Pub Date : 2026-01-01Epub Date: 2026-02-18DOI: 10.1016/j.medcle.2026.107251
Thais Lizondo López , Belén López García , Neus Basté , Isabel Vilaseca , Juan José Grau , Esther Carcelero San Martín
Introduction
Recurrent respiratory papillomatosis is a rare benign airway disease caused by human papillomavirus, typically types 6 and 11. Management is often difficult due to high recurrence rates and lack of effective pharmacologic options. Recent studies suggest that EGFR and COX-2 pathways play a role in the pathogenesis of human papillomavirus-related lesions.
Patients and methods
We present an observational retrospective study of three patients with PCR confirmed human papillomavirus DNA associated to recurrent respiratory papillomatosis treated with erlotinib and celecoxib at a tertiary hospital between 2017 and 2024. Inclusion criteria were histological diagnosis, prior failure to conventional therapies, and complete clinical follow-up.
Results
Two patients exhibited sustained improvement in symptoms and lesion burden, with no significant adverse events. In one case, treatment was well tolerated over six years. A third patient discontinued therapy due to disease progression, treated with immunotherapy afterwards.
Conclusion
Combined EGFR and COX-2 inhibition may be a promising treatment strategy for recurrent respiratory papillomatosis refractory to standard therapy. These preliminary observations support further prospective investigation in selected patients.
{"title":"Recurrent respiratory papillomatosis treated with combined erlotinib and celecoxib: A retrospective study","authors":"Thais Lizondo López , Belén López García , Neus Basté , Isabel Vilaseca , Juan José Grau , Esther Carcelero San Martín","doi":"10.1016/j.medcle.2026.107251","DOIUrl":"10.1016/j.medcle.2026.107251","url":null,"abstract":"<div><h3>Introduction</h3><div>Recurrent respiratory papillomatosis is a rare benign airway disease caused by human papillomavirus, typically types 6 and 11. Management is often difficult due to high recurrence rates and lack of effective pharmacologic options. Recent studies suggest that EGFR and COX-2 pathways play a role in the pathogenesis of human papillomavirus-related lesions.</div></div><div><h3>Patients and methods</h3><div>We present an observational retrospective study of three patients with PCR confirmed human papillomavirus DNA associated to recurrent respiratory papillomatosis treated with erlotinib and celecoxib at a tertiary hospital between 2017 and 2024. Inclusion criteria were histological diagnosis, prior failure to conventional therapies, and complete clinical follow-up.</div></div><div><h3>Results</h3><div>Two patients exhibited sustained improvement in symptoms and lesion burden, with no significant adverse events. In one case, treatment was well tolerated over six years. A third patient discontinued therapy due to disease progression, treated with immunotherapy afterwards.</div></div><div><h3>Conclusion</h3><div>Combined EGFR and COX-2 inhibition may be a promising treatment strategy for recurrent respiratory papillomatosis refractory to standard therapy. These preliminary observations support further prospective investigation in selected patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107251"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409495","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 : 2026-01-01Epub Date: 2026-02-18DOI: 10.1016/j.medcle.2026.107247
Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo
Background and objectives
Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).
Methods
We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.
Results
One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.
Conclusions
Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.
{"title":"Initiation and titration of guideline-directed medical therapy during hospitalization for acute decompensation of heart failure with reduced ejection fraction","authors":"Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo","doi":"10.1016/j.medcle.2026.107247","DOIUrl":"10.1016/j.medcle.2026.107247","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).</div></div><div><h3>Methods</h3><div>We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.</div></div><div><h3>Results</h3><div>One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.</div></div><div><h3>Conclusions</h3><div>Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107247"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409720","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 : 2026-01-01Epub Date: 2026-02-18DOI: 10.1016/j.medcle.2026.107264
Cristina Cremades Artacho, Inés Monge-Escartín, Esther Carcelero San Martín
{"title":"Treatment of aspergillosis in a hematologic patient with intraventricular amphotericin B","authors":"Cristina Cremades Artacho, Inés Monge-Escartín, Esther Carcelero San Martín","doi":"10.1016/j.medcle.2026.107264","DOIUrl":"10.1016/j.medcle.2026.107264","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107264"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394965","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 : 2026-01-01Epub Date: 2026-02-18DOI: 10.1016/j.medcle.2026.107232
Antonio San-José , María José Abadías , Emmanuel Giménez , Marta Losada , Carmen Pérez-Bocanegra , María Gabriela Carrizo , María Arranz , Jordi Acezat , Jordi Ibáñez , Miriam Barrecheguren , Ana Belén Méndez , Neus Gual
Background
With an ageing population, the prevalence of multimorbidity is increasing. This leads to increasing frailty and repeated Emergency Department (ED) visits. This study aim was to evaluate the impact of an integrated transitional care programme on ED revisits and Health-Related-Quality-of-Life (HRQoL) in older patients with multimorbidity.
