de Torres Chacón R, Pérez-Sánchez S, Tamayo Toledo JA
… +7 more, Villegas I, Antonio Cabezas J, Fernández D, Fernández J, Montaner J, SUR-PROJECT Study Group, SUR-PROJECT Study Group
BACKGROUND: Hidden atrial fibrillation (AF) is considered a major contributor to embolic strokes of undetermined source (ESUS). Prolonged cardiac monitoring is effective for detecting AF, especially when started soon aft...BACKGROUND: Hidden atrial fibrillation (AF) is considered a major contributor to embolic strokes of undetermined source (ESUS). Prolonged cardiac monitoring is effective for detecting AF, especially when started soon after stroke onset. METHODS: This prospective multicentre study evaluated the rate of AF detection in ESUS patients under real-world clinical conditions using wearable Holter cardiac monitoring for 30 days. RESULTS: A total of 352 patients were included. The mean age was 67.8 years, and 46% were women. The AF detection rate was 17.1%, with a mean episode duration of 401.7min. Compared with patients without AF, those with AF were older (72.2 vs 67.0 years; mean difference, 5.16 years; 95% CI, 2.24-8.09; p=0.0012), had a higher frequency of large vessel occlusion (35.9% vs 17.0%; OR, 2.66; 95% CI, 1.40-5.05; p=0.002), showed larger left atrial diameter (40.4 vs 38.1mm; mean difference, 2.25mm; 95% CI, 0.56-3.95; p=0.013), and more often had excessive supraventricular ectopic activity on 24-hour Holter monitoring (37.5% vs 20.5%; OR, 2.33; 95% CI, 1.26-4.32; p=0.006). Notably, 73.3% of AF cases were detected during monitoring initiated within the first 6 months after stroke onset. CONCLUSIONS: These findings support the potential clinical utility of 30-day prolonged cardiac monitoring to detect AF in ESUS patients, highlighting its value in etiological stroke assessment in real-world clinical practice, with greater efficacy during the first 30 days, but also in cases where monitoring is initiated months after the event.
Med Clin (Barc)
· 2026 Jun · PMID 42372495
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OBJECTIVE: To describe the clinical profile and comorbidities of confirmed dengue cases during the 2024 epidemic in northern Peru. METHODS: A retrospective case series including 2,449 patients with confirmed dengue treat...OBJECTIVE: To describe the clinical profile and comorbidities of confirmed dengue cases during the 2024 epidemic in northern Peru. METHODS: A retrospective case series including 2,449 patients with confirmed dengue treated at a tertiary care hospital was conducted. Dengue was classified according to World Health Organization criteria, and demographic characteristics, clinical manifestations, and comorbidities were analyzed. RESULTS: Of the cases, 54.4% corresponded to dengue without warning signs, 45.0% to dengue with warning signs, and 0.7% to severe dengue. The most frequent manifestations were fever, headache, retro-orbital pain, and lumbar pain. Patients with greater clinical severity more frequently presented chest pain, encephalopathy, and signs of hemodynamic compromise. Additionally, a higher frequency of cardiovascular and renal comorbidities was observed in these patients. CONCLUSIONS: The epidemic was characterized by a high proportion of cases with warning signs, and a higher frequency of comorbidities was observed in patients with greater clinical severity.
Pérez-Hickman-Estevan M, Núñez-Cruz JM, Seguí-Pérez C
… +12 more, Milla-Olaya B, Seguí-Pérez M, Maciá-Candela MT, Cintas-Martínez A, Pérez-Martín S, Jover-Ríos MD, Andreu-Giménez L, Auladell-Alemany MÁ, López-Corbalán JC, Serna-Torres L, Santano-Pérez C, Seguí-Ripoll JM
Med Clin (Barc)
· 2026 Jun · PMID 42365820
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BACKGROUND: Mesenteric panniculitis is a chronic inflammation of the mesenteric adipose tissue, of uncertain clinical significance and with a possible link to malignancy. This study evaluated the clinical, radiological a...BACKGROUND: Mesenteric panniculitis is a chronic inflammation of the mesenteric adipose tissue, of uncertain clinical significance and with a possible link to malignancy. This study evaluated the clinical, radiological and prognostic characteristics of primary and secondary forms in an internal medicine cohort. METHODS: A retrospective cohort of adults with a radiological diagnosis of mesenteric panniculitis (2013-2024), analyzing demographic data, comorbidities, clinical presentation, radiological findings and clinical course. Cases were classified as primary or secondary when associated malignancy, autoimmune disease, or infection was present. RESULTS: One hundred eleven patients included (50% women; mean age 72.2±13.1 years). 61.3% were primary and 38.7% secondary. 31.5% were asymptomatic; abdominal pain was the most common symptom. Mesenteric thickening was the predominant radiological finding. During follow-up, 85.6% remained clinically stable. Overall mortality was 8.1%, slightly higher in secondary forms, mainly those associated with neoplasms, with no significant differences compared to primary cases. CONCLUSIONS: Mesenteric panniculitis mainly affected older adults, with a generally indolent course in primary forms, whilst secondary forms showed greater comorbidity.
