Pub Date : 2025-01-10DOI: 10.1016/j.medcle.2024.09.003
Andrés Pérez Hurtado , Isabel Martínez Cordellat , Roxana González Mazario , Elene Grau García , José Andrés Román Ivorra
Background and objectives
Rhupus is a very rare syndrome of overlapping rheumatoid arthritis and systemic lupus erythematosus, characterized by the presence of erosive polyarthritis associated with symptoms and signs of systemic lupus erythematosus and the presence of high specificity autoantibodies. The analysis of HLA-DR molecules would allow us to genetically characterize patients diagnosed with rhupus, being able to differentiate them from the HLA-DR profile of patients with rheumatoid arthritis and systemic lupus erythematosus.
Materials and methods
Cross-sectional observational study of 9 patients diagnosed with Rhupus in whom the HLA-DR genotype was genetically characterized.
Results
Rhupus is usually more frequent in women with initial diagnosis of RA. The most frequent clinical manifestations are articular and, serologically, ANA, RF and anti-CCP positivity stand out. The most frequent HLA-DR were HLA-DR1, HLA-DR3, HLA-DR4, HLA-DR7 and HLA-DR13.
Conclusions
A higher proportion of HLA-DR1 and DR9 was observed in patients with Rhupus compared to RA and SLE, as well as a lower proportion of HLA-DR2, DR6 and DR8, which would help the early characterization of these patients prior to the overlap diagnosis.
{"title":"Rhupus syndrome: description of 9 cases with special atenttion to the HLA-DR genotype","authors":"Andrés Pérez Hurtado , Isabel Martínez Cordellat , Roxana González Mazario , Elene Grau García , José Andrés Román Ivorra","doi":"10.1016/j.medcle.2024.09.003","DOIUrl":"10.1016/j.medcle.2024.09.003","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Rhupus is a very rare syndrome of overlapping rheumatoid arthritis and systemic lupus erythematosus, characterized by the presence of erosive polyarthritis associated with symptoms and signs of systemic lupus erythematosus and the presence of high specificity autoantibodies. The analysis of HLA-DR molecules would allow us to genetically characterize patients diagnosed with rhupus, being able to differentiate them from the HLA-DR profile of patients with rheumatoid arthritis and systemic lupus erythematosus.</div></div><div><h3>Materials and methods</h3><div>Cross-sectional observational study of 9 patients diagnosed with Rhupus in whom the HLA-DR genotype was genetically characterized.</div></div><div><h3>Results</h3><div>Rhupus is usually more frequent in women with initial diagnosis of RA. The most frequent clinical manifestations are articular and, serologically, ANA, RF and anti-CCP positivity stand out. The most frequent HLA-DR were HLA-DR1, HLA-DR3, HLA-DR4, HLA-DR7 and HLA-DR13.</div></div><div><h3>Conclusions</h3><div>A higher proportion of HLA-DR1 and DR9 was observed in patients with Rhupus compared to RA and SLE, as well as a lower proportion of HLA-DR2, DR6 and DR8, which would help the early characterization of these patients prior to the overlap diagnosis.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 1","pages":"Pages 16-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093338","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 : 2025-01-10DOI: 10.1016/j.medcle.2024.08.003
Jose Alberto de Agustín , Orlando Figueroa , Carmen Olmos Blanco , Eduardo Pozo Osinalde , Patricia Mahia Casado , María Luaces , María Rivadeneira , Pedro Marcos-Alberca , Jose Juan Gómez de Diego , Luis Collado Yurrita , Antonio Fernández-Ortiz , Julián Villacastín
Introduction and aims
Tricuspid regurgitation (TR) induced by the implantation of cardiac implantable electronic devices (CIED) is an increasingly common cause of severe TR. Our aim was to describe the echocardiographic phenotypic characteristics of CIED-induced severe TR.
Methods
Retrospective cohort study that included patients with severe TR related to CIED diagnosed in the cardiac imaging unit of a spanish tertiary hospital.
