Medicina clinica (English ed.)最新文献

英文中文

Diaphragmatic paralysis in eosinophilic granulomatosis with polyangiitis 嗜酸性肉芽肿伴多血管炎的膈肌麻痹

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-06 DOI: 10.1016/j.medcle.2026.107275

Ernesto Cairoli , Cecilia Rivero , Gerard Espinosa

引用次数: 0

Familial hemophagocytic lymphohistiocytosis type 2 mimicking CLIPPERS syndrome 家族性2型模仿CLIPPERS综合征的噬血细胞淋巴组织细胞增多症

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-04 DOI: 10.1016/j.medcle.2026.107280

Héctor Lago-Gancedo, Ana Cuesta-Díaz de Rada, María Balboa-Alonso

引用次数: 0

Prevalence of subclinical vascular disease in relation to the estimated cardiovascular risk and the presence of the metabolic syndrome 亚临床血管疾病的患病率与估计的心血管风险和代谢综合征的存在有关

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-02 DOI: 10.1016/j.medcle.2026.107262

Francisco Sivianes-Ramírez , Yale Tung-Chen

引用次数: 0

Crusted scabies 陈年的疥疮

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-01-30 DOI: 10.1016/j.medcle.2026.107233

Elisabeth Gómez Moyano , Alberto Andamoyo Castañeda , Irene López Riquelme , Leandro Martínez Pilar

引用次数: 0

Diagnostic value of angiotensin-converting enzyme levels for assessing organ involvement in sarcoidosis: A retrospective single-centre study 血管紧张素转换酶水平对结节病脏器受累的诊断价值：一项回顾性单中心研究

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107278

Jesus López-Martínez, Andrea Fernández-Valmaña, Álex Mayer-Fuentes, Joan María Mercadé-Torras, Estefanía Díaz-Martín, María García-González, Laia Mas-Maresma, Carlos Feijoo-Massó

Background

Angiotensin-converting enzyme (ACE) is the most widely studied biomarker in sarcoidosis; however, its association with epidemiology and multi-organ involvement remains unclear. The aim of our study was to analyse whether elevated ACE levels are associated with epidemiological factors, as well as with pulmonary, extrathoracic, and multi-organ involvement in patients with sarcoidosis.

Methods

A retrospective single-centre study was conducted on patients diagnosed with sarcoidosis between 2000 and 2024. Multi-organ disease was defined as involvement of three or more organs, and elevated ACE levels were defined as values equal to or greater than 50 IU/L.

Results

A total of 177 patients were analysed, of whom 117 patients (66.1%) presented with elevated ACE levels at the time of diagnosis. A significant relationship between elevated ACE levels and multi-organ involvement was observed (OR = 4.99 [95% CI 1.56–15.96]), while White patients (OR = 4.9 [95% CI 1.04–23.25]), skin involvement (OR = 2.55 [95% CI 1.27–5.12]), and age (OR = 1.02 [95% CI 1.0–1.04]) were associated with normal ACE levels. A receiver operating characteristic (ROC) curve to differentiate multi-organ from limited involvement yielded an area under the curve (AUC) of 0.788, with 86.2% sensitivity and 36.5% specificity using the conventional cut-off (50 IU/L).

Conclusions

Patients with sarcoidosis and multi-organ involvement had elevated ACE levels. In contrast, older age, White race/ethnicity, and skin involvement were associated with ACE levels within the reference range.

