Medicina clinica (English ed.)最新文献

Background

Patients with Systemic Lupus Erythematosus (SLE) have an increased risk of metabolic syndrome (MS) and cardiovascular disease (CVD). MS is evaluated binary, limiting the understanding of each component's severity individually. Therefore, severity scores for MS that evaluate them separately have been developed. This study aims to determine the prognosis between MS severity and the occurrence of major adverse cardiovascular events (MACE) in SLE patients.

Methods

10-year follow-up cohort study. Premenopausal >18-year-old women with a previous diagnosis of SLE were included. Patients with recent cardiovascular (CV) events, pregnancy, thyroid disease, and liposuction were excluded. The variables of interest were CV events, the confounding variables, and the MS severity indexes were examined. Hazard ratios and Kaplan–Meier survival curves were estimated through Cox regression.

Results

238 women were analyzed; 22 presented MACE, and 216 did not. MS prevalence, measured according to Consensus and ATPII criteria, was higher in MACE patients (50% and 40,95%, respectively). The MetSx-IMC severity index was higher within the MACE group. COX analysis showed an increase in the MetSX-IMC associated with the risk of suffering MACE in a 1,107 ratio.

Conclusions

The MetSx-IMC severity index, contrary to the binary approaches, is suggested to evaluate MS as a predictor of MACE in SLE patients. Offering improved and more accurate prognosis in patients at risk of developing MCE.

Frailty, sarcopenia and osteoporosis are entities specific to the elderly, who share some risk factors. For this reason, their relationship has been studied in different works, which have provided disparate results, probably because these studies have not always focused on the same aspects. This article reviews the relationship of frailty and sarcopenia with osteoporosis.

Background and objectives

Evidence on the long-term use of tolvaptan in autosomal dominant polycystic kidney disease (ADPKD) is limited. The aim was to evaluate the tolvaptan effectiveness and safety in real clinical setting.

Material and methods

A single-center observational study (2016–2022) involving ADPKD patients treated with tolvaptan was conducted. Annual change in serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) before and after treatment initiation were evaluated. Change in total kidney volume (TKV), blood pressure (BP) and urinary albuminuria at 12, 24 and 36 months after initiation were also determined. Adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were analyzed.

Results

A total of 22 patients were included. No significant differences pre- vs post tolvaptan treatment in annual rate of change in eGFR (−3.52 ml/min/1.73 m² [−4.98%] vs −3.98 ml/min/1.73 m² [−8.48%], p = 0.121) and sCr (+0.06 mg/dL [4.22%] vs +0.15 mg/dL [7.77%], p = 0.429) were observed. Tolvaptan improved urinary osmolality at 12 (p = 0.019) and 24 months (p = 0.008), but not at 36 months (p = 0.11). There were no changes in TKV, BP control and urinary albuminuria at 12, 24 or 36 months. A worse response was shown in patients with rapid kidney function decline (p = 0.042). A 36.4% of the patients developed grade III/IV AEs. A 22.7% discontinued treatment due to unacceptable toxicity.

Conclusions

This study shows a modest benefit of tolvaptan in ADPKD patients, as well as safety concerns.

Objective

To investigate the association between left ventricular structure and disease severity in COPD patients.

Methods

Twenty-eight COPD patients were stratified according to the disease severity, using the BODE index, into L_ower (n = 17) and H_igher (n = 11) groups, composed of patients with lower severity (BODE <5) and higher severity (BODE ≥5), respectively. Left ventricle (LV) was assessed by 2D-echocardiography. BODE index was calculated using body mass index (BMI); forced expiratory volume in the first second (FEV₁, %); modified Medical Research Council (mMRC) and distance walked during 6-minute walk test (6MWD).

Results

Patients in the H_igher group showed lower oxygen arterial saturation (p = 0.02), FEV₁ (p < 0.01) and 6MWD (p = 0.02) and higher value of relative posterior wall thickness (RWT) compared to L_ower group (p = 0.02). There were significant associations between LV end-systolic diameter (LVESD) and BODE index (r = −0.38, p = 0.04), LV end-diastolic diameter (LVEDD) and FEV₁ (r = 0.44, p = 0.02), LVEDD and BMI (r = 0.45, p = 0.02), LVESD and BMI (r = 0.54, p = 0.003) and interventricular septal thickness and 6MWD (r = −0.39, p = 0.04).

Conclusions

More severe COPD patients, BODE score ≥5, may have higher RWT, featuring a possible higher concentric remodeling of LV in this group. Besides that, a greater disease severity may be related to LV chamber size reduction.

Introduction and objectives

Smoking is associated with various health risks, including cancer, cardiovascular disease, and chronic obstructive pulmonary disease. In this retrospective cohort study, we aimed to determine whether smoking is harmful to the whole metabolic system.

Methods

We collected data from 340 randomly selected participants who were divided into three groups: smokers (n = 137), non-smokers (n = 134), and ex-smokers (n = 69). We obtained information on participants’ body mass index, waist circumference, indicators of glucose metabolism, lipid metabolism, bone metabolism, and uric acid from health screen data during the past three years. A cluster analysis was used to synthesize each participant's overall metabolic characteristics.

Results

According to the cluster analysis, the 340 participants were divided into three groups: excellent metabolizers (137, 40.3%), adverse metabolizers (32, 9.4%), and intermediate metabolizers (171, 50.3%). The Chi-squared test analysis shows that people with different smoking statuses have different metabolic patterns. Non-smokers had the highest proportion of excellent metabolizers (56%), and current smokers had the highest proportion of adverse metabolizers (15.3%). The proportion of adverse metabolizers (5.8%) in the ex-smoker group was clinically relevantly lower than that of current smokers.

Conclusion

The statistically significant differences in the distribution of smokers into different metabolic clusters indicate that smoking has adverse effects on the whole metabolic system of the human body, which further increases the existing global burden of metabolic disorders.