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Towards a convergence of European and North American prevention guidelines?" 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Panel A: combination of various genetic scores for genes associated with changes in cholesterol levels and incidence of coronary artery disease adjusted for a reduction of 10<span class="elsevierStyleHsp" style=""></span>mg/dL in LDL-C. Panel B: cardiovascular protective effect of various drug treatments that act on the previously mentioned genetic variants adjusted for a reduction of 38.7<span class="elsevierStyleHsp" style=""></span>mg/dL in randomized clinical trials. The results show that the effect of the changes in LDL-C of genetic origin on the risk of vascular events is approximately the same for each unit change in LDL-C performed through an upregulation of LDL receptor. Similarly, the cardiovascular protective effect of statins, ezetimibe and PCSK9 inhibitors is similar for equivalent changes in LDL-C. Note that the protective effect of genetic changes (that act over the course of a lifetime) is approximately 4 times greater than that of drug treatments (typical duration of 4–5 years). The effect of bempedoic acid has not yet been evaluated in randomized clinical trials. There are no drugs that act directly on LDL receptor expression. <span class="elsevierStyleItalic">Abbreviations</span>: ACLY, ATP citrate lyase; bempedoic A., bempedoic acid; CI, confidence interval; LDLR, LDL receptor; NPC1L1, Niemann-Pick C1-Like 1 protein; (i) PCSK9 (inhibitors of) convertase subtilisin/kexin type 9 proprotein; OR, odds ratio.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Guijarro, M. Camafort" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Guijarro" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Camafort" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519301596" "doi" => "10.1016/j.rce.2019.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301596?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301511?idApp=WRCEE" "url" => "/22548874/0000022000000006/v2_202102250828/S2254887419301511/v2_202102250828/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in Images</span>" "titulo" => "Amoxicillin-induced crystalluria" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "383" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Melero López, I. Hidalgo Mayoral, A. Delmiro Magdalena" "autores" => array:3 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Melero López" "email" => array:1 [ 0 => "david.melero@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Hidalgo Mayoral" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Delmiro Magdalena" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Bioquímica Clínica, Hospital Universitario 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cristaluria causada por amoxicilina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 665 "Ancho" => 750 "Tamanyo" => 154349 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 74-year-old patient was admitted for suspected bronchoaspiration and was started on intravenous antibiotherapy with amoxicillin–clavulanate at a dosage of 2<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h for 6 days.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After 4 days, laboratory workup was requested, including a urinary sediment analysis. Macroscopically, the urine was white-yellowish and turbid, with small white particles that sedimented. Microscopy revealed abundant scattered needle-shaped crystals, forming bundles with acuminate ends (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Ruling out similar looking crystals and after reviewing the medical history, we suspected crystals of amoxicillin-related origin, which was confirmed with an indirect method of high-performance liquid chromatography. The antibiotic treatment ended without the crystalluria affecting the patient's renal function (glomerular filtration rate, CKD-EPI >90<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> throughout the episode) and without the onset of other adverse reactions from the treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Amoxicillin is one of the most widely used antibiotics in hospital settings and is prescribed at high doses to treat numerous diseases. The most common adverse reactions are diarrhea, nausea and rash, although other uncommon reactions have been reported, such as crystalluria, which can cause renal damage.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to understand this possible crystallization of the antibiotic and adopt appropriate preventive measures: maintain an adequate intake of liquids during the treatment and conduct a close follow-up of renal function that includes microscopy of the urinary sediment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-01-17" "fechaAceptado" => "2019-02-05" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Melero López D, Hidalgo Mayoral I, Delmiro Magdalena A. Cristaluria causada por amoxicilina. Rev Clin Esp. 2020;220:383.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 665 "Ancho" => 750 "Tamanyo" => 154349 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000006/v2_202102250828/S2254887419301225/v2_202102250828/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000006/v2_202102250828/S2254887419301225/v2_202102250828/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301225?idApp=WRCEE" ]
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