Pub Date : 2024-11-15DOI: 10.1016/j.medcli.2024.04.024
Sonia Pascual García , Ana Castell Herrera , Juan Julian Cuesta Pérez , Adriana Rodriguez Perojo , Araceli Abad Fernández , Maria Teresa Río Ramirez
Background
Mechanical thrombectomy is a useful technique in patients with high-risk pulmonary embolism. It is indicated as an alternative to systemic fibrinolysis when it is contraindicated or as an adjuvant therapy when it fails.
Objective
To describe clinical characteristics, evolution and survival of patients with high-risk pulmonary embolism who have undergone mechanical thrombectomy.
Method
Single-center retrospective descriptive study of consecutive patients who underwent mechanical thrombectomy. Demographic, clinical and survival variables were analyzed.
Results
9 patients were included (56% men, 44% women). All patients had pulmonary artery pressure assessed using a Swan-Ganz catheter before thrombectomy. The median pulmonary artery pressure before the procedure was 46 mmHg (51-38 mmHg). Systemic fibrinolysis was also performed in 5 cases, in 2 of them in the setting of cardiorespiratory arrest, without hemorrhagic complications. No patient died during hospitalization. Survival one month after the procedure was 100%.
Conclusions
In our series, mechanical thrombectomy is a useful technique as an alternative to systemic fibrinolysis or as an adjuvant therapy to it.
{"title":"Terapia dirigida por catéter en embolia pulmonar de alto riesgo: análisis de 9 casos","authors":"Sonia Pascual García , Ana Castell Herrera , Juan Julian Cuesta Pérez , Adriana Rodriguez Perojo , Araceli Abad Fernández , Maria Teresa Río Ramirez","doi":"10.1016/j.medcli.2024.04.024","DOIUrl":"10.1016/j.medcli.2024.04.024","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical thrombectomy is a useful technique in patients with high-risk pulmonary embolism. It is indicated as an alternative to systemic fibrinolysis when it is contraindicated or as an adjuvant therapy when it fails.</div></div><div><h3>Objective</h3><div>To describe clinical characteristics, evolution and survival of patients with high-risk pulmonary embolism who have undergone mechanical thrombectomy.</div></div><div><h3>Method</h3><div>Single-center retrospective descriptive study of consecutive patients who underwent mechanical thrombectomy. Demographic, clinical and survival variables were analyzed.</div></div><div><h3>Results</h3><div>9 patients were included (56% men, 44% women). All patients had pulmonary artery pressure assessed using a Swan-Ganz catheter before thrombectomy. The median pulmonary artery pressure before the procedure was 46<!--> <!-->mmHg (51-38<!--> <!-->mmHg). Systemic fibrinolysis was also performed in 5 cases, in 2 of them in the setting of cardiorespiratory arrest, without hemorrhagic complications. No patient died during hospitalization. Survival one month after the procedure was 100%.</div></div><div><h3>Conclusions</h3><div>In our series, mechanical thrombectomy is a useful technique as an alternative to systemic fibrinolysis or as an adjuvant therapy to it.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"163 9","pages":"Pages 469-472"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498426","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 : 2024-11-15DOI: 10.1016/j.medcli.2024.09.009
Maria José Temido, Margarida Peixinho, Rosário Cunha, Andrea Silva, Sandra Lopes, Sofia Mendes, Ana Margarida Ferreira, Manuela Ferreira, Pedro Figueiredo, Francisco Portela
Background: An ideal test to evaluate the inflammatory burden in ulcerative colitis is still an unmet need. Fecal calprotectin (FCP) and C-reactive protein (CRP) have significant limitations. Plasma calprotectin (PC) seems to be promising in inflammatory diseases, but its value in IBD is still to be determined. Our aim was to assess whether PC correlates with inflammatory activity in UC.
Methods: Prospective single center cohort study. Consecutive patients previously diagnosed with UC undergoing endoscopy were included (June 2021-September 2022). Demographic, clinical, analytical (CRP, PC and FCP), endoscopic and histologic data was collected at the time of colonoscopy. PC was assessed with Gentian Calprotectin Immunoassay and, in a subgroup of patients, also with QUANTA Flash Circulating Calprotectin from INOVA.
Results: Inclusion of 98 patients (60.2% male) with a median age 49 (38-61) years. The extent of colitis was distal in 12 (12.2%), left-sided in 49 (50%), and extensive in 37 (37.8%). Mesalazine was taken by 65 (66.3%) patients, with biologic monotherapy used in 24 (24.5%) and combination therapy in 6 (6.1%). Clinical, endoscopic and histological remission were detected, in 56 (57.1%), 48 (49%) and in 55 (56.1%) patients, respectively. Comparing MES 0/1 vs MES 2/3, a statistically significant difference was found with PC, CRP and FCP. Concerning endoscopic (MES=1) and histological (GS<2) remission, FCP was the only biomarker able to detect these outcomes. PC (Gentian) and PCi (INOVA) were highly correlated with CRP.
