Pub Date : 2025-10-01DOI: 10.1016/j.medcle.2025.107106
Neus Ruiz-Xivillé , Mireia Morgades , Laura Blanco , Dolors Costa , Blanca Espinet , Elisabet Talavera , Emma Triviño , Margarita Ortega , Eva Villamon , Lurdes Zamora , José Tomás Navarro , Montserrat Arnan , Susana Vives , Jordi Esteve , Jorge Sierra , Josep-Maria Ribera , Isabel Granada
Background and objective
In acute myeloid leukemia (AML), cytogenetic alterations have influence on treatment response and are essential for risk stratification, although some have uncertain prognostic relevance. In this study, the prognostic impact of cytogenetic alterations was analyzed in a series of newly diagnosed AML patients treated with risk-adapted protocols.
Patients and method
The cytogenetic profile of 1417 adult patients diagnosed with de novo AML (without t (15;17) or PML::RARA) enrolled in the CETLAM cooperative group protocols from 1994 to 2012 was studied, and its impact on survival was evaluated.
Results
Multivariable analysis showed that anomalies such as t (8;21) and inv(16)/t(16;16) predict a favorable prognosis, with no significant effect of additional anomalies on outcome. In contrast, abnormalities like monosomy of chromosome 7, structural alterations of chromosome 1, complex karyotype (5 or more abnormalities), and monosomal karyotype were associated with worse outcomes. Patients were classified into three prognostic groups based on their cytogenetic alterations, which demonstrated the effectiveness of the proposed system in predicting prognosis.
Conclusion
This study confirms the prognostic impact of cytogenetic alterations in AML and their usefulness in stratifying patients into risk groups.
{"title":"Prognostic impact of cytogenetic alterations in newly diagnosed acute myeloid leukemia treated with risk-adapted protocols","authors":"Neus Ruiz-Xivillé , Mireia Morgades , Laura Blanco , Dolors Costa , Blanca Espinet , Elisabet Talavera , Emma Triviño , Margarita Ortega , Eva Villamon , Lurdes Zamora , José Tomás Navarro , Montserrat Arnan , Susana Vives , Jordi Esteve , Jorge Sierra , Josep-Maria Ribera , Isabel Granada","doi":"10.1016/j.medcle.2025.107106","DOIUrl":"10.1016/j.medcle.2025.107106","url":null,"abstract":"<div><h3>Background and objective</h3><div>In acute myeloid leukemia (AML), cytogenetic alterations have influence on treatment response and are essential for risk stratification, although some have uncertain prognostic relevance. In this study, the prognostic impact of cytogenetic alterations was analyzed in a series of newly diagnosed AML patients treated with risk-adapted protocols.</div></div><div><h3>Patients and method</h3><div>The cytogenetic profile of 1417 adult patients diagnosed with de novo AML (without t (15;17) or <em>PML</em>::<em>RARA</em>) enrolled in the CETLAM cooperative group protocols from 1994 to 2012 was studied, and its impact on survival was evaluated.</div></div><div><h3>Results</h3><div>Multivariable analysis showed that anomalies such as t (8;21) and inv(16)/t(16;16) predict a favorable prognosis, with no significant effect of additional anomalies on outcome. In contrast, abnormalities like monosomy of chromosome 7, structural alterations of chromosome 1, complex karyotype (5 or more abnormalities), and monosomal karyotype were associated with worse outcomes. Patients were classified into three prognostic groups based on their cytogenetic alterations, which demonstrated the effectiveness of the proposed system in predicting prognosis.</div></div><div><h3>Conclusion</h3><div>This study confirms the prognostic impact of cytogenetic alterations in AML and their usefulness in stratifying patients into risk groups.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107106"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290198","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107153
Camila Milad , Sergio Logwin , Nerea Antón , Amanda Jiménez , Lilliam Flores , Ainitze Ibarzábal , Violeta Moizé , Adriana Pané , Josep Vidal , Ana de Hollanda
Introduction
Approximately 25– of patients undergoing bariatric surgery (BS) experience weight regain or suboptimal weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a therapeutic option in these cases.
Aim
To evaluate the effectiveness of GLP-1 RAs in managing weight regain and suboptimal weight response after BS in a real-world setting.
Materials and methods
Retrospective study of BS patients treated with GLP-1 RAs due to weight regain or suboptimal weight response.
