Pub Date : 2026-01-22DOI: 10.1016/j.medcli.2025.107338
Mònica Ribell Bachs , Javier Valdivielso , Maria Teresa Coll Sibina
{"title":"Pseudoefedrina oral en el tratamiento del priapismo isquémico recurrente en un paciente con anemia de células falciforme","authors":"Mònica Ribell Bachs , Javier Valdivielso , Maria Teresa Coll Sibina","doi":"10.1016/j.medcli.2025.107338","DOIUrl":"10.1016/j.medcli.2025.107338","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107338"},"PeriodicalIF":2.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022955","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}
Pub Date : 2026-01-22DOI: 10.1016/j.medcli.2025.107339
Rocío Fernández Gavira, Roberto Pertusa Mataix, José Salvador García Morillo
{"title":"Hypokalemic periodic paralysis type 1 with respiratory involvement: A case report and critical review of the diagnostic and therapeutic approach","authors":"Rocío Fernández Gavira, Roberto Pertusa Mataix, José Salvador García Morillo","doi":"10.1016/j.medcli.2025.107339","DOIUrl":"10.1016/j.medcli.2025.107339","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107339"},"PeriodicalIF":2.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036914","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":"Asociación entre la obstrucción al flujo aéreo y la mortalidad en una cohorte de pacientes con insuficiencia cardíaca","authors":"Nerea Alonso Suárez , Aida Muñoz Ferrer , Evelyn Santiago-Vacas , Ignasi Garcia-Olivé","doi":"10.1016/j.medcli.2025.107337","DOIUrl":"10.1016/j.medcli.2025.107337","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107337"},"PeriodicalIF":2.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023982","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":"Hepatitis tóxica por uso de anticonceptivo subcutáneo de levonorgestrel: estudio de un caso","authors":"Senith Marcela Beleño Rodríguez , Dadier Antonio Arroyo Monterroza , Martha Lucia Fontalvo Muñoz","doi":"10.1016/j.medcli.2025.107320","DOIUrl":"10.1016/j.medcli.2025.107320","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107320"},"PeriodicalIF":2.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036915","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}
Pub Date : 2026-01-21DOI: 10.1016/j.medcli.2025.107290
Shyla Gupta , Rohan Kalasipudi , Praveen Tharusha Gurusinghe , Ayush Gautam , Ken Huang , Edward Dababneh , Prithviraj Dhonde , María Gabriela Matta
Background and objective
Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics and 12-month outcomes between obese and non-obese patients with AF and to identify predictors of recurrence and mortality.
Materials and methods
A retrospective analysis was conducted on 225 patients hospitalized for AF, classified according to obesity (BMI ≥30 kg/m2). The primary outcome was AF-related rehospitalization within 12 months, and the secondary outcome was all-cause mortality. Clinical, biochemical, and sociodemographic data were collected.
Results
Obesity was present in 43% of patients and was associated with younger age, a higher prevalence of sleep apnea, and hypertriglyceridemia. At 12 months, 24.9% of patients were rehospitalized and 14.0% experienced AF recurrence. Obesity (OR 2.84; 95% CI 1.17–6.90; p = 0.021) and excessive alcohol consumption (OR 3.49; 95% CI 1.07–11.41; p = 0.039) independently predicted AF recurrence. Advanced age, low socioeconomic status, and hypokalaemia were associated with higher mortality, whereas obesity was linked to a lower risk (OR 0.38; 95% CI 0.16–0.95; p = 0.038).
Conclusions
In this cohort, obesity was associated with increased AF recurrence but reduced mortality, supporting the “obesity paradox.” Excessive alcohol intake and low socioeconomic status also influenced outcomes, underscoring the need for individualized management strategies.