Fernández Rodriguez JM, Carrasco-Sánchez FJ, González-Franco Á
… +2 more, Diez-Manglano J, Formiga F
Med Clin (Barc)
· 2026 Jun · PMID 42365815
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BACKGROUND AND AIM: Patients diagnosed with non-valvular atrial fibrillation (NVAF) often present with concomitant type 2 diabetes mellitus (T2DM), both conditions are associated with an increased risk of mortality due t...BACKGROUND AND AIM: Patients diagnosed with non-valvular atrial fibrillation (NVAF) often present with concomitant type 2 diabetes mellitus (T2DM), both conditions are associated with an increased risk of mortality due to cardiovascular complications such as stroke and heart failure. Given the observed gender differences not only in baseline characteristics but also in direct oral anticoagulant (DOACs) prescription patterns, the aim of the present study was to evaluate edoxaban dosing patterns and safety in men and women with both NVAF and T2DM in a real-world setting. METHODS: Patients with NVAF and T2DM undergoing treatment with edoxaban for 3-6 months prior to inclusion were enrolled in the FADIA study. This was an observational, real-world, prospective, single-cohort, multicentric study with a 12-month follow-up period after inclusion. RESULTS: Data from 204 patients were analysed: 92 women (45.1%) and 112 men (54.9%). Women were older, had worse renal function compared to men and received on-label prescriptions for edoxaban less frequently (73.6% vs. 87.3%, p=0.01) while being more often overdosed (16.5% vs. 5.5%, p<0.01). Rates of major and clinically relevant non-major (CRNM) bleeding, stroke or systemic embolism, and one-year all-cause mortality were statistically similar between the two groups. CONCLUSIONS: Edoxaban appears to be safe in NVAF and T2DM patients, regardless of gender. However, the higher prevalence of inadequate dosing in women, coupled with their worse baseline clinical characteristics, underscores the importance of accurately estimating the appropriate edoxaban dose to maximize its benefits and minimize bleeding risk.
de Asteasu MLS, Izquierdo M, Zambom-Ferraresi F
… +3 more, Cadore EL, Chenhuichen C, Martínez-Velilla N
Med Clin (Barc)
· 2026 Jun · PMID 42365812
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Hospitalization is usually linked to dramatic adverse events in older adults, including hospital-associated disability (HAD). Despite advancements in geriatric medicine to mitigate this trend, hospital models have often...Hospitalization is usually linked to dramatic adverse events in older adults, including hospital-associated disability (HAD). Despite advancements in geriatric medicine to mitigate this trend, hospital models have often remained antiquated rather than being designed to minimize the risk of harm and reduce the associated burdens. The objective of this narrative review is to identify the personal and in-hospital process risk factors that may contribute to the development of HAD and determine efficacious therapeutic strategies to reverse these negative consequences. Age, sex, ethnicity, number of comorbidities, frailty, dementia, functional status at hospital admission, and polypharmacy may influence the development of HAD. Additional factors related to hospital processes, including prolonged length of hospital stay, low mobility, malnutrition, muscle function loss, social isolation, and sensory alterations, may increase the risk of HAD. Comprehensive geriatric assessment and in-hospital physical exercise appear to be effective therapeutic strategies for preventing HAD in acutely hospitalized older adults and should be part of the clinical routine. However, further research is necessary to examine the feasibility and effectiveness of new integrative care models to provide optimal and widely accessible treatments.
Cheballier MR, Fernández P, Maldonado JP
… +8 more, Schwarz G, Luján P, Mazzotta M, Saad EJ, de Arteaga J, Douthat W, de la Fuente J, Chiurchiu C
Med Clin (Barc)
· 2026 Jun · PMID 42365808
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INTRODUCTION: According to KDIGO guidelines, in patients with nephrotic syndrome without atypical features (estimated glomerular filtration rate <60ml/min/1.73 m, rapid decline in kidney function, or significant hematuri...INTRODUCTION: According to KDIGO guidelines, in patients with nephrotic syndrome without atypical features (estimated glomerular filtration rate <60ml/min/1.73 m, rapid decline in kidney function, or significant hematuria), without suspicion of secondary causes or diabetes mellitus, and with the presence of anti-phospholipase A2 receptor antibodies (anti-PLA2R), a kidney biopsy is not required to confirm the diagnosis of primary membranous nephropathy (PMN). The aim of this study was to evaluate the diagnostic utility of anti-PLA2R for predicting PMN. METHODS: We conducted a cross-sectional study including adult patients with suspected nephrotic syndrome in whom serum anti-PLA2R was measured and who subsequently underwent a kidney biopsy between January 1, 2019, and December 31, 2022, at our institution. RESULTS: A total of 44 patients were included; 17 had positive anti-PLA2R and 27 were anti-PLA2R negative. All patients with positive anti-PLA2R were diagnosed with PMN on kidney biopsy (100%; n=17). Among anti-PLA2R-negative patients (n=27), 13 (48.1%) had membranous nephropathy, of whom 9 were classified as PMN. Using a cutoff value>20 RU/mL, anti-PLA2R showed a specificity and positive predictive value of 100% for the diagnosis of PMN, with a sensitivity of 56.7% and a negative predictive value of 51.9%. CONCLUSION: Measurement of anti-PLA2R demonstrates high diagnostic accuracy for PMN in our setting and may allow kidney biopsy to be avoided in a selected subgroup of patients with a typical clinical presentation, thereby optimizing resources and reducing invasive procedures. Larger local studies are needed to confirm these findings.