Results
37 patients with severe TR induced by lead/electrode interference formed our study group. TR was predominantly severe (68%), followed by massive (21%) and torrential (11%). The leaflet most affected by the interference was the septal. 58% of the sample presented severe dilatation of the right atrium (RA) (mean RA area 28 cm2). Mean tricuspid annulus measurement was 42 mm. The usual parameters for quantifying RV systolic function were on average within the normal range (TAPSE mean 19 mm, S' wave 10 mm, FAC 41%), while global RV strain (RVGLS -15%) and free wall strain (RVFWLS -19%) were found reduced. An incipient degree of ventricular/pulmonary arterial uncoupling was evident (mean TAPSE/PSAP 0.34, SGLVD/PSAP 0.27%/mmHg).
Conclusions
Our patients with CIED-induced severe TR are characterized by a heterogeneous phenotype with a high prevalence of severe RA and tricuspid annulus dilatation. RVGLS, RVFWLS, and arterial ventricular coupling were the most sensitive parameters for early assessment of RV systolic dysfunction.
{"title":"Phenotype of severe tricuspid regurgitation induced by intracardiac pacing devices","authors":"Jose Alberto de Agustín , Orlando Figueroa , Carmen Olmos Blanco , Eduardo Pozo Osinalde , Patricia Mahia Casado , María Luaces , María Rivadeneira , Pedro Marcos-Alberca , Jose Juan Gómez de Diego , Luis Collado Yurrita , Antonio Fernández-Ortiz , Julián Villacastín","doi":"10.1016/j.medcle.2024.08.003","DOIUrl":"10.1016/j.medcle.2024.08.003","url":null,"abstract":"<div><h3>Introduction and aims</h3><div>Tricuspid regurgitation (TR) induced by the implantation of cardiac implantable electronic devices (CIED) is an increasingly common cause of severe TR. Our aim was to describe the echocardiographic phenotypic characteristics of CIED-induced severe TR.</div></div><div><h3>Methods</h3><div>Retrospective cohort study that included patients with severe TR related to CIED diagnosed in the cardiac imaging unit of a spanish tertiary hospital.</div></div><div><h3>Results</h3><div>37 patients with severe TR induced by lead/electrode interference formed our study group. TR was predominantly severe (68%), followed by massive (21%) and torrential (11%). The leaflet most affected by the interference was the septal. 58% of the sample presented severe dilatation of the right atrium (RA) (mean RA area 28<!--> <!-->cm<sup>2</sup>). Mean tricuspid annulus measurement was 42<!--> <!-->mm. The usual parameters for quantifying RV systolic function were on average within the normal range (TAPSE mean 19<!--> <!-->mm, S' wave 10<!--> <!-->mm, FAC 41%), while global RV strain (RVGLS -15%) and free wall strain (RVFWLS -19%) were found reduced. An incipient degree of ventricular/pulmonary arterial uncoupling was evident (mean TAPSE/PSAP 0.34, SGLVD/PSAP 0.27%/mmHg).</div></div><div><h3>Conclusions</h3><div>Our patients with CIED-induced severe TR are characterized by a heterogeneous phenotype with a high prevalence of severe RA and tricuspid annulus dilatation. RVGLS, RVFWLS, and arterial ventricular coupling were the most sensitive parameters for early assessment of RV systolic dysfunction.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 1","pages":"Pages 10-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128229","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 : 2025-01-10DOI: 10.1016/j.medcle.2024.05.029
Nuria Puente Ruiz , M. Carmen Valero Díaz de Lamadrid , José A. Riancho
Long-term hypophosphatemia, defined by serum phosphorus (P) levels <2.5 mg/dl, impairs the development and quality of mineralized tissue of the skeletal, dental, and auditory systems. P homeostasis depends mainly on intestinal absorption and renal excretion. Hypophosphatemia may be due to the redistribution of P to the intracellular space, increased renal losses, or decreased intestinal absorption. Hypophosphatemia can be categorized as acute or chronic, depending on the time course. Most cases, either acute or chronic, are due to acquired causes. However, some chronic cases may have a genetic origin. Accurate and early diagnosis, followed by adequate treatment, is essential to limit its negative effects on the body.