背景和目的：肥胖是心房颤动（AF）的可改变危险因素；然而，其对复发率和死亡率的影响仍存在争议。本研究旨在比较肥胖和非肥胖房颤患者的临床特征和12个月的预后，并确定复发和死亡率的预测因素。材料与方法：回顾性分析225例AF住院患者，按肥胖（BMI≥30kg/m2）分类。主要结局是房颤相关的12个月内再住院，次要结局是全因死亡率。收集临床、生化和社会人口学数据。结果：43%的患者存在肥胖，并且与年龄较小、睡眠呼吸暂停和高甘油三酯血症的患病率较高有关。12个月时，24.9%的患者再次住院，14.0%的患者出现房颤复发。肥胖（OR 2.84; 95% CI 1.17-6.90; p=0.021）和过度饮酒（OR 3.49; 95% CI 1.07-11.41; p=0.039）独立预测AF复发。高龄、低社会经济地位和低钾血症与较高的死亡率相关，而肥胖与较低的风险相关（OR 0.38; 95% CI 0.16-0.95; p=0.038）。结论：在该队列中，肥胖与房颤复发率增加有关，但与死亡率降低有关，支持“肥胖悖论”。过度饮酒和低社会经济地位也会影响结果，强调个性化管理策略的必要性。
{"title":"Predictors of symptomatic atrial fibrillation recurrence and all-cause mortality at 12 months in obese and non-obese patients","authors":"Shyla Gupta , Rohan Kalasipudi , Praveen Tharusha Gurusinghe , Ayush Gautam , Ken Huang , Edward Dababneh , Prithviraj Dhonde , María Gabriela Matta","doi":"10.1016/j.medcli.2025.107290","DOIUrl":"10.1016/j.medcli.2025.107290","url":null,"abstract":"<div><h3>Background and objective</h3><div>Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics and 12-month outcomes between obese and non-obese patients with AF and to identify predictors of recurrence and mortality.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis was conducted on 225 patients hospitalized for AF, classified according to obesity (BMI ≥30<!--> <!-->kg/m<sup>2</sup>). The primary outcome was AF-related rehospitalization within 12 months, and the secondary outcome was all-cause mortality. Clinical, biochemical, and sociodemographic data were collected.</div></div><div><h3>Results</h3><div>Obesity was present in 43% of patients and was associated with younger age, a higher prevalence of sleep apnea, and hypertriglyceridemia. At 12 months, 24.9% of patients were rehospitalized and 14.0% experienced AF recurrence. Obesity (OR 2.84; 95% CI 1.17–6.90; <em>p</em> <!-->=<!--> <!-->0.021) and excessive alcohol consumption (OR 3.49; 95% CI 1.07–11.41; <em>p</em> <!-->=<!--> <!-->0.039) independently predicted AF recurrence. Advanced age, low socioeconomic status, and hypokalaemia were associated with higher mortality, whereas obesity was linked to a lower risk (OR 0.38; 95% CI 0.16–0.95; <em>p</em> <!-->=<!--> <!-->0.038).</div></div><div><h3>Conclusions</h3><div>In this cohort, obesity was associated with increased AF recurrence but reduced mortality, supporting the “obesity paradox.” Excessive alcohol intake and low socioeconomic status also influenced outcomes, underscoring the need for individualized management strategies.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107290"},"PeriodicalIF":2.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030003","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}
Pub Date : 2026-01-21DOI: 10.1016/j.medcli.2025.107335
Miriam Rodríguez de Rivera , Jon Zubiaur , Itziar Cucurull Ortega , Elton Carreiro Da Cunha , Raquel Pérez Barquín , Adrian Margarida de Castro , Andrea Teira Calderón , Fermín Sáinz Laso , Dae-Hyun Lee Hwang , Tamara García-Camarero , Gabriela Veiga , Aritz Gil Ongay , Celia Garilleti , Rigoberto Hernández , Sergio Barrera , Víctor Fradejas , Cristina Obregón , Jose María De la Torre Hernández
Introduction and objectives
Ischemic heart disease remains a leading cause of mortality, with women facing unique social and clinical challenges that impact outcomes. This study aimed to examine sex and gender specific differences in social and clinical predictors of long-term outcomes in coronary artery disease.
Materials and methods
This prospective cohort study used the RECORVAL registry, including patients with coronary artery disease undergoing coronary angiography. Clinical data were extracted from electronic health records, and social determinants were collected via a structured questionnaire. Outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, revascularization, stroke, major bleeding and a composite endpoint (cardiovascular death, myocardial infarction or revascularization). Sex-stratified Kaplan–Meier curves, Fine–Gray competing risk models, and multivariate Cox regression models adjusted for social and clinical variables were used.
Results
Among 2219 patients (23.4% women) followed for a median of 2421 days, women were older (68.5 vs. 64.3 years) and had greater social disadvantages, including lower education, employment, and internet access. Percutaneous intervention rates were similar, but coronary artery bypass grafting was less frequent in women (3.5% vs. 6.0%). No significant differences were observed in all-cause or cardiovascular mortality (aHR 0.80; 95% CI 0.51–1.24). Women showed a non-significant trend toward lower composite endpoint risk (aHR 0.81; 95% CI 0.64–1.04), lower myocardial infarction and revascularization risk, and higher major bleeding (aHR 1.39; 95% CI 0.92–2.11).
Conclusions
Women face significant social disadvantages requiring personalized prevention addressing gender-specific risks. Similar mortality rates suggest improving equity, while differing ischemic–haemorrhagic profiles call for sex-tailored therapy to improve outcomes.
