Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.09.030
Francisco Epelde
{"title":"Respiratory infection caused by Achromobacter xylosoxidans in an 80-year old patient","authors":"Francisco Epelde","doi":"10.1016/j.medcle.2024.09.030","DOIUrl":"10.1016/j.medcle.2024.09.030","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 316-317"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.11.006
Javier Santos , Patricia Laura Maran , Amanda Rodríguez-Urrutia
The prevailing mind-body dualism in contemporary medicine, rooted in reductionism and the fragmentation of knowledge, has impeded the development of a conceptual model that can adequately address the complexity of illnesses. Integrating biomedical data into a cohesive model that considers the mind–body–context interconnections is essential. This integration is not merely theoretical; rather, it has significant clinical implications. This is exemplified by chronic stress-related mental and digestive disorders. The onset and development of these disorders are intimately linked to chronic psychological stress via the brain–gut–microbiota axis. The present article examines the evidence and mechanisms indicating that stress is a primary factor and a potentiator of symptom severity in common mental health and digestive diseases, with a particular focus on human studies. However, due to space limitations, only a very general overview of preventive and therapeutic clinical strategies is provided. It is hoped that the recurring phrase, “Everything that happens to you is due to stress,” will become more comprehensible to the physician after reading this manuscript.
{"title":"Stress, microbiota, and the gut–brain axis in mental and digestive health","authors":"Javier Santos , Patricia Laura Maran , Amanda Rodríguez-Urrutia","doi":"10.1016/j.medcle.2024.11.006","DOIUrl":"10.1016/j.medcle.2024.11.006","url":null,"abstract":"<div><div>The prevailing mind-body dualism in contemporary medicine, rooted in reductionism and the fragmentation of knowledge, has impeded the development of a conceptual model that can adequately address the complexity of illnesses. Integrating biomedical data into a cohesive model that considers the mind–body–context interconnections is essential. This integration is not merely theoretical; rather, it has significant clinical implications. This is exemplified by chronic stress-related mental and digestive disorders. The onset and development of these disorders are intimately linked to chronic psychological stress via the brain–gut–microbiota axis. The present article examines the evidence and mechanisms indicating that stress is a primary factor and a potentiator of symptom severity in common mental health and digestive diseases, with a particular focus on human studies. However, due to space limitations, only a very general overview of preventive and therapeutic clinical strategies is provided. It is hoped that the recurring phrase, “Everything that happens to you is due to stress,” will become more comprehensible to the physician after reading this manuscript.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 295-304"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.11.005
Yoseba Cánovas Zaldúa , Mónica Rodríguez Carballeria , Aina Mas Tena , Sara Rodoreda Noguerola
{"title":"The attractiveness of the internal medicine specialty for the election of medical residence in Spain","authors":"Yoseba Cánovas Zaldúa , Mónica Rodríguez Carballeria , Aina Mas Tena , Sara Rodoreda Noguerola","doi":"10.1016/j.medcle.2024.11.005","DOIUrl":"10.1016/j.medcle.2024.11.005","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 306-311"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.10.011
Joan Pou Bordoy , Alfonso Leiva , Maria José Albendín Ariza , Roberto Elosúa Llanos , Fernando Rigo Carratalà , Dora Romaguera , Jordi Salas-Salvadó , Nancy Babio , Miguel Angel Martinez-González , Estefanía Toledo , Montserrat Fitó , Fernando Aros , Ramon Estruch , Miquel Fiol Sala
Introduction
Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events.
Objective
To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO).
Method
1752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel’s C Indices, Nam d’Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated.
Results
At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51−58.03, p < 0.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38−4.21, p = 0.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76−18.72, p = 0.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36−7.71, p < 0.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed.
Conclusions
MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.