Methods
Prospective intervention pre-post study comparing the programme impact 6 months before and 6 after launching (from November-2022 to June-2023). The programme involved automated daily lists, a patient distribution protocol and a specialized case – manager nurse. Patients included had two or more ED visits in the 6 months prior due to Heart Failure (HF) decompensation or Chronic Obstructive Pulmonary Disease (COPD) exacerbation with multimorbidity. The programme involved the tertiary, intermediate and primary care centres of an integrated care health area of a Spanish city.
Results
In 126 older patients with multimorbidity and repeated ED visits (91 HF, 29 COPD, 6 both), an integrated transitional care programme resulted in a significant 33% reduction in ED visits after six months. The reduction was higher among women (39.6% reduction vs 27.6% in men) and patients experiencing HF (38.7% vs 17.2% in COPD). Most participants (68.2%) reported an improvement or maintenance of quality of life.
Conclusion
A combined intervention between automated lists, territorial consensus, and a specialized case-manager nurse is efficacious to achieve ED re-visits decreases with a majority of patients having maintained or improved HRQoL.
{"title":"Impact of an integrated transitional care programme for older patients with multimorbidity and repeated emergency department visits","authors":"Antonio San-José , María José Abadías , Emmanuel Giménez , Marta Losada , Carmen Pérez-Bocanegra , María Gabriela Carrizo , María Arranz , Jordi Acezat , Jordi Ibáñez , Miriam Barrecheguren , Ana Belén Méndez , Neus Gual","doi":"10.1016/j.medcle.2026.107232","DOIUrl":"10.1016/j.medcle.2026.107232","url":null,"abstract":"<div><h3>Background</h3><div>With an ageing population, the prevalence of multimorbidity is increasing. This leads to increasing frailty and repeated Emergency Department (ED) visits. This study aim was to evaluate the impact of an integrated transitional care programme on ED revisits and Health-Related-Quality-of-Life (HRQoL) in older patients with multimorbidity.</div></div><div><h3>Methods</h3><div>Prospective intervention pre-post study comparing the programme impact 6 months before and 6 after launching (from November-2022 to June-2023). The programme involved automated daily lists, a patient distribution protocol and a specialized case – manager nurse. Patients included had two or more ED visits in the 6 months prior due to Heart Failure (HF) decompensation or Chronic Obstructive Pulmonary Disease (COPD) exacerbation with multimorbidity. The programme involved the tertiary, intermediate and primary care centres of an integrated care health area of a Spanish city.</div></div><div><h3>Results</h3><div>In 126 older patients with multimorbidity and repeated ED visits (91 HF, 29 COPD, 6 both), an integrated transitional care programme resulted in a significant 33% reduction in ED visits after six months. The reduction was higher among women (39.6% reduction vs 27.6% in men) and patients experiencing HF (38.7% vs 17.2% in COPD). Most participants (68.2%) reported an improvement or maintenance of quality of life.</div></div><div><h3>Conclusion</h3><div>A combined intervention between automated lists, territorial consensus, and a specialized case-manager nurse is efficacious to achieve ED re-visits decreases with a majority of patients having maintained or improved HRQoL.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107232"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409612","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 : 2026-01-01Epub Date: 2026-01-31DOI: 10.1016/j.medcle.2026.107242
Daniel Enríquez-Vázquez , Gonzalo Barge-Caballero , Mario Porto-Souto , Manuel López-Pérez , Andrea López-López , Eva González-Babarro , Mario Gutiérrez-Feijoo , Raquel Bilbao-Quesada , Inés Gómez-Otero , Alfonso Varela-Román , María G. Crespo-Leiro , Eduardo Barge-Caballero
Introduction and objectives
Sex differences in clinical presentation of ATTR-CA have been described, although published information is scarce. We aimed to compare baseline characteristics and outcomes between women and men with ATTR-CA.