简介和目标：缺血性心脏病仍然是死亡的主要原因，妇女面临着影响结果的独特社会和临床挑战。本研究旨在探讨冠状动脉疾病长期预后的社会和临床预测因素的性别和性别特异性差异。材料和方法：这项前瞻性队列研究使用了RECORVAL登记，包括接受冠状动脉造影的冠状动脉疾病患者。从电子健康记录中提取临床数据，并通过结构化问卷收集社会决定因素。结果包括全因死亡率、心血管死亡率、心肌梗死、血运重建术、中风、大出血和复合终点（心血管死亡、心肌梗死或血运重建术）。使用了性别分层的Kaplan-Meier曲线、Fine-Gray竞争风险模型和针对社会和临床变量调整的多变量Cox回归模型。结果：在2219例患者中（23.4%为女性），随访时间中位数为2421天，女性年龄较大（68.5岁对64.3岁），社会劣势较大，包括教育程度、就业和互联网接入水平较低。经皮介入率相似，但女性冠状动脉旁路移植术较少（3.5%对6.0%）。全因死亡率和心血管死亡率无显著差异（aHR 0.80; 95% CI 0.51-1.24）。女性患者的综合终点风险较低（aHR 0.81; 95% CI 0.64-1.04），心肌梗死和血运重建风险较低，大出血风险较高（aHR 1.39; 95% CI 0.92-2.11）。结论：女性面临显著的社会劣势，需要针对性别风险进行个性化预防。相似的死亡率表明要提高公平性，而不同的缺血性出血情况则需要针对不同性别的治疗来改善结果。
{"title":"Sex and gender disparities in ischemic heart disease: The role of social and clinical factors in long-term outcomes from the RECORVAL registry","authors":"Miriam Rodríguez de Rivera , Jon Zubiaur , Itziar Cucurull Ortega , Elton Carreiro Da Cunha , Raquel Pérez Barquín , Adrian Margarida de Castro , Andrea Teira Calderón , Fermín Sáinz Laso , Dae-Hyun Lee Hwang , Tamara García-Camarero , Gabriela Veiga , Aritz Gil Ongay , Celia Garilleti , Rigoberto Hernández , Sergio Barrera , Víctor Fradejas , Cristina Obregón , Jose María De la Torre Hernández","doi":"10.1016/j.medcli.2025.107335","DOIUrl":"10.1016/j.medcli.2025.107335","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Ischemic heart disease remains a leading cause of mortality, with women facing unique social and clinical challenges that impact outcomes. This study aimed to examine sex and gender specific differences in social and clinical predictors of long-term outcomes in coronary artery disease.</div></div><div><h3>Materials and methods</h3><div>This prospective cohort study used the RECORVAL registry, including patients with coronary artery disease undergoing coronary angiography. Clinical data were extracted from electronic health records, and social determinants were collected via a structured questionnaire. Outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, revascularization, stroke, major bleeding and a composite endpoint (cardiovascular death, myocardial infarction or revascularization). Sex-stratified Kaplan–Meier curves, Fine–Gray competing risk models, and multivariate Cox regression models adjusted for social and clinical variables were used.</div></div><div><h3>Results</h3><div>Among 2219 patients (23.4% women) followed for a median of 2421 days, women were older (68.5 vs. 64.3 years) and had greater social disadvantages, including lower education, employment, and internet access. Percutaneous intervention rates were similar, but coronary artery bypass grafting was less frequent in women (3.5% vs. 6.0%). No significant differences were observed in all-cause or cardiovascular mortality (aHR 0.80; 95% CI 0.51–1.24). Women showed a non-significant trend toward lower composite endpoint risk (aHR 0.81; 95% CI 0.64–1.04), lower myocardial infarction and revascularization risk, and higher major bleeding (aHR 1.39; 95% CI 0.92–2.11).</div></div><div><h3>Conclusions</h3><div>Women face significant social disadvantages requiring personalized prevention addressing gender-specific risks. Similar mortality rates suggest improving equity, while differing ischemic–haemorrhagic profiles call for sex-tailored therapy to improve outcomes.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 3","pages":"Article 107335"},"PeriodicalIF":2.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030035","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}
Pub Date : 2026-01-20DOI: 10.1016/j.medcli.2025.107328
M. Acebo Castro, J.D. Álvarez Mavárez, C. Mañana Valdés
{"title":"Fondaparinux-associated thrombocytopenia as a cause of bilateral pulmonary embolism","authors":"M. Acebo Castro, J.D. Álvarez Mavárez, C. Mañana Valdés","doi":"10.1016/j.medcli.2025.107328","DOIUrl":"10.1016/j.medcli.2025.107328","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107328"},"PeriodicalIF":2.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018630","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}
Pub Date : 2026-01-20DOI: 10.1016/j.medcli.2025.107317
Ernestina Angarola , Analia Pasqua , Matías Horacio Castro , Agustín Cáceres , Juan Carlos Spina , Paola Casciato , IgG4-RD Interdisciplinary Unit
Background and objective
IgG4-RD is a multisystemic disease, often underdiagnosed, with natural progression to chronic organ damage. We aim to describe clinical features, relapse and chronic organ damage.
