Medicine - Programa de Formación Médica Continuada Acreditado最新文献

{"title":"Cronobiología y aplicaciones médicas (I). Los ritmos circadianos","authors":"O. Fraile-Martínez ,&nbsp;C. García-Montero ,&nbsp;L. Ríos ,&nbsp;M.A. Sáez ,&nbsp;M. Álvarez de Mon-Soto ,&nbsp;M.A. Ortega","doi":"10.1016/j.med.2024.11.020","DOIUrl":"10.1016/j.med.2024.11.020","url":null,"abstract":"<div><div>Chronobiology is a discipline that studies how biological processes are organized in time cycles in response to environmental fluctuations, including circadian, ultradian, and infradian rhythms. Circadian rhythms, which last approximately 24<!--> <!-->hours, respond to the changes from light to darkness and other variations, whereas ultradian rhythms occur in cycles of less than 24<!--> <!-->hours and infradian rhythms encompass cycles longer than one day. Chronobiology has multiple medical applications. The importance of each of these rhythms has been demonstrated in a wide variety of physiological processes. They act in a coordinated manner to regulate the body's different functions. On the other hand, the loss or disruption of these rhythms has been associated with a wide variety of clinical diseases. The dysregulation of these rhythms is associated with an endless number of medical conditions. In this first part of the work, the concept of chronobiology will be explained and the main types of biological rhythms in the body will be presented. After, it will focus on detailing the key underlying mechanisms of circadian rhythms together with their influence on different physiological and pathological processes.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 23","pages":"Pages 1350-1363"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153895","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}

{"title":"Tabaquismo: concepto e impacto individual y social","authors":"V. Herrera-Yépez ,&nbsp;M. Llavero-Valero ,&nbsp;M.Á. Álvarez-Mon","doi":"10.1016/j.med.2024.11.023","DOIUrl":"10.1016/j.med.2024.11.023","url":null,"abstract":"<div><div>Tobacco use is a chronic, recurring disease characterized by nicotine addiction and constant exposure to the various toxins present in tobacco. This condition is associated with a high degree of morbidity and mortality, as tobacco use is associated with multiple health problems such as respiratory diseases, cardiovascular diseases, and cancer, among others. It is one of the public health problems that is most difficult to eradicate, despite the multiple campaigns there are at present, given that a large percentage of individuals worldwide continue to use tobacco. Health professionals play a fundamental role in the fight against tobacco use, both in prevention and in treatment. The two main pillars in stopping tobacco use are cognitive behavioral therapy and drug therapy. The scientific evidence has demonstrated that current treatments for stopping smoking are safe and effective, but there are financial and personal conditions that limit access to them.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 23","pages":"Pages 1394-1400"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154445","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}

{"title":"¿Existe el consumo saludable de alcohol?","authors":"A. Acosta ,&nbsp;T. Mijancos ,&nbsp;M. Barbería ,&nbsp;M.Á. Álvarez-Mon","doi":"10.1016/j.med.2024.11.022","DOIUrl":"10.1016/j.med.2024.11.022","url":null,"abstract":"<div><div>Moderate alcohol intake (more specifically, of red wine) is one of the supposed beneficial components of the traditional Mediterranean diet. Many well-conducted, non-randomized studies have demonstrated that mild or moderate alcohol consumption is not only associated with a reduction in risk of cardiovascular disease, but also with lower all-cause mortality. Nevertheless, alcohol is an addictive substance that is a significant threat to public health. Alcohol use is associated with an increased risk of cancer, neurological damage, injuries, and other adverse outcomes. Multiple international studies have recently supported the notion that the healthiest level of alcohol consumption is no consumption. Therefore, despite the findings of conventional observational epidemiological studies that support a possible beneficial role of wine in the context of a healthy Mediterranean diet, there continues to be significant controversy on this topic. This review will attempt to individualize the message according to patient characteristics and will address practical strategies to motivate patients toward healthier alcohol consumption.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 23","pages":"Pages 1385-1393"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153481","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}

