Fraile Gómez P, López Cano M, Villanueva Sánchez E
… +3 more, Lizarazo Suarez A, Sánchez-Montero S, Lorenzo Gómez F
Med Clin (Barc)
· 2026 May · PMID 42150471
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INTRODUCTION: Kidney transplant (KT) recipients have a very high cardiovascular and renal risk. Sodium-glucose cotransporter-2 inhibitors (iSGLT2) have demonstrated cardiorenal benefits in non-transplanted populations wi...INTRODUCTION: Kidney transplant (KT) recipients have a very high cardiovascular and renal risk. Sodium-glucose cotransporter-2 inhibitors (iSGLT2) have demonstrated cardiorenal benefits in non-transplanted populations with chronic kidney disease, both diabetic and non-diabetic, but evidence in KT recipients remains scarce. There is an unmet clinical need for additional nephroprotective and cardiometabolic interventions in KT without diabetes mellitus (DM). We aimed to assess safety, renal function and metabolic effects of SGLT2i in non-diabetic KT recipients. METHODS: Retrospective single-centre observational study including 28 non-diabetic KT recipients (no pre-existing DM or post-transplant DM) from the University Hospital of Salamanca treated with SGLT2i (2023-2025). We analysed renal function trajectories (serum creatinine, eGFR CKD-EPI, urine protein/creatinine ratio [PCR] and urine albumin/creatinine ratio [ACR), lipid profile, electrolytes, HbA1c, immunosuppression, adverse events and acute rejection, with follow-up at 1, 6 and 12 months. RESULTS: Mean age at SGLT2i initiation was 57±13 years; 89,3% were men. The main indication was non-nephrotic proteinuria. After an initial eGFR decline, renal function subsequently stabilised. PCR and ACR decreased significantly at one year. Body mass index and total cholesterol also declined. There were no clinically relevant changes in immunosuppressant levels and no increase in rejection episodes. Diarrhoea and urinary tract infections (7%) were the most frequent adverse events, without euglycaemic ketoacidosis. CONCLUSIONS: SGLT2i therapy showed acceptable safety and a possible reno-metabolic benefit in non-diabetic KT recipients. Controlled trials with longer follow-up are required to determine the robustness of this indication.
Barroso Hernández S, Matallana Encinas E, Romero León JM
… +6 more, Guerrero Fernández A, Alcalá Peña MI, Rodríguez Sabillón JA, Álvarez López Á, Cerezo Arias I, Robles-Pérez Monteoliva NR
Med Clin (Barc)
· 2026 May · PMID 42140081
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INTRODUCTION: ANCA-associated vasculitides with anti-MPO or anti-PR3 specificity cause inflammation of the glomerular capillary, leading to deterioration of renal function and potentially resulting in advanced kidney dis...INTRODUCTION: ANCA-associated vasculitides with anti-MPO or anti-PR3 specificity cause inflammation of the glomerular capillary, leading to deterioration of renal function and potentially resulting in advanced kidney disease. Histological findings are overlapping for both subtypes; however, the genetic background differs, which may lead to differences in disease progression or response to treatment. OBJECTIVES: To evaluate the differences between both subtypes in the progression of renal function and in the responses to treatments administered in real-world clinical practice at a single center. MATERIALS AND METHODS: Patients with impaired renal function and ANCA positivity with anti-MPO or anti-PR3 specificity who had undergone a renal biopsy were included. RESULTS: A total of 113 patients were included, of whom 36% had histological findings different from those expected in the context of renal involvement due to vasculitis. No significant differences were found in the progression of renal function after treatment, nor between the different types of treatments administered. The determinants of renal survival were baseline creatinine levels, the presence of anti-GBM antibodies, and elevated levels of complement factor C4. A baseline creatinine level above 4mg/dL was associated with poorer renal survival. CONCLUSIONS: In patients with impaired renal function and anti-MPO or PR3 ANCA specificity who undergo a renal biopsy, we do not find significant differences in the progression of renal function between ANCA vasculitis subtypes or according to the type of immunosuppressive treatment administered. A high percentage of patients present histological findings that differ from those expected.
