Pub Date : 2024-09-24DOI: 10.1016/j.medcle.2024.04.015
Fernando Armestar , Sara Vitoria Rubio , Isabel Ojanguren Sabán , Jaume Coll-Cantí , Hipólito Perez Molto
Background
Acquired critical illness weakness (AWCIP) is the most frequent neuromuscular disease in intensive care medicine departments. Its importance is given by the prolongation of hospital stay and the delayed recovery it causes to patients after hospitalization.
The main objective of this study was to investigate the association between neuromuscular blocking agents and the development of acquired weakness in critically ill patients.
Material and methods
We conducted a prospective study of 103 critically ill patients who were periodically monitored with electromyography.
Results
The development of AWCIP was observed in 63 patients. The group of patients who developed AWCIP had a significantly higher utilization of neuromuscular blocking agents than the group who did not develop AWCIP [79.4% vs 50%, OR:3.85 (1.63–9.39), p < 0.02]; likewise, this group of patients had a longer ICU stay [32 days vs 14 days, OR: 1.11 (1.06–1.17), p < 0.001] and a longer mechanical ventilation time [24 days vs 9 days, OR:1.2 (1.11–1.32), p < 0.001].
Conclusion
Neuromuscular blocking agents are a factor associated with the occurrence of AWCIP.
背景获得性危重病无力（AWCIP）是重症医学科最常见的神经肌肉疾病。本研究的主要目的是调查神经肌肉阻滞剂与危重病人获得性肌无力的发生之间的关系。材料和方法我们对 103 名定期接受肌电图监测的危重病人进行了前瞻性研究。发生 AWCIP 的一组患者使用神经肌肉阻滞剂的比例明显高于未发生 AWCIP 的一组患者[79.4% vs 50%，OR:3.85 (1.63-9.39)，p < 0.02]；同样，这组患者在重症监护室的住院时间也更长[32 天 vs 14 天，OR: 1.11 (1.06-1.17)，p <0.001]，机械通气时间更长[24 天 vs 9 天，OR:1.2 (1.11-1.32)，p <0.001]。
{"title":"Role of neuromuscular blocking agents in the development of polyneuropathy and myopathy in critically ill patients","authors":"Fernando Armestar , Sara Vitoria Rubio , Isabel Ojanguren Sabán , Jaume Coll-Cantí , Hipólito Perez Molto","doi":"10.1016/j.medcle.2024.04.015","DOIUrl":"10.1016/j.medcle.2024.04.015","url":null,"abstract":"<div><h3>Background</h3><div>Acquired critical illness weakness (AWCIP) is the most frequent neuromuscular disease in intensive care medicine departments. Its importance is given by the prolongation of hospital stay and the delayed recovery it causes to patients after hospitalization.</div><div>The main objective of this study was to investigate the association between neuromuscular blocking agents and the development of acquired weakness in critically ill patients.</div></div><div><h3>Material and methods</h3><div>We conducted a prospective study of 103 critically ill patients who were periodically monitored with electromyography.</div></div><div><h3>Results</h3><div>The development of AWCIP was observed in 63 patients. The group of patients who developed AWCIP had a significantly higher utilization of neuromuscular blocking agents than the group who did not develop AWCIP [79.4% vs 50%, OR:3.85 (1.63–9.39), p < 0.02]; likewise, this group of patients had a longer ICU stay [32 days vs 14 days, OR: 1.11 (1.06–1.17), p < 0.001] and a longer mechanical ventilation time [24 days vs 9 days, OR:1.2 (1.11–1.32), p < 0.001].</div></div><div><h3>Conclusion</h3><div>Neuromuscular blocking agents are a factor associated with the occurrence of AWCIP.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 7","pages":"Pages 323-326"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417988","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 : 2024-09-24DOI: 10.1016/j.medcle.2024.03.026
Andrés Tenes , Aldara García-Sánchez , Beatriz Pintado-Cort , Sara González-Castro , Winnifer Briceño , Diego Durán , Raquel Morillo , David Jiménez
Background and objectives
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic pulmonary hypertension leading to right heart failure and death. While pulmonary endarterectomy is the treatment of choice, some patients might benefit from medical therapy or balloon pulmonary angioplasty. Sex differences in outcomes of these therapies are not well characterized.