Conclusion: PC has low value in distinguishing patients in remission from patients with endoscopic or histologic activity in UC. This essential role must continue be played by FCP.
{"title":"Plasma calprotectin as a biomarker of inflammatory activity in ulcerative colitis.","authors":"Maria José Temido, Margarida Peixinho, Rosário Cunha, Andrea Silva, Sandra Lopes, Sofia Mendes, Ana Margarida Ferreira, Manuela Ferreira, Pedro Figueiredo, Francisco Portela","doi":"10.1016/j.medcli.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.medcli.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>An ideal test to evaluate the inflammatory burden in ulcerative colitis is still an unmet need. Fecal calprotectin (FCP) and C-reactive protein (CRP) have significant limitations. Plasma calprotectin (PC) seems to be promising in inflammatory diseases, but its value in IBD is still to be determined. Our aim was to assess whether PC correlates with inflammatory activity in UC.</p><p><strong>Methods: </strong>Prospective single center cohort study. Consecutive patients previously diagnosed with UC undergoing endoscopy were included (June 2021-September 2022). Demographic, clinical, analytical (CRP, PC and FCP), endoscopic and histologic data was collected at the time of colonoscopy. PC was assessed with Gentian Calprotectin Immunoassay and, in a subgroup of patients, also with QUANTA Flash Circulating Calprotectin from INOVA.</p><p><strong>Results: </strong>Inclusion of 98 patients (60.2% male) with a median age 49 (38-61) years. The extent of colitis was distal in 12 (12.2%), left-sided in 49 (50%), and extensive in 37 (37.8%). Mesalazine was taken by 65 (66.3%) patients, with biologic monotherapy used in 24 (24.5%) and combination therapy in 6 (6.1%). Clinical, endoscopic and histological remission were detected, in 56 (57.1%), 48 (49%) and in 55 (56.1%) patients, respectively. Comparing MES 0/1 vs MES 2/3, a statistically significant difference was found with PC, CRP and FCP. Concerning endoscopic (MES=1) and histological (GS<2) remission, FCP was the only biomarker able to detect these outcomes. PC (Gentian) and PCi (INOVA) were highly correlated with CRP.</p><p><strong>Conclusion: </strong>PC has low value in distinguishing patients in remission from patients with endoscopic or histologic activity in UC. This essential role must continue be played by FCP.</p>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644040","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 : 2024-11-15DOI: 10.1016/j.medcli.2024.05.015
Claudia Abadía Molina , Nuria Goñi Ros , Ricardo González Tarancón , Luis Rello Varas , M. del Valle Recasens Flores , Silvia Izquierdo Álvarez
Background
The main genetic cause of iron overload is haemochromatosis (HC). In recent years, the study of non-HFE genes (HFE2, HJV, HAMP, TRF2, SLC40A1, and BMP6) has become relevant thanks to next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) techniques. Our objectives were to estimate the prevalence of both HFE (C282Y/HY63D variants) and non-HFE variants attending a tertiary hospital in Aragón, to predict the effect of the variants on the protein, and to establish a genotype–phenotype correlation evaluating with the clinical context.
Methods
Retrospective descriptive study from 2006 to 2020 of patients attended at genetic consultation in a reference hospital for HC in Aragon. We calculated prevalence of HFE and non-HFE variants. We analysed non-HFE genes (HFE2, HJV, HAMP, TRF2, SLC40A1, and BMP6), used bioinformatics tools, consulted different databases and measured clinical parameters (laboratory and imaging).
Results
The prevalence of C282Y homozygous was 5.95% respect the total of cases and 0.025% respect our population. The prevalence of non-HFE HC variants was 1.94% respect the total of cases and 0.008% respect our population. We found 27 variants in non-HFE genes and 4 in HFE gene, of which 6 were classified as variant of uncertain clinical significance (VUS), or likely pathogenic or pathogenic according to the ACMG classification criteria.
Conclusion
Our prevalence results are as expected, and similar to those obtained by other studies. Although some of the genetic findings explain the clinical symptoms of some of our patients, we remain have a high number of patients without a clear molecular diagnosis.