Methods
We evaluated all patients with ATTR-CA included in the Galician registry of cardiac amyloidosis (AMIGAL) between January 1st, 2018 and September 30th, 2023.
Results
We included 385 patients with ATTR-CA - 95 women (24.7%) and 290 men (75.3%), with a median age of 82.5 years. Female sex presented more frequently NYHA class ≥ III (36.8% vs. 25.2%, P = .028) and had higher LVEF (56.0% vs. 52.6%, P = .003) and indexed left ventricular maximum thickness (10.2 mm/m2 vs. 9.2 mm/m2, P = .001). Women received more thiazide diuretics (18.9% vs. 10.3%, P = .028) and less SGLT2i (15.8% vs. 27.2%, P = .024) and tafamidis (15.8% vs. 26.6%, P = .033). Incidence of HF hospitalizations was lower in female sex (IR 167.39 vs. 245.61, P = .033). There was no differences in mean survival, which was 4.1 years in both sexes.
Conclusions
Women with AC-ATTR presented with worse functional class, higher LVEF and higher left ventricular thicknesses than men. Female patients received less frequently SGLT2i and tafamidis, and were admitted to hospital for HF less frequently compared to male patients, while survival was similar.
介绍和目的atr - ca临床表现的性别差异已经被描述，尽管公开的信息很少。我们的目的是比较女性和男性atr - ca的基线特征和结果。方法：我们评估了2018年1月1日至2023年9月30日加利西亚心脏淀粉样变性（AMIGAL）登记的所有atr - ca患者。结果纳入385例atr - ca患者，女性95例（24.7%），男性290例（75.3%），中位年龄82.5岁。女性出现NYHA≥III级的频率更高（36.8%比25.2%,P = 0.028）， LVEF（56.0%比52.6%,P = 0.003）和指标性左室最大厚度（10.2 mm/m2比9.2 mm/m2, P = .001）。女性使用较多噻嗪类利尿剂（18.9% vs. 10.3%, P = 0.028），较少使用SGLT2i （15.8% vs. 27.2%, P = 0.024）和他法米底斯（15.8% vs. 26.6%, P = 0.033）。女性HF住院率较低（IR 167.39比245.61,P = 0.033）。男女的平均生存期均为4.1年，没有差异。结论AC-ATTR患者女性功能分级差，左室血流密度高，左室厚度高。与男性患者相比，女性患者接受SGLT2i和tafamidis治疗的频率较低，因心衰住院的频率也较低，但生存率相似。
{"title":"Clinical presentation and prognosis of transthyretin cardiac amyloidosis according to gender. Analysis of the Galician registry of cardiac amyloidosis (AMIGAL)","authors":"Daniel Enríquez-Vázquez , Gonzalo Barge-Caballero , Mario Porto-Souto , Manuel López-Pérez , Andrea López-López , Eva González-Babarro , Mario Gutiérrez-Feijoo , Raquel Bilbao-Quesada , Inés Gómez-Otero , Alfonso Varela-Román , María G. Crespo-Leiro , Eduardo Barge-Caballero","doi":"10.1016/j.medcle.2026.107242","DOIUrl":"10.1016/j.medcle.2026.107242","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Sex differences in clinical presentation of ATTR-CA have been described, although published information is scarce. We aimed to compare baseline characteristics and outcomes between women and men with ATTR-CA.</div></div><div><h3>Methods</h3><div>We evaluated all patients with ATTR-CA included in the Galician registry of cardiac amyloidosis (AMIGAL) between January 1st, 2018 and September 30th, 2023.</div></div><div><h3>Results</h3><div>We included 385 patients with ATTR-CA - 95 women (24.7%) and 290 men (75.3%), with a median age of 82.5 years. Female sex presented more frequently NYHA class ≥ III (36.8% vs. 25.2%, <em>P</em> = .028) and had higher LVEF (56.0% vs. 52.6%, <em>P</em> = .003) and indexed left ventricular maximum thickness (10.2 mm/m<sup>2</sup> vs. 9.2 mm/m<sup>2</sup>, <em>P</em> = .001). Women received more thiazide diuretics (18.9% vs. 10.3%, <em>P</em> = .028) and less SGLT2i (15.8% vs. 27.2%, <em>P</em> = .024) and tafamidis (15.8% vs. 26.6%, <em>P</em> = .033). Incidence of HF hospitalizations was lower in female sex (IR 167.39 vs. 245.61, <em>P</em> = .033). There was no differences in mean survival, which was 4.1 years in both sexes.</div></div><div><h3>Conclusions</h3><div>Women with AC-ATTR presented with worse functional class, higher LVEF and higher left ventricular thicknesses than men. Female patients received less frequently SGLT2i and tafamidis, and were admitted to hospital for HF less frequently compared to male patients, while survival was similar.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107242"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409613","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 : 2026-01-01Epub Date: 2026-02-18DOI: 10.1016/j.medcle.2026.107281
Aysun Şeker , Nurdan Şentürk Durmuş
Objective
Orthostatic hypotension (OH) is a common, but often overlooked, complication in patients with type 2 diabetes mellitus. The aim of this study was to evaluate the prevalence of OH in patients with type 2 diabetes mellitus and investigate its associations with glycemic control, medication use, and microvascular complications.