{"title":"Major abnormalities of the electrocardiogram and cardiovascular risk in a medium and high-risk Mediterranean population","authors":"Joan Pou Bordoy , Alfonso Leiva , Maria José Albendín Ariza , Roberto Elosúa Llanos , Fernando Rigo Carratalà , Dora Romaguera , Jordi Salas-Salvadó , Nancy Babio , Miguel Angel Martinez-González , Estefanía Toledo , Montserrat Fitó , Fernando Aros , Ramon Estruch , Miquel Fiol Sala","doi":"10.1016/j.medcle.2024.10.011","DOIUrl":"10.1016/j.medcle.2024.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events.</div></div><div><h3>Objective</h3><div>To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO).</div></div><div><h3>Method</h3><div>1752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel’s C Indices, Nam d’Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated.</div></div><div><h3>Results</h3><div>At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51−58.03, <em>p</em> < 0.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38−4.21, <em>p</em> = 0.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76−18.72, <em>p</em> = 0.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36−7.71, <em>p</em> < 0.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed.</div></div><div><h3>Conclusions</h3><div>MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 277-286"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.12.002
José M. Porcel
{"title":"The internist as an expert in invasive ultrasound: Breaking barriers","authors":"José M. Porcel","doi":"10.1016/j.medcle.2024.12.002","DOIUrl":"10.1016/j.medcle.2024.12.002","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 292-294"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.09.029
Shuo Wu , Meihong Ye , Chaoming Wang
{"title":"Adenocarcinoma of the renal pelvis and ureteral junction: A case report","authors":"Shuo Wu , Meihong Ye , Chaoming Wang","doi":"10.1016/j.medcle.2024.09.029","DOIUrl":"10.1016/j.medcle.2024.09.029","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 315-316"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.09.032
Yin Zhao , Fumin Qi , Na Zhang , Tong Yang , Wenwen Sun , Xin Li , Yongjie Chen , Wei Wei
Background and objectives
Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. For newly diagnosed SLE, there are few studies analyzing whether the use of belimumab can reduce the dose of glucocorticoids while maintaining disease remission. To explore this, we conducted this single-center, real-world setting study, based on a prospective cohort.
Methods
Newly diagnosed SLE taking Belimumab and standard-of-care (SoC) treatment were consecutively enrolled from July 2021 to December 2023 in a prospective manner. Disease assessments (SLE Responder Index 4 (SRI-4) response (a composite indicator to evaluate the efficacy of belimumab in RCTs), SLEDAI-2K) were conducted regularly. Patients were followed up for at least 12 months. Matched patients with SoC alone were enrolled after propensity score matching. Difference examination and generalized estimated equations were conducted.
Results
A total of 31 patients were enrolled in Belimumab group. SRI-4 response rate was 87.10% at 12 months. Serological parameters (anti-dsDNA and C3/C4), SLEDAI-2K and daily prednisone intake were improved overall. Compared with SoC group, SRI-4 rate and the trends of complement C4, SLEDAI-2K during follow up was similar in two groups. Trends of complement C3 (13.16 (4.14–22.18), P = 0.004), anti-dsDNA titer (−60.29 (−103.95 to −16.63), P = 0.007) and prednisone intake (−18.59 (−26.88 to −10.30), P = 0.000) were more significantly in Belimumab group. Belimumab group had significantly lower cumulative prednisone intake with overall well-tolerance.
Conclusion
Our data supported that prompt initiation of add-on Belimumab should be considered to control the disease and facilitate GC tapering/discontinuation, without prior failure to one or more conventional drugs.
{"title":"Impact of belimumab on glucocorticoid intake in newly diagnosed systemic lupus erythematosus","authors":"Yin Zhao , Fumin Qi , Na Zhang , Tong Yang , Wenwen Sun , Xin Li , Yongjie Chen , Wei Wei","doi":"10.1016/j.medcle.2024.09.032","DOIUrl":"10.1016/j.medcle.2024.09.032","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Systemic lupus erythematosus (SLE) is an autoimmune disease with unknown etiology. For newly diagnosed SLE, there are few studies analyzing whether the use of belimumab can reduce the dose of glucocorticoids while maintaining disease remission. To explore this, we conducted this single-center, real-world setting study, based on a prospective cohort.</div></div><div><h3>Methods</h3><div>Newly diagnosed SLE taking Belimumab and standard-of-care (SoC) treatment were consecutively enrolled from July 2021 to December 2023 in a prospective manner. Disease assessments (SLE Responder Index 4 (SRI-4) response (a composite indicator to evaluate the efficacy of belimumab in RCTs), SLEDAI-2K) were conducted regularly. Patients were followed up for at least 12 months. Matched patients with SoC alone were enrolled after propensity score matching. Difference examination and generalized estimated equations were conducted.</div></div><div><h3>Results</h3><div>A total of 31 patients were enrolled in Belimumab group. SRI-4 response rate was 87.10% at 12 months. Serological parameters (anti-dsDNA and C3/C4), SLEDAI-2K and daily prednisone intake were improved overall. Compared with SoC group, SRI-4 rate and the trends of complement C4, SLEDAI-2K during follow up was similar in two groups. Trends of complement C3 (13.16 (4.14–22.18), <em>P</em> <!-->=<!--> <!-->0.004), anti-dsDNA titer (−60.29 (−103.95 to −16.63), <em>P</em> <!-->=<!--> <!-->0.007) and prednisone intake (−18.59 (−26.88 to −10.30), <em>P</em> <!-->=<!--> <!-->0.000) were more significantly in Belimumab group. Belimumab group had significantly lower cumulative prednisone intake with overall well-tolerance.</div></div><div><h3>Conclusion</h3><div>Our data supported that prompt initiation of add-on Belimumab should be considered to control the disease and facilitate GC tapering/discontinuation, without prior failure to one or more conventional drugs.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 271-276"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1016/j.medcle.2024.09.031
Hadeer Zakaria , Noha Alaa Hamdy , Nagy A.H. Sayed-Ahmed , Ahmed El-Mallah
Background
Hemodialysis (HD) patients often have elevated levels of hepcidin hormone, which is a key regulator of systemic iron homeostasis. While pentoxifylline (PTX) has been demonstrated to have anti-inflammatory properties, it is unclear if these effects would also have an inhibitory effect on hepcidin. This study aimed to examine the potential role of PTX on hepcidin and its consequent effects on iron profile and anemia in HD patients.