Sánchez Berná I, Martín Armada M, Zamora Pasadas M
… +2 more, Martín Belmonte AM, Navarrete Navarrete N
Med Clin (Barc)
· 2026 May · PMID 42140080
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INTRODUCTION: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by marked clinical and therapeutic heterogeneity. In Spain, patient care is primarily shared between Rheumatology and Interna...INTRODUCTION: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by marked clinical and therapeutic heterogeneity. In Spain, patient care is primarily shared between Rheumatology and Internal Medicine departments. The characterization of local patients series and their comparison with national registries allows clinical profiles and management patterns to be contextualized across different healthcare settings. METHODS: A retrospective cross-sectional study was conducted including all patients with SLE under active follow-up in a specialized autoimmune diseases unit within the Department of Internal Medicine at a Spanish tertiary hospital between 2024 and 2025. Demographic, clinical, immunological, and therapeutic variables were analyzed. Findings were compared with previously published data from the Spanish Society of Rheumatology's Systemic Lupus Erythematosus Registry (RELESSER). RESULTS: A total of 305 patients were included, predominantly women (89.8%), with a mean age at diagnosis of 34.2±15.4 years and a mean disease duration of 15.7±11.8 years. Musculoskeletal (83.3%) and mucocutaneous manifestations (79.3%) were the most frequent, followed by hematological (38.4%) and renal involvement (29.5%). Disease activity and accumulated damage were low [SLEDAI 2 (0-4), SLEDAIc 0 (0-1), SDI 0 (0-1)]. Compared with RELESSER, our series showed longer disease duration, higher use of antimalarials, lower exposure to corticosteroids and conventional immunosuppressive agents, and a higher use of biologic therapies. CONCLUSIONS: This single-center registry shows overall clinical characteristics comparable to those reported in RELESSER, with relevant differences in treatment patterns, reflecting the variability in SLE management in real-world clinical practice.
Beira Salvador PM, García Grandal T, Iglesias Méndez R
Med Clin (Barc)
· 2026 May · PMID 42140079
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OBJECTIVE: To assess the prevalence of HSIL/CIN2+ lesions in women with negative cytology and high-risk HPV (HR-HPV) referred to colposcopy from population-based screening, as well as to describe histological findings an...OBJECTIVE: To assess the prevalence of HSIL/CIN2+ lesions in women with negative cytology and high-risk HPV (HR-HPV) referred to colposcopy from population-based screening, as well as to describe histological findings and the need for excisional treatment. METHODS: Prospective observational study (November 2022-June 2025). Included were women referred to colposcopy with negative cytology and positive HR-HPV results: (1) HPV16/18, (2) persistent non-16/18 HR-HPV, (3) HPV16/18 + HR-HPV co-infection, and (4) non-16/18 HR-HPV infection evolving to HR + 16/18 co-infection after one year. Clinical data, histological outcomes, and excisional procedures were analyzed. RESULTS: A total of 519 women were studied (mean age 50.9 years). Distribution: HPV16/18 (55.2%), non-16/18 HR-HPV (34.9%), co-infection (9.1%), and non-16/18 HR-HPV evolving to HR + 16/18 co-infection (0.8%). Among exocervical biopsies (n=276), 37 showed HSIL and 2 carcinomas were identified. In endocervical samples (n=476), 6 HSIL and 1 carcinoma were detected. Excisional treatment was performed in 42 women, revealing 19 HSIL, 1 adenocarcinoma, and 1 squamous carcinoma. The overall prevalence of HSIL/CIN2+ was 9.6%, higher in women with HPV16/18 (13.6%) compared to non-16/18 HR-HPV (4.9%), RR=2.76 (95% CI: 1.37-5.56; p<0.05). CONCLUSIONS: Detection of HR-HPV identifies clinically significant lesions even in women with negative cytology. Our findings support immediate colposcopy in HPV16/18-positive cases and close follow-up in persistent infections with other HR-HPV genotypes.
Díez-Villanueva P, Jiménez-Méndez C, Esteban-Fernández A
… +10 more, Pérez-Rivera Á, Barge Caballero E, López J, Ortiz C, Goirigolzarri J, Cobo M, Montes N, Ariza-Solé A, Martínez-Sellés M, Alfonso F
Med Clin (Barc)
· 2026 Jun · PMID 42025233
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INTRODUCTION: Malnutrition is common in patients with heart failure (HF) but its prognostic impact in advanced age patients remains unsettled. We sought to prospectively assess the impact the Mini Nutritional Assessment-...INTRODUCTION: Malnutrition is common in patients with heart failure (HF) but its prognostic impact in advanced age patients remains unsettled. We sought to prospectively assess the impact the Mini Nutritional Assessment-Short Form (MNA-SF), in elderly patients with chronic HF. PATIENTS AND METHODS: We analyzed data from the FRAGIC study a multicentre prospective registry conducted across 16 cardiology departments in Spain that included HF outpatients aged ≥75 years. RESULTS: From 499 patients (mean age 81.4±4.3 years, 192 [38%] women), 235 had MNA-SF ≤11 (47%). Compared with patients with normal nutritional status, these patients were older (82±7 vs. 81±7, p=0.047), more frequently women (45% vs. 33%, p=0.005), and frail (66% vs. 43%, p=<.001), and showed a more advanced functional class (NYHA≥II 90% vs. 80%, p=0.03) and higher natriuretic peptide levels (NTproBNP>1000pg/ml: 77% vs. 65%, p=0.005). During a median follow-up of 371 days, 58 patients (11.6%) died. One-year mortality was higher in patients with worse nutritional status (39 [17%] vs. 19 [7.2%], p=0.001), which was independently associated with one-year mortality (hazard ratio 1.97, 95% confidence interval 1.09-3.55, p=0.02). CONCLUSION: A MNA-SF score≤11 is common in older patients with chronic HF and it is associated with higher mortality at one-year follow-up.
