Pub Date : 2025-12-01DOI: 10.1016/j.medcle.2025.107196
Alicia Viñas Barros , Andrea Viñas Barros , Esteban Fernando Noroña Vásconez
{"title":"Cerebral air embolism secondary to spontaneous rupture of pulmonary bullae in the context of pulmonary tuberculosis","authors":"Alicia Viñas Barros , Andrea Viñas Barros , Esteban Fernando Noroña Vásconez","doi":"10.1016/j.medcle.2025.107196","DOIUrl":"10.1016/j.medcle.2025.107196","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107196"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697882","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107189
Alberto de Leiva Hidalgo , Ferran Morell Brotad
Werner and Bell synthesized metformin in 1922. In 2006, the International Diabetes Federation recognized metformin as the first-line drug for the treatment of type 2 diabetes. This review updates the pharmacological properties, adverse effects and therapeutic pleiotropism of metformin applied to the treatment of diabetes mellitus, gestational diabetes, polycystic ovary syndrome, appetite regulation, intestinal flora dysbiosis, cardiovascular and renal protection, treatment of idiopathic pulmonary fibrosis, reduction of risk and mortality from various neoplasms, and prolongation of lifespan.
{"title":"Metformin: Paradigm of therapeutic pleiotropism (1922–2025)","authors":"Alberto de Leiva Hidalgo , Ferran Morell Brotad","doi":"10.1016/j.medcle.2025.107189","DOIUrl":"10.1016/j.medcle.2025.107189","url":null,"abstract":"<div><div>Werner and Bell synthesized metformin in 1922. In 2006, the International Diabetes Federation recognized metformin as the first-line drug for the treatment of type 2 diabetes. This review updates the pharmacological properties, adverse effects and therapeutic pleiotropism of metformin applied to the treatment of diabetes mellitus, gestational diabetes, polycystic ovary syndrome, appetite regulation, intestinal flora dysbiosis, cardiovascular and renal protection, treatment of idiopathic pulmonary fibrosis, reduction of risk and mortality from various neoplasms, and prolongation of lifespan.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107189"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697967","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107200
João Victor de Oliveira Ramos , João Vitor Andrade Fernandes , Yan Gadelha de Abrantes Formiga , Carlos Henrique de Oliveira Ferreira , Fabyan Esberard de Lima Beltrão , Marcelo Dantas Tavares de Melo
Introduction
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease caused by cardiac amyloid deposition. Transthyretin stabilizers (TTRS) are a potential treatment, but their efficacy and safety remain uncertain. This study aims to evaluate the effects of TTRS on all-cause mortality, functional capacity, quality of life, and adverse events in ATTR-CM patients.
Methods
A systematic review and meta-analysis was conducted in February 2025 using Cochrane Central, PubMed, and Embase to identify clinical trials and observational studies comparing TTRS versus no-TTRS therapies. Two reviewers independently assessed study eligibility and extracted data. Outcomes were analyzed using odds ratios (OR) and mean differences (MD) with 95% confidence intervals. Heterogeneity was evaluated using I2 statistics, and sensitivity analyses were performed where appropriate. Risk of bias was assessed using ROBINS-I V2 and RoB 2 tools.
Results
Seventeen studies with 5209 participants (2399 TTRS; 2810 controls) were included. TTRS significantly reduced all-cause mortality (OR 0.20; 95% CI 0.11–0.37; p < 0.01). In the tafamidis subgroup, the effect remained significant (OR 0.25; 95% CI 0.13–0.48; p < 0.01). No mortality benefit was observed in groups with mixed tafamidis doses (OR 0.75; 95% CI 0.41–1.38; p = 0.14). TTRS improved quality of life (KCCQ-OS: MD 11.70) and functional capacity (6-minute walk test: SMD 50.68). Fewer adverse events (OR 0.19) and serious events (OR 0.54) were reported, with no difference in severe events.
Conclusion
TTRS, especially tafamidis, reduce mortality and improve outcomes in ATTR-CM.
