Gupta S, Kalasipudi R, Tharusha Gurusinghe P
… +5 more, Gautam A, Huang K, Dababneh E, Dhonde P, Matta MG
Med Clin (Barc)
· 2026 Mar · PMID 41570598
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BACKGROUND AND OBJECTIVE: Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics a...BACKGROUND AND OBJECTIVE: Obesity is a modifiable risk factor for atrial fibrillation (AF); however, its influence on recurrence and mortality remains controversial. This study aimed to compare clinical characteristics and 12-month outcomes between obese and non-obese patients with AF and to identify predictors of recurrence and mortality. MATERIALS AND METHODS: A retrospective analysis was conducted on 225 patients hospitalized for AF, classified according to obesity (BMI ≥30kg/m). The primary outcome was AF-related rehospitalization within 12 months, and the secondary outcome was all-cause mortality. Clinical, biochemical, and sociodemographic data were collected. RESULTS: Obesity was present in 43% of patients and was associated with younger age, a higher prevalence of sleep apnea, and hypertriglyceridemia. At 12 months, 24.9% of patients were rehospitalized and 14.0% experienced AF recurrence. Obesity (OR 2.84; 95% CI 1.17-6.90; p=0.021) and excessive alcohol consumption (OR 3.49; 95% CI 1.07-11.41; p=0.039) independently predicted AF recurrence. Advanced age, low socioeconomic status, and hypokalaemia were associated with higher mortality, whereas obesity was linked to a lower risk (OR 0.38; 95% CI 0.16-0.95; p=0.038). CONCLUSIONS: In this cohort, obesity was associated with increased AF recurrence but reduced mortality, supporting the "obesity paradox." Excessive alcohol intake and low socioeconomic status also influenced outcomes, underscoring the need for individualized management strategies.
Rodríguez de Rivera M, Zubiaur J, Cucurull Ortega I
… +15 more, Carreiro Da Cunha E, Pérez Barquín R, Margarida de Castro A, Teira Calderón A, Sáinz Laso F, Lee Hwang DH, García-Camarero T, Veiga G, Gil Ongay A, Garilleti C, Hernández R, Barrera S, Fradejas V, Obregón C, De la Torre Hernández JM
Med Clin (Barc)
· 2026 Mar · PMID 41570597
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INTRODUCTION AND OBJECTIVES: Ischemic heart disease remains a leading cause of mortality, with women facing unique social and clinical challenges that impact outcomes. This study aimed to examine sex and gender specific...INTRODUCTION AND OBJECTIVES: Ischemic heart disease remains a leading cause of mortality, with women facing unique social and clinical challenges that impact outcomes. This study aimed to examine sex and gender specific differences in social and clinical predictors of long-term outcomes in coronary artery disease. MATERIALS AND METHODS: This prospective cohort study used the RECORVAL registry, including patients with coronary artery disease undergoing coronary angiography. Clinical data were extracted from electronic health records, and social determinants were collected via a structured questionnaire. Outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, revascularization, stroke, major bleeding and a composite endpoint (cardiovascular death, myocardial infarction or revascularization). Sex-stratified Kaplan-Meier curves, Fine-Gray competing risk models, and multivariate Cox regression models adjusted for social and clinical variables were used. RESULTS: Among 2219 patients (23.4% women) followed for a median of 2421 days, women were older (68.5 vs. 64.3 years) and had greater social disadvantages, including lower education, employment, and internet access. Percutaneous intervention rates were similar, but coronary artery bypass grafting was less frequent in women (3.5% vs. 6.0%). No significant differences were observed in all-cause or cardiovascular mortality (aHR 0.80; 95% CI 0.51-1.24). Women showed a non-significant trend toward lower composite endpoint risk (aHR 0.81; 95% CI 0.64-1.04), lower myocardial infarction and revascularization risk, and higher major bleeding (aHR 1.39; 95% CI 0.92-2.11). CONCLUSIONS: Women face significant social disadvantages requiring personalized prevention addressing gender-specific risks. Similar mortality rates suggest improving equity, while differing ischemic-haemorrhagic profiles call for sex-tailored therapy to improve outcomes.