Methods
Dynamic ambispective cohort including patients from the Institutional Registry of IgG4-RD at Hospital Italiano de Buenos Aires who met ACR/EULAR 2019 criteria. We analyzed clinical phenotypes, response to treatment, biomarkers and chronic organ damage.
Results
Sixty patients were included; 73% were male and median age at diagnosis was 61 years. Median time to diagnosis was 9 months (IQR 3–21), 10% had >10 years of delay. Multiorgan disease was present at diagnosis in 65% and the most common phenotype was pancreatohepatobiliary (40%). Corticosteroids were used at diagnosis in 77%; seven patients with totally resected disease required no further immunosuppression (median 59 months; IQR 31–144). Relapses occurred in 47%, predominantly in those with multiorgan involvement (89%). Kidneys and the biliary tract were most commonly affected in relapse. Relapsing predictive biomarkers were present in 63% at the onset; multiorgan involvement was associated with relapsing disease (p = 0.002). Chronic organ damage occurred in 71%, in 44% after surgical resection. The most frequent was exocrine pancreatic insufficiency (35%). Patients with baseline damage had a significantly longer diagnostic delay (p = 0.03). After a year of diagnosis, 85% of patients experienced damage.
Conclusion
Baseline organ damage was highly frequent, particularly with delayed diagnosis, while multiorgan involvement predicted relapse, underscoring the need for earlier and multidisciplinary management.
{"title":"Clinical characteristics, disease course, and chronic organ damage in a real-world cohort of IgG4-related disease: Insights from an Interdisciplinary Unit","authors":"Ernestina Angarola , Analia Pasqua , Matías Horacio Castro , Agustín Cáceres , Juan Carlos Spina , Paola Casciato , IgG4-RD Interdisciplinary Unit","doi":"10.1016/j.medcli.2025.107317","DOIUrl":"10.1016/j.medcli.2025.107317","url":null,"abstract":"<div><h3>Background and objective</h3><div>IgG4-RD is a multisystemic disease, often underdiagnosed, with natural progression to chronic organ damage. We aim to describe clinical features, relapse and chronic organ damage.</div></div><div><h3>Methods</h3><div>Dynamic ambispective cohort including patients from the Institutional Registry of IgG4-RD at Hospital Italiano de Buenos Aires who met ACR/EULAR 2019 criteria. We analyzed clinical phenotypes, response to treatment, biomarkers and chronic organ damage.</div></div><div><h3>Results</h3><div>Sixty patients were included; 73% were male and median age at diagnosis was 61 years. Median time to diagnosis was 9 months (IQR 3–21), 10% had >10 years of delay. Multiorgan disease was present at diagnosis in 65% and the most common phenotype was pancreatohepatobiliary (40%). Corticosteroids were used at diagnosis in 77%; seven patients with totally resected disease required no further immunosuppression (median 59 months; IQR 31–144). Relapses occurred in 47%, predominantly in those with multiorgan involvement (89%). Kidneys and the biliary tract were most commonly affected in relapse. Relapsing predictive biomarkers were present in 63% at the onset; multiorgan involvement was associated with relapsing disease (<em>p</em> <!-->=<!--> <!-->0.002). Chronic organ damage occurred in 71%, in 44% after surgical resection. The most frequent was exocrine pancreatic insufficiency (35%). Patients with baseline damage had a significantly longer diagnostic delay (<em>p</em> <!-->=<!--> <!-->0.03). After a year of diagnosis, 85% of patients experienced damage.</div></div><div><h3>Conclusion</h3><div>Baseline organ damage was highly frequent, particularly with delayed diagnosis, while multiorgan involvement predicted relapse, underscoring the need for earlier and multidisciplinary management.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107317"},"PeriodicalIF":2.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018967","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}
Pub Date : 2026-01-20DOI: 10.1016/j.medcli.2025.107336
Juyi Liu , Guang Ji , Xueqin Song
{"title":"Coexistence of McArdle disease and hypokalemic periodic paralysis: A case report","authors":"Juyi Liu , Guang Ji , Xueqin Song","doi":"10.1016/j.medcli.2025.107336","DOIUrl":"10.1016/j.medcli.2025.107336","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107336"},"PeriodicalIF":2.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018126","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}
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