Medicina Clinica最新文献

英文中文

Características de los ensayos clínicos no farmacológicos financiados por el Instituto de Salud Carlos III completados en 2009-2024 2009-2024年完成的由Salud Carlos III研究所资助的非药物临床试验的特点。

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107279

Rafael Dal-Ré , Elena García-Méndez , Ignacio Mahillo-Fernández

引用次数: 0

Uso racional de las inmunoglobulinas 合理使用免疫球蛋白。

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107260

José Antonio García Erce , Ingrid Magnolia Parra Salinas

引用次数: 0

Ticagrelor versus clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis 替格瑞洛与氯吡格雷在经皮冠状动脉介入治疗的慢性冠状动脉综合征患者中的作用：倾向评分匹配分析

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107256

Ignacio Gallo , Gloria Heredia , Rafael Gonzalez-Manzanares , Cristina Urbano , Diana Ladera , Luis Carlos Maestre , Inmaculada Osuna , Francesco Costa , Javier Suarez de Lezo , Francisco Hidalgo , Jorge Perea , Miguel Romero , Manuel Pan , Soledad Ojeda

Aims

This study aimed to evaluate the efficacy and safety of ticagrelor-based dual antiplatelet therapy (DAPT) compared to clopidogrel-based DAPT in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI) in a real-world setting.

Methods and results

This was a retrospective, single-centre study including consecutive CCS patients discharged on DAPT after elective PCI between 2019 and 2022. Propensity score matching (PSM) was performed to account for confounding factors, including clinical, angiographic, and procedural variables. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included the individual components of MACE and major bleeding, A total of 1236 patients were included, 731 treated with ticagrelor and 505 with clopidogrel. Before matching, ticagrelor prescription was associated with higher thrombotic risk and lower bleeding risk profile. PSM resulted in 351 pairs. Ticagrelor was associated with a lower 1-year incidence of MACE (2.3% vs. 6.6%; HR 0.34, 95% CI 0.15–0.76; p = 0.008) and all-cause mortality (2.3% vs. 5.1%; HR 0.43, 95% CI 0.19–0.99; p = 0.049). No significant differences were observed in non-fatal myocardial infarction, non-fatal stroke, or major bleeding.

Conclusion

In this cohort of patients with CCS undergoing PCI, ticagrelor was associated with a lower incidence of MACE at 1-year follow-up compared to clopidogrel, without an increase in major bleeding. Dedicated randomised controlled trials are needed to confirm these findings.

目的：本研究旨在评估基于替格洛的双重抗血小板治疗（DAPT）与基于氯吡格雷的双重抗血小板治疗（DAPT）在现实世界中接受选择性经皮冠状动脉介入治疗（PCI）的慢性冠状动脉综合征（CCS）患者的疗效和安全性。方法和结果：这是一项回顾性的单中心研究，包括2019年至2022年期间在选择性PCI术后连续行DAPT出院的CCS患者。采用倾向评分匹配（PSM）来解释混杂因素，包括临床、血管造影和程序变量。主要终点是1年随访期间主要不良心血管事件（MACE）的发生率，定义为全因死亡、非致死性心肌梗死和非致死性卒中的综合发生率。次要终点包括MACE的个体成分和大出血，共纳入1236例患者，替格瑞洛治疗731例，氯吡格雷治疗505例。配对前，替格瑞洛处方与较高的血栓形成风险和较低的出血风险相关。PSM结果为351对。替格瑞洛与较低的1年MACE发生率（2.3%比6.6%;HR 0.34, 95% CI 0.15-0.76; p=0.008）和全因死亡率（2.3%比5.1%;HR 0.43, 95% CI 0.19-0.99; p=0.049）相关。在非致死性心肌梗死、非致死性卒中或大出血方面没有观察到显著差异。结论：在接受PCI的CCS患者队列中，与氯吡格雷相比，替格瑞洛与1年随访时MACE发生率较低相关，且未增加大出血。需要专门的随机对照试验来证实这些发现。