Manjón Rodríguez MD, Sánchez Berna I, García Hernández FJ
… +12 more, de la Hera Fernández FJ, Pérez de Pedro I, Gil Morillas A, Navarrete Navarrete N, Callejas Rubio JL, Ayala Gutiérrez MDM, Romero Gómez C, León Ruíz L, Gómiz Rodríguez G, Borrachero Garro C, Vílchez Parras A, Colodro Ruiz A
Med Clin (Barc)
· 2026 Jun · PMID 42025232
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BACKGROUND AND OBJECTIVES: Systemic lupus erythematosus (SLE) is an autoimmune disease with numerous immune defects described. Anifrolumab (ANF) is an effective and safe biologic drug approved for SLE after completion of...BACKGROUND AND OBJECTIVES: Systemic lupus erythematosus (SLE) is an autoimmune disease with numerous immune defects described. Anifrolumab (ANF) is an effective and safe biologic drug approved for SLE after completion of a rigorous clinical development program. By building on the experience gained in clinical practice, it is possible to expand the knowledge of real-world benefits. The aim of the study is to study the efficacy and safety of ANF in real life. METHODS: Observational study conducted in hospitals in the autonomous community of Andalusia on the early efectiveness and safety of ANF treatment in 56 patients with SLE. Indicators of activity and chronicity were determined at baseline and at 3 and 6 months. RESULTS: The main clinical domains were mucocutaneous (80.4%) and osteoarticular (37.5%). At 3 and 6 months, response rates were SRI-4: 48% and 66%, BICLA: 57% and 77%, CLASI-A50: 85% and 93%, LLDAS: 71% and 66%, and DORIS remission, 36% and 43%, respectively. There was a decrease in mean daily prednisone dose after ANF initiation, with 76.8% and 80.3% of patients at a dose ≤ 7.5mg/day at 3 and 6 months respectively. No significant adverse effects were observed. CONCLUSIONS: In SLE, especially in patients with mucocutaneous and joint involvement, ANF is an effectiveness and safe therapeutic option in real clinical practice, with improvement of activity markers at 3 and 6 months of treatment.
Guillén Del Castillo A, Lledó-Ibáñez GM, Sáez Comet L
… +14 more, Freire Dapena M, Mesa Navas M, Martín Cascón M, Simeon CP, Martinez Robles E, Todolí Parra J, Varela DC, Udaondo Gascon C, Maldonado G, Mosquera Angarita JM, Marín A, Pérez Abad L, Ramos Ibáñez E, Gracia Tello BDC
Med Clin (Barc)
· 2026 Jun · PMID 42013567
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OBJECTIVES: Nailfold videocapillaroscopy (NVC) is the gold-standard to identify scleroderma patterns. Our aim was to establish the minimum requirements; number of fingers, length of nailbed samples, location of nailbed a...OBJECTIVES: Nailfold videocapillaroscopy (NVC) is the gold-standard to identify scleroderma patterns. Our aim was to establish the minimum requirements; number of fingers, length of nailbed samples, location of nailbed areas, to diagnose the existence of systemic sclerosis patterns (SSc-P) and further identify non-SSc-P and SSc-P subtypes reliably. METHODS: NVCs were taken during routine explorations by capillaroscopists from 12 hospitals, who made four diagnosis per patient according to the examination of the following: 32 images (4 images/finger, mean 59.43mm); 16 images (2 medial images/finger [mean 29.28mm]); 8 images (1 medial image/finger [mean 14.50mm]); 4 images (1 medial image per middle fingers [mean 7.22mm]). Diagnosis matches and discrepancies considering 32 versus 16, 8 or 4 images, were calculated, with the goal of estimating the information loss when not covering the whole nailbed. The same analysis was performed using the CAPI-Score and CAPI-Detect algorithms. RESULTS: A total of 2,387 NVCs were used. Disagreement in pattern assignment was 26.7%, 36.6% and 41.5% when the analysis was performed over 16, 8 or 4 images, respectively. When 16 images were used, 18.5% of expert observers changed their assigned pattern in 18.5% of cases from SSc-P to non-SSc-P, and >30% of patients diagnosed were assigned a different subtype. Although to a lesser extent, diagnosis discrepancies were observed when CAPI-Score and CAPI-Detect algorithms were applied. CONCLUSION: All fingers but thumbs have to be considered to identify scleroderma patterns accurately. Four nailbed areas in the analysis demonstrated to be superior than using a partial sample.
