Revista clinica espanola最新文献

{"title":"Incidencia de embolia pulmonar relacionada con el embarazo en España 2016-2021: un estudio observacional retrospectivo de base poblacional","authors":"J.A. Rueda Camino ,&nbsp;A. Azcoaga-Lorenzo ,&nbsp;R. Noguero Meseguer ,&nbsp;D. Joya Seijo ,&nbsp;M.A. García ,&nbsp;D. Trujillo ,&nbsp;C. Miranda ,&nbsp;R. Barba-Martín","doi":"10.1016/j.rce.2024.06.014","DOIUrl":"10.1016/j.rce.2024.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission.</div></div><div><h3>Methods</h3><div>In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission.</div></div><div><h3>Results</h3><div>Among 2,178,805 births from 2016-2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (<em>P</em>=.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period.</div></div><div><h3>Conclusion</h3><div>The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 553-559"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documento de posicionamiento sobre la oclusión arterial de la retina. SEMI-SERV","authors":"R. García-Alonso ,&nbsp;L. Arias-Barquet ,&nbsp;L. Castilla Guerra ,&nbsp;M. Martín Asenjo ,&nbsp;A.J. Gómez-Escobar ,&nbsp;E. Gutierrez-Sánchez ,&nbsp;J. Pagán Escribano ,&nbsp;A. Lorenzo Hernández ,&nbsp;O. Madridano Cobo ,&nbsp;F. Jaén Águila ,&nbsp;M.E. Salguero Cámara ,&nbsp;N. Muñoz-Rivas","doi":"10.1016/j.rce.2024.06.012","DOIUrl":"10.1016/j.rce.2024.06.012","url":null,"abstract":"<div><div>The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.</div><div>In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 588-597"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraso diagnóstico y oportunidades perdidas en la detección precoz de la fibrilación auricular: estudio transversal","authors":"F. Richard Espiga ,&nbsp;M. Almendro Delia ,&nbsp;F. Caballero Martínez ,&nbsp;D. Monge Martín ,&nbsp;F. Neria Serrano ,&nbsp;R. Quirós López","doi":"10.1016/j.rce.2024.06.011","DOIUrl":"10.1016/j.rce.2024.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.</div></div><div><h3>Methods</h3><div>This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.</div></div><div><h3>Results</h3><div>A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1-6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.</div></div><div><h3>Conclusions</h3><div>In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 560-568"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria","authors":"L. Chen ,&nbsp;X.-J. Zeng ,&nbsp;X.-Y. Guo ,&nbsp;J. Liu ,&nbsp;F-H. Du ,&nbsp;C-X. Guo","doi":"10.1016/j.rce.2024.06.016","DOIUrl":"10.1016/j.rce.2024.06.016","url":null,"abstract":"<div><h3>Aims</h3><div>Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end-products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.</div></div><div><h3>Materials and methods</h3><div>In this cross-sectional study, sRAGE and urinary albumin to creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.</div></div><div><h3>Results</h3><div>There were 127 CHD patients (mean age: 63.06<!--> <!-->±<!--> <!-->10.93 years, 93 males) in the study, whose sRAGE were 1.83<!--> <!-->±<!--> <!-->0.64<!--> <!-->μg/L. The sRAGE level was higher in kidney injury group (uACR ≥<!--> <!-->30<!--> <!-->mg/g) compared with no kidney injury group (uACR &lt;<!--> <!-->30<!--> <!-->mg/g) [2.08<!--> <!-->±<!--> <!-->0.70 vs. 1.75<!--> <!-->±<!--> <!-->0.61<!--> <!-->μg/L, <em>P</em> <!-->&lt;<!--> <!-->.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (<em>r</em> <!-->=<!--> <!-->0.196, <em>P</em> <!-->&lt;<!--> <!-->.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [odd ratio<!--> <!-->=<!--> <!-->2.62 (1.12-6.15), <em>P</em> <!-->&lt;<!--> <!-->.05]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543-0.778), <em>P</em> <!-->&lt;<!--> <!-->.01].</div></div><div><h3>Conclusions</h3><div>Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 580-587"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectiva clínica de las miopatías necrotizantes inmunomediadas anti-HMG-Co-A-reductasa: análisis de tres casos","authors":"J.P. de la Fuente Peñaloza ,&nbsp;L. Quintana Cabezas ,&nbsp;M.C. Yubini Lagos","doi":"10.1016/j.rce.2024.07.002","DOIUrl":"10.1016/j.rce.2024.07.002","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 623-625"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia de la inflamación y metabolismo del hierro en las enfermedades crónicas","authors":"S. Conde Díez ,&nbsp;R. de las Cuevas Allende ,&nbsp;E. Conde García","doi":"10.1016/j.rce.2024.06.013","DOIUrl":"10.1016/j.rce.2024.06.013","url":null,"abstract":"<div><div>Anemia of inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient's quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 598-608"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resumen ejecutivo de la reflexión estratégica de la Sociedad Española de Medicina Interna 2025-2029 para garantizar la asistencia integral a la persona enferma en un Sistema Nacional de Salud de alto valor","authors":"J. Carretero Gómez ,&nbsp;M.M. Chimeno Viñas ,&nbsp;J.M. Porcel Pérez ,&nbsp;M. Méndez Bailón ,&nbsp;P. Pérez Martínez ,&nbsp;M.T. Herranz Marín ,&nbsp;F.J. Elola Somoza ,&nbsp;en nombre de los miembros de los comités para el proceso de reflexión estratégica de la SEMI","doi":"10.1016/j.rce.2024.08.001","DOIUrl":"10.1016/j.rce.2024.08.001","url":null,"abstract":"<div><h3>Aims</h3><div>To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Methods</h3><div>Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.