{"title":"Hereditary haemochromatosis: Prevalence and characterization of the disease in a tertiary hospital in Aragon, Spain","authors":"Claudia Abadía Molina , Nuria Goñi Ros , Ricardo González Tarancón , Luis Rello Varas , M. del Valle Recasens Flores , Silvia Izquierdo Álvarez","doi":"10.1016/j.medcli.2024.05.015","DOIUrl":"10.1016/j.medcli.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><div>The main genetic cause of iron overload is haemochromatosis (HC). In recent years, the study of non-HFE genes (<em>HFE2</em>, <em>HJV</em>, <span><em>HAMP</em></span>, <em>TRF2</em>, <em>SLC40A1</em>, and <span><span>BMP6</span></span>) has become relevant thanks to next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) techniques. Our objectives were to estimate the prevalence of both HFE (C282Y/HY63D variants) and non-HFE variants attending a tertiary hospital in Aragón, to predict the effect of the variants on the protein, and to establish a genotype–phenotype correlation evaluating with the clinical context.</div></div><div><h3>Methods</h3><div>Retrospective descriptive study from 2006 to 2020 of patients attended at genetic consultation in a reference hospital for HC in Aragon. We calculated prevalence of HFE and non-HFE variants. We analysed non-HFE genes (<em>HFE2</em>, <em>HJV</em>, <em>HAMP</em>, <em>TRF2</em>, <em>SLC40A1</em>, and <em>BMP6</em>), used bioinformatics tools, consulted different databases and measured clinical parameters (laboratory and imaging).</div></div><div><h3>Results</h3><div>The prevalence of C282Y homozygous was 5.95% respect the total of cases and 0.025% respect our population. The prevalence of non-HFE HC variants was 1.94% respect the total of cases and 0.008% respect our population. We found 27 variants in non-<em>HFE</em> genes and 4 in <em>HFE</em> gene, of which 6 were classified as variant of uncertain clinical significance (VUS), or likely pathogenic or pathogenic according to the ACMG classification criteria.</div></div><div><h3>Conclusion</h3><div>Our prevalence results are as expected, and similar to those obtained by other studies. Although some of the genetic findings explain the clinical symptoms of some of our patients, we remain have a high number of patients without a clear molecular diagnosis.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"163 9","pages":"Pages 442-448"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603879","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 : 2024-11-15DOI: 10.1016/j.medcli.2024.05.023
Maria G. Matta , Laura Schreier , Augusto Lavalle-Cobo , Sebastian Garcia-Zamora , Agustina Ferraresi , Angeles Madsen , Sofia Bellini , Guadalupe Ramos , Paula Roubicek , Pablo Corral
Objectives
Lipoprotein(a) [Lp(a)] is a significant risk factor for cardiovascular disease, yet it is often overlooked in routine clinical assessments. As a primarily genetically determined risk factor, the traditional recommendation is to assess its level once in a lifetime, as the variability of Lp(a) over time is considered to be minimal. This study aims to evaluate the potential variability of Lp(a) in clinically stable patients and investigate factors contributing to the lack of stable levels.
Methods
A retrospective analysis was conducted on a sample of adult patients attending a lipid clinic. Participants with at least two Lp(a) measurements taken with a minimum interval of four months were included. Lp(a) measurements were performed using the immunoturbidimetric assay. Variability in Lp(a) values was calculated as a percentage change from baseline, with participants exceeding a 25% change classified as having hypervariable Lp(a) levels. Additional clinical and biochemical variables were assessed.
Results
61 participants with 171 Lp(a) determinations were included. Thirty-four percent exhibited a variability of 25% or higher (hypervariable). Men showed slightly greater variability than women. Changes in Lp(a) categories were observed among hypervariable patients, with some participants experiencing an increase while others showed a decrease. Menopause was present in all the women with hypervariable levels.
Conclusion
Our study suggests reconsidering the reliance on a single Lp(a) measurement for assessing cardiovascular risk. Repeat measurements, particularly in borderline cases, may be beneficial.
