Pub Date : 2024-11-20DOI: 10.1016/j.medcle.2024.06.007
Funda Erbasan , Tahir Saygın Öğüt , Melis Dilbil , Mine Nokay , Mustafa Ender Terzioğlu , Veli Yazısız
Objectives
To evaluate the treatment modalities and their effects in primary Sjögren's syndrome (pSS) patients with interstitial lung disease (ILD).
Methods
In this chart review study, patients diagnosed with pSS-related ILD (pSS-ILD) between January 2004 and August 2022 were screened. Glucocorticoid use and administered disease-modifying antirheumatic drugs (DMARDs) were determined. The difference between forced vital capacity (FVC) and diffusion capacity of the lungs for carbon monoxide (DLCO) before and after treatment was evaluated.
Results
ILD was present in 44 of 609 patients (7.2%) diagnosed with pSS. In 27 patients included in the study, steroid usage was 81.5%. There was a statistically insignificant increase in FVC% (from 80.20 ± 22.1 to 81.6 ± 23.0) and a decrease in DLCO% (53.7 ± 15.3–52.2 ± 19.3) with DMARD treatment (p = 0.434 and p = 0.652, respectively). There was no significant difference between the treatment groups (azathioprine [AZA], mycophenolate mofetil [MMF], and rituximab [RTX]) in terms of the change in FVC% and DLCO% compared with baseline levels. The effect of treatment on FVC and DLCO was similar in UIP and NSIP patterns.
Conclusions
AZA, MMF, and RTX have similar effects on pulmonary functions in pSS-ILD and provide disease stabilization.
{"title":"Efficacy of disease-modifying antirheumatic drugs in primary Sjögren's syndrome-related interstitial lung disease","authors":"Funda Erbasan , Tahir Saygın Öğüt , Melis Dilbil , Mine Nokay , Mustafa Ender Terzioğlu , Veli Yazısız","doi":"10.1016/j.medcle.2024.06.007","DOIUrl":"10.1016/j.medcle.2024.06.007","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the treatment modalities and their effects in primary Sjögren's syndrome (pSS) patients with interstitial lung disease (ILD).</div></div><div><h3>Methods</h3><div>In this chart review study, patients diagnosed with pSS-related ILD (pSS-ILD) between January 2004 and August 2022 were screened. Glucocorticoid use and administered disease-modifying antirheumatic drugs (DMARDs) were determined. The difference between forced vital capacity (FVC) and diffusion capacity of the lungs for carbon monoxide (DLCO) before and after treatment was evaluated.</div></div><div><h3>Results</h3><div>ILD was present in 44 of 609 patients (7.2%) diagnosed with pSS. In 27 patients included in the study, steroid usage was 81.5%. There was a statistically insignificant increase in FVC% (from 80.20<!--> <!-->±<!--> <!-->22.1 to 81.6<!--> <!-->±<!--> <!-->23.0) and a decrease in DLCO% (53.7<!--> <!-->±<!--> <!-->15.3–52.2<!--> <!-->±<!--> <!-->19.3) with DMARD treatment (<em>p</em> <!-->=<!--> <!-->0.434 and <em>p</em> <!-->=<!--> <!-->0.652, respectively). There was no significant difference between the treatment groups (azathioprine [AZA], mycophenolate mofetil [MMF], and rituximab [RTX]) in terms of the change in FVC% and DLCO% compared with baseline levels. The effect of treatment on FVC and DLCO was similar in UIP and NSIP patterns.</div></div><div><h3>Conclusions</h3><div>AZA, MMF, and RTX have similar effects on pulmonary functions in pSS-ILD and provide disease stabilization.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 10","pages":"Pages 490-495"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707297","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}
{"title":"Utility of 18F-FDG PET/CT in the diagnosis and follow-up of a patient with eosinophilic granulomatosis with polyangiitis and large vessel vasculitis","authors":"Montserrat Negre Busó , Gemma Alvarez Martínez , Antoni Rubió Rodríguez","doi":"10.1016/j.medcle.2024.05.022","DOIUrl":"10.1016/j.medcle.2024.05.022","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 10","pages":"Pages 524-525"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707289","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}
Cardiac implantable electronic devices have transformed medicine as they improve quality of life and prevent premature death. In palliative care settings, deactivation of these devices must be discussed, particularly at end-of-life. In terminally ill patients it is consensual to recommend implantable cardioverter defibrillator deactivation once shocks are frequent and painful. Concerning pacemakers, the decision to deactivate is controversial and it usually is not an option at patients’ end-of-life, since in pacing-dependent patients, such low heart rates might induce symptoms of bradycardia, with no impact on survival. Regarding cardiac resynchronization therapy, deactivation is not recommended as it can worsen symptoms. Left ventricular assistance device deactivation at end-of-life is a well-accepted practice, since it has the benefit of ending the physical burden associated with the device. Advance care planning should be encouraged and patients should be informed that deactivation is possible.