</div></div><div><h3>Results</h3><div>The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.</div></div><div><h3>Conclusions</h3><div>SEMI seeks to be a key player in the transformation of the Spanish healthcare system.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 609-622"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resultados de la implementación del proyecto DP-TRANSFERS en Cataluña: un método traslacional para mejorar el cribado y la prevención de la diabetes en atención primaria","authors":"J.J. Cabré ,&nbsp;F. Barrio ,&nbsp;J. Vizcaíno ,&nbsp;A. Martínez ,&nbsp;T. Mur ,&nbsp;R. Sagarra ,&nbsp;S. Dalmau","doi":"10.1016/j.rce.2024.06.017","DOIUrl":"10.1016/j.rce.2024.06.017","url":null,"abstract":"<div><h3>Introduction</h3><div>DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.</div></div><div><h3>Objective</h3><div>Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.</div></div><div><h3>Methodology</h3><div>Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC<!--> <!-->&gt;11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.</div></div><div><h3>Results</h3><div>The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2,381 subjects screened, 1,713 participated in the basic module, with 1,186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second.</div><div>The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference.</div></div><div><h3>Conclusions</h3><div>The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 569-579"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La amiloidosis cardiaca empeora el pronóstico en los pacientes con insuficiencia cardiaca: hallazgos del estudio PREVAMIC","authors":"R. Ruiz Hueso ,&nbsp;P. Salamanca Bautista ,&nbsp;M.A. Quesada Simón ,&nbsp;S. Yun ,&nbsp;A. Conde Martel ,&nbsp;J.L. Morales Rull ,&nbsp;I. Fiteni Mera ,&nbsp;D. Abad Pérez ,&nbsp;I. Páez Rubio ,&nbsp;Ó. Aramburu Bodas ,&nbsp;en representación del grupo de trabajo PREVAMIC","doi":"10.1016/j.rce.2024.06.006","DOIUrl":"10.1016/j.rce.2024.06.006","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Cardiac amyloidosis (CA) is a common pathology in elderly patients that usually presents as heart failure (HF). However, it is not clear whether CA associated with HF has a worse prognosis compared with HF due to other etiologies.</div></div><div><h3>Material and methods</h3><div>Prospective, observational cohort study that recruited patients ≥65 years of age with HF in 30 Spanish centers. The cohort was divided according to whether the patients had AC or not. Patients were followed for 1 year.</div></div><div><h3>Results</h3><div>A total of 484 patients were included in the analysis. The population was elderly (median 86 years) and 49% were women CA was present in 23.8% of the included patients. In the CA group, there was a lower prevalence of diabetes mellitus and valvular disease. At one year of follow-up, mortality was significantly more frequent in patients with CA compared to those without (33.0 vs.14.9%, p<!--> <!-->&lt;<!--> <!-->0.001). However, there were no differences between both groups in visits to the emergency room or readmissions. In the multivariate analysis, the variables that were shown to predict all-cause mortality at one year of follow-up were chronic kidney disease (HR 1.75 (1.01-3.05) p<!--> <span>=</span> <!-->0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) p<!--> <!-->&lt;<!--> <!-->0.001), confusion (HR 2.05 (1.01-4.17), p<!--> <span>=</span> <!-->0.048), and the presence of CA (HR 1.77 (1.11-2.84), p<!--> <span>=</span> <!-->0.017).</div></div><div><h3>Conclusion</h3><div>The presence of CA in elderly patients with HF is related to a worse prognosis at one year of follow-up. Early diagnosis of the pathology and multidisciplinary management can help improve patient outcomes.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 8","pages":"Pages 494-502"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocystis jirovecii en la enfermedad humana, ¿sólo neumonía?","authors":"E.J. Calderón ,&nbsp;V. Friaza","doi":"10.1016/j.rce.2024.07.001","DOIUrl":"10.1016/j.rce.2024.07.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 8","pages":"Pages 546-548"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}