{"title":"Cronobiología y aplicaciones médicas (II). Ritmos ultradianos e infradianos. Cronomedicina","authors":"C. García-Montero ,&nbsp;O. Fraile-Martínez ,&nbsp;L. Ríos ,&nbsp;M.A. Sáez ,&nbsp;M. Álvarez de Mon-Soto ,&nbsp;M.A. Ortega","doi":"10.1016/j.med.2024.11.021","DOIUrl":"10.1016/j.med.2024.11.021","url":null,"abstract":"<div><div>Chronobiology is a discipline that investigates how biological processes are structured in time cycles in response to environmental variations, including circadian, ultradian, and infradian rhythms. Despite the fact that research has paid more attention to circadian rhythms, ultradian and infradian rhythms are also key to a comprehensive understanding of chronobiology. Ultradian rhythms, with cycles of less than 24<!--> <!-->hours, tend to be anticipatory mechanisms that respond to unpredictable disturbances, notable among which are circahoral rhythms (cycles between 20<!--> <!-->minutes and 2<!--> <!-->hours) and circatidal rhythms (approximately 12<!--> <!-->hours). Infradian rhythms include cycles greater than one day, notable among which are circaseptal rhythms (approximately 7 days), circalunar rhythms (28 – 32 days), and seasonal or circannual rhythms (regulated by temporal processes associated with the seasons of the year). The involvement of these rhythms in different physiological and pathological processes has also been demonstrated, thus supporting the relevance of considering both as an element of study in the area of chronobiology. On the other hand, chronomedicine is a translational area that is in expansion. It attempts to apply a basic knowledge of chronobiology to clinical practice, influencing sleep management and the pharmacological and non-pharmacological approach to different diseases. This second part will describe the relevance of ultradian and infradian rhythms in health and disease. It will also describe the underlying mechanisms of these biological rhythms. In addition, it will discuss how the knowledge of these rhythms and of circadian rhythms can be applied in the medical setting, exploring possible translational focuses based on chronobiology for the treatment and management of diseases. It will also highlight lifestyle-based interventions or specific aspects associated with women's menstrual cycles.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 23","pages":"Pages 1364-1384"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153480","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}

{"title":"Estado actual del tratamiento antirretroviral","authors":"M. Suárez-Robles ,&nbsp;C.M. Cano-de Luque ,&nbsp;D. Gayoso ,&nbsp;A.G. García-Ruiz de Morales ,&nbsp;S. Moreno","doi":"10.1016/j.med.2024.11.019","DOIUrl":"10.1016/j.med.2024.11.019","url":null,"abstract":"<div><div>Since the discovery of human immunodeficiency virus (HIV) in 1983, both the epidemiology and the prognosis of HIV infection have changed notably thanks to the development of antiretroviral therapy (ART). Currently, the development of effective ART has changed the natural history the infection, allowing for people living with HIV (PLHIV) to have a life expectancy similar to that of the general population. The administration of ART is universal for all PLHIV, with very similar starting regimen among the main clinical guidelines. Certain special situations in which ART must be modified must be taken into account. The aim is to achieve viral suppression and revert the immunosuppressed state with the least toxicity possible while monitoring probable interactions among the various antiretroviral agents. New drugs are being developed that allow for long-term administration and which will also become an alternative in cases of virologic failure. What's more, the use of antiretrovirals in HIV prevention prior to exposure in situations of risk has allowed for decreasing the transmission of this infection.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 23","pages":"Pages 1337-1349"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153894","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}

{"title":"Leucemias agudas","authors":"P. García Ramírez,&nbsp;P.A. Rodríguez Barquero,&nbsp;P. Gili Herreros,&nbsp;C. Portocarrero de las Heras Pérez","doi":"10.1016/j.med.2024.10.022","DOIUrl":"10.1016/j.med.2024.10.022","url":null,"abstract":"<div><div>Acute leukemias are neoplastic proliferations of clonal immature hematopoietic cells (blasts) whose progressive accumulation in the bone marrow (BM) is accompanied by a decrease in the rest of the series. The natural evolution is a rapid progression with symptoms of spinal cord failure and infiltration of other tissues. There are two main groups according to the cell type that causes the proliferation: acute lymphoblastic leukemia if the neoplastic cell is of lymphoid origin or acute myeloid leukemia if the neoplastic cell is of myeloid origin. This update will focus on the latter, which are more common as individuals age. Diagnosis is based on a bone marrow aspiration with the presence of 20% blasts or a lower percentage in the presence of a defining genetic alteration. Therefore, phenotypic, genetic, and molecular characterization is essential for determining prognosis and guiding treatment with both target agents and through minimal residual disease (MRD). In young patients who are candidates for intensive treatment, induction polychemotherapy regimens are used followed by allogeneic or autologous transplantation guided by prognostic risk or MRD. The inclusion of older adult patients in clinical trials and the use of targeted therapies are now common.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1183-1192"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663670","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}