Research design and methods
This retrospective, cross-sectional study included 155 patients with type 2 diabetes mellitus. OH was defined as a sustained drop in systolic and/or diastolic blood pressure within 3 min of standing. Demographic data, laboratory parameters, and medication use were analyzed. Logistic regression models and receiver operating characteristic curve analyses were performed to identify and assess the predictive value of independent predictors of OH.
Results
Patients with OH (23.87%) had significantly higher HbA1c levels and a longer duration of diabetes. OH was significantly more common in patients taking diuretics and sodium-glucose co-transporter-2 (SGLT2) inhibitors. However, no significant association between OH and the use of ACE inhibitors (ACEIs) or angiotensin receptor blockers was observed. OH was significantly associated with diabetic neuropathy and retinopathy, but not with nephropathy. HbA1c was a significant predictor of OH, with an optimal cut-off value of 7.95% (sensitivity: 73%; specificity: 57%).
Conclusions
OH is prevalent in patients with type 2 diabetes mellitus and strongly associated with poor glycemic control, longer diabetes duration, and use of diuretics and SGLT2 inhibitors. Therefore, routine screening for OH in high-risk patients with type 2 diabetes mellitus is recommended. Optimization of glycemic control and careful medication selection may mitigate OH risk.
{"title":"Orthostatic hypotension in type 2 diabetes: Prevalence and risk factors","authors":"Aysun Şeker , Nurdan Şentürk Durmuş","doi":"10.1016/j.medcle.2026.107281","DOIUrl":"10.1016/j.medcle.2026.107281","url":null,"abstract":"<div><h3>Objective</h3><div>Orthostatic hypotension (OH) is a common, but often overlooked, complication in patients with type 2 diabetes mellitus. The aim of this study was to evaluate the prevalence of OH in patients with type 2 diabetes mellitus and investigate its associations with glycemic control, medication use, and microvascular complications.</div></div><div><h3>Research design and methods</h3><div>This retrospective, cross-sectional study included 155 patients with type 2 diabetes mellitus. OH was defined as a sustained drop in systolic and/or diastolic blood pressure within 3<!--> <!-->min of standing. Demographic data, laboratory parameters, and medication use were analyzed. Logistic regression models and receiver operating characteristic curve analyses were performed to identify and assess the predictive value of independent predictors of OH.</div></div><div><h3>Results</h3><div>Patients with OH (23.87%) had significantly higher HbA1c levels and a longer duration of diabetes. OH was significantly more common in patients taking diuretics and sodium-glucose co-transporter-2 (SGLT2) inhibitors. However, no significant association between OH and the use of ACE inhibitors (ACEIs) or angiotensin receptor blockers was observed. OH was significantly associated with diabetic neuropathy and retinopathy, but not with nephropathy. HbA1c was a significant predictor of OH, with an optimal cut-off value of 7.95% (sensitivity: 73%; specificity: 57%).</div></div><div><h3>Conclusions</h3><div>OH is prevalent in patients with type 2 diabetes mellitus and strongly associated with poor glycemic control, longer diabetes duration, and use of diuretics and SGLT2 inhibitors. Therefore, routine screening for OH in high-risk patients with type 2 diabetes mellitus is recommended. Optimization of glycemic control and careful medication selection may mitigate OH risk.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107281"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409616","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}
Gastrointestinal angiodysplasia (GIAD) is a common cause of obscure gastrointestinal bleeding. Pharmacological interventions assume significance in cases refractory to endoscopic management or in surgically inaccessible locations. A comprehensive literature search was conducted to identify relevant studies on the pharmacological management of GIAD, focusing primarily on hormonal therapy, thalidomide, and octreotide. Of 325 references, 290 were screened, 85 full texts were assessed, and 59 publications were included. Hormonal therapy lacks consistent evidence of efficacy and has significant side effects. Thalidomide has potential, albeit with substantial adverse events. Octreotide, demonstrates efficacy with minimal side effects, with its long-acting formulation appearing advantageous. While both thalidomide and octreotide present promising avenues, further research is warranted to assess their efficacy and safety profiles. Comparative studies could also provide invaluable insights for clinical practice.