Results
A total of 953 patients underwent BS between 2015 and 2020; 122 initiated treatment with GLP-1 RAs. The cohort was composed 78% women, with a mean age of 50.4 ± 10.6 years and a baseline BMI of 44.7 ± 6.3 kg/m2. At the start of treatment, 41.9 ± 20.5 months post-BS, the mean weight loss was 18.6 ± 10%; 52% had lost <20% of their initial weight and 82% had regained >20% of the weight lost. 35% received liraglutide (LIRA) (1.8 ± 0.5 mg/day) and 65% semaglutide (SEMA) (1.0 ± 0.8 mg/week), with a mean treatment duration of 19.3 ± 17.3 months. Maximum weight loss was 4.7 ± 4.8% with LIRA vs. 8.3 ± 5.9% with SEMA (p = 0.01). Total weight loss (BS + GLP-1 RA) was 21.6 ± 9.2% with LIRA vs. 25.6 ± 10.5% with SEMA. The proportion of patients with a suboptimal weight response after BS + pharmacotherapy (<20%) significantly decreased (from 52% to 31%).
Conclusions
SEMA led to greater weight reduction than LIRA, positioning it as a more effective option for managing post-BS weight regain.
{"title":"Treatment of obesity with GLP-1 receptor agonist after bariatric surgery: Real-world evidence","authors":"Camila Milad , Sergio Logwin , Nerea Antón , Amanda Jiménez , Lilliam Flores , Ainitze Ibarzábal , Violeta Moizé , Adriana Pané , Josep Vidal , Ana de Hollanda","doi":"10.1016/j.medcle.2025.107153","DOIUrl":"10.1016/j.medcle.2025.107153","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 25– of patients undergoing bariatric surgery (BS) experience weight regain or suboptimal weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a therapeutic option in these cases.</div></div><div><h3>Aim</h3><div>To evaluate the effectiveness of GLP-1 RAs in managing weight regain and suboptimal weight response after BS in a real-world setting.</div></div><div><h3>Materials and methods</h3><div>Retrospective study of BS patients treated with GLP-1 RAs due to weight regain or suboptimal weight response.</div></div><div><h3>Results</h3><div>A total of 953 patients underwent BS between 2015 and 2020; 122 initiated treatment with GLP-1 RAs. The cohort was composed 78% women, with a mean age of 50.4 ± 10.6 years and a baseline BMI of 44.7 ± 6.3 kg/m<sup>2</sup>. At the start of treatment, 41.9 ± 20.5 months post-BS, the mean weight loss was 18.6 ± 10%; 52% had lost <20% of their initial weight and 82% had regained >20% of the weight lost. 35% received liraglutide (LIRA) (1.8 ± 0.5 mg/day) and 65% semaglutide (SEMA) (1.0 ± 0.8 mg/week), with a mean treatment duration of 19.3 ± 17.3 months. Maximum weight loss was 4.7 ± 4.8% with LIRA vs. 8.3 ± 5.9% with SEMA (p = 0.01). Total weight loss (BS + GLP-1 RA) was 21.6 ± 9.2% with LIRA vs. 25.6 ± 10.5% with SEMA. The proportion of patients with a suboptimal weight response after BS + pharmacotherapy (<20%) significantly decreased (from 52% to 31%).</div></div><div><h3>Conclusions</h3><div>SEMA led to greater weight reduction than LIRA, positioning it as a more effective option for managing post-BS weight regain.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107153"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290206","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107122
Gilberto Pérez López
Obesity represents a global public health challenge, with specific characteristics and needs in adolescent and elderly populations. GLP-1 (glucagon-like peptide-1) receptor agonists such as liraglutide and semaglutide, as well as the GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor co-agonist tirzepatide, have emerged as promising therapeutic options for obesity management. This review analyzes the clinical development, efficacy, safety, and tolerability of these drugs specifically in adolescents and the elderly, populations typically underrepresented in initial clinical trials. Findings from pivotal clinical studies and real-world data are detailed, showing that these medications offer significant benefits in weight reduction, albeit with particular safety considerations for each age group. Additionally, emerging GLP-1 molecules in clinical development with potential application in these special populations are explored. The conclusions emphasize the need for a personalized approach considering the specific pathophysiological, pharmacokinetic, and pharmacodynamic differences of each population group.
