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Tetralogía de Fallot ¿cómo determinamos el riesgo de muerte súbita? 法洛四联：我们如何确定猝死的风险？
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.037
M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez
{"title":"Tetralogía de Fallot ¿cómo determinamos el riesgo de muerte súbita?","authors":"M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.037","DOIUrl":"10.1016/j.med.2025.06.037","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2290.e1-2290.e3"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513776","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
Cardio-oncología Cardio-oncología
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.032
E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez
{"title":"Cardio-oncología","authors":"E. Hernández Sánchez,&nbsp;M.A. Sanromán Guerrero,&nbsp;J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.032","DOIUrl":"10.1016/j.med.2025.06.032","url":null,"abstract":"<div><div>Cardio-oncology is a discipline that comprehensively addresses cardiovascular disease in patients with cancer. With the advances in cancer diagnosis and treatment, the survival rate of many malignant neoplasms has considerably increased in recent decades. This has brought the cardiovascular morbidity and mortality associated with various treatment regimens into greater focus. The optimal management of these patients throughout the different stages of the oncologic process is based on proper cardiovascular risk stratification and the development of preventive strategies, followed by close monitoring using imaging techniques and serum cardiac biomarkers. The early introduction of heart failure medications in response to ventricular function deterioration as well as assessing interrupting oncologic treatment or the use of alternative regimens, in addition to cardioprotective agents or less cardiotoxic formulations, must be decided through consensus by multidisciplinary teams. It is also essential to establish a long-term follow-up plan for cancer survivors, whether pediatric or adult, and to ensure a healthy lifestyle along with optimal control of cardiovascular risk factors throughout the entire process.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2258-2271"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514315","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
Protocolo diagnóstico de las aftas y las úlceras orales 口腔癌和溃疡的诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.008
A. Movasat Hajkhan, E. Rico Sánchez-Mateos, E. Fernández Fernández, E. Rabadán Rubio
{"title":"Protocolo diagnóstico de las aftas y las úlceras orales","authors":"A. Movasat Hajkhan,&nbsp;E. Rico Sánchez-Mateos,&nbsp;E. Fernández Fernández,&nbsp;E. Rabadán Rubio","doi":"10.1016/j.med.2025.06.008","DOIUrl":"10.1016/j.med.2025.06.008","url":null,"abstract":"<div><div>This protocol presents a comprehensive review of the differential diagnosis of aphthous ulcers and oral ulcers, frequent and recurrent conditions that may manifest as single or multiple lesions on the oral mucosa. The diagnostic process, which includes a systemic case history, physical examination, and the necessary complementary tests, is described. Aphthae are classified as simple or complex, describing their distinctive characteristics and progress. This work discusses the main etiologies, including recurrent aphthous stomatitis, viral and bacterial infections, neoplasms, systemic autoimmune diseases, gastrointestinal diseases, nutritional deficits, and pharmacological reactions. The importance of a differential diagnosis to identify the underlying cause is emphasized, especially in cases of complex aphthae that may be the initial manifestation of systemic diseases such as Behçet's disease or inflammatory bowel disease.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2099-2103"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271818","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
Vasculitis de gran vaso 大血管炎
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.002
J. Campos Esteban, E. Fernández Fernández, C. Corral Cuadrado, L. Ruiz Gutiérrez, E. Rico Sánchez-Mateos
{"title":"Vasculitis de gran vaso","authors":"J. Campos Esteban,&nbsp;E. Fernández Fernández,&nbsp;C. Corral Cuadrado,&nbsp;L. Ruiz Gutiérrez,&nbsp;E. Rico Sánchez-Mateos","doi":"10.1016/j.med.2025.06.002","DOIUrl":"10.1016/j.med.2025.06.002","url":null,"abstract":"<div><div>Large-vessel vasculitis (LVV) includes giant cell arteritis (GCA) and Takayasu's arteritis (TA), autoimmune inflammatory diseases that affect large caliber arteries. GCA is more common in adults older than 50 years of age, with manifestations such as headache, jaw claudication, and vision loss, whereas TA predominantly affects young women, with nonspecific initial symptoms followed by severe vascular involvement. The diagnosis of both conditions is based on clinical criteria, laboratory tests, and advanced imaging studies such as Doppler ultrasound, positron emission tomography combined with computed tomography (PET-CT), and magnetic resonance angiography (MRA). The principle treatment is glucocorticoids, with immunosuppressive and biologic therapies as steroid-sparing options. Early, appropriate management is essential to prevent serious complications such as stroke, heart failure, and ocular ischemia.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2047-2053"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271834","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 ventricular izquierda reducida y ligeramente reducida 慢性心力衰竭，左心室射流部分减少和轻微减少
