Medicine - Programa de Formación Médica Continuada Acreditado最新文献

Varón de 49 años con lesiones purpúricas en ambas piernas, poliartralgias, parestesias en las extremidades, síndrome constitucional e infección por el virus de la hepatitis C 49岁男性，双腿紫色病变、多关节痛、四肢麻痹、体质综合征和丙型肝炎感染

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.009

M. Ramírez Martín, C. Corral Cuadrado, E. Rico Sánchez-Mateos, J. Muñoz Serrano

引用次数: 0

Vasculitis de mediano vaso 中血管炎

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.003

A. Abbasi Pérez , J. Campos Esteban , L. Antúnez Segura , E. Rico Sánchez-Mateos , E. Fernández Fernández

{"title":"Vasculitis de mediano vaso","authors":"A. Abbasi Pérez , J. Campos Esteban , L. Antúnez Segura , E. Rico Sánchez-Mateos , E. Fernández Fernández","doi":"10.1016/j.med.2025.06.003","DOIUrl":"10.1016/j.med.2025.06.003","url":null,"abstract":"<div><div>Medium-vessel vasculitides are inflammatory diseases that mainly affect medium muscle and visceral arteries, causing necrotizing inflammation. They include polyarteritis nodosa (PAN), Kawasaki disease (KD), and ANCA-associated vasculitis (AAV). PAN is a rare vasculitis that affects medium-sized vessels. It is characterized by systemic symptoms such as fever, weight loss, and involvement of organs such as the skin, kidneys, and nerves. Its diagnosis is based on histology and imaging techniques which show characteristic aneurysms. Treatment includes corticosteroids and immunosuppressants. KD, more common in children, affects coronary arteries and manifests as persistent fever, conjunctivitis, lymphadenopathy, and mucocutaneous lesions. Management includes intravenous immunoglobulins and acetylsalicylic acid to prevent aneurysms. AAVs are necrotizing vasculitides and include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). These affect small- and medium-sized vessels, with frequent involvement of the kidneys, lungs, and upper respiratory tract. Diagnosis is based on ANCA positivity and confirmed by biopsy. Treatment depends on the severity, considering that it can be life-threatening, and combines immunosuppressants such as rituximab or cyclophosphamide with corticosteroids.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2054-2063"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insuficiencia cardíaca crónica con fracción de eyección del ventrículo izquierdo conservada 左心室喷射部分保存的慢性心力衰竭

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.012

J. Serpa Morán , E. García Romo , A. Leandro Barros , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó

{"title":"Insuficiencia cardíaca crónica con fracción de eyección del ventrículo izquierdo conservada","authors":"J. Serpa Morán , E. García Romo , A. Leandro Barros , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó","doi":"10.1016/j.med.2025.06.012","DOIUrl":"10.1016/j.med.2025.06.012","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (HFpEF) is defined as a clinical syndrome characterized by the presence of symptoms and/or signs arising from a structural and/or functional abnormality of the heart at rest or on exertion. It is accompanied by elevated natriuretic peptide levels or objective evidence of diastolic dysfunction and preserved left ventricular ejection fraction (equal to or greater than 50%). It is a heterogeneous syndrome whose diagnosis requires ruling out diseases that may justify the symptoms (respiratory diseases, coronary artery disease, valvular or hypertensive heart disease, or cardiomyopathies, among others). It is essential to perform an electrocardiogram, NT-proBNP measurement, and echocardiogram in addition to additional tests according to the patient's clinical context (computed tomography coronary angiogram and cardiac magnetic resonance imaging, among others). Current guidelines recommend the use of diuretics and treatment with SGLT2is to reduce congestive symptoms and the risk of hospitalization due to HF. There are currently no pharmacological treatments that have demonstrated a decrease in mortality in this group of patients. Recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP1-ra) may improve quality of life and decrease symptoms in patients with HFpEF and obesity.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2126-2136"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tratamiento de la hipertensión pulmonar 肺动脉高压的治疗

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.030

M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez

引用次数: 0

Enfermedad venosa aguda 急性静脉疾病

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.022

J. Reina Barrera , F. Álvarez Herrero , A. Bartolomé Sánchez , O. Uclés Cabeza , A. Baturone Blanco , A. Martín-Conejero

{"title":"Enfermedad venosa aguda","authors":"J. Reina Barrera , F. Álvarez Herrero , A. Bartolomé Sánchez , O. Uclés Cabeza , A. Baturone Blanco , A. Martín-Conejero","doi":"10.1016/j.med.2025.06.022","DOIUrl":"10.1016/j.med.2025.06.022","url":null,"abstract":"<div><div>Acute venous disease includes thrombosis and trauma, with the latter being much less frequent. It mainly consists of venous thromboembolic disease (VTED), which includes deep vein thrombosis (DVT) of the lower limbs. DVT is classified according to anatomical area (proximal or distal), etiology (primary or secondary), and episode (first or subsequent). The pathophysiology of DVT involves Virchow's triad: hypercoagulable states, endothelial damage, and venous stasis. The clinical manifestations vary and include pain, edema, and cutaneous signs. Diagnosis is based on clinical suspicion, clinical prediction (Wells score), D-dimer analysis, and confirmation by Doppler ultrasound. Complications can be early (pulmonary embolism) or late (recurrent DVT and post-thrombotic syndrome). Treatment includes hygienic and dietary measures, anticoagulants, fibrinolytics, and surgery in select cases. Superficial vein thrombosis is a common entity that is diagnosed clinically and confirmed via Doppler ultrasound. Treatment includes general measures, non-steroidal anti-inflammatory drugs, and elastic stockings.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2192-2200"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insuficiencia cardíaca aguda 急性心力衰竭