{"title":"GLP-1 receptor agonists and GIP/GLP-1 co-agonists in the treatment of obesity in adolescents and the elderly","authors":"Gilberto Pérez López","doi":"10.1016/j.medcle.2025.107122","DOIUrl":"10.1016/j.medcle.2025.107122","url":null,"abstract":"<div><div>Obesity represents a global public health challenge, with specific characteristics and needs in adolescent and elderly populations. GLP-1 (glucagon-like peptide-1) receptor agonists such as liraglutide and semaglutide, as well as the GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor co-agonist tirzepatide, have emerged as promising therapeutic options for obesity management. This review analyzes the clinical development, efficacy, safety, and tolerability of these drugs specifically in adolescents and the elderly, populations typically underrepresented in initial clinical trials. Findings from pivotal clinical studies and real-world data are detailed, showing that these medications offer significant benefits in weight reduction, albeit with particular safety considerations for each age group. Additionally, emerging GLP-1 molecules in clinical development with potential application in these special populations are explored. The conclusions emphasize the need for a personalized approach considering the specific pathophysiological, pharmacokinetic, and pharmacodynamic differences of each population group.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107122"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290207","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107076
Enrique Casado , Guillermo Martínez-Díaz-Guerra , José Ramon Caeiro
Teriparatide (TPTD) and abaloparatide (ABL) are osteoanabolic drugs belonging to the group of parathyroid hormone analogues and parathyroid hormone-related protein analogues, respectively. Both drugs have been shown to be effective and safe in the treatment of postmenopausal osteoporosis (PMO), reducing the risk of vertebral and nonvertebral fractures and improving bone microarchitecture, especially in patients with severe osteoporosis. For this reason, guidelines recommend their use as first-line treatment for patients at very high risk of fracture. Although TPTD and ABL act on the same receptor, PTHR1, they trigger a different signalling response, which explains why their effects on bone remodelling are also different, with similar osteoanabolic action, but with less stimulation of resorption by ABL, which confers a greater benefit on cortical bone.
{"title":"PTH/PTHrP analogues as osteoanabolic treatment in patients with osteoporosis","authors":"Enrique Casado , Guillermo Martínez-Díaz-Guerra , José Ramon Caeiro","doi":"10.1016/j.medcle.2025.107076","DOIUrl":"10.1016/j.medcle.2025.107076","url":null,"abstract":"<div><div>Teriparatide (TPTD) and abaloparatide (ABL) are osteoanabolic drugs belonging to the group of parathyroid hormone analogues and parathyroid hormone-related protein analogues, respectively. Both drugs have been shown to be effective and safe in the treatment of postmenopausal osteoporosis (PMO), reducing the risk of vertebral and nonvertebral fractures and improving bone microarchitecture, especially in patients with severe osteoporosis. For this reason, guidelines recommend their use as first-line treatment for patients at very high risk of fracture. Although TPTD and ABL act on the same receptor, PTHR1, they trigger a different signalling response, which explains why their effects on bone remodelling are also different, with similar osteoanabolic action, but with less stimulation of resorption by ABL, which confers a greater benefit on cortical bone.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107076"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290205","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107119
Víctor Manuel Martínez-Castilla , Marina Valenzuela-Espejo , Yaiza Díaz-Castillo , Marta Bacete-Cebrián , Rubén Alonso-Beato , Arturo Álvarez-Luque , Luís Antonio Álvarez-Sala Walther , Francisco Galeano-Valle
Introduction
Segmental arterial mediolysis (SAM) and fibromuscular dysplasia (FMD) are rare vasculopathies. Differentiating between them is difficult due to its similarities. The aim is to describe and compare the clinical characteristics, presenting symptoms, diagnostic tests, treatment, and outcomes.
Patients and methods
Single center retrospective review of patients diagnosed with FMD or SAM between 2016 and 2023.
Results
Four patients with SAM and 18 with FMD were included. SAM predominated in males with abdominal pain (75%), while FMD in young women (61.1%) with neurological manifestations (66.6%). Anticoagulation was the main treatment for SAM, and antiplatelet therapy for FMD. Surgical treatment was performed in 25% and 22.2%, while percutaneous intervention was performed in none and 27.7% of patient, respectively. During follow-up (median 3.4 years), mortality was similar in both groups (10%).
Conclusion
There are key differences in clinical presentation, management, and outcomes that may help guide the treatment of both conditions.