{"title":"Ticagrelor versus clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis","authors":"Ignacio Gallo , Gloria Heredia , Rafael Gonzalez-Manzanares , Cristina Urbano , Diana Ladera , Luis Carlos Maestre , Inmaculada Osuna , Francesco Costa , Javier Suarez de Lezo , Francisco Hidalgo , Jorge Perea , Miguel Romero , Manuel Pan , Soledad Ojeda","doi":"10.1016/j.medcli.2025.107256","DOIUrl":"10.1016/j.medcli.2025.107256","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to evaluate the efficacy and safety of ticagrelor-based dual antiplatelet therapy (DAPT) compared to clopidogrel-based DAPT in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI) in a real-world setting.</div></div><div><h3>Methods and results</h3><div>This was a retrospective, single-centre study including consecutive CCS patients discharged on DAPT after elective PCI between 2019 and 2022. Propensity score matching (PSM) was performed to account for confounding factors, including clinical, angiographic, and procedural variables. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included the individual components of MACE and major bleeding, A total of 1236 patients were included, 731 treated with ticagrelor and 505 with clopidogrel. Before matching, ticagrelor prescription was associated with higher thrombotic risk and lower bleeding risk profile. PSM resulted in 351 pairs. Ticagrelor was associated with a lower 1-year incidence of MACE (2.3% vs. 6.6%; HR 0.34, 95% CI 0.15–0.76; <em>p</em>  =0.049). No significant differences were observed in non-fatal myocardial infarction, non-fatal stroke, or major bleeding.</div></div><div><h3>Conclusion</h3><div>In this cohort of patients with CCS undergoing PCI, ticagrelor was associated with a lower incidence of MACE at 1-year follow-up compared to clopidogrel, without an increase in major bleeding. Dedicated randomised controlled trials are needed to confirm these findings.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107256"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933974","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}

引用次数: 0

Retos de los estudios con datos reales: causalidad, intervención y reproducibilidad 实际数据研究的挑战：因果关系、干预和可重复性

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-14 DOI: 10.1016/j.medcli.2025.107292

Inmaculada Arostegui , Josep Roma Millan , Nora Amama-BenHassun , Erik Cobo Valeri

引用次数: 0

Prevalence of elevated lipoprotein(a) in individuals with inflammatory bowel disease: Potential implications for cardiovascular risk 炎症性肠病患者中脂蛋白(a)升高的患病率：对心血管风险的潜在影响

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-13 DOI: 10.1016/j.medcli.2025.107303

Walter Masson , Gonzalo Fernandez-Villar , Solange Martinez-Elhelou , Fernando Garagoli , María Belen Sánchez , María Josefina Etchevers , Rodolfo Pizarro , María Josefina Sobrero

Background and aims

Elevated lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular risk and have been implicated in various inflammatory conditions. However, evidence regarding the role of Lp(a) in patients with inflammatory bowel disease (IBD) remains limited. This study aimed to evaluate Lp(a) levels in a group of patients with IBD.

Methods

A cross-sectional study was conducted involving patients with IBD actively followed by a multidisciplinary team. As part of routine care, patients with cardiovascular risk factors were systematically referred for comprehensive cardiology evaluation. For comparison, a control group matched for age and sex in a 2:1 ratio was randomly selected from the hospital database.

Results

Seventy-eight patients with IBD and 156 controls (mean age 56.1 years; 59% male) were included. Among patients with IBD, 56.4% had ulcerative colitis and 43.6% Crohn's disease. The IBD group showed a non-significant trend toward higher Lp(a) levels compared to controls (median [IQR]: 19.1 [5.9–71.3] vs. 17.5 [7.0–39.0] mg/dL; p = 0.274). A significantly greater proportion of IBD patients had high-risk Lp(a) levels (>50 mg/dL) than controls (35.9% vs. 19.2%; p = 0.02). Additionally, IBD patients with Lp(a) > 50 mg/dL exhibited a non-significant trend toward higher inflammatory marker values.

Conclusion

A substantial proportion of IBD patients exhibited elevated Lp(a) levels. Given its inflammatory, prothrombotic, and proatherogenic properties, Lp(a) may contribute to the increased cardiovascular risk observed in this population.