转甲状腺素淀粉样心肌病（atr - cm）是一种由心脏淀粉样蛋白沉积引起的进行性疾病。甲状腺素稳定剂（TTRS）是一种潜在的治疗方法，但其疗效和安全性仍不确定。本研究旨在评估trs对atr - cm患者全因死亡率、功能能力、生活质量和不良事件的影响。方法于2025年2月使用Cochrane Central、PubMed和Embase进行了一项系统回顾和荟萃分析，以确定比较TTRS与非TTRS治疗的临床试验和观察性研究。两名审稿人独立评估研究资格并提取数据。结果分析采用比值比（OR）和平均差异（MD），置信区间为95%。使用I2统计量评估异质性，并在适当情况下进行敏感性分析。使用ROBINS-I V2和rob2工具评估偏倚风险。结果纳入17项研究，5209名受试者（2399名TTRS， 2810名对照）。TTRS显著降低了全因死亡率（OR 0.20; 95% CI 0.11-0.37; p < 0.01）。在他法底斯亚组中，效果仍然显著（OR 0.25; 95% CI 0.13-0.48; p < 0.01）。混合他法底斯剂量组未观察到死亡率获益（OR 0.75; 95% CI 0.41-1.38; p = 0.14）。TTRS改善了生活质量（KCCQ-OS: MD 11.70）和功能能力（6分钟步行测试：SMD 50.68）。不良事件（OR 0.19）和严重事件（OR 0.54）较少，严重事件无差异。结论ttrs可降低atr - cm患者的死亡率，改善预后。
{"title":"Transthyretin stabilizer targeting for transthyretin amyloid cardiomyopathy: A systematic review and meta-analysis","authors":"João Victor de Oliveira Ramos , João Vitor Andrade Fernandes , Yan Gadelha de Abrantes Formiga , Carlos Henrique de Oliveira Ferreira , Fabyan Esberard de Lima Beltrão , Marcelo Dantas Tavares de Melo","doi":"10.1016/j.medcle.2025.107200","DOIUrl":"10.1016/j.medcle.2025.107200","url":null,"abstract":"<div><h3>Introduction</h3><div>Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease caused by cardiac amyloid deposition. Transthyretin stabilizers (TTRS) are a potential treatment, but their efficacy and safety remain uncertain. This study aims to evaluate the effects of TTRS on all-cause mortality, functional capacity, quality of life, and adverse events in ATTR-CM patients.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted in February 2025 using Cochrane Central, PubMed, and Embase to identify clinical trials and observational studies comparing TTRS versus no-TTRS therapies. Two reviewers independently assessed study eligibility and extracted data. Outcomes were analyzed using odds ratios (OR) and mean differences (MD) with 95% confidence intervals. Heterogeneity was evaluated using <em>I</em><sup>2</sup> statistics, and sensitivity analyses were performed where appropriate. Risk of bias was assessed using ROBINS-I V2 and RoB 2 tools.</div></div><div><h3>Results</h3><div>Seventeen studies with 5209 participants (2399 TTRS; 2810 controls) were included. TTRS significantly reduced all-cause mortality (OR 0.20; 95% CI 0.11–0.37; <em>p</em> <!--><<!--> <!-->0.01). In the tafamidis subgroup, the effect remained significant (OR 0.25; 95% CI 0.13–0.48; <em>p</em> <!--><<!--> <!-->0.01). No mortality benefit was observed in groups with mixed tafamidis doses (OR 0.75; 95% CI 0.41–1.38; <em>p</em> <!-->=<!--> <!-->0.14). TTRS improved quality of life (KCCQ-OS: MD 11.70) and functional capacity (6-minute walk test: SMD 50.68). Fewer adverse events (OR 0.19) and serious events (OR 0.54) were reported, with no difference in severe events.</div></div><div><h3>Conclusion</h3><div>TTRS, especially tafamidis, reduce mortality and improve outcomes in ATTR-CM.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107200"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697979","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107139
Alicia Guzmán-Carreras , Sahar Okab , Irene Ruiz-Torrubia , Rafael Sánchez-del Hoyo , Mateo Paz-Cabezas , Beatriz Sánchez-Sauce , Noel Lorenzo-Villalba , Manuel Méndez-Bailón , on behalf of all collaborators of the PROFUND-IC registry
Background
Heart failure is a prevalent disease causing high morbidity and mortality. It is associated with comorbidities like renal impairment that worsen its prognosis.
