Cancer of unknown primary (CUP) is a clinical type of metastatic malignancy where the primary tumor remains unidentified despite thorough diagnostic evaluation. It presents a significant challenge in modern oncology due to its complex management and diagnostic difficulties. Although CUP accounts for approximately 2 to 5% of cancer cases worldwide, recent advancements in diagnostic techniques, such as immunohistochemistry and genomic sequencing, have improved the ability to classify and treat CUP using targeted therapies. However, limitations persist, including the biological heterogeneity of CUP and the frequent need for empirical treatments. This review discusses advancements in CUP diagnosis and treatment, emphasizing the importance of a multidisciplinary approach that integrates precision oncology and palliative care to enhance patient quality of life.
{"title":"Cancer of unknown primary: Diagnosis, treatment and technological advances","authors":"Ferran Losa Gaspà , Raquel Legido Díaz , Sheila Sánchez Pérez","doi":"10.1016/j.medcle.2025.107118","DOIUrl":"10.1016/j.medcle.2025.107118","url":null,"abstract":"<div><div>Cancer of unknown primary (CUP) is a clinical type of metastatic malignancy where the primary tumor remains unidentified despite thorough diagnostic evaluation. It presents a significant challenge in modern oncology due to its complex management and diagnostic difficulties. Although CUP accounts for approximately 2 to 5% of cancer cases worldwide, recent advancements in diagnostic techniques, such as immunohistochemistry and genomic sequencing, have improved the ability to classify and treat CUP using targeted therapies. However, limitations persist, including the biological heterogeneity of CUP and the frequent need for empirical treatments. This review discusses advancements in CUP diagnosis and treatment, emphasizing the importance of a multidisciplinary approach that integrates precision oncology and palliative care to enhance patient quality of life.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107118"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435243","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107152
Miguel A. Rubio-Herrera , Sara Mera-Carreiro
Obesity is a chronic and relapsing disease associated with medical complications and mortality. Our improved understanding of the relevance of the gut–brain axis in regulating appetite and body weight has encouraged research into nutrient-stimulated gastroenteropancreatic hormones as a new therapeutic arsenal for the treatment of people living with obesity. Beyond the necessary lifestyle changes, this new era with second-generation drugs has been able to achieve weight loss of 15–25%, close to that of bariatric surgery. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), used as weekly injectable monotherapy or daily oral (semaglutide), achieve weight loss of 15–17%, with a good safety profile. The synergistic combination with other hormones (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, or amylin) will allow to increase weight loss, as well as improve cardiometabolic variables. Tirzepatide (a dual GLP-1/GIP receptor agonist) achieves weight loss of up to 22.5% at the highest doses. In this same range of weight loss, it is expected that it can be achieved with the combination of Cagrisema (cagrilintide 2.4 mg plus semaglutide 2.4 mg), combinations of GLP-1 RAs – glucagon agonists or with the triple combination of GLP-1 RAs-GIP-Glucagon (Retatrutide). In this review, we will examine the efficacy and safety of the drugs marketed and others under ongoing clinical trials for the treatment of persons with obesity, as well as the main challenges faced by both healthcare professionals and patients in maintaining long-term treatment.