背景和目的脂蛋白(a) [Lp(a)]水平升高与心血管风险增加有关，并与各种炎症有关。然而，关于Lp(a)在炎症性肠病（IBD）患者中的作用的证据仍然有限。本研究旨在评估一组IBD患者的Lp(a)水平。方法对IBD患者进行横断面研究，由多学科团队积极随访。作为常规护理的一部分，系统地转介有心血管危险因素的患者进行全面的心脏病学评估。为了进行比较，从医院数据库中随机选择年龄和性别比例为2:1的对照组。结果纳入78例IBD患者和156例对照组（平均年龄56.1岁，男性59%）。在IBD患者中，56.4%患有溃疡性结肠炎，43.6%患有克罗恩病。与对照组相比，IBD组Lp(a)水平升高的趋势不显著（中位数[IQR]: 19.1 [5.9-71.3] vs. 17.5 [7.0-39.0] mg/dL; p = 0.274）。IBD患者高危脂蛋白(A)水平（50 mg/dL）的比例明显高于对照组（35.9% vs. 19.2%; p = 0.02）。此外，Lp(a) >； 50 mg/dL的IBD患者炎症标志物值升高的趋势不显著。结论相当比例的IBD患者出现Lp(a)水平升高。鉴于其炎症性、血栓性和致动脉粥样硬化性，Lp(a)可能导致该人群心血管风险增加。

{"title":"Prevalence of elevated lipoprotein(a) in individuals with inflammatory bowel disease: Potential implications for cardiovascular risk","authors":"Walter Masson , Gonzalo Fernandez-Villar , Solange Martinez-Elhelou , Fernando Garagoli , María Belen Sánchez , María Josefina Etchevers , Rodolfo Pizarro , María Josefina Sobrero","doi":"10.1016/j.medcli.2025.107303","DOIUrl":"10.1016/j.medcli.2025.107303","url":null,"abstract":"<div><h3>Background and aims</h3><div>Elevated lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular risk and have been implicated in various inflammatory conditions. However, evidence regarding the role of Lp(a) in patients with inflammatory bowel disease (IBD) remains limited. This study aimed to evaluate Lp(a) levels in a group of patients with IBD.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted involving patients with IBD actively followed by a multidisciplinary team. As part of routine care, patients with cardiovascular risk factors were systematically referred for comprehensive cardiology evaluation. For comparison, a control group matched for age and sex in a 2:1 ratio was randomly selected from the hospital database.</div></div><div><h3>Results</h3><div>Seventy-eight patients with IBD and 156 controls (mean age 56.1 years; 59% male) were included. Among patients with IBD, 56.4% had ulcerative colitis and 43.6% Crohn's disease. The IBD group showed a non-significant trend toward higher Lp(a) levels compared to controls (median [IQR]: 19.1 [5.9–71.3] vs. 17.5 [7.0–39.0]mg/dL; <em>p</em>   =0.02). Additionally, IBD patients with Lp(a)>50mg/dL exhibited a non-significant trend toward higher inflammatory marker values.</div></div><div><h3>Conclusion</h3><div>A substantial proportion of IBD patients exhibited elevated Lp(a) levels. Given its inflammatory, prothrombotic, and proatherogenic properties, Lp(a) may contribute to the increased cardiovascular risk observed in this population.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107303"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976123","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}

引用次数: 0

Prognostic value of senescence, lymphatic proliferation, and histology in post-COVID-19 interstitial lung disease 衰老、淋巴增生和组织学对covid -19后间质性肺病的预后价值

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-14 DOI: 10.1016/j.medcli.2025.107252

María Florencia Pilia , Irene Sansano , Diego Varona , Marina Sánchez , David Espejo , Mario Culebras , Xavier Muñoz , Iñigo Ojanguren , Santiago Ramón y Cajal

Background

In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to evaluate the prognostic value of histopathological patterns, cellular senescence, and lymphatic proliferation in patients with post-COVID-19 ILD.

Methods

This prospective observational study of patients hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia and presenting respiratory symptoms, radiological alterations, and pulmonary function test impairment during the 3-month follow-up visit after discharge. Lung cryobiopsies were performed, and the histopathological findings and expression of senescence and lymphatic proliferation (P16 and D2-40) were analyzed.

Results

Between March 2020 and February 2021, 4332 patients were hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia, and 1403 were visited in the Respiratory Clinic 3 months after discharge. The first 66 patients presenting with respiratory symptoms, radiological alterations, and decreased pulmonary function tests during the post hospitalization follow-up underwent cryobiopsy for diagnostic purposes. Multivariate regression showed that Masson bodies in the 3-month cryobiopsy were related to a higher forced vital capacity at 6 months whereas higher expression of senescence and lymphatic proliferation markers, such as P-16 and D2-40, in the histological samples were related to decreased carbon monoxide transfer test values at 6 months.