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.013

A. Leandro Barros, D. García Arribas, J. Serpa Morán, C. Tejada González, A. Ruiz-Saavedra, A. García Lledó

{"title":"Insuficiencia cardíaca aguda","authors":"A. Leandro Barros, D. García Arribas, J. Serpa Morán, C. Tejada González, A. Ruiz-Saavedra, A. García Lledó","doi":"10.1016/j.med.2025.06.013","DOIUrl":"10.1016/j.med.2025.06.013","url":null,"abstract":"<div><div>Acute heart failure (AHF) is a severe condition that requires urgent care, with high mortality and readmission rates. It mainly affects older adults and can occur <em>de</em> <em>novo</em> or as decompensation of chronic heart failure. It is a complex clinical syndrome with multiple pathogenic mechanisms that include cardiac and extracardiac factors. It can be triggered by ischemia, hypertension, arrhythmias, or infections. In addition, cardiac function and peripheral vasculature play key roles in its pathophysiology. It mainly presents with signs of congestion or peripheral hypoperfusion with four clinical forms: acute decompensation of heart failure, acute pulmonary edema, isolated right ventricular failure, and cardiogenic shock. Diagnosis is based on physical examination and additional tests such as an electrocardiogram (ECG), echocardiography, and biomarker analysis (BNP, NT-proBNP). Treatment of AHF focuses on relieving congestion and improving peripheral perfusion, identifying and treating triggers and optimizing long-term treatments. It includes diuretics, vasodilators, and vasoconstrictors to improve perfusion and inotropics to improve cardiac function when necessary.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2137-2146"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Paciente varón de 87 años con múltiples factores de riesgo vascular y lesión trófica en miembro inferior derecho 87岁男性患者，有多种血管危险因素和右下肢营养损伤

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.028

O. Uclés Cabeza , F. Álvarez Herrero , A. Baturone Blanco , A. Bartolomé Sánchez , J. Reina Barrera , A. Martín-Conejero

引用次数: 0

Enfermedad arterial periférica de miembros inferiores 下肢周围动脉疾病

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.020

A. Bartolomé Sánchez , O. Uclés Cabeza , J. Reina Barrera , F. Álvarez Herrero , A. Baturone Blanco , A. Martín-Conejero

引用次数: 0

Isquemia arterial aguda

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.023

A. Bartolomé Sánchez , O. Uclés Cabeza , A. Martín-Conejero , J. Reina Barrera , A. Baturone Blanco , F. Álvarez Herrero

{"title":"Isquemia arterial aguda","authors":"A. Bartolomé Sánchez , O. Uclés Cabeza , A. Martín-Conejero , J. Reina Barrera , A. Baturone Blanco , F. Álvarez Herrero","doi":"10.1016/j.med.2025.06.023","DOIUrl":"10.1016/j.med.2025.06.023","url":null,"abstract":"<div><div>Acute arterial ischemia is a serious medical condition characterized by the sudden interruption of arterial blood flow toward a specific limb or territory that lasts for less than two weeks. There are two main pathophysiological causes: embolism and thrombosis. Embolisms occur when material, usually from the heart, travels to an artery in a different area. On the other hand, in thrombosis, the obstruction has an intrinsic origin in the arterial wall (frequently an atheroma plaque). Symptoms depends on the area of arterial occlusion, collateral circulation, and speed of onset. The rule of six Ps (pain, pallor, paresis, pulses, paresthesia, and poikilothermia) summarizes its manifestations. CT angiogram has become the test of choice due to its high resolution, availability, and minimal invasiveness, although arteriography remains the gold standard in the diagnosis of acute ischemia. Treatment must be started immediately after diagnosis. Initial measures include intravenous hydration, systemic heparinization, intravenous analgesia, and adequate oxygenation. The type of surgical treatment will depend on the cause of the ischemia.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2201-2207"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enfermedad venosa crónica 慢性静脉疾病

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.021

F. álvarez Herrero , O. Uclés Cabeza , A. Bartolomé Sánchez , J. Reina Barrera , A. Baturone Blanco , A. Martín-Conejero

{"title":"Enfermedad venosa crónica","authors":"F. álvarez Herrero , O. Uclés Cabeza , A. Bartolomé Sánchez , J. Reina Barrera , A. Baturone Blanco , A. Martín-Conejero","doi":"10.1016/j.med.2025.06.021","DOIUrl":"10.1016/j.med.2025.06.021","url":null,"abstract":"<div><div>Chronic venous disease (CVD) is a condition that affects the superficial or deep venous system. It can cause a variety of symptoms and complications. It is defined as any morphological and/or functional anomaly of the venous system that has a long duration and is manifested by any sign or symptom that needs study or treatment.</div><div>CVD is caused by a combination of factors that can lead to venous hypertension, which is a key factor in the development of CVD. The CEAP classification is the most widely used to describe CVD and takes into account the symptoms, etiology, anatomy, and pathophysiology of each case. The symptoms of CVD are highly variable and include heaviness or tiredness of the legs, a feeling of swelling or itching of the skin, cramps, or night pains. The diagnosis of CVD is based on a case history, physical examination, and Doppler ultrasound. Treatment of CVD includes general measures such as physical exercise and limb elevation as well as specific treatments such as compression therapy, venoactive drugs, and surgery. A multidisciplinary approach and comprehensive care are essential in order to address this complex, prevalent condition.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2185-2191"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0