Aims
To analyse whether renal function influences the effectiveness of SGLT2 inhibitors in reducing readmissions or mortality in elderly pluripathological patients with acute heart failure (AHF).
Materials and methods
Retrospective study of 913 pluripathological patients with AHF from the PROFUND-IC registry. The sample was divided into three groups by glomerular filtration rate (GFR): ≤25th percentile (GFR ≤ 30.41 ml/min/1.73m²; N = 229), 25th–75th percentile (GFR 30.41–65.14; N = 456), and ≥75th percentile (GFR ≥ 65.14; N = 228). Group differences were analysed using chi-square test for qualitative variables and ANOVA for quantitative ones, with Fisher and Kruskal-Wallis tests applied when indicated. Kaplan-Meier curves evaluated survival and readmissions according to treatment with iSGLT2.
Results
913 patients were included, with mean GFR of 49 ml/min/1.73 m² and mean creatinine of 1.4 mg/dL. 58.2% were women, with a mean age of 84 years, and mean left ventricular ejection fraction of 51.45%. Patients with lower GFR were older (p < 0.001), had more diabetes mellitus (p < 0.001), and worse functional class (p = 0.038). Mortality and readmission rates did not differ across GFR categories. SGLT2 inhibitors use was associated with reduced readmissions in all groups, although significant differences in mortality (p = 0.0068) and readmissions (p = 0.021) were only observed in patients with GFR between 30.41 and 65.14 ml/min/1.73 m2.
Conclusion
SGLT2 inhibitors significantly reduced readmissions and mortality in elderly pluripathological patients with AHF and GFR between 30.41 and 65.14 ml/min/1.73m².
{"title":"Influence of glomerular filtration rate on effectiveness of sodium-glucose cotransporter type 2 inhibitors (iSGLT2) in elderly patients with acute heart failure. PROFUND-IC registry","authors":"Alicia Guzmán-Carreras , Sahar Okab , Irene Ruiz-Torrubia , Rafael Sánchez-del Hoyo , Mateo Paz-Cabezas , Beatriz Sánchez-Sauce , Noel Lorenzo-Villalba , Manuel Méndez-Bailón , on behalf of all collaborators of the PROFUND-IC registry","doi":"10.1016/j.medcle.2025.107139","DOIUrl":"10.1016/j.medcle.2025.107139","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure is a prevalent disease causing high morbidity and mortality. It is associated with comorbidities like renal impairment that worsen its prognosis.</div></div><div><h3>Aims</h3><div>To analyse whether renal function influences the effectiveness of SGLT2 inhibitors in reducing readmissions or mortality in elderly pluripathological patients with acute heart failure (AHF).</div></div><div><h3>Materials and methods</h3><div>Retrospective study of 913 pluripathological patients with AHF from the PROFUND-IC registry. The sample was divided into three groups by glomerular filtration rate (GFR): ≤25th percentile (GFR ≤ 30.41 ml/min/1.73m²; <em>N</em> = 229), 25th–75th percentile (GFR 30.41–65.14; <em>N</em> = 456), and ≥75th percentile (GFR ≥ 65.14; <em>N</em> = 228). Group differences were analysed using chi-square test for qualitative variables and ANOVA for quantitative ones, with Fisher and Kruskal-Wallis tests applied when indicated. Kaplan-Meier curves evaluated survival and readmissions according to treatment with iSGLT2.</div></div><div><h3>Results</h3><div>913 patients were included, with mean GFR of 49 ml/min/1.73 m² and mean creatinine of 1.4 mg/dL. 58.2% were women, with a mean age of 84 years, and mean left ventricular ejection fraction of 51.45%. Patients with lower GFR were older (<em>p</em> < 0.001), had more diabetes mellitus (<em>p</em> < 0.001), and worse functional class (<em>p</em> = 0.038). Mortality and readmission rates did not differ across GFR categories. SGLT2 inhibitors use was associated with reduced readmissions in all groups, although significant differences in mortality (<em>p</em> = 0.0068) and readmissions (<em>p</em> = 0.021) were only observed in patients with GFR between 30.41 and 65.14 ml/min/1.73 m<sup>2</sup>.</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitors significantly reduced readmissions and mortality in elderly pluripathological patients with AHF and GFR between 30.41 and 65.14 ml/min/1.73m².</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107139"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697996","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107141