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.011
J. Serpa Morán , J. Gómez Delgado , A. Leandro Barros , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó
{"title":"Insuficiencia cardíaca crónica con fracción de eyección ventricular izquierda reducida y ligeramente reducida","authors":"J. Serpa Morán ,&nbsp;J. Gómez Delgado ,&nbsp;A. Leandro Barros ,&nbsp;A. Ruiz-Saavedra ,&nbsp;C. Tejada González ,&nbsp;A. García Lledó","doi":"10.1016/j.med.2025.06.011","DOIUrl":"10.1016/j.med.2025.06.011","url":null,"abstract":"<div><div>Heart failure with reduced or slightly reduced ejection fraction is defined as a clinical syndrome characterized by the presence of symptoms and/or signs arising from structural and/or functional abnormality of the heart. It is confirmed by elevated natriuretic peptide levels or objective evidence of pulmonary or systemic congestion in addition to a decreased left ventricular ejection fraction equal to or less than 40% or between 41%–49%, respectively. Its most frequent etiology is coronary artery disease followed by hypertension, valvular heart disease, and cardiomyopathies, among others. Its diagnosis is based on an interview with suggestive symptoms and typical clinical signs of heart failure. It is essential to perform an electrocardiogram, NT-proBNP measurement, and echocardiogram as well as additional tests according to the patient's clinical context. Treatment includes lifestyle changes, diuretics to control fluid overload and congestive symptoms, and drugs with prognostic implications. There are four main drug groups: beta-adrenergic blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid antagonists, and SGLT2 inhibitors.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2114-2125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338660","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
Protocolo terapéutico de la insuficiencia cardíaca con fracción de eyección conservada 保留射精分数的心力衰竭治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.015
J. Serpa Morán , E. García Romo , A. Leandro Barros , C. Tejada González , A. Ruiz-Saavedra , A. García Lledó
{"title":"Protocolo terapéutico de la insuficiencia cardíaca con fracción de eyección conservada","authors":"J. Serpa Morán ,&nbsp;E. García Romo ,&nbsp;A. Leandro Barros ,&nbsp;C. Tejada González ,&nbsp;A. Ruiz-Saavedra ,&nbsp;A. García Lledó","doi":"10.1016/j.med.2025.06.015","DOIUrl":"10.1016/j.med.2025.06.015","url":null,"abstract":"<div><div>Heart failure with preserved left ventricular ejection fraction (HFpEF) is a heterogeneous syndrome that is usually accompanied by multiple comorbidities. Its management has prognostic implications in these patients. The comorbidities that most frequently accompany HFpEF are hypertension, coronary artery disease, atrial fibrillation, obesity, diabetes mellitus, and chronic kidney disease, among others. A healthy diet with low sodium intake, regular moderate physical exercise, and stopping smoking and alcohol use are recommended. In regard to pharmacological treatment, until recently, there was no treatment with evidence to show it reduces hospitalizations due to HF or cardiovascular mortality. Therefore, treatment was focused on controlling congestive symptoms (loop diuretics). It has now been shown that treatment with SGLT2is, GLP1-ras in patients with obesity, and mineralocorticoid receptor antagonists (MRAs) in symptomatic patients, despite optimal treatment, has decreased the incidence of cardiovascular events. Treatment with SGLT2is is recommended in all patients with HFpEF unless there are contraindications.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2150-2153"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338533","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
Protocolo diagnóstico de la hipertensión pulmonar 肺动脉高压诊断规程
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.033
M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez
{"title":"Protocolo diagnóstico de la hipertensión pulmonar","authors":"M.A. Sanromán Guerrero,&nbsp;E. Hernández Sánchez,&nbsp;J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.033","DOIUrl":"10.1016/j.med.2025.06.033","url":null,"abstract":"<div><div>Pulmonary hypertension is a rare, underdiagnosed disease that is more frequent in women. Diagnosis is often delayed due to the nonspecific nature of symptoms during the early stages of the disease. Consequently, a high degree of clinical suspicion is required, along with the implementation of a differential diagnosis protocol for dyspnea, in order to provide a specific treatment and improve the prognosis of these patients. Echocardiography is the initial imaging technique of choice, as it provides a certain degree of probability of pulmonary hypertension. Right heart catheterization is indicated in patients with a high probability in order to confirm and classify it.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2272-2276"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514316","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
Protocolo diagnóstico y terapéutico del tromboembolismo crónico 慢性血栓栓塞的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.034
M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez
{"title":"Protocolo diagnóstico y terapéutico del tromboembolismo crónico","authors":"M.A. Sanromán Guerrero,&nbsp;E. Hernández Sánchez,&nbsp;J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.034","DOIUrl":"10.1016/j.med.2025.06.034","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication that occurs following an acute episode of pulmonary embolism (PE) or in patients with multiple risk factors who may or may not have had a previous acute PE episode. It is defined as the presence of at least one ventilation-perfusion defect in a segment after three months of appropriate anticoagulation following an acute PE. Consequently, a high degree of clinical suspicion is needed to ensure an accurate diagnosis and appropriate treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2277-2280"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514356","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
Protocolo de evaluación de la extensión y la actividad en las vasculitis de mediano y gran calibre 中型和大型血管炎的范围和活动评估议定书
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.005
E. Fernández Fernández, J. Campos Esteban, E. Rico Sánchez-Mateos, L. Ruiz Gutiérrez
{"title":"Protocolo de evaluación de la extensión y la actividad en las vasculitis de mediano y gran calibre","authors":"E. Fernández Fernández,&nbsp;J. Campos Esteban,&nbsp;E. Rico Sánchez-Mateos,&nbsp;L. Ruiz Gutiérrez","doi":"10.1016/j.med.2025.06.005","DOIUrl":"10.1016/j.med.2025.06.005","url":null,"abstract":"<div><div>This protocol addresses the assessment of the extent and monitoring of the activity of major medium- and large-caliber vasculitides, such as polyarteritis nodosa, giant cell arteritis, and Takayasu's arteritis. These autoimmune diseases affect multiple organs and require differentiation between inflammatory activity and irreversible damage in order to guide treatment. Monitoring is performed by combining clinical, analytical, and imaging parameters. Regular follow-up is essential to detect relapses or disease progression as well as to assess long-term vascular damage. The imaging techniques of choice for each type of vasculitis and the most current recommendations on when and how often to use them are described.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2082-2086"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271848","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
Protocolo de tratamiento del paciente con insuficiencia cardíaca aguda 急性心力衰竭患者的治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.014
A. Leandro Barros , D. García Arribas , J. Serpa Morán , A. Ruiz-Saavedra , C Tejada González , A. García Lledó
{"title":"Protocolo de tratamiento del paciente con insuficiencia cardíaca aguda","authors":"A. Leandro Barros ,&nbsp;D. García Arribas ,&nbsp;J. Serpa Morán ,&nbsp;A. Ruiz-Saavedra ,&nbsp;C Tejada González ,&nbsp;A. García Lledó","doi":"10.1016/j.med.2025.06.014","DOIUrl":"10.1016/j.med.2025.06.014","url":null,"abstract":"<div><div>Treatment of acute heart failure (AHF) focuses on reducing congestion and improving possible hypoperfusion in peripheral organs. Diuretics, especially loop diuretics, are the cornerstone of treatment for relieving fluid overload. Vasodilators, such as nitrates, help reduce congestion and ventricular filling pressures. In cases of cardiogenic shock, vasoconstrictors, such as noradrenaline, and inotropics, such as dobutamine, are essential for improving peripheral perfusion. Non-pharmacological measures include oxygen therapy and non-invasive mechanical ventilation in cases of respiratory failure. In severe situations, mechanical circulatory support devices may be used to improve perfusion and survival.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2147-2149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338532","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
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