血管紧张素转换酶（ACE）是结节病研究最广泛的生物标志物；然而，其与流行病学和多器官受累的关系尚不清楚。本研究的目的是分析ACE水平升高是否与流行病学因素以及结节病患者的肺、胸外和多器官累及有关。方法对2000 ~ 2024年诊断为结节病的患者进行回顾性单中心研究。多器官疾病定义为累及三个或更多器官，ACE水平升高定义为等于或大于50 IU/L。结果共分析177例患者，其中117例（66.1%）在诊断时出现ACE水平升高。观察到ACE水平升高与多器官受累之间存在显著关系（OR = 4.99 [95% CI 1.56-15.96]），而白人患者（OR = 4.9 [95% CI 1.04-23.25]）、皮肤受累（OR = 2.55 [95% CI 1.27-5.12]）和年龄（OR = 1.02 [95% CI 1.0-1.04]）与ACE水平正常相关。用于区分多器官和有限受累的受试者工作特征（ROC）曲线的曲线下面积（AUC）为0.788，使用常规截止值（50 IU/L）的灵敏度为86.2%，特异性为36.5%。结论结节病伴多脏器受累患者ACE水平升高。相比之下，年龄较大，白人种族/民族和皮肤受累与参考范围内的ACE水平相关。

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引用次数: 0

Serum amyloid A as predictive factor in PFAPA syndrome attack 血清淀粉样蛋白A作为PFAPA综合征发作的预测因素

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107244

Halil Kazanasmaz, Fırat Gündoğmuş, Ender Can Eroğlu, Mukaddes Kalyoncu

Purpose

This study aimed to assess the diagnostic value of serum amyloid A (SAA) levels during attacks of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.

Methods

A retrospective analysis was conducted on the medical records of 51 children diagnosed with PFAPA and 51 control patients. Serum levels of SAA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the neutrophil-to-lymphocyte ratio (NLR) were measured.

Results

The median SAA levels were significantly higher in the PFAPA group than in controls (p < 0.05). ROC analysis revealed that SAA had a sensitivity of 100% and a specificity of 96.1% at a cutoff value of ≥12.43 mg/L, outperforming CRP and ESR in diagnostic accuracy. While CRP and ESR had high sensitivities (90.2% and 90%, respectively), their specificities were lower (96% and 58.8%, respectively). Moreover, the high positive predictive value of SAA underscores its potential role as a reliable marker for the differential diagnosis of PFAPA.

Conclusion

SAA is a highly sensitive and specific marker for PFAPA attack, showing greater diagnostic accuracy compared to CRP and ESR. These findings suggest that SAA can serve as a valuable biomarker in the differential diagnosis of PFAPA.

目的探讨血清淀粉样蛋白A （SAA）水平对周期性发热、口疮性口炎、咽炎和腺炎（PFAPA）综合征发作的诊断价值。方法回顾性分析51例确诊为PFAPA患儿和51例对照患儿的病历资料。测定血清SAA、c反应蛋白（CRP）、红细胞沉降率（ESR）和中性粒细胞与淋巴细胞比值（NLR）。结果PFAPA组SAA水平中位数显著高于对照组（p < 0.05）。ROC分析显示，SAA在临界值≥12.43 mg/L时敏感性为100%，特异性为96.1%，诊断准确性优于CRP和ESR。CRP和ESR具有较高的敏感性（分别为90.2%和90%），但特异性较低（分别为96%和58.8%）。此外，SAA的高阳性预测值强调了其作为PFAPA鉴别诊断的可靠标志物的潜在作用。结论saa对PFAPA发作具有较高的敏感性和特异性，与CRP和ESR相比具有更高的诊断准确性。这些结果提示SAA可作为PFAPA鉴别诊断的有价值的生物标志物。

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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

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107265

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.

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12,995例诊断为败血症的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。

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引用次数: 0

Role of alcohol consumption in the outcomes of non-variceal upper gastrointestinal bleeding: A retrospective study 酒精摄入在非静脉曲张上消化道出血结局中的作用：一项回顾性研究

Medicina clinica (English ed.)

Pub Date : 2026-01-01 Epub Date: 2026-02-18 DOI: 10.1016/j.medcle.2026.107245

Raúl Fernández García , Rita Jiménez Rosales , Manuel López Vico , Ana Lancho Muñoz , Eva-Julissa Ortega Suazo , Jose María López Tobaruela , Juan Gabriel Martínez Cara , Eduardo Redondo Cerezo

Introduction

Non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the most common conditions in gastroenterology, with an incidence of 47 cases per 100,000 inhabitants per year. Alcohol consumption is a known risk factor. However, its impact on the need for intervention and clinical outcomes in patients without liver cirrhosis has not been fully evaluated. This study aimed to analyze the effect of alcohol consumption on NVUGIB outcomes.