Gustavo Tolchinsky Wisen , Albert Casasa , Mercedes Martinez Pérez , Jaume Padrós i Selma
{"title":"Framework and accreditation criteria of Web Médica Acreditada: Consolidating 25 years of development","authors":"Gustavo Tolchinsky Wisen , Albert Casasa , Mercedes Martinez Pérez , Jaume Padrós i Selma","doi":"10.1016/j.medcle.2025.107141","DOIUrl":"10.1016/j.medcle.2025.107141","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107141"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697975","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107184
Nuria Vilarrasa , Silvia Pellitero
Agents targeting the glucagon-like peptide-1 receptor (GLP-1R) are effective in managing metabolic conditions associated with obesity, such as obstructive sleep apnea (OSA), metabolic dysfunction-associated steatotic liver disease (MASLD), and chronic kidney disease (CKD). In OSA, studies with first generation GLP-1R agonists (ArGLP-1) and co-agonists (GLP-1/GIP) have demonstrated significant improvements in the apnea-hypopnea index and weight reduction. In MASLD, GLP-1RAs and co-agonists (GLP-1/GIP or GLP-1/glucagon) have shown efficacy in reducing hepatic fat, improving fibrosis, and resolving steatohepatitis, with promising results from trials such as ESSENCE and SYNERGY-NASH. In CKD, semaglutide has been associated with a reduction in renal events and slower disease progression. Beyond their metabolic and cardiovascular benefits, these agents represent a comprehensive approach to treating obesity and its complications, with ongoing research exploring their potential indications in chronic inflammatory diseases such as psoriasis and hidradenitis suppurativa.
{"title":"GLP-1-based therapies for obesity: Impact on comorbidities or obesity-related diseases","authors":"Nuria Vilarrasa , Silvia Pellitero","doi":"10.1016/j.medcle.2025.107184","DOIUrl":"10.1016/j.medcle.2025.107184","url":null,"abstract":"<div><div>Agents targeting the glucagon-like peptide-1 receptor (GLP-1R) are effective in managing metabolic conditions associated with obesity, such as obstructive sleep apnea (OSA), metabolic dysfunction-associated steatotic liver disease (MASLD), and chronic kidney disease (CKD). In OSA, studies with first generation GLP-1R agonists (ArGLP-1) and co-agonists (GLP-1/GIP) have demonstrated significant improvements in the apnea-hypopnea index and weight reduction. In MASLD, GLP-1RAs and co-agonists (GLP-1/GIP or GLP-1/glucagon) have shown efficacy in reducing hepatic fat, improving fibrosis, and resolving steatohepatitis, with promising results from trials such as ESSENCE and SYNERGY-NASH. In CKD, semaglutide has been associated with a reduction in renal events and slower disease progression. Beyond their metabolic and cardiovascular benefits, these agents represent a comprehensive approach to treating obesity and its complications, with ongoing research exploring their potential indications in chronic inflammatory diseases such as psoriasis and hidradenitis suppurativa.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107184"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697984","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107185
Luis Luque Caraballo , Manuel Garrido Montes , José Salvador García Morillo
{"title":"Use of tocilizumab as a therapeutic option for hereditary apolipoprotein AI-associated amyloidosis","authors":"Luis Luque Caraballo , Manuel Garrido Montes , José Salvador García Morillo","doi":"10.1016/j.medcle.2025.107185","DOIUrl":"10.1016/j.medcle.2025.107185","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107185"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697880","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 : 2025-12-01DOI: 10.1016/j.medcle.2025.107170
Luis Gorospe, Esther Gambí-Pisonero, Ana María Ayala-Carbonero
{"title":"False positive AI results due to breast implants on chest radiographs: The importance of the lateral view","authors":"Luis Gorospe, Esther Gambí-Pisonero, Ana María Ayala-Carbonero","doi":"10.1016/j.medcle.2025.107170","DOIUrl":"10.1016/j.medcle.2025.107170","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 6","pages":"Article 107170"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697983","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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