{"title":"Temporal variability of Lp(a) in clinically stable patients: Implications for cardiovascular risk assessment","authors":"Maria G. Matta , Laura Schreier , Augusto Lavalle-Cobo , Sebastian Garcia-Zamora , Agustina Ferraresi , Angeles Madsen , Sofia Bellini , Guadalupe Ramos , Paula Roubicek , Pablo Corral","doi":"10.1016/j.medcli.2024.05.023","DOIUrl":"10.1016/j.medcli.2024.05.023","url":null,"abstract":"<div><h3>Objectives</h3><div>Lipoprotein(a) [Lp(a)] is a significant risk factor for cardiovascular disease, yet it is often overlooked in routine clinical assessments. As a primarily genetically determined risk factor, the traditional recommendation is to assess its level once in a lifetime, as the variability of Lp(a) over time is considered to be minimal. This study aims to evaluate the potential variability of Lp(a) in clinically stable patients and investigate factors contributing to the lack of stable levels.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on a sample of adult patients attending a lipid clinic. Participants with at least two Lp(a) measurements taken with a minimum interval of four months were included. Lp(a) measurements were performed using the immunoturbidimetric assay. Variability in Lp(a) values was calculated as a percentage change from baseline, with participants exceeding a 25% change classified as having hypervariable Lp(a) levels. Additional clinical and biochemical variables were assessed.</div></div><div><h3>Results</h3><div>61 participants with 171 Lp(a) determinations were included. Thirty-four percent exhibited a variability of 25% or higher (hypervariable). Men showed slightly greater variability than women. Changes in Lp(a) categories were observed among hypervariable patients, with some participants experiencing an increase while others showed a decrease. Menopause was present in all the women with hypervariable levels.</div></div><div><h3>Conclusion</h3><div>Our study suggests reconsidering the reliance on a single Lp(a) measurement for assessing cardiovascular risk. Repeat measurements, particularly in borderline cases, may be beneficial.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"163 9","pages":"Pages 436-441"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734632","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 : 2024-11-15DOI: 10.1016/j.medcli.2024.05.003
Aina Capdevila-Reniu , Margarita Navarro-López , Cristina Sierra-Benito , Victor Sapena , Ana Suárez-Lombraña , Miguel Camafort-Babkowski , Alfonso López-Soto
Background and objectives
Evaluate clinical and subclinical arteriosclerotic disease in older patients with hip fracture compared with patients without fracture in order to increase knowledge about the relation between both diseases in older individuals.
Patients and methods
Age- and sex-matched case–control study of octogenarians with and without recent hip fracture. Vascular risk factors, subclinical vascular diseases (assessed by carotid plaques, carotid intima media thickness and arterial stiffness) as well as cardiovascular diseases were analyzed. Univariate and multivariate logistic models were used to estimate odds ratios (OR) with their 95% confidence intervals (CI) to assess the association of the arteriosclerosis and hip fracture.
Results
We analyzed 95 patients per group with a median age of 82 [79–87] years of whom 77.9% were female. Patients in both groups have elevated rates of vascular disease (25%) without differences between them. Patients with hip fracture had higher subclinical arteriosclerotic alterations with higher percentage of carotid plaques (OR 3.25 [1.06–9.97]) compared with the control group.
Conclusions
Older patients with hip fracture had significantly higher presence of subclinical alterations but not increase on rate of cardiovascular arteriosclerotic disease compared with those without hip fracture.
{"title":"Clinical and subclinical arteriosclerotic disease in octagenarians with hip fracture. A case–control study","authors":"Aina Capdevila-Reniu , Margarita Navarro-López , Cristina Sierra-Benito , Victor Sapena , Ana Suárez-Lombraña , Miguel Camafort-Babkowski , Alfonso López-Soto","doi":"10.1016/j.medcli.2024.05.003","DOIUrl":"10.1016/j.medcli.2024.05.003","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Evaluate clinical and subclinical arteriosclerotic disease in older patients with hip fracture compared with patients without fracture in order to increase knowledge about the relation between both diseases in older individuals.</div></div><div><h3>Patients and methods</h3><div>Age- and sex-matched case–control study of octogenarians with and without recent hip fracture. Vascular risk factors, subclinical vascular diseases (assessed by carotid plaques, carotid intima media thickness and arterial stiffness) as well as cardiovascular diseases were analyzed. Univariate and multivariate logistic models were used to estimate odds ratios (OR) with their 95% confidence intervals (CI) to assess the association of the arteriosclerosis and hip fracture.</div></div><div><h3>Results</h3><div>We analyzed 95 patients per group with a median age of 82 [79–87] years of whom 77.9% were female. Patients in both groups have elevated rates of vascular disease (25%) without differences between them. Patients with hip fracture had higher subclinical arteriosclerotic alterations with higher percentage of carotid plaques (OR 3.25 [1.06–9.97]) compared with the control group.</div></div><div><h3>Conclusions</h3><div>Older patients with hip fracture had significantly higher presence of subclinical alterations but not increase on rate of cardiovascular arteriosclerotic disease compared with those without hip fracture.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"163 9","pages":"Pages 431-435"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580221","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 : 2024-11-15DOI: 10.1016/j.medcli.2024.07.008
Adam J. Streeter , Andreas Schmeling , André Karch
{"title":"How certainty is certain enough? Challenges in the statistical methodology for forensic age assessment of living individuals","authors":"Adam J. Streeter , Andreas Schmeling , André Karch","doi":"10.1016/j.medcli.2024.07.008","DOIUrl":"10.1016/j.medcli.2024.07.008","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"163 9","pages":"Pages e92-e97"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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