Methods
Eighty HD patients were randomly assigned 1:1 to the pentoxifylline group, receiving a daily dose of PTX (800 mg), or the placebo group, receiving placebo capsules for 6-months. Different laboratory parameters, including hepcidin, hemoglobin (Hb), red blood cells (RBCs), hypoxia-inducible factor-2 alpha (HIF-2α), serum iron, total iron-binding capacity (TIBC), ferritin, transferrin saturation (TSAT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs.CRP), were used for evaluation the patients’ response.
Results
In the PTX-treated patients, the hepcidin levels reduced significantly (p = 0.001) from 628.03 (334.4–800.85) ng/ml to 235.25 (192.8–508.76) ng/ml, and this reduction was also statistically significant as compared to the placebo group (p < 0.001). Also, there were significant changes (p < 0.001) regarding other iron hemostasis parameters including Hb, RBCs, serum iron, TIBC, TSAT, and HIF-2α. Levels of IL-6 and hs.CRP, as a reflection of inflammatory status, decreased significantly (p = 0.002 and p = 0.003, respectively) in the pentoxifylline group, and the percent reduction in these parameters was also statistically significant compared to the placebo group (p < 0.001).
Conclusions
This study reveals that PTX reduces hepcidin levels and consequently provides an improvement in the iron profile and anemia in HD patients.
{"title":"Effect of pentoxifylline on hepcidin and iron profile in hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial","authors":"Hadeer Zakaria , Noha Alaa Hamdy , Nagy A.H. Sayed-Ahmed , Ahmed El-Mallah","doi":"10.1016/j.medcle.2024.09.031","DOIUrl":"10.1016/j.medcle.2024.09.031","url":null,"abstract":"<div><h3>Background</h3><div>Hemodialysis (HD) patients often have elevated levels of hepcidin hormone, which is a key regulator of systemic iron homeostasis. While pentoxifylline (PTX) has been demonstrated to have anti-inflammatory properties, it is unclear if these effects would also have an inhibitory effect on hepcidin. This study aimed to examine the potential role of PTX on hepcidin and its consequent effects on iron profile and anemia in HD patients.</div></div><div><h3>Methods</h3><div>Eighty HD patients were randomly assigned 1:1 to the pentoxifylline group, receiving a daily dose of PTX (800<!--> <!-->mg), or the placebo group, receiving placebo capsules for 6-months. Different laboratory parameters, including hepcidin, hemoglobin (Hb), red blood cells (RBCs), hypoxia-inducible factor-2 alpha (HIF-2α), serum iron, total iron-binding capacity (TIBC), ferritin, transferrin saturation (TSAT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs.CRP), were used for evaluation the patients’ response.</div></div><div><h3>Results</h3><div>In the PTX-treated patients, the hepcidin levels reduced significantly (<em>p</em> <!-->=<!--> <!-->0.001) from 628.03 (334.4–800.85)<!--> <!-->ng/ml to 235.25 (192.8–508.76)<!--> <!-->ng/ml, and this reduction was also statistically significant as compared to the placebo group (<em>p</em> <!--><<!--> <!-->0.001). Also, there were significant changes (<em>p</em> <!--><<!--> <!-->0.001) regarding other iron hemostasis parameters including Hb, RBCs, serum iron, TIBC, TSAT, and HIF-2α. Levels of IL-6 and hs.CRP, as a reflection of inflammatory status, decreased significantly (<em>p</em> <!-->=<!--> <!-->0.002 and <em>p</em> <!-->=<!--> <!-->0.003, respectively) in the pentoxifylline group, and the percent reduction in these parameters was also statistically significant compared to the placebo group (<em>p</em> <!--><<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>This study reveals that PTX reduces hepcidin levels and consequently provides an improvement in the iron profile and anemia in HD patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 6","pages":"Pages 263-270"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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