BACKGROUND: Superior vena cava (SVCS) is an uncommon but potentially life-threatening condition caused by partial or complete obstruction of venous return through the superior vena cava, most commonly due to malignancy o...BACKGROUND: Superior vena cava (SVCS) is an uncommon but potentially life-threatening condition caused by partial or complete obstruction of venous return through the superior vena cava, most commonly due to malignancy or catheter-related thrombosis. While SVCS is clinically relevant, contemporary data describing its presentation, management, and outcomes remain limited. The primary objective of this study was to describe the clinical characteristics, treatments, and outcomes of this population, and the secondary objective was to identify factors associated with mortality. METHOD: Retrospective, single-center observational study including patients over 18 years of age diagnosed with SVCS between 2012 and 2023. Data were collected from electronic medical records. SVCS was confirmed by imaging. Life-threatening presentations were defined by the presence of cerebral or laryngeal edema, hemodynamic instability, or ICU admission. RESULTS: Ninety-one patients were included (mean age 59.5 years; 51.6% women). Most cases were malignancy-related (90.1%), primarily lung cancer (50.5%). At diagnosis, 26.4% had life-threatening symptoms and 19.8% had concurrent venous thromboembolism. Interventional treatment was required in 38.4%, with stenting being the most common procedure. During follow-up (median 124 days), 82.4% of patients died, mainly from cancer progression. Mortality was associated with older age, corticosteroid use, and malignancy. Thrombotic etiology and incidental diagnosis were linked to better outcomes. In multivariate analysis, lung cancer remained an independent predictor of mortality (OR 4.67; 95% CI: 1.05-23.4). CONCLUSION: In this cohort, SVCS was predominantly associated with malignancy, mainly lung cancer, and carried a high mortality rate. Catheter-related and thrombotic SVCS showed more favorable outcomes, emphasizing the prognostic importance of the underlying etiology.
"Red eye" is one of the main reasons of urgent consultation in Primary Care and in Ophthalmologic Emergencies. In many cases, the underlying cause is a benign condition that can be managed by the Primary Care Physician...."Red eye" is one of the main reasons of urgent consultation in Primary Care and in Ophthalmologic Emergencies. In many cases, the underlying cause is a benign condition that can be managed by the Primary Care Physician. However, not every red eye is a conjunctivitis, so it is important to recognize the warning signs and symptoms associated with potentially serious conditions. Causes of red eye include diseases of the ocular surface (conjunctivitis), which are generally benign; internal eye diseases (uveitis, glaucoma, scleritis, trauma) and extraocular diseases (cavernous sinus thrombosis, orbital cellulitis), which are generally ophthalmic and systemically severe, respectively. In this expert review, we aim to provide a practical approach to the differential diagnosis of red eye in general practice, defining the criteria of severity and urgency for referral to a specialized Ophthalmology consultation.
Guijarro-Martínez P, Quesada-Muñoz L, Ciudad-Gutierrez P
… +3 more, Molina-Mendoza MD, Delgado-Silveira E, Álvarez-Díaz AM
Med Clin (Barc)
· 2026 May · PMID 41950886
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BACKGROUND: Mobile digital health has expanded worldwide. Despite the high number of electronic tools developed, few of them are focused on improving medication adherence, particularly in patients undergoing solid organ...BACKGROUND: Mobile digital health has expanded worldwide. Despite the high number of electronic tools developed, few of them are focused on improving medication adherence, particularly in patients undergoing solid organ transplantation. METHODS: A systematic review of studies evaluating electronic tools supporting medication adherence in transplant patients. The review was registered in PROSPERO (CRD42024548913) and followed PRISMA guidelines. Searches were performed in PubMed, EMBASE, Cochrane Library, and Web of Science. Of 2032 records, eight studies met inclusion criteria. RESULTS: Eight mobile apps designed for patients, caregivers and clinicians were identified. Users valued electronic medication monitoring systems and interactive reminders, although improvements in data confidentiality and navigation were suggested. Five tools demonstrated significant adherence improvements compared with non-use. CONCLUSION: Most identified apps improved medication adherence, although methodological heterogeneity limits comparability. Further high-quality research is needed to determine the clinical impact of digital tools in solid organ transplantation.
