3 ANCA specificity who undergo a renal biopsy, we do not find significant differences in the progression of renal function between ANCA vasculitis subtypes or according to the type of immunosuppressive treatment administered. A high percentage of patients present histological findings that differ from those expected.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107455"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148640757","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":"Risk of HSIL/CIN2+ Lesions in Women with Negative Cytology and High-Risk HPV Referred for Colposcopy: Experience in a Population-Based Screening Program","authors":"Pedro Manuel Beira Salvador,&nbsp;Tamara García Grandal,&nbsp;Raquel Iglesias Méndez","doi":"10.1016/j.medcle.2026.107451","DOIUrl":"10.1016/j.medcle.2026.107451","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prevalence of HSIL/CIN2+ lesions in women with negative cytology and high-risk HPV (HR-HPV) referred to colposcopy from population-based screening, as well as to describe histological findings and the need for excisional treatment.</div></div><div><h3>Methods</h3><div>Prospective observational study (November 2022–June 2025). Included were women referred to colposcopy with negative cytology and positive HR-HPV results: (1) HPV16/18, (2) persistent non-16/18 HR-HPV, (3) HPV16/18 + HR-HPV co-infection, and (4) non-16/18 HR-HPV infection evolving to HR + 16/18 co-infection after one year. Clinical data, histological outcomes, and excisional procedures were analyzed.</div></div><div><h3>Results</h3><div>A total of 519 women were studied (mean age 50.9 years). Distribution: HPV16/18 (55.2%), non-16/18 HR-HPV (34.9%), co-infection (9.1%), and non-16/18 HR-HPV evolving to HR + 16/18 co-infection (0.8%). Among exocervical biopsies (n = 276), 37 showed HSIL and 2 carcinomas were identified. In endocervical samples (n = 476), 6 HSIL and 1 carcinoma were detected. Excisional treatment was performed in 42 women, revealing 19 HSIL, 1 adenocarcinoma, and 1 squamous carcinoma. The overall prevalence of HSIL/CIN2+ was 9.6%, higher in women with HPV16/18 (13.6%) compared to non-16/18 HR-HPV (4.9%), RR = 2.76 (95% CI: 1.37–5.56; p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Detection of HR-HPV identifies clinically significant lesions even in women with negative cytology. Our findings support immediate colposcopy in HPV16/18-positive cases and close follow-up in persistent infections with other HR-HPV genotypes.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107451"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148640806","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":"Continuous glucose monitoring to support the diagnosis of MODY: A multicenter cross-sectional and prospective study","authors":"Jesus Moreno-Fernandez,&nbsp;Jose Ignacio Martínez Montoro,&nbsp;Jose Ramon Muñoz-Rodriguez,&nbsp;Sandra Herranz-Antolin,&nbsp;Amparo Marco,&nbsp;Pedro Pines,&nbsp;María Ruiz de Ancos,&nbsp;Javier González,&nbsp;Esther Maqueda,&nbsp;Julia Sastre,&nbsp;María José Picón","doi":"10.1016/j.medcle.2026.107450","DOIUrl":"10.1016/j.medcle.2026.107450","url":null,"abstract":"<div><h3>Aim</h3><div>Maturity onset diabetes of the young (MODY) is often misdiagnosed as type 1 diabetes (T1D). We proposed using continuous glucose monitoring (CGM) data as an additional tool to select patients in whom the fulfillment of classical MODY criteria should be reassessed, who may then be considered for genetic testing.</div></div><div><h3>Method</h3><div>A multicentric cross-sectional and prospective study was designed to evaluate the clinical utility of CGM in the diagnosis of MODY among adult patients initially diagnosed as T1D with active CGM data. Pre-specified CGM criteria included: glucose management indicator &lt;7%, time in range (70–180<!--> <!-->mg/dL [3.9–10.0<!--> <!-->mmol/L]) &gt;70% and coefficient of variation &lt;36%. Those meeting these requirements were assessed for classical clinical criteria and subsequently genetic testing.</div></div><div><h3>Results</h3><div>A total of 503 subjects with T1D out of 5571 fulfilled the pre-established glycometric requirements. After reviewing their medical records, 42 of them met the classic clinical criteria for MODY and genetic testing was performed in 34 patients. Finally, we found 5 new cases of MODY (3 patients with HNF1A-MODY3, 1 patient with HNF1B-MODY5 and 1 patient with ABCC8-MODY12) and detected 3 patients with heterozygous mutations associated with the development of diabetes.</div></div><div><h3>Conclusion</h3><div>CGM added to classic clinical criteria for MODY may constitute an effective and easily implemented approach in routine clinical practice to identify patients with MODY who have been misdiagnosed as having T1D.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107450"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148660544","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":"Removing the “penicillin allergy'' label","authors":"Ángeles Morales Martínez,&nbsp;Carmen Rogina del Pozo","doi":"10.1016/j.medcle.2026.107465","DOIUrl":"10.1016/j.medcle.2026.107465","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107465"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148634675","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":"Acrodermatitis continua of Hallopeau induced by bisoprolol","authors":"Sara Becerril-Andrés,&nbsp;Miguel Mansilla-Polo,&nbsp;Andrés Zúñiga-Vera","doi":"10.1016/j.medcle.2026.107460","DOIUrl":"10.1016/j.medcle.2026.107460","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 7","pages":"Article 107460"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148640803","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}