Revista clinica espanola最新文献

{"title":"Los derechos e intereses de los participantes como límites de los ensayos clínicos","authors":"R. Dal-Ré","doi":"10.1016/j.rce.2024.10.001","DOIUrl":"10.1016/j.rce.2024.10.001","url":null,"abstract":"<div><div>Point 8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point 8 be modified to indicate the opposite, that is, that it is acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change. What happened with the masked placebo-controlled trials of experimental vaccines against SARS-CoV-2 is held up as an example. When the high efficacy of the vaccines became evident, questions arose as to what should be done, whether to keep the trials masked until data on long-term efficacy, immunogenicity, and safety were obtained or to unmask the trials and offer the vaccine that had been shown to be efficacious to participants who received the placebo. The latter was the correct approach, which translates point 8 into practice.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 28-34"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137040","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":"Estudio prospectivo del síndrome de piernas inquietas en una muestra de donantes de sangre","authors":"L. Lillo-Triguero ,&nbsp;A. del Castillo-Rueda ,&nbsp;J.M. Bellón ,&nbsp;R. Peraita-Adrados","doi":"10.1016/j.rce.2024.07.010","DOIUrl":"10.1016/j.rce.2024.07.010","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Blood donation is suggested to increase the risk of restless legs syndrome (RLS). This study aims to assess the prevalence of RLS in Spanish blood donors and determined its potential correlation with iron metabolism parameters.</div></div><div><h3>Materials and methods</h3><div>Prospective cohort study of 129 blood donors (54.3% men, 39.44 years<!--> <!-->±<!--> <!-->11.0) that underwent a physical examination, blood analysis (hemoglobin, ferritin, transferrin saturation index and soluble transferrin receptor) and a RLS screening questionnaire followed by a prospective follow-up study including a clinical phone interview. A multivariate logistic regression model was performed to examine the association between RLS and other variables.</div></div><div><h3>Results</h3><div>Eighty-four (65.1%) participants were repeat blood donors (mean of 2.11 donations/year) at inclusion and 61 (47.4%) at follow-up (mean of 2.09 donations/year). Non-anemic iron deficiency (ferritin<!--> <!-->&lt;<!--> <!-->50<!--> <!-->μg /L) was high in women <em>P</em>&lt;0.001 and in repeat donors <em>(P</em>=0.003). The prevalence of RLS was 14.1% at inclusion increasing prospectively (19.5%; <em>P</em>=0.065). On multivariate analysis, gender was the only variable significantly associated with a RLS diagnosis, being higher in women (OR 5.1; 95% CI 1.71-15.3; <em>P</em>=0.003).</div></div><div><h3>Conclusions</h3><div>Despite the high prevalence of non-anemic iron deficiency there was no association between ferritin, soluble transferrin receptor concentration values and RLS diagnosis. Gender was associated with RLS diagnosis regardless of other variables.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 9-15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137095","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":"Recomendaciones 2024 de la Sociedad Española de Medicina Interna (SEMI) para el manejo de la trombosis venosa asociada al cáncer","authors":"A. Villalobos ,&nbsp;R. Valle ,&nbsp;J. Pagán-Escribano ,&nbsp;M. Ortiz ,&nbsp;P. Demelo-Rodríguez ,&nbsp;C. Font","doi":"10.1016/j.rce.2024.09.003","DOIUrl":"10.1016/j.rce.2024.09.003","url":null,"abstract":"<div><div>Venous thromboembolic disease (VTD) is a common complication associated to greater mortality in patients with cancer. Its etiology is multifactorial and depends on the characteristics and co-morbidities of the patient, the tumor type and extension, and the oncological treatment. The management of VTD is more complex in patients with cancer due to an increased risk of recurrence and major bleeding complications during anticoagulation compared to the general non-oncological population. The above differences have led to the development of specific clinical trials to assess the efficacy and safety of anticoagulant therapy in patients with cancer. The present clinical guidelines are intended to provide general recommendations on the management of cancer-associated VTD according to updated according to the most recent scientific evidence.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 35-44"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137039","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":"Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardiaca y enfermedad pulmonar obstructiva crónica: programa UMIPIC","authors":"M. Méndez Bailón ,&nbsp;Á. González-Franco ,&nbsp;J.M. Cerqueiro ,&nbsp;J. Pérez-Silvestre ,&nbsp;C. Moreno García ,&nbsp;A. Conde-Martel ,&nbsp;J.C. Arévalo-Lorido ,&nbsp;F. Formiga Pérez ,&nbsp;L. Manzano-Espinosa ,&nbsp;M. Montero-Pérez-Barquero","doi":"10.1016/j.rce.2024.09.002","DOIUrl":"10.1016/j.rce.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and a history of COPD.</div></div><div><h3>Methods</h3><div>A total of 5644 patients were prospectively recruited, of which 1320 had a history of COPD between March 2008 and March 2020. They were divided into two follow-up groups at the time of discharge, one in follow-up in the UMIPIC program (435 patients) and another treated conventionally (885 patients). The baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching and admissions and mortality were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.