Material and methods
We conducted a systematic review and meta-analysis to investigate sex differences in outcomes of various therapies for CTEPH. We searched MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library databases between January 1, 2010 and April 30, 2021, published in English. We pooled incidence estimates using random-effects meta-analyses. We evaluated heterogeneity using the I2 statistic. We assessed publication bias using Begg's and Egger's tests. This study is registered in PROSPERO, CRD42021268504.
Results
A total of 19 studies met the eligibility criteria, but only 3 trials provided separate outcomes for women and men. Two studies evaluated the efficacy of BPA, and one study evaluated the efficacy of riociguat (129 patients). Overall, 57.3% of patients were women and 62.6% were in functional class III. Mean time of follow-up was 55.5 (SD 26.1) weeks. Women showed a significantly better response in cardiac index (mean difference [MD], 0.10 L/min/m2; 95% confidence interval [CI], 0.04–0.16; I2 = 0%; P = 0.001). Alternatively, the reduction of pulmonary vascular resistances was significantly higher for men than for women (MD, 161.17 dyn s cm−5; 95% CI, 67.99–254.35; I2 = 0%; P = 0.0007).
Conclusions
Women and men might show different hemodynamic responses to riociguat or BPA for CTEPH.
{"title":"Chronic thromboembolic pulmonary hypertension treatment and sex: Systematic review and meta-analysis","authors":"Andrés Tenes , Aldara García-Sánchez , Beatriz Pintado-Cort , Sara González-Castro , Winnifer Briceño , Diego Durán , Raquel Morillo , David Jiménez","doi":"10.1016/j.medcle.2024.03.026","DOIUrl":"10.1016/j.medcle.2024.03.026","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic pulmonary hypertension leading to right heart failure and death. While pulmonary endarterectomy is the treatment of choice, some patients might benefit from medical therapy or balloon pulmonary angioplasty. Sex differences in outcomes of these therapies are not well characterized.</div></div><div><h3>Material and methods</h3><div>We conducted a systematic review and meta-analysis to investigate sex differences in outcomes of various therapies for CTEPH. We searched MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library databases between January 1, 2010 and April 30, 2021, published in English. We pooled incidence estimates using random-effects meta-analyses. We evaluated heterogeneity using the <em>I</em><sup>2</sup> statistic. We assessed publication bias using Begg's and Egger's tests. This study is registered in PROSPERO, CRD42021268504.</div></div><div><h3>Results</h3><div>A total of 19 studies met the eligibility criteria, but only 3 trials provided separate outcomes for women and men. Two studies evaluated the efficacy of BPA, and one study evaluated the efficacy of riociguat (129 patients). Overall, 57.3% of patients were women and 62.6% were in functional class III. Mean time of follow-up was 55.5 (SD 26.1) weeks. Women showed a significantly better response in cardiac index (mean difference [MD], 0.10<!--> <!-->L/min/m<sup>2</sup>; 95% confidence interval [CI], 0.04–0.16; <em>I</em><sup>2</sup> <!-->=<!--> <!-->0%; <em>P</em> <!-->=<!--> <!-->0.001). Alternatively, the reduction of pulmonary vascular resistances was significantly higher for men than for women (MD, 161.17<!--> <!-->dyn<!--> <!-->s<!--> <!-->cm<sup>−5</sup>; 95% CI, 67.99–254.35; <em>I</em><sup>2</sup> <!-->=<!--> <!-->0%; <em>P</em> <!-->=<!--> <!-->0.0007).</div></div><div><h3>Conclusions</h3><div>Women and men might show different hemodynamic responses to riociguat or BPA for CTEPH.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 6","pages":"Pages 269-274"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315217","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 : 2024-09-23DOI: 10.1016/j.medcle.2024.03.028
Carolina Fonseca de Jesus Silva, Alberto Martin Arribas, Pilar Fraile Gómez
{"title":"Membranous nephropathy and Crohn’s disease: Is it a cause and effect or just a coincidence?","authors":"Carolina Fonseca de Jesus Silva, Alberto Martin Arribas, Pilar Fraile Gómez","doi":"10.1016/j.medcle.2024.03.028","DOIUrl":"10.1016/j.medcle.2024.03.028","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 7","pages":"Pages 368-369"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417986","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 : 2024-09-14DOI: 10.1016/j.medcle.2024.03.022
Manuel Heras Benito
{"title":"Refractorily to diuretics in volume overload: Report of a case treated with metolazone","authors":"Manuel Heras Benito","doi":"10.1016/j.medcle.2024.03.022","DOIUrl":"10.1016/j.medcle.2024.03.022","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 6","pages":"Pages 313-314"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315425","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 : 2024-09-12DOI: 10.1016/j.medcle.2024.03.025
Alejandro de la Sierra , Anna Oliveras
Even though a large number of antihypertensive drugs are suitable for hypertension treatment, some new therapeutic targets are recently under development. Most are focused in the treatment of resistant hypertension, added to the drugs currently available for treating such condition. Others have specific particularities in their duration of action, which allows their use once per month or every six months and could become alternatives to the current antihypertensive treatment. Most interesting therapeutic targets are the renin-angiotensin-aldosterone system, through interference with the RNA of the angiotensinogen, the inhibition of brain aminopeptidase III, the inhibition of aldosterone synthase, and new non-steroidal aldosterone receptor antagonists. In addition, dual endothelin receptor antagonists or agonists of the NPR1 receptor, the main effector of natriuretic peptides are other new interesting therapeutic possibilities. In this paper, we review clinical data on the development of the most interesting molecules acting through these new therapeutic targets.