Conclusion

Cellular senescence and lymphatic proliferation in lung tissue are associated with impaired gas exchange in mid-term follow-up, suggesting their potential as prognostic markers in post-COVID-19 ILD.

背景：在一部分患者中，COVID-19肺炎后的间质性肺病（ILD）后遗症在出院后持续超过6个月。然而，潜在的病理生理机制仍然知之甚少。本研究旨在评估组织病理学模式、细胞衰老和淋巴增生在covid -19后ILD患者中的预后价值。方法前瞻性观察研究在瓦尔德希伯伦大学医院因COVID-19肺炎住院并在出院后3个月随访期间出现呼吸道症状、影像学改变和肺功能检查损害的患者。行肺冷冻活检，分析组织病理学结果及衰老和淋巴细胞增殖（P16、D2-40）表达。结果2020年3月至2021年2月，希布伦大学附属医院新冠肺炎住院患者4332例，出院3个月后到呼吸门诊就诊患者1403例。在住院后随访期间出现呼吸道症状、影像学改变和肺功能检查下降的前66例患者接受冷冻活检以进行诊断。多因素回归显示，3个月冷冻标本中的马松体与6个月时较高的强迫肺活量有关，而组织样本中衰老和淋巴增殖标志物（如P-16和D2-40）的高表达与6个月时一氧化碳转移试验值的降低有关。结论中期随访中，肺组织细胞衰老和淋巴增生与气体交换受损相关，提示其可能作为covid -19 ILD的预后指标。

{"title":"Prognostic value of senescence, lymphatic proliferation, and histology in post-COVID-19 interstitial lung disease","authors":"María Florencia Pilia , Irene Sansano , Diego Varona , Marina Sánchez , David Espejo , Mario Culebras , Xavier Muñoz , Iñigo Ojanguren , Santiago Ramón y Cajal","doi":"10.1016/j.medcli.2025.107252","DOIUrl":"10.1016/j.medcli.2025.107252","url":null,"abstract":"<div><h3>Background</h3><div>In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to evaluate the prognostic value of histopathological patterns, cellular senescence, and lymphatic proliferation in patients with post-COVID-19 ILD.</div></div><div><h3>Methods</h3><div>This prospective observational study of patients hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia and presenting respiratory symptoms, radiological alterations, and pulmonary function test impairment during the 3-month follow-up visit after discharge. Lung cryobiopsies were performed, and the histopathological findings and expression of senescence and lymphatic proliferation (P16 and D2-40) were analyzed.</div></div><div><h3>Results</h3><div>Between March 2020 and February 2021, 4332 patients were hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia, and 1403 were visited in the Respiratory Clinic 3 months after discharge. The first 66 patients presenting with respiratory symptoms, radiological alterations, and decreased pulmonary function tests during the post hospitalization follow-up underwent cryobiopsy for diagnostic purposes. Multivariate regression showed that Masson bodies in the 3-month cryobiopsy were related to a higher forced vital capacity at 6 months whereas higher expression of senescence and lymphatic proliferation markers, such as P-16 and D2-40, in the histological samples were related to decreased carbon monoxide transfer test values at 6 months.</div></div><div><h3>Conclusion</h3><div>Cellular senescence and lymphatic proliferation in lung tissue are associated with impaired gas exchange in mid-term follow-up, suggesting their potential as prognostic markers in post-COVID-19 ILD.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107252"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976124","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}

引用次数: 0

Initiation and titration of guideline-directed medical therapy during hospitalization for acute decompensation of heart failure with reduced ejection fraction 急性心力衰竭失代偿伴射血分数降低住院期间指导药物治疗的开始和滴定

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-13 DOI: 10.1016/j.medcli.2025.107247

Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo

Background and objectives

Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).

Methods

We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.

Results

One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.

Conclusions

Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.