Medina Rodríguez A, Rodríguez Vallejo A, González López A
… +6 more, Sosa Cabrera Y, Cristo Rodríguez-Pérez M, Dorta León HL, Hernández Cabezudo I, Jimenez Sosa I, Rodríguez-Baz Í
Med Clin (Barc)
· 2026 Jun · PMID 41946118
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BACKGROUND: Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. However, evidence remains limited in patients outside top-tier recommendation criteria,...BACKGROUND: Mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. However, evidence remains limited in patients outside top-tier recommendation criteria, particularly in medium-vessel occlusions, tandem occlusions, and posterior circulation strokes. METHODS: We conducted a retrospective, cross-sectional study of consecutive patients with AIS treated with MT at a tertiary hospital between 2012 and 2022. Clinical, radiological, and procedural data were collected. Patients were stratified according to class of recommendation, vascular territory, and occlusion segment. A favorable functional outcome was defined as a modified Rankin Scale score of 0-2 at 90 days. RESULTS: A total of 334 patients were included (mean age 67.7±13.8 years; 52.7% women), of whom 146 (43.7%) met high-level recommendation criteria for MT. Cardioembolic etiology was the most frequent (47.6%), whereas atherosclerosis predominated in tandem occlusions. Successful recanalization was achieved in 80.3% of cases, without significant differences across subgroups. Symptomatic intracranial hemorrhage occurred in 11% of patients. Ninety-day mortality was 22.1%, reaching 34.6% in posterior circulation strokes. Overall, 58.2% of patients achieved a favorable functional outcome at 90 days, with the highest rates observed in M2 segment occlusions of the middle cerebral artery (73.5%). CONCLUSION: MT for AIS was safe and effective across a broad range of occlusion locations, including patients outside high-level evidence criteria. These findings suggest the need for studies evaluating broader clinical profiles.
Med Clin (Barc)
· 2026 Jun · PMID 41946117
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OBJECTIVE: To investigate the clinical and laboratory characteristics of idiopathic inflammatory myopathy (IIM) patients with dysphagia and determine associated factors. METHODS: We conducted an observational study of 96...OBJECTIVE: To investigate the clinical and laboratory characteristics of idiopathic inflammatory myopathy (IIM) patients with dysphagia and determine associated factors. METHODS: We conducted an observational study of 96 patients with IIM in the Department of Rheumatology and Immunology at Ma'anshan People's Hospital from September 2019 to June 2024, whose swallowing function was assessed and recorded. Clinical and laboratory characteristics were compared between patients with and without dysphagia in this cross-sectional study. Logistic regression analysis was used to identify factors associated with dysphagia in patients with IIM. RESULTS: Among the 96 patients with IIM, 20 (21%) experienced dysphagia. The incidence was 2 of 9 patients (22%) with polymyositis, 12 of 54 patients (22%) with dermatomyositis, 2 of 27 patients (7%) with antisynthetase syndrome, and 4 of 6 patients (67%) with immune-mediated necrotizing myopathy (IMNM), with significant differences (P=0.015). Patients with dysphagia exhibited significantly higher levels of creatine kinase-MB isoenzyme (CK-MB), lactate dehydrogenase, serum ferritin, rates of concomitant tumor, and positivity for autoantibodies directed against transcription intermediary factor 1-γ (anti-TIF1γ) and against the signal recognition particle (anti-SRP) than those without (all P<0.05). Logistic regression analysis indicated that anti-SRP antibodies, anti-TIF1γ antibodies, concomitant tumor, and elevated CK-MB levels were independent risk factors for the development of dysphagia in patients with IIM. Receiver operator characteristic curve (ROC) analysis demonstrated that the areas under the curve (AUC) for anti-TIF1γ antibody, concomitant tumor, and CK-MB levels alone in predicting dysphagia in IIM patients were 0.699, 0.759, and 0.656, respectively. The combined predictive model yielded an area under the curve (AUC) of 0.914. CONCLUSION: Dysphagia is not rare in patients with IIM. It is important to be vigilant for the occurrence of dysphagia in IIM patients positive for anti-SRP antibodies, anti-TIFγ antibodies, concomitant tumors, and elevated CK-MB levels. Anti-TIF1γ antibodies, concomitant tumors, and elevated CK-MB levels may have potential value in identifying IIM patients at higher risk of dysphagia.