{"title":"New therapeutic targets in hypertension","authors":"Alejandro de la Sierra , Anna Oliveras","doi":"10.1016/j.medcle.2024.03.025","DOIUrl":"10.1016/j.medcle.2024.03.025","url":null,"abstract":"<div><div>Even though a large number of antihypertensive drugs are suitable for hypertension treatment, some new therapeutic targets are recently under development. Most are focused in the treatment of resistant hypertension, added to the drugs currently available for treating such condition. Others have specific particularities in their duration of action, which allows their use once per month or every six months and could become alternatives to the current antihypertensive treatment. Most interesting therapeutic targets are the renin-angiotensin-aldosterone system, through interference with the RNA of the angiotensinogen, the inhibition of brain aminopeptidase III, the inhibition of aldosterone synthase, and new non-steroidal aldosterone receptor antagonists. In addition, dual endothelin receptor antagonists or agonists of the NPR1 receptor, the main effector of natriuretic peptides are other new interesting therapeutic possibilities. In this paper, we review clinical data on the development of the most interesting molecules acting through these new therapeutic targets.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 6","pages":"Pages 301-305"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315419","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 : 2024-09-11DOI: 10.1016/j.medcle.2024.03.024
Marta Araujo-Castro
Pheochromocytomas are rare neuroendocrine tumours that derive from the chromaffin cells of the adrenal medulla and secrete catecholamines. The measurement of plasma or fractionated urine metanephrines is the hormonal determination of choice for the biochemical diagnosis. Once the biochemical diagnosis is confirmed, the next step is the localization study. It is recommended to request a genetic study in all patients with pheochromocytomas since 40% of cases are hereditary. Once the diagnostic study is completed, preoperative treatment with alpha blockers should be instituted at least 7–14 days before adrenalectomy. However, in low-risk patients, the omission of presurgical treatment could be considered if the surgery is performed in centres with experience and a strict monitoring of the patient is carried out during the perioperative period. This document offers a practical guide on the diagnosis and perioperative approach in patients with pheochromocytomas.
{"title":"Pheochromocytoma. Preoperative approach","authors":"Marta Araujo-Castro","doi":"10.1016/j.medcle.2024.03.024","DOIUrl":"10.1016/j.medcle.2024.03.024","url":null,"abstract":"<div><div>Pheochromocytomas are rare neuroendocrine tumours that derive from the chromaffin cells of the adrenal medulla and secrete catecholamines. The measurement of plasma or fractionated urine metanephrines is the hormonal determination of choice for the biochemical diagnosis. Once the biochemical diagnosis is confirmed, the next step is the localization study. It is recommended to request a genetic study in all patients with pheochromocytomas since 40% of cases are hereditary. Once the diagnostic study is completed, preoperative treatment with alpha blockers should be instituted at least 7–14 days before adrenalectomy. However, in low-risk patients, the omission of presurgical treatment could be considered if the surgery is performed in centres with experience and a strict monitoring of the patient is carried out during the perioperative period. This document offers a practical guide on the diagnosis and perioperative approach in patients with pheochromocytomas.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"163 6","pages":"Pages 294-300"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315418","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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