</div></div><div><h3>Results</h3><div>The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for HF (21 vs. 30%, respectively; hazard ratio<!--> <!-->=<!--> <!-->0.64; 95% CI: 0.54–0.84; <em>p</em> <!-->=<!--> <!-->0.002) and mortality (28 vs. 36%, respectively; hazard ratio<!--> <!-->=<!--> <!-->0.68; 95% CI: 0.51–0.90; <em>p</em> <!-->=<!--> <!-->0.008). From a therapeutic point of view, patients with HF and a history of COPD who were followed in the UMIPIC program received a higher percentage of beta-blockers (63.9 vs. 54.2%; <em>p</em> <!-->&lt;<!--> <!-->0.05) and direct-acting anticoagulants (17 vs. 9%; <em>p</em> <!-->&lt;<!--> <!-->0.05) than those followed conventionally.</div></div><div><h3>Conclusions</h3><div>The implementation of the UMIPIC care program for patients with HF and a history of COPD, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up. The prescription of beta-blockers and direct-acting anticoagulants was also higher during follow-up in the UMIPIC program.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137145","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":"Impacto del abandono del hábito de fumar sobre los parámetros metabólicos y la función renal en pacientes con y sin diabetes mellitus","authors":"C.-P. Fu ,&nbsp;P.-K. Fu ,&nbsp;M.-C. Lu ,&nbsp;Y.-Y. Liao ,&nbsp;J.-S. Wang","doi":"10.1016/j.rce.2024.08.003","DOIUrl":"10.1016/j.rce.2024.08.003","url":null,"abstract":"<div><h3>Backgroud and objectives</h3><div>As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.</div></div><div><h3>Materials and methods</h3><div>Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.</div></div><div><h3>Result</h3><div>A total of 1,954 patients joined the smoking cessation program, and 1,381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.</div></div><div><h3>Conclusion</h3><div>Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 16-22"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137172","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":"Anticuerpos anti-NOR90 y su significación clínica: experiencia multicéntrica en el sur de España","authors":"J. Martínez de Victoria Carazo ,&nbsp;D. Fernández Reyes ,&nbsp;F.J. de la Hera Fernández ,&nbsp;T. González Cejudo ,&nbsp;N. Navarrete Navarrete ,&nbsp;J.L. Callejas Rubio","doi":"10.1016/j.rce.2024.08.002","DOIUrl":"10.1016/j.rce.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-NOR90 antibodies were initially described in patients with autoimmune diseases based on staining of a nucleolar region known as the nucleolar organizer region (NOR). This study aims to explore the clinical aspects of anti-NOR90 antibodies in patients with systemic autoimmune diseases.</div></div><div><h3>Methods</h3><div>Observational study of patients with positive anti-NOR90 antibodies using the EUROLINE Systemic Sclerosis profile (IgG) kit (Euroimmun, Germany). Data on demographics, comorbidities, autoimmune diseases, treatment, and clinical manifestations were collected.</div></div><div><h3>Results</h3><div>Fifteen patients with positive anti-NOR90 antibodies were included. Majority were female (86.7%), with median age of 54 years. Most common clinical manifestations were Raynaud's phenomenon, dryness, and interstitial lung disease (ILD). Some patients had hematological or solid organ neoplasms. EPID was prevalent, with one case showing rapid progression requiring aggressive treatment.</div></div><div><h3>Discussion and conclusions</h3><div>This study highlights the association between anti-NOR90 antibodies and systemic autoimmune diseases, particularly SS and ES. EPID was a notable feature, suggesting its consideration in IPAF diagnosis for anti-NOR90 positive patients. Further multicenter studies are needed for better understanding and detection methods optimization.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 51-55"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137173","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":"Sarampión en la sala de urgencias: el enemigo sigue ahí","authors":"J. Ena","doi":"10.1016/j.rce.2024.09.001","DOIUrl":"10.1016/j.rce.2024.09.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 650-651"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757359","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 del documento de consenso sobre la realización de la ecografía clínica: recomendaciones desde los Grupos de Trabajo de Ecografía Clínica de la SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC y SEMG","authors":"Y. Tung-Chen ,&nbsp;J. Short Apellaniz ,&nbsp;R. Alonso Roca ,&nbsp;J.R. Alonso Viladot ,&nbsp;I. Arnanz González ,&nbsp;L. Beltrán Romero ,&nbsp;A. Calvo Cebrián ,&nbsp;R. Campo Linares ,&nbsp;K.A. Foo Gil ,&nbsp;I. García Suárez ,&nbsp;A.D. González Delgado ,&nbsp;A. Hernández Martínez ,&nbsp;M.F. Marchese Ratti ,&nbsp;O. Martínez Villén ,&nbsp;J. Mercadal Mercadal ,&nbsp;E. Minguela Puras ,&nbsp;Maria Ester Montes Belloso ,&nbsp;P.P. Reinoso Párraga ,&nbsp;E. Rodríguez Urteaga ,&nbsp;A. Romero Galán ,&nbsp;Paola Pastora Reinoso Párraga","doi":"10.1016/j.rce.2024.07.006","DOIUrl":"10.1016/j.rce.2024.07.006","url":null,"abstract":"<div><div>Point-of-Care Ultrasound has significantly evolved, establishing itself as an essential tool in daily medical practice, especially in various clinical contexts. This consensus document, supported by several Spanish medical societies, proposes guidelines for the effective integration of ultrasound in healthcare, promoting its standardization and ensuring the quality and systematic application of this technique. The working groups, composed of experts from different specialties, conducted a comprehensive review of the literature in MEDLINE and extensively discussed recommendations to formulate a coherent and practical set of guidelines for different application areas: hospital and out-of-hospital emergencies and critical care, primary care, and outpatient hospital care, hospitalization.