背景和目的心力衰竭伴射血分数降低（HFrEF）是世界范围内发病率和死亡率的主要原因。在住院期间启动或维持指导药物治疗（GDMT）是至关重要的，因为早期干预可以显著影响预后。GDMT包括肾素-血管紧张素-醛固酮系统抑制剂（血管紧张素转换酶抑制剂（ACEIs）、血管紧张素II受体阻滞剂（ARB）、血管紧张素受体-neprilysin抑制剂（ARNI）和矿皮质激素受体拮抗剂（MRA））、β受体阻滞剂和钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）。我们的目的是评估住院期间实现四联治疗的患者百分比，记录未实现的原因，并描述特殊亚组（慢性肾脏疾病（CKD）或高龄）的结果。方法于2021年9月至2024年2月进行前瞻性单中心研究，纳入我院心力衰竭科（HFU）治疗的急性失代偿性HFrEF患者，患者射血分数≤40%。结果共纳入196例患者，平均年龄69.2岁。常见的合并症包括高血压（70.4%）、糖尿病（41.8%）和CKD（35.2%）。平均住院时间为8天。出院时，92.9%的患者开了ACEI/ARB/ARNI， 88.8%的患者开了β受体阻滞剂，68.9%的患者开了MRA， 91.8%的患者开了sgltni。58.2%的患者接受了四联治疗。结论我们的研究强调了GDMT在HFrEF住院患者中的耐受性和安全性。相当比例的患者在出院时成功地接受了四联治疗，包括那些患有慢性肾脏疾病（CKD）或高龄的患者。主要限制因素为低血压、肾功能恶化和电解质失衡。

{"title":"Initiation and titration of guideline-directed medical therapy during hospitalization for acute decompensation of heart failure with reduced ejection fraction","authors":"Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo","doi":"10.1016/j.medcli.2025.107247","DOIUrl":"10.1016/j.medcli.2025.107247","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).</div></div><div><h3>Methods</h3><div>We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.</div></div><div><h3>Results</h3><div>One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.</div></div><div><h3>Conclusions</h3><div>Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107247"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976678","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}

引用次数: 0

Impacto del inicio de la monitorización flash de glucosa (MFG) en los parámetros de control glucémico de pacientes adultos con diabetes mellitus tipo 2 启动瞬时血糖监测（FGM）对成人2型糖尿病患者血糖控制参数的影响

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107255

Carmela Manrique Mutiozábal , Amaia Legarreta Alday , Zuria Alba Muñoz , Eunate Sánchez Uribe , Ainara Deusto Puertas , Santos Zorrozúa Borja , Maria Luisa Antuñano López , Teresa Ruiz de Azúa Arteche , Estela Benito Martínez , Ester Caballero Renilla , Maite Guimón Bardesi

Introduction

The effective implementation of the FGM contributes to achieving glycemic control, reducing hypoglycemic and hyperglycemic decompensations as well as enhancing patient self-management and improving their perception of quality of life. The aim of our study was to evaluate the glycemic control in type 2 diabetes patients after having implemented FGM in clinical practice.

Material and methods

Current patients with type 2 diabetes treated in our unit were monitored (FGM). A Structured Therapeutic Education Program was carried out and glycemic control variables were compared at the start and after 3 months of treatment.

Results

A total of 36 patients were included (mean age of 67.8 ± 12.4 years, 36.11% female, diabetes duration 21.5 ± 2.12 years and a previous median glycated hemoglobine of 7.55%). Comparing the baseline data and the measures at 3 months, it was found a decrease in both glucose management indicator (GMI) (0.15% [0.40;0.30], P 0,537) and the coefficient of variation (CV) (1,42 ± 4,66%, P 0,07), as well as an increase in time in range (TIR) (3,44 ± 14.72%, P 0,169). Furthermore, a decrease in time in hyperglycemia > 250 mg/dl was observed (2,00% [−6,50;0,00] P 0,001).

Conclusion

FGM has led to a favorable advance in the management and glycemic control in patients with type 2 diabetes.

引言：女性生殖器切割的有效实施有助于实现血糖控制，减少低血糖和高血糖失代偿，增强患者自我管理，提高患者对生活质量的感知。本研究的目的是评估2型糖尿病患者在临床实践中实施女性生殖器切割后的血糖控制情况。材料和方法：对目前在我单位治疗的2型糖尿病患者进行FGM监测。进行了结构化治疗教育计划，并在治疗开始和治疗3个月后比较血糖控制变量。结果：共纳入36例患者（平均年龄67.8±12.4岁，女性36.11%，糖尿病病程21.5±2.12年，既往糖化血红蛋白中位数为7.55%）。将基线数据与3个月时的测量数据进行比较，发现血糖管理指标（GMI）（0.15% [0.40;0.30], P 0.537）和变异系数（CV）（1.42±4.66%,P 0.007）下降，时间范围（TIR）（3.44±14.72%,P 0.169）增加。此外，观察到在250mg/dl时高血糖时间减少（2,00% [-6,50;0,000]P,001）。结论：女性生殖器切割在2型糖尿病患者的治疗和血糖控制方面取得了良好的进展。