{"title":"Clinical spectrum and therapeutic strategies of fibromuscular dysplasia and segmental arterial mediolysis: A cohort study","authors":"Víctor Manuel Martínez-Castilla , Marina Valenzuela-Espejo , Yaiza Díaz-Castillo , Marta Bacete-Cebrián , Rubén Alonso-Beato , Arturo Álvarez-Luque , Luís Antonio Álvarez-Sala Walther , Francisco Galeano-Valle","doi":"10.1016/j.medcle.2025.107119","DOIUrl":"10.1016/j.medcle.2025.107119","url":null,"abstract":"<div><h3>Introduction</h3><div>Segmental arterial mediolysis (SAM) and fibromuscular dysplasia (FMD) are rare vasculopathies. Differentiating between them is difficult due to its similarities. The aim is to describe and compare the clinical characteristics, presenting symptoms, diagnostic tests, treatment, and outcomes.</div></div><div><h3>Patients and methods</h3><div>Single center retrospective review of patients diagnosed with FMD or SAM between 2016 and 2023.</div></div><div><h3>Results</h3><div>Four patients with SAM and 18 with FMD were included. SAM predominated in males with abdominal pain (75%), while FMD in young women (61.1%) with neurological manifestations (66.6%). Anticoagulation was the main treatment for SAM, and antiplatelet therapy for FMD. Surgical treatment was performed in 25% and 22.2%, while percutaneous intervention was performed in none and 27.7% of patient, respectively. During follow-up (median 3.4 years), mortality was similar in both groups (10%).</div></div><div><h3>Conclusion</h3><div>There are key differences in clinical presentation, management, and outcomes that may help guide the treatment of both conditions.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107119"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290199","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107043
Pablo Peláez , Pilar Peris , Núria Guañabens
Background
Camurati–Engelmann disease (CED) is an extremely rare autosomal dominant bone dysplasia characterized by hyperostosis of the long bones and, in severe cases, of the skull and axial skeleton. This study aims to analyze the impact on quality of life in a non-selected group of CED patients.
Methods
This monocentric case series study included 15 patients who completed a survey that collected demographic characteristics, disease-related information and a validated SF-12 questionnaire to assess quality of life. Physical (PCS-12) and Mental (MCS-12) Component Summary scores were compared with the mean SF-12 scores of the U.S. reference population.
Results
Patients had significantly lower PCS-12 score [29.8 (7.5)] compared to the reference population [50.0 (10.0)] (p < 0.0001). However, there were no differences in the MCS-12 score [48.8 (11.23) vs 50.0 (10.0)]. The most reported symptoms were fatigue (100%), pain in the limbs (93.3%) and muscle pain (86.7%).
Conclusions
CED patients have significantly lower physical quality of life than the general population, due to the high prevalence of physically limiting problems. However, mental health appears unaffected.
{"title":"Health-related quality of life in patients with Camurati–Engelmann disease: A case series study","authors":"Pablo Peláez , Pilar Peris , Núria Guañabens","doi":"10.1016/j.medcle.2025.107043","DOIUrl":"10.1016/j.medcle.2025.107043","url":null,"abstract":"<div><h3>Background</h3><div>Camurati–Engelmann disease (CED) is an extremely rare autosomal dominant bone dysplasia characterized by hyperostosis of the long bones and, in severe cases, of the skull and axial skeleton. This study aims to analyze the impact on quality of life in a non-selected group of CED patients.</div></div><div><h3>Methods</h3><div>This monocentric case series study included 15 patients who completed a survey that collected demographic characteristics, disease-related information and a validated SF-12 questionnaire to assess quality of life. Physical (PCS-12) and Mental (MCS-12) Component Summary scores were compared with the mean SF-12 scores of the U.S. reference population.</div></div><div><h3>Results</h3><div>Patients had significantly lower PCS-12 score [29.8 (7.5)] compared to the reference population [50.0 (10.0)] (<em>p</em> <!--><<!--> <!-->0.0001). However, there were no differences in the MCS-12 score [48.8 (11.23) vs 50.0 (10.0)]. The most reported symptoms were fatigue (100%), pain in the limbs (93.3%) and muscle pain (86.7%).</div></div><div><h3>Conclusions</h3><div>CED patients have significantly lower physical quality of life than the general population, due to the high prevalence of physically limiting problems. However, mental health appears unaffected.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107043"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290196","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 : 2025-10-01DOI: 10.1016/j.medcle.2025.107069
Alex de Novais Batista, João Eudes Magalhães
{"title":"Scalloped pupil in a patient with hereditary amyloidosis transthyretin","authors":"Alex de Novais Batista, João Eudes Magalhães","doi":"10.1016/j.medcle.2025.107069","DOIUrl":"10.1016/j.medcle.2025.107069","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 4","pages":"Article 107069"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290017","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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