{"title":"Neoplasias mieloproliferativas crónicas. Clasificación. Leucemia mieloide crónica","authors":"J.M. Aspa-Cilleruelo ,&nbsp;G. López de Hontanar Torres ,&nbsp;M. Menor Gómez ,&nbsp;E. Magro Mazo","doi":"10.1016/j.med.2024.10.019","DOIUrl":"10.1016/j.med.2024.10.019","url":null,"abstract":"<div><div>Myeloproliferative neoplasms (MPN) are proliferative clonal disorders that originate in hematopoietic progenitor cells. They include different diseases that may overlap in which one or more cell lines proliferate. The diagnosis must be integrated, taking into account analytical, clinical, molecular, and histological data. They are chronic diseases. Following publication of the new WHO classification in 2022, these diseases include chronic myeloid leukemia (CML), polycythemia vera, essential thrombocythemia, primary myelofibrosis, chronic neutrophilic leukemia, chronic eosinophilic leukemia, and unclassified MPNs. Clinical manifestations are secondary to cell proliferation and include constitutional symptoms, anemia, infections, hemorrhagic and thrombotic events, and manifestations related to splenomegaly (which is common in all these entities). With the exception of CML, which is treated with tyrosine kinase inhibitors (TKI), treatment for the rest of MPNs mainly consists of controlling the symptoms arising from the disease (pruritus, headache, anemia, splenomegaly, etc.) and cytoreductive treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1149-1156"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663702","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}

{"title":"Alteraciones del sistema hemostático","authors":"C.I. Morellón Peña,&nbsp;A. Mendoza Martínez,&nbsp;A.C. Leal Ferrero,&nbsp;V. Jiménez Yuste","doi":"10.1016/j.med.2024.11.010","DOIUrl":"10.1016/j.med.2024.11.010","url":null,"abstract":"<div><div>Hemostasis is a dynamic process that involves the finely coordinated regulation of various components, including platelets, plasma proteins, and the endothelium, to maintain hemostatic balance and prevent bleeding diathesis and thrombosis. The understanding of this process has evolved toward a model where interactions occur mainly on cell surfaces. This update analyzes the physiology of hemostasis, with greater emphasis on secondary hemostasis. It addresses various diagnostic techniques used to evaluate bleeding diathesis, from basic studies to molecular analysis, highlighting the importance of molecular diagnostics in the accurate identification of these disorders. A review of the pathophysiology, diagnosis, and treatment of the most common congenital coagulation disorders (hemophilia and von Willebrand disease) is also presented, along with a brief mention of less common hereditary coagulopathies and congenital hyperfibrinolysis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 22","pages":"Pages 1275-1287"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141394","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}

{"title":"Síndromes mielodisplásicos y leucemia mielomonocítica crónica","authors":"M. Callejas Charavía,&nbsp;G. López de Hontanar Torres,&nbsp;G. Motornaya Morozova,&nbsp;M. Menor Gómez","doi":"10.1016/j.med.2024.10.021","DOIUrl":"10.1016/j.med.2024.10.021","url":null,"abstract":"<div><div>Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal diseases of hematopoietic progenitor cells. They are characterized by hypercellular bone marrow and ineffective hematopoiesis, which leads to the onset of cytopenia, morphological abnormalities, and a greater tendency to progress to acute myeloblastic leukemia (AML). Due to the highly variable clinical course, it is recommended that prognostic indexes be established to help identify progression to AML and make treatment decisions. However, when starting treatment, not only does the prognostic index have an influence, but age, comorbidities, Eastern Cooperative Oncology Group (ECOG) functional status, and the social environment must also be taken into account. Unlike high-risk MDS, where the goal of treatment is to modify the natural history of the disease and prolong overall survival, in low-risk MDS, the main goal is to improve cytopenia and quality of life with as little toxicity as possible.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1171-1182"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663669","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}

{"title":"Protocolo diagnóstico de las leucocitosis afebriles","authors":"A. Puchol,&nbsp;P. Villafuerte","doi":"10.1016/j.med.2024.10.024","DOIUrl":"10.1016/j.med.2024.10.024","url":null,"abstract":"<div><div>Leukocytosis, defined as an increase in the white blood cell count, can occur in a multitude of clinical situations. This protocol will focus on afebrile leukocytosis. To assess leukocytosis, the type of cell with increased values, the degree of leukocytosis, and the patient's symptoms must be evaluated and the morphology of cells observed under the microscope must be taken into account.</div><div>Neutrophilia refers to an increase of at least two standard deviations above the mean in the number of neutrophils in peripheral blood. The most frequent causes of neutrophilia are reactive forms (secondary to another condition) and the other group are those of primary origin when there is autonomous medullary hyperproduction.</div><div>Lymphocytosis is defined as an absolute lymphocyte count greater than 4000/μl, although up to 8000/μl may be normal in newborns and children. Reactive causes are more common in children or young adults, notable among which are mononucleosis syndromes. Other important causes are those secondary to clonal disorders; therefore, a blood smear study for cell morphology and flow cytometry study are required.</div><div>Monocytosis is defined as an increase in the number of monocytes in peripheral blood above 1000/μl. The most frequent causes are infections. Other important causes to consider, especially if monocytosis is sustained and secondary causes have been ruled out, are primary hematologic malignancies, especially in older adults or in patients with unexplained cytopenias.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 20","pages":"Pages 1198-1203"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142663699","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}