{"title":"Pharmacological therapy for gastrointestinal angiodysplasia","authors":"Rita Tinoco Magalhães, Rita Valadas, Patrícia Cipriano, Diogo Cruz","doi":"10.1016/j.medcle.2026.107287","DOIUrl":"10.1016/j.medcle.2026.107287","url":null,"abstract":"<div><div>Gastrointestinal angiodysplasia (GIAD) is a common cause of obscure gastrointestinal bleeding. Pharmacological interventions assume significance in cases refractory to endoscopic management or in surgically inaccessible locations. A comprehensive literature search was conducted to identify relevant studies on the pharmacological management of GIAD, focusing primarily on hormonal therapy, thalidomide, and octreotide. Of 325 references, 290 were screened, 85 full texts were assessed, and 59 publications were included. Hormonal therapy lacks consistent evidence of efficacy and has significant side effects. Thalidomide has potential, albeit with substantial adverse events. Octreotide, demonstrates efficacy with minimal side effects, with its long-acting formulation appearing advantageous. While both thalidomide and octreotide present promising avenues, further research is warranted to assess their efficacy and safety profiles. Comparative studies could also provide invaluable insights for clinical practice.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107287"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409619","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}
Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune diseases characterized by skeletal muscle involvement. The association of anti-nuclear antibody (ANA) testing with clinical features in IIM patients has not been fully elucidated.
Methods
We retrospectively included patients who were diagnosed with IIM between January 2012 and February 2023, then systematically tested ANA titers and analyzed the ANA patterns of IIM patients by indirect immunofluorescence assay (IFA). Demographic, clinical and relevant laboratory data were recorded and further analyzed in 673 ANA-positive IIM patients.
Results
Of the 673 IIM patients, 487 (72.4%) were female. Nuclear speckled (58.2%) and cytoplasmic speckled (21.5%) were the most common observed ANA patterns in our cohort. The high ANA titer group had lower complement (C3: P = 0.001; C4: P < 0.0001), white blood cell counts (P = 0.023) and elevated positive rates of extractable nuclear antigen (ENA) antibodies (all P < 0.05) compared to the low ANA titer group. In addition, the proportion of nuclear speckled patterns was higher in the low ANA titer group (P < 0.0001), while the high ANA titer group displayed more cytoplasmic speckled patterns (P = 0.001). There were statistically significant differences in ANA titers (P = 0.015) and patterns (P = 0.023) among different myositis subtypes. Meanwhile, it was notable that patients with cytoplasmic speckled patterns had the highest interstitial lung disease (ILD) prevalence.
Conclusions
ANA titers and patterns may predict prognosis in IIM patients.
