Burgos Bencosme N, Herrera Parra JE, Antuña Montes L
… +3 more, Rodríguez Santiago SE, González Delgado M, Gutiérrez Rodríguez J
Med Clin (Barc)
· 2026 Jun · PMID 42365807
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BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) and prolonged hospitalization are known risk factors for cognitive decline (CD). However, whether anticoagulation quality during admission is associated with differences...BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) and prolonged hospitalization are known risk factors for cognitive decline (CD). However, whether anticoagulation quality during admission is associated with differences in CD risk among geriatric patients remains unknown. The objective is to evaluate the association between anticoagulation profile and the frequency of new-onset CD in older hospitalized patients with AF. MATERIAL AND METHODS: Ambispective observational study including 254 patients aged ≥80 years with AF admitted to an acute geriatric unit (2019-2022). The retrospective phase included the collection of baseline clinical variables from electronic health records; the prospective phase comprised scheduled cognitive follow-up at 6 and 12 months after discharge. Hospital length of stay and anticoagulation quality (Adequate, Inadequate/Underdosing, or No treatment) were analyzed. The primary outcome was the cumulative frequency of new-onset CD at 12 months. RESULTS: The cumulative frequency of CD was 18.9%. Patients with adequate anticoagulation had a lower frequency (13.5%; 95%CI 8.3-18.7) compared with those with inadequate dosing (27.9%; 95%CI 18.2-37.6) and no treatment (33.9%; 95%CI 21.4-46.4). In multivariable analysis, inadequate anticoagulation (HR 1.78; 95%CI 1.15-2.85) and absence of treatment (HR 2.25; 95%CI 1.35-3.65) were independently associated with CD, as was very prolonged hospital stay (HR 2.41; 95%CI 1.45-3.95). Adequate anticoagulation was associated with greater deterioration-free survival even among patients with prolonged stays. CONCLUSIONS: Prolonged hospitalization and inadequate or absent anticoagulation were associated with a higher frequency of new-onset cognitive decline. Optimizing anticoagulation represents a recommended and timely strategy associated with cognitive preservation in older hospitalized patients.
Med Clin (Barc)
· 2026 Jun · PMID 42365806
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INTRODUCTION: The study of oropharyngeal infection with Human Papillomavirus (HPV) has become increasingly relevant in recent years due to its association with oropharyngeal carcinomas. Unlike genital infection, the natu...INTRODUCTION: The study of oropharyngeal infection with Human Papillomavirus (HPV) has become increasingly relevant in recent years due to its association with oropharyngeal carcinomas. Unlike genital infection, the natural history of oropharyngeal infection remains poorly understood, and no population-based screening programs are currently available. In the search for potential risk groups, this study aimed to evaluate the prevalence of oropharyngeal HPV infection in women with persistent genital HPV infection. MATERIALS AND METHODS: A cross-sectional study was conducted in 135 women with persistent genital HPV infection. Patients with genital lesions and immunosuppression were excluded. Gynecological and oropharyngeal samples were collected from each participant by brushing and analyzed with PCR and hybrid capture for viral detection and genotyping. Clinical, immunological, and sexual behavior variables were also recorded. RESULTS: The prevalence of oropharyngeal HPV infection was 1.48% (2/135). The genotypes detected were HPV 52 and HPV 66. The mean age was 44.3 years. Single genotype genital infection was identified in 62.2% of cases. Orogenital intercourses were reported by 77.8% of participants, with limited use of barrier protection methods. Additionally, 57.1% had received HPV vaccination. CONCLUSION: The low prevalence observed contrasts with previous studies conducted in the general population, suggesting that women with persistent genital HPV infection do not appear to be more susceptible to oropharyngeal infection. However, further studies are needed to confirm these findings.
Gamazo-Herrero J, Vela-Martín A, Rodríguez-Delgado L
… +4 more, Gómez-García S, Martín-Asenjo M, Cusacovich I, González-Fuentes R
Med Clin (Barc)
· 2026 Jun · PMID 42365805
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BACKGROUND AND OBJECTIVE: The classic treatment for giant cell arteritis (GCA) is based on glucocorticoids (GC), whose prolonged use causes adverse effects. Therefore, GC-sparing drugs are used, although few direct compa...BACKGROUND AND OBJECTIVE: The classic treatment for giant cell arteritis (GCA) is based on glucocorticoids (GC), whose prolonged use causes adverse effects. Therefore, GC-sparing drugs are used, although few direct comparative studies exist. We assessed the efficacy and safety of GC monotherapy (GC), GC with methotrexate (GC+MTX), and GC with tocilizumab (GC+TCZ). METHODS: Retrospective cohort study of patients with GCA. A composite endpoint (REACT-G) was defined that included relapses, serious infections, and GC-related adverse events at 78 weeks, and the cumulative dose of GC was analyzed. RESULTS: A total of 52 patients were included; 15 received GC, 30 received GC+MTX, and 7 received GC+TCZ. The REACT-G endpoint occurred in 27 patients, mainly due to relapses. GC+TCZ was associated with a lower REACT-G rate (14%) than GC (67%) and GC+MTX (53%) (p=0.082). In the GC+MTX group, the REACT-G was lower with higher doses of MTX (p=0.009). In the multivariate analysis, the use of GC+TCZ was the only independent protective factor against REACT-G (p=0.038). The cumulative GC dose at 78 weeks was higher in the GC group (7143.7±2977.7mg) than in GC+MTX group (5273.2±1745.3mg; p=0.032) and GC+TCZ group (3733.9±2286.8mg; p=0.005). In the multivariate analysis, only the GC+TCZ group accumulated significantly lower GC doses (p=0.034). CONCLUSIONS: Compared with GC, GC+TCZ combination was associated with a significant reduction in REACT-G events in the multivariate analysis and a lower cumulative dose of GC at 78 weeks. The benefit of GC+MTX was moderate and, like the prevention of REACT-G events, appears to be dose-dependent.