Material and methods

We conducted a retrospective cohort study including patients with NVUGIB from 2013 to 2022. Risky alcohol consumption was defined as intake > 20 g/day. A total of 965 patients were analyzed: 830 without risky alcohol use (Group 1) and 135 with alcohol consumption (Group 2). Statistical analysis was performed using SPSS version 26.0.

Results

Group 2 had a higher proportion of males (95.6% vs. 61.2%, p < 0.001) and a lower mean age (57 vs. 66 years, p < 0.001). Group 1 showed greater baseline comorbidity. The need for endoscopic treatment was higher among alcohol consumers (47.4% vs. 38%, p = 0.039). No significant differences were found in acute mortality; however, six-month mortality was higher in Group 1 (8.8% vs. 3.2%, p = 0.031). Multivariate analysis identified higher ASA scores and MAPASH > 2 as risk factors for delayed mortality, while alcohol consumption and MAPASH > 2 were associated with the need for endoscopic therapy.

Discussion

Alcohol consumption may increase the need for endoscopic intervention, while delayed mortality appears to be more influenced by comorbidity and severity.

非静脉曲张性上消化道出血（NVUGIB）是胃肠病学中最常见的疾病之一，每年每10万居民中有47例。饮酒是一个已知的危险因素。然而，其对无肝硬化患者干预需求和临床结果的影响尚未得到充分评估。本研究旨在分析饮酒对NVUGIB结局的影响。材料和方法我们对2013年至2022年NVUGIB患者进行了回顾性队列研究。危险饮酒被定义为每天摄入20克。共分析965例患者：830例无危险饮酒（第一组），135例有饮酒（第二组）。采用SPSS 26.0版本进行统计学分析。结果2组男性比例较高（95.6%比61.2%,p < 0.001），平均年龄较低（57比66岁，p < 0.001）。组1显示出更高的基线合并症。酒精消费者对内窥镜治疗的需求更高（47.4%比38%，p = 0.039）。急性死亡率无显著差异；然而，组1的6个月死亡率更高（8.8% vs. 3.2%, p = 0.031）。多因素分析发现，较高的ASA评分和MAPASH >； 2是延迟死亡的危险因素，而饮酒和MAPASH >； 2与内窥镜治疗的需要有关。饮酒可能增加内窥镜干预的需要，而延迟死亡似乎更多地受到合并症和严重程度的影响。

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引用次数: 0

Cerebral air embolism secondary to spontaneous rupture of pulmonary bullae in the context of pulmonary tuberculosis 在肺结核的背景下继发于自发性肺大泡破裂的脑空气栓塞

Medicina clinica (English ed.)

Pub Date : 2025-12-01 Epub Date: 2025-11-06 DOI: 10.1016/j.medcle.2025.107196

Alicia Viñas Barros , Andrea Viñas Barros , Esteban Fernando Noroña Vásconez

引用次数: 0

Metformin: Paradigm of therapeutic pleiotropism (1922–2025) 二甲双胍：治疗多效性的范例（1922-2025）

Medicina clinica (English ed.)

Pub Date : 2025-12-01 Epub Date: 2025-11-06 DOI: 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.

维尔纳和贝尔在1922年合成了二甲双胍。2006年，国际糖尿病联合会认定二甲双胍为治疗2型糖尿病的一线药物。本文综述了二甲双胍在治疗糖尿病、妊娠糖尿病、多囊卵巢综合征、食欲调节、肠道菌群失调、心血管和肾脏保护、特发性肺纤维化、降低各种肿瘤的风险和死亡率、延长寿命等方面的药理作用、不良反应和治疗多效性。

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