Medicina Clinica最新文献

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Nódulo azulado solitario umbilical asociado a dolor cíclico 与循环疼痛相关的孤立的腰蓝色结节

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-27 DOI: 10.1016/j.medcli.2025.107293

Omar Alwattar-Ceballos , Araceli Jiménez-Lara , Mónica Gómez-Manzanares , Marina Montero-García

引用次数: 0

Utilidad del stroke risk analysis en práctica clínica habitual para predecir el riesgo de fibrilación auricular en pacientes con ictus isquémico o accidente isquémico transitorio 中风风险分析在常规临床实践中用于预测缺血性中风或短暂缺血性中风患者的耳纤颤风险

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-27 DOI: 10.1016/j.medcli.2025.107309

Rafael Francisco Galiano Blancart, Lidia Vidal Mogort, Adrià Quesada Simó, Carmen María Sanchis Llopis, Francisco Domínguez Sanz, José Manuel Ferrer Casanova, Lamberto Landete Pascual

Introduction

Atrial fibrillation (AF) stands as one of the most frequent causes of ischemic stroke. Therefore, its prompt detection carries considerable importance. Stroke risk analysis (SRA) is an ECG monitoring system that allows the detection of AF and identifies patterns with high or low risk of suffering paroxysmal AF.

The objective of this study is to analyze the usefulness of SRA routine clinical practice for the search for AF in patients after cerebral ischemia.

Methods

We conducted a single-center retrospective study that includes patients with transient ischemic attack (TIA) or recent ischemic stroke in whom the search for AF was initially negative. Vascular risk factors were recorded together with the clinical and neuroimaging characteristics of stroke. The presence of AF in the low- and high-risk groups was reassessed over a one-year follow-up period.

Results

We enrolled 708 patients (58% male, median age 73,0, IQR 62,0-82,0) among whom 576 suffered a stroke (81%) and 132 (19%) a TIA. The registry indicated a low risk of AF in 537 (76%), while 171 (24%) displayed an elevated risk. One year later, follow-up was conducted on 693 patients, revealing that 32 individuals had developed AF, accounting for 5.1% of the total cohort; 23/171 (13%) of patients classified as high risk versus 9/537 (1,7%) of those classified as low risk. Patients diagnosed with AF were older, had a higher frequency of Embolic Stroke of Undetermined Source (ESUS), greater left auricular dilation, and a risk of AF development based on SRA findings. This group also suffered more strokes during the year of follow-up.

Conclusions

In routine clinical practice, the Holter-SRA emerges as a valuable instrument that, combined with other clinical data and complementary tests, can help prioritize the search for paroxysmal AF following cerebral ischemic events.

心房颤动（AF）是缺血性脑卒中最常见的病因之一。因此，及时发现它具有相当重要的意义。卒中风险分析（SRA）是一种心电图监测系统，可以检测房颤并识别发作性房颤的高或低风险模式。本研究的目的是分析SRA在脑缺血后房颤的常规临床实践中的实用性。方法我们进行了一项单中心回顾性研究，包括短暂性脑缺血发作（TIA）或近期缺血性脑卒中患者，这些患者最初的房颤搜索为阴性。记录血管危险因素以及脑卒中的临床和神经影像学特征。在一年的随访期间，对低风险组和高风险组房颤的存在进行重新评估。结果共入组708例患者（58%为男性，中位年龄73,0岁，IQR为62,0-82,0），其中576例（81%）发生卒中，132例（19%）发生TIA。登记显示537例（76%）AF风险低，171例（24%）AF风险高。一年后，对693名患者进行随访，发现32人发生房颤，占总队列的5.1%；23/171（13%）的患者被分类为高风险，9/537（1.7%）的患者被分类为低风险。诊断为房颤的患者年龄较大，发生来源不明的栓塞性卒中（ESUS）的频率较高，左耳廓扩张较大，根据SRA结果，房颤发展的风险较高。在随访的一年里，这组人也遭受了更多的中风。结论在常规临床实践中，Holter-SRA作为一种有价值的工具，与其他临床数据和补充试验相结合，可以帮助优先寻找脑缺血事件后阵发性房颤。

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引用次数: 0

Inhibidores de SGLT2 en insuficiencia cardiaca aguda: estrato 8 intermedio de filtrado glomerular, sesgos potenciales y aplicabilidad en urgencias 急性心力衰竭中的SGLT2抑制剂：第8层肾小球过滤中间体，潜在的偏倚和在紧急情况中的适用性

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-27 DOI: 10.1016/j.medcli.2025.107332

Ivan Agra Montava, Antoni Moline Pareja, Meritxell Motos Bescos

引用次数: 0

Giant lipoma causing carpal tunnel syndrome 引起腕管综合征的巨大脂肪瘤

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-27 DOI: 10.1016/j.medcli.2025.107331

Marco Colangeli , Paolo Spinnato , Francesca Agugiaro , Marco Fava , Marco Palmas

引用次数: 0

Pseudoefedrina oral en el tratamiento del priapismo isquémico recurrente en un paciente con anemia de células falciforme 口服伪麻黄碱用于治疗镰状细胞贫血患者复发性缺血性阴茎炎

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-22 DOI: 10.1016/j.medcli.2025.107338

Mònica Ribell Bachs , Javier Valdivielso , Maria Teresa Coll Sibina

引用次数: 0

Hypokalemic periodic paralysis type 1 with respiratory involvement: A case report and critical review of the diagnostic and therapeutic approach 伴呼吸系统受累的1型低钾血症性周期性麻痹：一例报告及诊断和治疗方法的重要回顾

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-22 DOI: 10.1016/j.medcli.2025.107339

Rocío Fernández Gavira, Roberto Pertusa Mataix, José Salvador García Morillo

引用次数: 0

Asociación entre la obstrucción al flujo aéreo y la mortalidad en una cohorte de pacientes con insuficiencia cardíaca 在一组心力衰竭患者中，气流阻塞与死亡率之间的关联

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-22 DOI: 10.1016/j.medcli.2025.107337

Nerea Alonso Suárez , Aida Muñoz Ferrer , Evelyn Santiago-Vacas , Ignasi Garcia-Olivé

引用次数: 0

Hepatitis tóxica por uso de anticonceptivo subcutáneo de levonorgestrel: estudio de un caso 左炔诺孕酮皮下避孕药具引起的毒性肝炎：个案研究

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-22 DOI: 10.1016/j.medcli.2025.107320

Senith Marcela Beleño Rodríguez , Dadier Antonio Arroyo Monterroza , Martha Lucia Fontalvo Muñoz

引用次数: 0

Predictors of symptomatic atrial fibrillation recurrence and all-cause mortality at 12 months in obese and non-obese patients 肥胖和非肥胖患者12个月症状性房颤复发和全因死亡率的预测因素

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-21 DOI: 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。

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引用次数: 0

Sex and gender disparities in ischemic heart disease: The role of social and clinical factors in long-term outcomes from the RECORVAL registry 缺血性心脏病的性别差异：来自RECORVAL登记的社会和临床因素在长期预后中的作用

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-21 DOI: 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。

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