{"title":"Impacto del inicio de la monitorización flash de glucosa (MFG) en los parámetros de control glucémico de pacientes adultos con diabetes mellitus tipo 2","authors":"Carmela Manrique Mutiozábal , Amaia Legarreta Alday , Zuria Alba Muñoz , Eunate Sánchez Uribe , Ainara Deusto Puertas , Santos Zorrozúa Borja , Maria Luisa Antuñano López , Teresa Ruiz de Azúa Arteche , Estela Benito Martínez , Ester Caballero Renilla , Maite Guimón Bardesi","doi":"10.1016/j.medcli.2025.107255","DOIUrl":"10.1016/j.medcli.2025.107255","url":null,"abstract":"<div><h3>Introduction</h3><div>The effective implementation of the FGM contributes to achieving glycemic control, reducing hypoglycemic and hyperglycemic decompensations as well as enhancing patient self-management and improving their perception of quality of life. The aim of our study was to evaluate the glycemic control in type 2 diabetes patients after having implemented FGM in clinical practice.</div></div><div><h3>Material and methods</h3><div>Current patients with type 2 diabetes treated in our unit were monitored (FGM). A Structured Therapeutic Education Program was carried out and glycemic control variables were compared at the start and after 3 months of treatment.</div></div><div><h3>Results</h3><div>A total of 36 patients were included (mean age of 67.8±12.4 years, 36.11% female, diabetes duration 21.5±2.12 years and a previous median glycated hemoglobine of 7.55%). Comparing the baseline data and the measures at 3 months, it was found a decrease in both glucose management indicator (GMI) (0.15% [0.40;0.30], <em>P</em> 0,537) and the coefficient of variation (CV) (1,42±4,66%, <em>P</em> 0,07), as well as an increase in time in range (TIR) (3,44±14.72%, <em>P</em> 0,169). Furthermore, a decrease in time in hyperglycemia >250mg/dl was observed (2,00% [−6,50;0,00] <em>P</em> 0,001).</div></div><div><h3>Conclusion</h3><div>FGM has led to a favorable advance in the management and glycemic control in patients with type 2 diabetes.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107255"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934107","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}

引用次数: 0

Influence of comorbidities and chronic medications on ICU mortality in sepsis: A population-based cohort study of 12,095 patients 合并症和慢性药物对脓毒症ICU死亡率的影响：一项基于人群的12095例患者队列研究

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107265

Rayden Iglesias , Josep M. Badia , Emili Vela , David Monterde , Juan Carlos Yébenes

Bacskground

Sepsis patients are becoming progressively older and frailer and often require chronic medication. Comorbidities and long-term pharmacological treatments may influence survival outcomes in sepsis. This study aimed to evaluate the association between baseline health status, chronic medication use, and in-hospital mortality among ICU-admitted patients with sepsis.

Methods

Retrospective population-based cohort study of ICU adult patients diagnosed with sepsis. The influence of baseline health status, measured using the adjusted morbidity groups (GMA) score, along with the effect of chronic medication use on post-sepsis survival was analysed. Pre-admission medication exposure was determined from outpatient prescription data for the eight months prior to admission. Multivariate logistic regression identified independent predictors of mortality.

Results

Twelve thousand ninety-five ICU-admitted patients with a diagnosis of sepsis were identified in the Catalan population database for 2018–2019. The cohort had a mean age of 68.2 years; high comorbidity burden (GMA: 33.2), high dependency on health services; and elevated baseline health expenditures. In 73.5% of cases infection was present at admission. The overall in-hospital mortality rate was 36.4%. Non-survivors exhibited higher comorbidity levels and greater medication use. In multivariate analysis, prior statin use was independently associated with reduced mortality (OR 0.794; 95% CI 0.723–0.872), whereas corticosteroids were linked to increased mortality (OR 1.321; 95% CI 1.108–1.575).

Conclusion

Comorbidities and chronic medication use significantly influence sepsis survival. Statin use prior to admission was associated with reduced mortality, whereas corticosteroid use correlated with worse outcomes. The GMA score may enhance predictive models, improving resource allocation and clinical decision-making in hospitals. ClinicalTrials.gov: NCT06354452.