{"title":"Deactivation of cardiac implantable electronic devices in palliative patients: When and how","authors":"Tatiana Oliveira, Nuno Ferreira Monteiro, Patrícia Cipriano","doi":"10.1016/j.medcle.2024.04.032","DOIUrl":"10.1016/j.medcle.2024.04.032","url":null,"abstract":"<div><div>Cardiac implantable electronic devices have transformed medicine as they improve quality of life and prevent premature death. In palliative care settings, deactivation of these devices must be discussed, particularly at end-of-life. In terminally ill patients it is consensual to recommend implantable cardioverter defibrillator deactivation once shocks are frequent and painful. Concerning pacemakers, the decision to deactivate is controversial and it usually is not an option at patients’ end-of-life, since in pacing-dependent patients, such low heart rates might induce symptoms of bradycardia, with no impact on survival. Regarding cardiac resynchronization therapy, deactivation is not recommended as it can worsen symptoms. Left ventricular assistance device deactivation at end-of-life is a well-accepted practice, since it has the benefit of ending the physical burden associated with the device. Advance care planning should be encouraged and patients should be informed that deactivation is possible.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 10","pages":"Pages 512-516"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707301","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 : 2024-11-20DOI: 10.1016/j.medcle.2024.07.009
Cristina Kirkegaard-Biosca , Carmen Moreno-Blas , Marta Lluch-Álvarez , Anna Falcó-Roget , Paula Salmerón , Clara Ramírez-Serra , Júlia Sellarès-Nadal , Joaquín Burgos , Núria Fernández-Hidalgo
Objective
Central nervous system (CNS) infection poses a diagnostic challenge especially in elderly patients who frequently exhibit atypical symptoms. Our study aimed to identify patients with a low risk of CNS infection, in whom lumbar puncture (LP) could be avoided.
Methods
Observational study of consecutive adult patients who underwent a LP in the emergency room (ER) of Hospital Universitari Vall d’Hebron between January 2017 and December 2021. We performed a univariate and multivariate analysis to identify factors associated with non-CNS infection. These factors were used to create a combined variable, and its diagnostic positive predictive value and specificity to detect patients without CNS infections were calculated.
Results
We included 489 patients of which 77 (15.7%) were diagnosed with CNS infection. Median age was 62 years (IQR 41–78) and 240 (49.1%) were male. In the multivariate analysis, variables associated with non-CNS infection were female sex (OR 1.89; 95% CI 1.12–3.20), age older than 80 years (OR 3.14; 95% CI 1.20–8.19), previous cognitive impairment (OR 3.91; 95% CI 1.18–13.01), and clinical presentation without meningitis triad (fever, headache and neck stiffness) (OR 4.12; 95% CI 1.72–9.85). A composite variable encompassing age older than 80, cognitive impairment, and the absence of the meningitis triad was used as a diagnostic tool to identify patients with non-CNS infection, exhibiting a 98% positive predictive value and 99% specificity.
Conclusions
This study identifies factors associated with a low risk of CNS infection. Thus, a more precise clinical approach could help clinicians to detect patients who would not benefit from a LP.
目的中枢神经系统（CNS）感染是一项诊断难题，尤其是对于经常表现出非典型症状的老年患者。我们的研究旨在确定中枢神经系统感染风险较低的患者，避免对其进行腰椎穿刺（LP）。方法对 2017 年 1 月至 2021 年 12 月期间在瓦尔德希伯伦大学医院急诊室（ER）接受腰椎穿刺的连续成年患者进行观察研究。我们进行了单变量和多变量分析，以确定与非中枢神经系统感染相关的因素。这些因素被用来创建一个综合变量，并计算其诊断阳性预测值和特异性，以检测无中枢神经系统感染的患者。结果我们纳入了489名患者，其中77人（15.7%）被诊断为中枢神经系统感染。中位年龄为 62 岁（IQR 41-78），男性 240 人（49.1%）。在多变量分析中，与非中枢神经系统感染相关的变量有女性（OR 1.89；95% CI 1.12-3.20）、年龄大于 80 岁（OR 3.14；95% CI 1.20-8.19）、既往认知障碍（OR 3.91；95% CI 1.18-13.01）和临床表现无脑膜炎三联征（发热、头痛和颈部僵硬）（OR 4.12；95% CI 1.72-9.85）。这项研究确定了与中枢神经系统感染低风险相关的因素。因此，更精确的临床方法可以帮助临床医生发现那些不会从 LP 中获益的患者。
{"title":"Risk stratification for CNS infection: A potential tool to avoid unwarranted lumbar punctures – An observational study","authors":"Cristina Kirkegaard-Biosca , Carmen Moreno-Blas , Marta Lluch-Álvarez , Anna Falcó-Roget , Paula Salmerón , Clara Ramírez-Serra , Júlia Sellarès-Nadal , Joaquín Burgos , Núria Fernández-Hidalgo","doi":"10.1016/j.medcle.2024.07.009","DOIUrl":"10.1016/j.medcle.2024.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>Central nervous system (CNS) infection poses a diagnostic challenge especially in elderly patients who frequently exhibit atypical symptoms. Our study aimed to identify patients with a low risk of CNS infection, in whom lumbar puncture (LP) could be avoided.