{"title":"Weight management treatment in obesity","authors":"Miguel A. Rubio-Herrera , Sara Mera-Carreiro","doi":"10.1016/j.medcle.2025.107152","DOIUrl":"10.1016/j.medcle.2025.107152","url":null,"abstract":"<div><div>Obesity is a chronic and relapsing disease associated with medical complications and mortality. Our improved understanding of the relevance of the gut–brain axis in regulating appetite and body weight has encouraged research into nutrient-stimulated gastroenteropancreatic hormones as a new therapeutic arsenal for the treatment of people living with obesity. Beyond the necessary lifestyle changes, this new era with second-generation drugs has been able to achieve weight loss of 15–25%, close to that of bariatric surgery. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), used as weekly injectable monotherapy or daily oral (semaglutide), achieve weight loss of 15–17%, with a good safety profile. The synergistic combination with other hormones (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, or amylin) will allow to increase weight loss, as well as improve cardiometabolic variables. Tirzepatide (a dual GLP-1/GIP receptor agonist) achieves weight loss of up to 22.5% at the highest doses. In this same range of weight loss, it is expected that it can be achieved with the combination of Cagrisema (cagrilintide 2.4<!--> <!-->mg plus semaglutide 2.4<!--> <!-->mg), combinations of GLP-1 RAs – glucagon agonists or with the triple combination of GLP-1 RAs-GIP-Glucagon (Retatrutide). In this review, we will examine the efficacy and safety of the drugs marketed and others under ongoing clinical trials for the treatment of persons with obesity, as well as the main challenges faced by both healthcare professionals and patients in maintaining long-term treatment.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107152"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435246","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107140
Manuel De Miguel-Escribano, Isabel Martín-Garrido, Manuel Garrido-Montes, Roberto Pertusa-Mataix, Jorge Corchero-Gijón, José Salvador García Morillo
Introduction
Despite the progressive socioeconomic and healthcare recovery following the SARS-CoV-2 pandemic, its sequelae remain markedly evident today. Among them, Long COVID significantly impairs patient functionality and quality of life. Neurocognitive impairment stands out as one of its most debilitating manifestations.
Patients and methods
We assessed 16 patients diagnosed with Long COVID and neurocognitive dysfunction, quantifying the degree of impairment using cognitive evaluation tests and comparing these results with findings from prior [18F]FDG-PET-CT brain scans.
Results
The mean cognitive test scores demonstrated significant impairment. Patients predominantly exhibited mild hypometabolism across various regions, with the cerebellum identified as the most frequently affected area. Those with more pronounced [18F]FDG-PET-CT abnormalities exhibited greater cognitive deficits. Greater hypometabolism and thalamic involvement were associated with lower cognitive assessment score.
Conclusion
We support the role of cerebral hypometabolism in the development of neurocognitive impairment associated with Long COVID, although its underlying pathophysiological mechanisms remain to be elucidated. We further endorse the potential link between cerebellar hypometabolism and cognitive decline. Greater severity in brain [18F]FDG-PET-CT abnormalities and thalamic dysfunction may correlate worse cognitive impairment.
{"title":"Brain hypometabolism and cognitive impairment in long COVID: Insights from [18F]FDG-PET-CT imaging and neurocognitive assessment","authors":"Manuel De Miguel-Escribano, Isabel Martín-Garrido, Manuel Garrido-Montes, Roberto Pertusa-Mataix, Jorge Corchero-Gijón, José Salvador García Morillo","doi":"10.1016/j.medcle.2025.107140","DOIUrl":"10.1016/j.medcle.2025.107140","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the progressive socioeconomic and healthcare recovery following the SARS-CoV-2 pandemic, its sequelae remain markedly evident today. Among them, Long COVID significantly impairs patient functionality and quality of life. Neurocognitive impairment stands out as one of its most debilitating manifestations.</div></div><div><h3>Patients and methods</h3><div>We assessed 16 patients diagnosed with Long COVID and neurocognitive dysfunction, quantifying the degree of impairment using cognitive evaluation tests and comparing these results with findings from prior [18F]FDG-PET-CT brain scans.</div></div><div><h3>Results</h3><div>The mean cognitive test scores demonstrated significant impairment. Patients predominantly exhibited mild hypometabolism across various regions, with the cerebellum identified as the most frequently affected area. Those with more pronounced [18F]FDG-PET-CT abnormalities exhibited greater cognitive deficits. Greater hypometabolism and thalamic involvement were associated with lower cognitive assessment score.</div></div><div><h3>Conclusion</h3><div>We support the role of cerebral hypometabolism in the development of neurocognitive impairment associated with Long COVID, although its underlying pathophysiological mechanisms remain to be elucidated. We further endorse the potential link between cerebellar hypometabolism and cognitive decline. Greater severity in brain [18F]FDG-PET-CT abnormalities and thalamic dysfunction may correlate worse cognitive impairment.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107140"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435240","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107102
Ignacio Novo Veleiro , Iván Fernández Castro , Grupo de Trabajo sobre Alcohol y Otras Drogas. Sociedad Española de Medicina Interna
{"title":"Hidden alcohol use disorder","authors":"Ignacio Novo Veleiro , Iván Fernández Castro , Grupo de Trabajo sobre Alcohol y Otras Drogas. Sociedad Española de Medicina Interna","doi":"10.1016/j.medcle.2025.107102","DOIUrl":"10.1016/j.medcle.2025.107102","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107102"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435242","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107147
José Vicente Rocha , Marta Vaz Lopes , Anabela Oliveira
{"title":"Hypogonadotropic hypogonadism in male patients with glycogen storage disease type 1a (GSD-1a): A different treatment approach","authors":"José Vicente Rocha , Marta Vaz Lopes , Anabela Oliveira","doi":"10.1016/j.medcle.2025.107147","DOIUrl":"10.1016/j.medcle.2025.107147","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107147"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435567","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 : 2025-11-01DOI: 10.1016/j.medcle.2025.107113
José Luis García-Klepzig , Manuel Méndez Bailón , Manuel Montero-Pérez-Barquero , Álvaro González-Franco , José M. Cerqueiro , José Pérez-Silvestre , María Prado Salamanca-Bautista , Sara Carrascosa-García , Maria del Carmen Moreno-García , Luis Manzano-Espinosa
Background
Patients with heart failure (HF) and atrial fibrillation (AF) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and AF.