Cetin TE, Tomar VB, Eken Y
… +6 more, Ogut B, Gonul II, Helvaci O, Derici U, Guz G, Akcay OF
Med Clin (Barc)
· 2026 Jun · PMID 42364282
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BACKGROUND: Thrombotic microangiopathy (TMA) represents a heterogeneous clinicopathologic entity characterized by endothelial injury, microvascular thrombosis, and variable clinical outcomes. Data on prognostic factors i...BACKGROUND: Thrombotic microangiopathy (TMA) represents a heterogeneous clinicopathologic entity characterized by endothelial injury, microvascular thrombosis, and variable clinical outcomes. Data on prognostic factors in biopsy-proven TMA remain limited. METHODS: This retrospective single-center study included 46 adult patients with biopsy-proven TMA diagnosed between 2000 and 2025. Demographic, clinical, laboratory, histopathologic, and genetic parameters were analyzed. The composite adverse outcome was defined as death or progression to end-stage renal disease (ESRD). Logistic regression analysis was performed to identify prognostic determinants. RESULTS: The most common etiologies were atypical hemolytic uremic syndrome (37.0%) and peripartum (pregnancy-associated) thrombotic microangiopathy (26.1%). During follow-up, 43.5% of patients progressed to end-stage renal disease or died. In univariate analyses, the presence of acute kidney injury at diagnosis (p=0.017) and lower estimated glomerular filtration rate (eGFR) (p=0.016) were associated with poorer outcomes. In contrast, both early treatment response within the first week (p=0.004) and peripartum TMA (p=0.042) were associated with more favorable outcomes. Notably, early treatment response remained significantly associated with improved outcomes in multivariate analyses (odds ratio [OR]=0.15; 95% confidence interval [CI], 0.03-0.75; p=0.021). Complement gene variants were identified in 5 of 10 tested patients, supporting a potential role for complement dysregulation in the pathogenesis of TMA. CONCLUSIONS: Early on-treatment response may serve as a dynamic prognostic marker reflecting short-term disease trajectory in biopsy-proven TMA. These findings highlight the potential importance of timely recognition and close monitoring of treatment response in patients with biopsy-proven TMA.
Med Clin (Barc)
· 2026 Jun · PMID 42330685
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BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a common complication among critically ill patients. Existing evidence indicates that critically ill patients frequently develop low triiodothyronine syndrome...BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a common complication among critically ill patients. Existing evidence indicates that critically ill patients frequently develop low triiodothyronine syndrome (LTS), and this thyroid hormone imbalance may disrupt muscle metabolic pathways and thereby promote the onset and progression of ICU-AW. However, the relationship between FT levels and ICU-AW remains inconclusive, and clinical research addressing this link remains limited. Accordingly, this study aims to examine the clinical relationship between FT levels and ICU-AW. METHODS: We enrolled patients with mechanical ventilation in the ICU of the Second Affiliated Hospital of Harbin Medical University from June 2024 to December 2025, dividing them into low-T group (n=46, FT<2.43pmol/L) and non-low T group (n=33, FT≥2.43pmol/L) by admission FT levels. ICU-AW was defined as a Medical Research Council score≤48. We collected clinical data including demographics, comorbidities and laboratory results, compared baseline characteristics, and adopted correlation, regression and subgroup analyses to assess relevant associations. RESULTS: Among 79 patients, 58.2% had reduced admission FT, and its incidence decreased with increasing MRC scores. Spearman analysis showed FT levels were positively correlated with MRC scores. Fully adjusted logistic regression confirmed FT as a factor associated with ICU-AW (OR=0.31; 95% CI, 0.10-0.97; p=0.0447). ROC analysis indicated FT had good discrimination for ICU-AW (AUC=0.84). CONCLUSIONS: Reduced FT levels are closely associated with the development of ICU-acquired weakness, with higher FT levels showing a positive correlation with higher MRC scores and a negative correlation with the risk of ICU-AW. TRIAL REGISTRATION: The study has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2500100201, registration date: April 3, 2025). This study is a retrospective registration.