</div><div>The methodology included virtual meetings and confidential voting to reach a consensus on the relevant recommendations. Ultrasound was highlighted as fundamental in the initial approach to various pathologies, such as abdominal, thoracic, and musculoskeletal issues, facilitating quick and accurate diagnoses, and reducing the need for unnecessary referrals. Furthermore, this technique has proven valuable in emergencies and critical care, guiding procedures and enhancing the safety and efficiency of clinical interventions.</div><div>These guidelines not only serve as a framework for clinical practice, education, and research but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence. The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in the daily practice of healthcare, thus improving the quality of the services provided in its various possible applications.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 670-678"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757362","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":"Asociación entre enfermedades autoinmnues y enfermedad de Alzheimer: análisis a partir de herramientas de big data","authors":"A.M. Diezma-Martín ,&nbsp;M.I. Morales-Casado ,&nbsp;L. Jiménez-Díaz ,&nbsp;J.D. Navarro-López ,&nbsp;B. Mondéjar-Marín ,&nbsp;J. Parra-Serrano ,&nbsp;A. Vadillo-Bermejo ,&nbsp;C. Marsal-Alonso ,&nbsp;P. Beneyto-Martín","doi":"10.1016/j.rce.2024.07.003","DOIUrl":"10.1016/j.rce.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>The objective is to analyze the prevalence of Alzheimer's disease in patients with and without a diagnosis of different autoimmune diseases and the possible association between both pathologies.</div></div><div><h3>Patients and methods</h3><div>A multicenter, retrospective, cohort study was conducted to study the prevalence of Alzheimer's disease among patients diagnosed with various autoimmune diseases compared to the general population. Data from electronic medical records from the Castilla-La Mancha healthcare system were analyzed using Natural Language Processing through the Savana Manager® artificial intelligence clinical platform. A total of 1,028,356 patients were analyzed, including 28,920 individuals with Alzheimer's disease and 999,436 control patients.</div></div><div><h3>Results</h3><div>Out of the 12 autoimmune diseases analyzed, 5 showed a significant association with Alzheimer's disease with <em>P</em> <!-->.05. Myasthenia gravis had an increased prevalence of AD with OR 1.49 (95% <span>C</span>I 1.11 - 2), systemic lupus erythematosus with OR 2.42 (95% CI 2.02 – 2.88), rheumatoid arthritis with OR 1.38 (95% CI 1.24 – 1.54), polymyalgia rheumatica with OR 2.01 (95% CI 1.08 – 2.23), and pernicious anemia with OR 2.06 (95% CI 1.59 – 2.66). The remaining autoimmune diseases analyzed did not show a higher prevalence of Alzheimer's disease compared to the general population.</div></div><div><h3>Conclusions</h3><div>There may be an association between certain systemic autoimmune diseases and Alzheimer's disease. Further studies are needed to confirm our findings, establish causality, and explore the underlying mechanisms of this association.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 627-633"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757414","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":"Seguimiento y tratamiento de la enfermedad tromboembólica venosa a largo plazo: recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 2024","authors":"M. Martín del Pozo ,&nbsp;M. Martín Asenjo ,&nbsp;A.I. Franco Moreno ,&nbsp;E. Usandizaga de Antonio ,&nbsp;F. Galeano Valle","doi":"10.1016/j.rce.2024.07.007","DOIUrl":"10.1016/j.rce.2024.07.007","url":null,"abstract":"<div><div>Venous thromboembolim (VTE) is a highly prevalent condition that requires long-term monitoring and treatment. This monitoring includes: 1) completing the etiological study and determining the risk of VTE recurrence; 2) establishing the optimal duration of anticoagulant treatment, as well as the type of therapy and its dosage; 3) estimating the risk of bleeding, and 4) identifying the occurrence of chronic complications. This consensus document, prepared by the VTE Group of the Spanish Society of Internal Medicine (SEMI), aims to update and establish consensus recommendations on these aspects. The document focuses on four aspects of management: the first includes risk factors for VTE recurrence after an unprovoked VTE episode and describes the predictive scores of VTE recurrence; the second focuses on risk factors for bleeding; the third provides recommendations for long-term follow-up in VTE, addressing specific considerations for screening chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome of the lower limbs; and the fourth provides guidance on the optimal duration of extended anticoagulant treatment, as well as the type of therapy and its dosage;. For each area, an exhaustive literature review was conducted, analyzing the updated VTE clinical guidelines and recent studies. This document is intended to be a guide in the long-term management of VTE based on the most current knowledge.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 652-663"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757360","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}