Medicina Clinica最新文献

Numerous epidemiological studies link bone loss with vascular calcification and cardiovascular disease. Osteoporosis and atherosclerosis share risk factors and are likely to share pathogenic mechanisms as well. On the other hand, drugs used in the treatment of osteoporosis could influence cardiovascular risk, just as those used in cardiovascular disease could affect bone mineral density and the development of fractures.

Objectives: Prognostic differences between central venous catheters (CVC) carriers and non-carriers, who have upper extremity deep vein thrombosis (UEDVT), have been described; however, evidence in hospitalized patients is limited.

Materials and methods: This retrospective cohort study included hospitalized patients from March 2012 to March 2023 with UEDVT, classified into CVC-associated and non-CVC-associated UEDVT groups. Rates of thrombotic recurrence, hemorrhage, post-thrombotic syndrome, and death from pulmonary embolism were analyzed using Kaplan-Meier curves and Cox proportional hazards models.

Results: A total of 135 patients were included (76 with CVC and 59 without CVC), with a mean age of 67±15 years and 44% female. No significant differences were observed in the incidence of the combined endpoint between CVC non-carriers and carriers (5.45 vs 6.74 per 1000 patient-months respectively; HR: 1.26; 95% CI: 0.51-3.06). After multivariable adjustment, no significant differences in risk were detected (HR: 1.09; 95% CI: 0.44-2.72).

Conclusions: There are no significant prognostic differences between patients with and without CVC hospitalized for UEDVT.

Introduction and objectives: Chronic obstructive pulmonary disease (COPD) frequently coexists with other comorbidities, including hypogonadism. However, the association between COPD severity and hypogonadism remains controversial. This study aimed to evaluate this association and compare the clinical characteristics of hypogonadal and eugonadal COPD patients.

Materials and methods: A cross-sectional study including men with stable COPD was performed. Hypogonadism was diagnosed based on the presence of symptoms, according to the Androgen Deficiency in Aging Males questionnaire, and a total testosterone deficit (<300ng/dL). COPD severity was classified according to the Spanish COPD guideline risk classification. A multivariate logistic regression analysis was performed in order to evaluate the relationship between COPD severity and hypogonadism.

Results: 134 subjects were recruited. The prevalence of hypogonadism was higher in severe COPD than in mild COPD, with a prevalence ratio of 1.8 (p=0.007). An increased odds of hypogonadism was observed in severe COPD subjects (OR 2.60, 95% CI 1.23-5.48, p=0.012) independent of age, body mass index, cardiovascular disease, and chronic renal failure. Hypogonadal COPD patients exhibited lower percentage levels of FVC and FEV₁ and a higher degree of dyspnea than compared to eugonadal COPD patients.

Conclusion: Patients with severe COPD had a higher prevalence of hypogonadism compared to those with mild COPD. Additionally, severe COPD was identified as an independent risk factor for hypogonadism. These findings suggest that hypogonadism should be evaluated in patients with COPD, particularly in those with severe disease.

Introduction: Tumor necrosis factor-alpha inhibitor (anti-TNF-α) agents are essential in treating inflammatory bowel diseases (IBD). Their use, however, may cause dermatoses. This study aims to characterize the dermatoses in IBD patients on anti-TNF-α therapy.

Methods: A total of 175 IBD patients, 105 (60%) on anti-TNF-α therapy were consecutively selected in a Brazilian referral center of gastroenterology and were evaluated by a dermatologist, regardless of whether they had dermatological complaints.

Results: The most prevalent disorders in patients receiving anti-TNF-α were skin infections (52.4%), unspecified alopecia not associated with psoriasiform eruptions (32.4%), seborrheic dermatitis (27.6%), infusion/injection reactions (14.5%), and psoriasiform eruptions (11.4%). The group not on anti-TNF-α treatment also presented a high prevalence of infection, seborrheic dermatitis, and alopecia, but no psoriasiform eruptions. There was a higher prevalence of dermatoses, when considered together, in patients taking anti-TNF-α. The use of these agents was independently associated with presence of dermatoses when grouped.

Conclusion: The prevalence of dermatoses, considering together, was higher in the anti-TNF-α group. Infections, alopecia, seborrheic dermatitis, administration reactions, and psoriasiform eruptions were the most frequent dermatoses in patients taking anti-TNF-α.

Objective: The objective of this study is to analyze the appropriateness of the indication for urinary catheterization (UC) in hospitalized patients and to analyze possible associated factors.

Methods: Cross-sectional observational study conducted in 15 hospitals. Patients over the age of 18 with UC were included in the study. Information on age, sex, healthcare area, documentation of the order in the medical record, and reason for UC was collected. Indications were considered appropriate according to the Centers for Disease Control's (CDC) Urinary Tract Infection Prevention Guidelines. Logistic regression was used to study the relationship of different variables with the appropriateness of UC and the presence of documentation of the reason for UC.

Results: 696 patients with UC at the time of evaluation were included, with a mean age of 73.3 years (SD 14.6), and 45.0% of them were female. The main indications for UC were preoperative, hemodynamic instability, and acute urinary retention. In 17.4% of cases, the reason for UC was not documented, and the prevalence of inappropriateness was 20.3%. Inappropriateness of UC was higher in the Emergency Department (35.1%), followed by medical services (17.2%) and surgical services (8.4%) (p<0.001 in all comparisons). Appropriateness was lower in older patients (p=0.021) and in centers with a higher number of beds (p<0.001).

Conclusions: Unappropriateness of urinary catheterization is a significant problem in our centers, especially in the Emergency Department and in older patients. Specific and multifocal quality improvement programs are needed to enhance knowledge of appropriate indications for UC and potential adverse consequences.