{"title":"Etiology of hypophosphatemia in adults","authors":"Nuria Puente Ruiz , M. Carmen Valero Díaz de Lamadrid , José A. Riancho","doi":"10.1016/j.medcle.2024.05.029","DOIUrl":"10.1016/j.medcle.2024.05.029","url":null,"abstract":"<div><div>Long-term hypophosphatemia, defined by serum phosphorus (P) levels <2.5<!--> <!-->mg/dl, impairs the development and quality of mineralized tissue of the skeletal, dental, and auditory systems. P homeostasis depends mainly on intestinal absorption and renal excretion. Hypophosphatemia may be due to the redistribution of P to the intracellular space, increased renal losses, or decreased intestinal absorption. Hypophosphatemia can be categorized as acute or chronic, depending on the time course. Most cases, either acute or chronic, are due to acquired causes. However, some chronic cases may have a genetic origin. Accurate and early diagnosis, followed by adequate treatment, is essential to limit its negative effects on the body.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 1","pages":"Pages 30-37"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128226","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 : 2024-12-27DOI: 10.1016/j.medcle.2024.07.012
Lucía Isabel Martínez Minuesa, Alba Manuel Vázquez, José Luis Ramos Rodríguez
{"title":"Syphilis as a cause of rectal tumour in an HIV-infected patient","authors":"Lucía Isabel Martínez Minuesa, Alba Manuel Vázquez, José Luis Ramos Rodríguez","doi":"10.1016/j.medcle.2024.07.012","DOIUrl":"10.1016/j.medcle.2024.07.012","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 12","pages":"Pages 641-642"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180157","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 : 2024-12-27DOI: 10.1016/j.medcle.2024.07.014
Carmen Riesco-Bárcena, José Ivorra-Cortés, Elena Grau-García, Luis González-Puig, Samuel Leal, Anderson Huaylla, José Román-Ivorra
Objective
To analyze the prevalence of hyperparathyroidism in patients treated with zoledronic acid (ZA) or denosumab, its relationship with other parameters and how it affects on bone mineral density (BMD) evolution.
Methods
Retrospective observational study in patients with osteoporosis or osteopenia and high risk of fracture, who have received denosumab or ZA for at least two years. Patients diagnosed with hyperparathyroidism or glomerular filtration rate <30 mL/min at baseline visit were excluded from the study.
Results
Ninety patients (ZA: 54.44%) were included. 18.36% of ZA-treated patients had elevated PTH levels at some time compared to 36.58% denosumab-treated patients (p > 0.05). Patients with persistently elevated PTH were 6.13% in the AZ group and 19.51% in the denosumab group (p < 0.04).
We found a statistically significant inverse association between elevated PTH levels, glomerular filtration rate (p = 0.007) and albumin-corrected calcium (p < 0.001). We did not find an association between hyperparathyroidism and BMD evolution.
Conclusions
A high incidence of hyperparathyroidism was observed in patients treated with AZ and especially denosumab. Hyperparathyroidism correlated inversely with glomerular filtration rate and albumin-corrected calcium. Elevated PTH does not appear to affect short-term bone mineral density evolution.
{"title":"Hyperparathyroidism in patients with low bone mineral density treated with zoledronic acid or denosumab","authors":"Carmen Riesco-Bárcena, José Ivorra-Cortés, Elena Grau-García, Luis González-Puig, Samuel Leal, Anderson Huaylla, José Román-Ivorra","doi":"10.1016/j.medcle.2024.07.014","DOIUrl":"10.1016/j.medcle.2024.07.014","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the prevalence of hyperparathyroidism in patients treated with zoledronic acid (ZA) or denosumab, its relationship with other parameters and how it affects on bone mineral density (BMD) evolution.</div></div><div><h3>Methods</h3><div>Retrospective observational study in patients with osteoporosis or osteopenia and high risk of fracture, who have received denosumab or ZA for at least two years. Patients diagnosed with hyperparathyroidism or glomerular filtration rate <30 mL/min at baseline visit were excluded from the study.</div></div><div><h3>Results</h3><div>Ninety patients (ZA: 54.44%) were included. 18.36% of ZA-treated patients had elevated PTH levels at some time compared to 36.58% denosumab-treated patients (<em>p</em> > 0.05). Patients with persistently elevated PTH were 6.13% in the AZ group and 19.51% in the denosumab group (<em>p</em> < 0.04).</div><div>We found a statistically significant inverse association between elevated PTH levels, glomerular filtration rate (<em>p</em> = 0.007) and albumin-corrected calcium (<em>p</em> < 0.001). We did not find an association between hyperparathyroidism and BMD evolution.</div></div><div><h3>Conclusions</h3><div>A high incidence of hyperparathyroidism was observed in patients treated with AZ and especially denosumab. Hyperparathyroidism correlated inversely with glomerular filtration rate and albumin-corrected calcium. Elevated PTH does not appear to affect short-term bone mineral density evolution.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 12","pages":"Pages 595-599"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179713","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 : 2024-12-27DOI: 10.1016/j.medcle.2024.05.028
Joan Ramon Roma , Pedro Castro Rebollo , Carla Bastida
Drug administration is crucial to achieve effective therapeutic drug outcomes. In medical emergencies, it is particularly convenient to use drugs that could be administered as an alternative to traditional routes (as oral or intravenous routes), that are not always suitable in these situations. Thus, sublingual and buccal routes offer an alternative to traditional routes, when a rapid onset of action is required. The main objective of this narrative review is to summarize the evidence for the use of sublingual and buccal drug administration in medical emergencies. The evidence obtained has been divided into four common scenarios found in the emergency department and intensive care units: cardiovascular emergencies, acute pain, agitation, and epileptic status. Moreover, the main advantages and disadvantages of sublingual and buccal routes are presented, as the future perspectives in the drug delivery field to overcome the limitations of these routes.