Angarola E, Pasqua A, Matías Castro H
… +4 more, Cáceres A, Carlos Spina J, Casciato P, IgG4-RD Interdisciplinary Unit
Med Clin (Barc)
· 2026 Feb · PMID 41564809
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BACKGROUND AND OBJECTIVE: IgG4-RD is a multisystemic disease, often underdiagnosed, with natural progression to chronic organ damage. We aim to describe clinical features, relapse and chronic organ damage. METHODS: Dynam...BACKGROUND AND OBJECTIVE: IgG4-RD is a multisystemic disease, often underdiagnosed, with natural progression to chronic organ damage. We aim to describe clinical features, relapse and chronic organ damage. METHODS: Dynamic ambispective cohort including patients from the Institutional Registry of IgG4-RD at Hospital Italiano de Buenos Aires who met ACR/EULAR 2019 criteria. We analyzed clinical phenotypes, response to treatment, biomarkers and chronic organ damage. RESULTS: Sixty patients were included; 73% were male and median age at diagnosis was 61 years. Median time to diagnosis was 9 months (IQR 3-21), 10% had >10 years of delay. Multiorgan disease was present at diagnosis in 65% and the most common phenotype was pancreatohepatobiliary (40%). Corticosteroids were used at diagnosis in 77%; seven patients with totally resected disease required no further immunosuppression (median 59 months; IQR 31-144). Relapses occurred in 47%, predominantly in those with multiorgan involvement (89%). Kidneys and the biliary tract were most commonly affected in relapse. Relapsing predictive biomarkers were present in 63% at the onset; multiorgan involvement was associated with relapsing disease (p=0.002). Chronic organ damage occurred in 71%, in 44% after surgical resection. The most frequent was exocrine pancreatic insufficiency (35%). Patients with baseline damage had a significantly longer diagnostic delay (p=0.03). After a year of diagnosis, 85% of patients experienced damage. CONCLUSION: Baseline organ damage was highly frequent, particularly with delayed diagnosis, while multiorgan involvement predicted relapse, underscoring the need for earlier and multidisciplinary management.
Med Clin (Barc)
· 2026 Jan · PMID 41564713
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Insomnia is one of the most prevalent conditions in clinical practice, with significant mental, physical, and social consequences. This review aims to provide an updated and clinically oriented synthesis of current evide...Insomnia is one of the most prevalent conditions in clinical practice, with significant mental, physical, and social consequences. This review aims to provide an updated and clinically oriented synthesis of current evidence on its diagnosis, pathophysiology, and therapeutic management, integrating cognitive perspectives and the role of shared decision-making. Its conceptualization has shifted from an unspecific symptom to a distinct disorder with well-established neurobiological foundations. Diagnosis is primarily clinical and requires assessment of functional impact, perpetuating factors, and patient expectations. International guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment, with pharmacotherapy reserved for selected cases. Sleep hygiene measures, while necessary, are insufficient when used in isolation. Dysfunctional beliefs and shared decision-making are central to optimizing adherence and preventing chronicity. Contemporary management demands an integral, personalized, and person-centered approach that combines educational strategies, psychotherapy, and rational pharmacological interventions.
Moñino-Dominguez L, Aguado-Paredes A, Cordero-Ramos J
… +4 more, Tirado-Pérez MJ, Martínez-Escudero A, Argüelles-Arias F, Merino-Bohórquez V
Med Clin (Barc)
· 2026 Feb · PMID 41558253
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INTRODUCTION: The predictive value of therapeutic drug monitoring (TDM) of vedolizumab in Crohn's disease (CD) during the maintenance phase remains uncertain. This study assessed its association with clinical and biochem...INTRODUCTION: The predictive value of therapeutic drug monitoring (TDM) of vedolizumab in Crohn's disease (CD) during the maintenance phase remains uncertain. This study assessed its association with clinical and biochemical remission in routine clinical practice and explored variables influencing trough concentration variability. METHODS: A retrospective observational study was conducted at a tertiary hospital between July 2022 and December 2024. Adult CD patients receiving vedolizumab during maintenance and undergoing routine TDM were included. Clinical variables (age, treatment duration, administration route, perianal disease), laboratory markers (albumin, C-reactive protein [CRP], fecal calprotectin [FCP]), and pharmacokinetic data were collected. Trough concentrations were measured using ELISA. Clinical remission was defined as a Harvey-Bradshaw Index <5 and biochemical remission as FCP <250μg/g, both evaluated six months after the trough level. Non-parametric tests, multiple linear regression, ROC analysis, and multiple imputation were used for statistical analysis. RESULTS: Seventy patients were included. Clinical remission was observed in 76.8%. Median trough levels were higher in patients in clinical remission (17.5μg/mL [IQR: 12.5-26.2]) than in those without remission (13.4μg/mL [IQR: 8.8-23.5]; p=0.07). A total of 65.2% reached ≥14μg/mL; however, remission rates did not differ significantly between groups with high or low exposure, for either clinical (84.4% vs. 62.5%; p=0.07) or biochemical remission (73.1% vs. 69.2%; p=1). ROC analysis identified an optimal threshold of 11.3μg/mL (AUC=0.647). Subcutaneous administration was associated with higher concentrations (p=0.0057), as were higher albumin levels (p=0.012). Significant correlations were found between vedolizumab levels and CRP (positive, p=0.0025) and FCP (inverse, p=0.0186). No anti-drug antibodies were detected. CONCLUSIONS: Vedolizumab trough levels were not significantly associated with clinical or biochemical remission during maintenance. These findings suggest that the isolated use of TDM may have limited predictive value. However, factors such as administration route, albumin, and inflammation levels influence exposure and should be integrated into the interpretation of drug concentrations in clinical practice.