</div></div><div><h3>Methods</h3><div>Observational study of consecutive adult patients who underwent a LP in the emergency room (ER) of Hospital Universitari Vall d’Hebron between January 2017 and December 2021. We performed a univariate and multivariate analysis to identify factors associated with non-CNS infection. These factors were used to create a combined variable, and its diagnostic positive predictive value and specificity to detect patients without CNS infections were calculated.</div></div><div><h3>Results</h3><div>We included 489 patients of which 77 (15.7%) were diagnosed with CNS infection. Median age was 62 years (IQR 41–78) and 240 (49.1%) were male. In the multivariate analysis, variables associated with non-CNS infection were female sex (OR 1.89; 95% CI 1.12–3.20), age older than 80 years (OR 3.14; 95% CI 1.20–8.19), previous cognitive impairment (OR 3.91; 95% CI 1.18–13.01), and clinical presentation without meningitis triad (fever, headache and neck stiffness) (OR 4.12; 95% CI 1.72–9.85). A composite variable encompassing age older than 80, cognitive impairment, and the absence of the meningitis triad was used as a diagnostic tool to identify patients with non-CNS infection, exhibiting a 98% positive predictive value and 99% specificity.</div></div><div><h3>Conclusions</h3><div>This study identifies factors associated with a low risk of CNS infection. Thus, a more precise clinical approach could help clinicians to detect patients who would not benefit from a LP.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 10","pages":"Pages 483-489"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707296","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 : 2024-11-15DOI: 10.1016/j.medcle.2024.05.018
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.medcle.2024.05.018","DOIUrl":"10.1016/j.medcle.2024.05.018","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":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 9","pages":"Pages 436-441"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656084","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 : 2024-11-15DOI: 10.1016/j.medcle.2024.04.031
Sichen Li, Yuxia Zhua, Xi Liu
Parkinsonism in liver diseases or dysfunction, mainly including neurological manifestations in hereditary liver diseases and neurological complications of advanced liver diseases, occur in isolation or in combination with other movement disorders, and progress along disease course. Prominent akinetic-rigidity syndrome, various onset and progression, poor levodopa response and metabolism abnormalities reflected by serum biomarkers and neuroimaging, make this atypical parkinsonism recognizable and notable in clinical practice. Different susceptibility of brain areas, especially in basal ganglia, to manganese, iron, copper, ammonia overload, together with subsequent oxidative stress, neurotransmitter alterations, disturbed glia-neuron homeostasis and eventually neurotoxicity, contribute to parkinsonism under the circumstances of insufficient liver clearance ability. These mechanisms are interrelated and may interact collectively, adding to the complexity of clinical manifestations and treatment responses. This review summarizes shared clinical features of parkinsonism in liver diseases or dysfunction, depicts their underlying mechanisms and suggests practical flowchart for differential diagnosis.
{"title":"Parkinsonism in liver diseases or dysfunction","authors":"Sichen Li, Yuxia Zhua, Xi Liu","doi":"10.1016/j.medcle.2024.04.031","DOIUrl":"10.1016/j.medcle.2024.04.031","url":null,"abstract":"<div><div>Parkinsonism in liver diseases or dysfunction, mainly including neurological manifestations in hereditary liver diseases and neurological complications of advanced liver diseases, occur in isolation or in combination with other movement disorders, and progress along disease course. Prominent akinetic-rigidity syndrome, various onset and progression, poor levodopa response and metabolism abnormalities reflected by serum biomarkers and neuroimaging, make this atypical parkinsonism recognizable and notable in clinical practice. Different susceptibility of brain areas, especially in basal ganglia, to manganese, iron, copper, ammonia overload, together with subsequent oxidative stress, neurotransmitter alterations, disturbed glia-neuron homeostasis and eventually neurotoxicity, contribute to parkinsonism under the circumstances of insufficient liver clearance ability. These mechanisms are interrelated and may interact collectively, adding to the complexity of clinical manifestations and treatment responses. This review summarizes shared clinical features of parkinsonism in liver diseases or dysfunction, depicts their underlying mechanisms and suggests practical flowchart for differential diagnosis.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 9","pages":"Pages 461-468"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656088","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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