{"title":"Sublingual and buccal drug administration in medical emergencies","authors":"Joan Ramon Roma , Pedro Castro Rebollo , Carla Bastida","doi":"10.1016/j.medcle.2024.05.028","DOIUrl":"10.1016/j.medcle.2024.05.028","url":null,"abstract":"<div><div>Drug administration is crucial to achieve effective therapeutic drug outcomes. In medical emergencies, it is particularly convenient to use drugs that could be administered as an alternative to traditional routes (as oral or intravenous routes), that are not always suitable in these situations. Thus, sublingual and buccal routes offer an alternative to traditional routes, when a rapid onset of action is required. The main objective of this narrative review is to summarize the evidence for the use of sublingual and buccal drug administration in medical emergencies. The evidence obtained has been divided into four common scenarios found in the emergency department and intensive care units: cardiovascular emergencies, acute pain, agitation, and epileptic status. Moreover, the main advantages and disadvantages of sublingual and buccal routes are presented, as the future perspectives in the drug delivery field to overcome the limitations of these routes.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 12","pages":"Pages 619-625"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180151","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 : 2024-12-27DOI: 10.1016/j.medcle.2024.07.017
Lucía Estévez Asensio , Montserrat García , Zoraida Verde Rello , Verónica Velasco-González , Ana M. Fernández-Araque , María Sainz-Gil
<div><h3>Introduction</h3><div>Hyponatraemia has negative effects on cognitive function and gait stability and is a risk factor for osteoporosis, falls, fractures and hospital mortality. Acute hyponatraemia can lead to neurological dysfunction due to cerebral oedema. Its rapid correction can also be fatal, leading to osmotic demyelination syndrome. For some antiepileptics, thiazides, benzodiazepines or antidepressants this reaction is widely described. Knowing which drugs are most likely to cause hyponatraemia will allow early detection and prevention of its complications, as well as individualising the prescription of these drugs according to the patient's characteristics.</div></div><div><h3>Objective</h3><div>The main objectives are to identify potential new safety signals related to hyponatraemia and to analyse the cases of hyponatraemia reported to the Spanish Pharmacovigilance System for Medicines for Human Use (SEFV-H).</div></div><div><h3>Method</h3><div>A disproportionality and a descriptive analysis of individual case safety reports (ICSR) was performed in the SEFV-H database (FEDRA).</div></div><div><h3>Results</h3><div>Six hundred and fifty-nine cases of suspected drug-induced hyponatraemia were found (0.6% of the total database). Over the 5 years period studied, there was a 57% increase in the number of hyponatraemia reports in Spain. Most of the reported cases were serious (93%). Patients were most often women (63.7%) and elderly (71.9%). The time to onset ranged from 1 to 7030 days (median, 79 days) and approximately 70% of the total occurred within the first year of treatment. Five hundred and forty-six patients (82.9%) showed complete recovery after the withdrawal of the suspected medicine. Diuretics (reported in 57.7% of the cases), antidepressants (in 25%), drugs acting on renin angiotensin system (in 24%) and antiepileptics (in 20.2%) were the most frequent involved drugs. Disproportionate reporting has been found for almost all the substances most frequently reported, higher for amiloride and oxcarbazepine. Regarding new safety signals, the Reporting Odds Ratio (ROR) (95% CI) was found to be statistically significant for valsartan [7.7 (5.1–11.5)], olmesartan [7.3 (4.7–11.1)], amlodipine [3.4 (2.1–5.4)], pregabalin [2.5 (1.4–4.5)], irbesartan [18.6 (9.6–35.9)], paliperidone [2.7 (1.3–5.7)], ritonavir [2.4 (1.1–5.5)], atosiban [29.7 (8.6–102.2)], melphalan [9.7 (3.5–26.8)] and clozapine [4.4 (1.6–11.8)]. These active ingredients do not include this reaction on their SPC and comply with the EMA criteria for a safety signals.</div></div><div><h3>Conclusion</h3><div>There are increasing reports of drug-induced hyponatraemia. It can be serious and seems to most often affect women over 65 years of age who take more than 1 medication. The time to onset varies and can be very long, so patient monitoring should be continuous throughout treatment. Hydrochlorothiazide is the drug with the highest number of reported cases in our setting.