Methods
A total of 5644 patients were prospectively recruited, of which 3005 had a history of AF between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in the UMIPIC program (1142 patients) and another treated conventionally (1863 patients). Baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching. Admissions, mortality, incidence of stroke, intracranial hemorrhage and any other bleeding were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.
Results
The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for any cause (35.6% vs. 44.8%, respectively; hazard ratio [HR] = 0.82; 95% confidence interval [95% CI]: 0.74−0.92; p < 0.001) and lower rate of admissions for HF (18.3% vs 29.6, respectively; hazard ratio [HR] = 0.74; 95% confidence interval [95% CI]: 0.66−0.83; p < 0.001) Mortality was lower in the UMIPIC group (23.2% vs. 31%, respectively; HR = 0.82; 95% CI: 0.73−0.92; p = 0.001). No differences were found in the incidence of ischemic stroke group (1.2 vs. 0.5%, respectively; HR = 0.71; 95% CI: 0.5–1.03; p = 0.714).
Conclusions
The implementation of the UMIPIC care program for patients with HF and a history of AF, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up without differences in ischemic stroke incidence.
{"title":"Benefits of a comprehensive care model in patients with heart failure and atrial fibrillation: UMIPIC Program","authors":"José Luis García-Klepzig , Manuel Méndez Bailón , Manuel Montero-Pérez-Barquero , Álvaro González-Franco , José M. Cerqueiro , José Pérez-Silvestre , María Prado Salamanca-Bautista , Sara Carrascosa-García , Maria del Carmen Moreno-García , Luis Manzano-Espinosa","doi":"10.1016/j.medcle.2025.107113","DOIUrl":"10.1016/j.medcle.2025.107113","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) and atrial fibrillation (AF) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and AF.</div></div><div><h3>Methods</h3><div>A total of 5644 patients were prospectively recruited, of which 3005 had a history of AF between March 2008 and March 2020. They were divided into 2 follow-up groups at the time of discharge, one in the UMIPIC program (1142 patients) and another treated conventionally (1863 patients). Baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching. Admissions, mortality, incidence of stroke, intracranial hemorrhage and any other bleeding were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.</div></div><div><h3>Results</h3><div>The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for any cause (35.6% vs. 44.8%, respectively; hazard ratio [HR] = 0.82; 95% confidence interval [95% CI]: 0.74−0.92; p < 0.001) and lower rate of admissions for HF (18.3% vs 29.6, respectively; hazard ratio [HR] = 0.74; 95% confidence interval [95% CI]: 0.66−0.83; p < 0.001) Mortality was lower in the UMIPIC group (23.2% vs. 31%, respectively; HR = 0.82; 95% CI: 0.73−0.92; p = 0.001). No differences were found in the incidence of ischemic stroke group (1.2 vs. 0.5%, respectively; HR = 0.71; 95% CI: 0.5–1.03; p = 0.714).</div></div><div><h3>Conclusions</h3><div>The implementation of the UMIPIC care program for patients with HF and a history of AF, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up without differences in ischemic stroke incidence.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 5","pages":"Article 107113"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435239","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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