Casado López I, Teigell Muñoz FJ, Casas Rojo JM
… +3 more, Mateos González M, Hernández Piriz A, Cubo Romano P
Med Clin (Barc)
· 2026 Feb · PMID 41548331
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OBJECTIVE: To evaluate the prognostic value of the PROFUND index for predicting all-cause mortality during hospitalization or within three months after discharge in patients hospitalized due to COPD exacerbation, as well...OBJECTIVE: To evaluate the prognostic value of the PROFUND index for predicting all-cause mortality during hospitalization or within three months after discharge in patients hospitalized due to COPD exacerbation, as well as predicting readmissions within three months. METHOD: An observational, retrospective, single-center study that included all patients hospitalized between January and December 2022 due to COPD exacerbation. RESULTS: The analysis included 172 patients. Half of the patients (50.6%) were multimorbid. These patients were older, had greater baseline dyspnea, a higher degree of obstruction, greater dependency for basic daily living activities, a higher PROFUND index, and were at higher risk of readmission within three months and in-hospital mortality (P<.05). There was a 35.98% readmission rate within three months, mostly due to a new COPD exacerbation (86%), an in-hospital mortality rate of 3.4%, and a three-month mortality rate of 5.2%. A high PROFUND index (≥7) was significantly associated with increased mortality during hospitalization or within the first 3 months after discharge (OR: 33; 95% CI: 3.9-273.4; P=.001) and a higher risk of hospital readmission for any cause (OR: 4.91; 95% CI: 1.99-12.13; P=.0003). The variables most influencing mortality were severe dyspnea, anemia, confusional syndrome, and functional impairment (Barthel index <60). CONCLUSION: The PROFUND index could be a good predictor of mortality and readmission risk in patients hospitalized due to a COPD exacerbation.
Armario P, Bellmunt S, Del Cura Rodriguez JL
… +6 more, Jiménez Zapater C, Gich IJ, Roure P, Fernandez Canabal E, Requeijo C, en representación de los investigadores de la red MAPAC
Med Clin (Barc)
· 2026 Feb · PMID 41548329
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Publisher ↗
OBJECTIVE: The objective of this study was to analyse appropriateness criteria in the request for carotid ultrasonography and to evaluate its association with the finding of a significative carotid stenosis. PATIENTS AND...OBJECTIVE: The objective of this study was to analyse appropriateness criteria in the request for carotid ultrasonography and to evaluate its association with the finding of a significative carotid stenosis. PATIENTS AND METHODS: This was an observational, prospective, analytical, multicentre study. Consecutive adult patients (>18years of age) who were scheduled for carotid ultrasound were included. Carotid ultrasound requests were made by the various departments of the participating hospitals and by primary care. Urgent indications were excluded. The reasons for the request and the results of the examinations were recorded. Appropriateness criteria of carotid ultrasonography were determined taking into account recommendations from the literature and clinical practice guidelines. A bivariate and multivariate analysis were performed to determine patient factors related to the appropriateness of requests. RESULTS: A total of 268 patients were included, with a mean age of 69.1 (SD12) years, 34.3% women. Most requests were classified as adequate (65.3%; 95%CI: 59.3-71.0), while the percentage of inadequate requests, according to previously established criteria, was 31.7% (95%CI: 26.2-37.7). The prevalence of significant stenosis in inappropriate requests was very low (1.2%). In the bivariate analysis, the factors associated with significant carotid stenosis (≥50%) were age, high blood pressure, and dyslipidaemia. When all three variables were included in the multivariate model, only dyslipidaemia was significant: OR: 5.47 (95%CI: 2.7-11.0). CONCLUSIONS: 32% of carotid ultrasonography requests were inappropriate, with a very low prevalence.