背景：脓毒症患者逐渐变老和虚弱，通常需要慢性药物治疗。合并症和长期药物治疗可能影响脓毒症的生存结果。本研究旨在评估icu收治的脓毒症患者的基线健康状况、慢性药物使用和住院死亡率之间的关系。方法：对诊断为脓毒症的ICU成年患者进行回顾性人群队列研究。使用调整发病率组（GMA）评分测量基线健康状况的影响，以及慢性药物使用对脓毒症后生存的影响进行了分析。根据入院前8个月的门诊处方数据确定入院前药物暴露情况。多变量逻辑回归确定了死亡率的独立预测因子。结果：2018-2019年，在加泰罗尼亚人口数据库中发现了1295名被诊断为败血症的icu住院患者。该队列的平均年龄为68.2岁；合并症负担高（GMA: 33.2），高度依赖保健服务；基线卫生支出升高。73.5%的病例入院时存在感染。住院总死亡率为36.4%。非幸存者表现出更高的合并症水平和更多的药物使用。在多变量分析中，既往使用他汀类药物与死亡率降低独立相关（OR 0.794; 95% CI 0.723-0.872），而皮质类固醇与死亡率增加相关（OR 1.321; 95% CI 1.108-1.575）。结论：合并症和慢性用药显著影响脓毒症患者的生存。入院前使用他汀类药物与降低死亡率相关，而使用皮质类固醇则与较差的结果相关。GMA评分可以增强预测模型，改善医院的资源配置和临床决策。Clinicaltrials: gov: NCT06354452。

{"title":"Influence of comorbidities and chronic medications on ICU mortality in sepsis: A population-based cohort study of 12,095 patients","authors":"Rayden Iglesias , Josep M. Badia , Emili Vela , David Monterde , Juan Carlos Yébenes","doi":"10.1016/j.medcli.2025.107265","DOIUrl":"10.1016/j.medcli.2025.107265","url":null,"abstract":"<div><h3>Bacskground</h3><div>Sepsis patients are becoming progressively older and frailer and often require chronic medication. Comorbidities and long-term pharmacological treatments may influence survival outcomes in sepsis. This study aimed to evaluate the association between baseline health status, chronic medication use, and in-hospital mortality among ICU-admitted patients with sepsis.</div></div><div><h3>Methods</h3><div>Retrospective population-based cohort study of ICU adult patients diagnosed with sepsis. The influence of baseline health status, measured using the adjusted morbidity groups (GMA) score, along with the effect of chronic medication use on post-sepsis survival was analysed. Pre-admission medication exposure was determined from outpatient prescription data for the eight months prior to admission. Multivariate logistic regression identified independent predictors of mortality.</div></div><div><h3>Results</h3><div>Twelve thousand ninety-five ICU-admitted patients with a diagnosis of sepsis were identified in the Catalan population database for 2018–2019. The cohort had a mean age of 68.2 years; high comorbidity burden (GMA: 33.2), high dependency on health services; and elevated baseline health expenditures. In 73.5% of cases infection was present at admission. The overall in-hospital mortality rate was 36.4%. Non-survivors exhibited higher comorbidity levels and greater medication use. In multivariate analysis, prior statin use was independently associated with reduced mortality (OR 0.794; 95% CI 0.723–0.872), whereas corticosteroids were linked to increased mortality (OR 1.321; 95% CI 1.108–1.575).</div></div><div><h3>Conclusion</h3><div>Comorbidities and chronic medication use significantly influence sepsis survival. Statin use prior to admission was associated with reduced mortality, whereas corticosteroid use correlated with worse outcomes. The GMA score may enhance predictive models, improving resource allocation and clinical decision-making in hospitals. ClinicalTrials.gov: <span><span>NCT06354452</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107265"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934137","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}

引用次数: 0

Severe hyperglycemia induced by alpelisib in breast cancer: A call for early monitoring alpelisib在乳腺癌中诱导的严重高血糖：早期监测的呼吁。

IF 2.1 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica

Pub Date : 2026-01-01 Epub Date: 2026-01-07 DOI: 10.1016/j.medcli.2025.107272

Carolina Peixe , José Vicente Rocha , Maria Inês Alexandre

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Medicina Clinica

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