{"title":"Drug-induced hyponatraemia and possible related signals: Analysis of 659 cases reported to the Spanish Pharmacovigilance System and disproportionality analysis","authors":"Lucía Estévez Asensio , Montserrat García , Zoraida Verde Rello , Verónica Velasco-González , Ana M. Fernández-Araque , María Sainz-Gil","doi":"10.1016/j.medcle.2024.07.017","DOIUrl":"10.1016/j.medcle.2024.07.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Hyponatraemia has negative effects on cognitive function and gait stability and is a risk factor for osteoporosis, falls, fractures and hospital mortality. Acute hyponatraemia can lead to neurological dysfunction due to cerebral oedema. Its rapid correction can also be fatal, leading to osmotic demyelination syndrome. For some antiepileptics, thiazides, benzodiazepines or antidepressants this reaction is widely described. Knowing which drugs are most likely to cause hyponatraemia will allow early detection and prevention of its complications, as well as individualising the prescription of these drugs according to the patient's characteristics.</div></div><div><h3>Objective</h3><div>The main objectives are to identify potential new safety signals related to hyponatraemia and to analyse the cases of hyponatraemia reported to the Spanish Pharmacovigilance System for Medicines for Human Use (SEFV-H).</div></div><div><h3>Method</h3><div>A disproportionality and a descriptive analysis of individual case safety reports (ICSR) was performed in the SEFV-H database (FEDRA).</div></div><div><h3>Results</h3><div>Six hundred and fifty-nine cases of suspected drug-induced hyponatraemia were found (0.6% of the total database). Over the 5 years period studied, there was a 57% increase in the number of hyponatraemia reports in Spain. Most of the reported cases were serious (93%). Patients were most often women (63.7%) and elderly (71.9%). The time to onset ranged from 1 to 7030 days (median, 79 days) and approximately 70% of the total occurred within the first year of treatment. Five hundred and forty-six patients (82.9%) showed complete recovery after the withdrawal of the suspected medicine. Diuretics (reported in 57.7% of the cases), antidepressants (in 25%), drugs acting on renin angiotensin system (in 24%) and antiepileptics (in 20.2%) were the most frequent involved drugs. Disproportionate reporting has been found for almost all the substances most frequently reported, higher for amiloride and oxcarbazepine. Regarding new safety signals, the Reporting Odds Ratio (ROR) (95% CI) was found to be statistically significant for valsartan [7.7 (5.1–11.5)], olmesartan [7.3 (4.7–11.1)], amlodipine [3.4 (2.1–5.4)], pregabalin [2.5 (1.4–4.5)], irbesartan [18.6 (9.6–35.9)], paliperidone [2.7 (1.3–5.7)], ritonavir [2.4 (1.1–5.5)], atosiban [29.7 (8.6–102.2)], melphalan [9.7 (3.5–26.8)] and clozapine [4.4 (1.6–11.8)]. These active ingredients do not include this reaction on their SPC and comply with the EMA criteria for a safety signals.</div></div><div><h3>Conclusion</h3><div>There are increasing reports of drug-induced hyponatraemia. It can be serious and seems to most often affect women over 65 years of age who take more than 1 medication. The time to onset varies and can be very long, so patient monitoring should be continuous throughout treatment. Hydrochlorothiazide is the drug with the highest number of reported cases in our setting.","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 12","pages":"Pages 600-608"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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