背景：特发性炎症性肌病（IIMs）是一组以累及骨骼肌为特征的自身免疫性疾病。抗核抗体（ANA）检测与IIM患者临床特征的关系尚未完全阐明。方法回顾性纳入2012年1月至2023年2月诊断为IIM的患者，系统检测患者的ANA滴度，并采用间接免疫荧光法（IFA）分析IIM患者的ANA模式。对673例ana阳性IIM患者的人口学、临床及相关实验室资料进行记录和分析。结果673例IIM患者中，女性487例，占72.4%。核斑（58.2%）和细胞质斑（21.5%）是我们队列中最常见的ANA模式。与低ANA滴度组相比，高ANA滴度组补体较低（C3: P = 0.001; C4: P < 0.0001），白细胞计数较低（P = 0.023），可提取核抗原（ENA）抗体阳性率较高（P < 0.05）。此外，低ANA滴度组核斑型比例更高（P < 0.0001），而高ANA滴度组出现更多细胞质斑型（P = 0.001）。不同肌炎亚型间ANA滴度（P = 0.015）和模式（P = 0.023）差异均有统计学意义。同时，值得注意的是，细胞质斑点型患者的间质性肺病（ILD）患病率最高。结论ana滴度和模式可预测IIM患者的预后。
{"title":"The distribution and clinical significance of anti-nuclear antibodies in patients with idiopathic inflammatory myopathy in Southwest China","authors":"Yixue Guo , Hongjiang Liu , Keyi Zhang , Liye Meng , Qian Niu , Junlong Zhang , Qibing Xie , Zhuochun Huang","doi":"10.1016/j.medcle.2026.107273","DOIUrl":"10.1016/j.medcle.2026.107273","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune diseases characterized by skeletal muscle involvement. The association of anti-nuclear antibody (ANA) testing with clinical features in IIM patients has not been fully elucidated.</div></div><div><h3>Methods</h3><div>We retrospectively included patients who were diagnosed with IIM between January 2012 and February 2023, then systematically tested ANA titers and analyzed the ANA patterns of IIM patients by indirect immunofluorescence assay (IFA). Demographic, clinical and relevant laboratory data were recorded and further analyzed in 673 ANA-positive IIM patients.</div></div><div><h3>Results</h3><div>Of the 673 IIM patients, 487 (72.4%) were female. Nuclear speckled (58.2%) and cytoplasmic speckled (21.5%) were the most common observed ANA patterns in our cohort. The high ANA titer group had lower complement (C3: <em>P</em> <!-->=<!--> <!-->0.001; C4: <em>P</em> <!--><<!--> <!-->0.0001), white blood cell counts (<em>P</em> <!-->=<!--> <!-->0.023) and elevated positive rates of extractable nuclear antigen (ENA) antibodies (all <em>P</em> <!--><<!--> <!-->0.05) compared to the low ANA titer group. In addition, the proportion of nuclear speckled patterns was higher in the low ANA titer group (<em>P</em> <!--><<!--> <!-->0.0001), while the high ANA titer group displayed more cytoplasmic speckled patterns (<em>P</em> <!-->=<!--> <!-->0.001). There were statistically significant differences in ANA titers (<em>P</em> <!-->=<!--> <!-->0.015) and patterns (<em>P</em> <!-->=<!--> <!-->0.023) among different myositis subtypes. Meanwhile, it was notable that patients with cytoplasmic speckled patterns had the highest interstitial lung disease (ILD) prevalence.</div></div><div><h3>Conclusions</h3><div>ANA titers and patterns may predict prognosis in IIM patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107273"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409718","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 : 2026-01-01Epub Date: 2026-02-09DOI: 10.1016/j.medcle.2026.107288
Pablo Mozas , David Quintela , Ángel Serna , on behalf of the Nexo en LLC
Despite its typically indolent course in most patients, chronic lymphocytic leukemia (CLL) can relapse or become refractory to the two main classes of drugs commonly used: covalent BTK inhibitors and BCL2 inhibitors. This review outlines the potential reasons for discontinuation of these drug classes, defines the concepts of double exposure (DE) and double refractoriness (DR), delineates the possible treatment sequences leading to DR, summarizes the poor prognosis of this patient subgroup, and describes the approved, investigational, and less optimal therapeutic alternatives for the management of this population. Finally, three illustrative clinical vignettes of patients with DE/DR CLL are presented, including case analysis and practical management recommendations, as well as teaching points.
{"title":"Double refractory chronic lymphocytic leukemia: clinical scenarios and therapeutic strategies","authors":"Pablo Mozas , David Quintela , Ángel Serna , on behalf of the Nexo en LLC","doi":"10.1016/j.medcle.2026.107288","DOIUrl":"10.1016/j.medcle.2026.107288","url":null,"abstract":"<div><div>Despite its typically indolent course in most patients, chronic lymphocytic leukemia (CLL) can relapse or become refractory to the two main classes of drugs commonly used: covalent BTK inhibitors and BCL2 inhibitors. This review outlines the potential reasons for discontinuation of these drug classes, defines the concepts of double exposure (DE) and double refractoriness (DR), delineates the possible treatment sequences leading to DR, summarizes the poor prognosis of this patient subgroup, and describes the approved, investigational, and less optimal therapeutic alternatives for the management of this population. Finally, three illustrative clinical vignettes of patients with DE/DR CLL are presented, including case analysis and practical management recommendations, as well as teaching points.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"166 1","pages":"Article 107288"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147409490","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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