Revista clinica espanola最新文献

{"title":"E-consulta entre Atención Primaria y Medicina Interna: implementación, accesibilidad, beneficios e implicaciones","authors":"F.J. Suárez-Dono ,&nbsp;C. Martínez-Rey ,&nbsp;J. Novo-Platas ,&nbsp;C. Fernández Peña ,&nbsp;M.L. Rodríguez Méndez ,&nbsp;A. Pérez Iglesias ,&nbsp;E. Casariego-Vales","doi":"10.1016/j.rce.2024.05.003","DOIUrl":"10.1016/j.rce.2024.05.003","url":null,"abstract":"<div><h3>Aim</h3><p>This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine.</p></div><div><h3>Methods</h3><p>This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed.</p></div><div><h3>Results</h3><p>A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15 to 102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5,645 patients (49.4%) were given an in-person appointment. For the remaining 5,789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (<em>p</em> <!-->&lt;<!--> <!-->0.0001), visited the emergency department more times (one month: <em>p</em> <!-->=<!--> <!-->0.04; three months: <em>p</em> <!-->=<!--> <!-->0.001), were admitted to the hospital more times (one month: <em>p</em> <!-->=<!--> <!-->0.0001; three months: <em>p</em> <!-->=<!--> <!-->0.0001), and had higher mortality at one year (12.7% vs. 9.8% <em>p</em> <!-->=<!--> <!-->0.0001). On the Cox analysis, only in-person appointments (RR<!--> <!-->=<!--> <!-->1.11; <em>p</em> <!-->=<!--> <!-->0.04) and age (RR<!--> <!-->=<!--> <!-->1.09; <em>p</em> <!-->&lt;<!--> <!-->0.01) were independent factors of mortality. No complaints or claims of any kind were registered.</p></div><div><h3>Conclusions</h3><p>These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 421-427"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950825","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":"Utilidad del 18F-FDG-PET/TC en la detección de vasculitis de gran vaso extracraneal en pacientes con polimialgia reumática o arteritis de células gigantes: revisión sistemática y metaanálisis","authors":"A. González-García ,&nbsp;M. Fabregate ,&nbsp;G. Serralta ,&nbsp;B. de Miguel Campo ,&nbsp;A. Noblejas Mozo ,&nbsp;Á. Robles-Marhuenda ,&nbsp;en representación de la Sección de Autoinmunes de la Sociedad de Medicina Interna Madrid-Castilla La Mancha","doi":"10.1016/j.rce.2024.04.016","DOIUrl":"10.1016/j.rce.2024.04.016","url":null,"abstract":"<div><h3>Objective</h3><p>Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using ¹⁸F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA).</p></div><div><h3>Materials and methods</h3><p>PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I² statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and ¹⁸F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test.</p></div><div><h3>Results</h3><p>268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial VGV by ¹⁸F-FDG PET/CT was 54.5% [95% CI: 42.6% to 66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, <em>P</em>= .006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial VGV (61.1% vs. 46.9%; <em>P</em>= .010). No publication bias was observed.</p></div><div><h3>Conclusions</h3><p>The ¹⁸F-FDGPET/CT test may be useful in the detection of extracranial VGV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 445-456"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950828","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":"Tratamiento anticoagulante oral en la fibrilación auricular: AFIRMA, el estudio de vida real realizado mediante procesamiento de lenguaje natural y aprendizaje automático","authors":"J. Cosín-Sales ,&nbsp;M. Anguita ,&nbsp;C. Suárez ,&nbsp;C. Arias-Cabrales ,&nbsp;L. Martínez-Sanchez ,&nbsp;S.R. group ,&nbsp;D. Arumi ,&nbsp;S. Fernández de Cabo","doi":"10.1016/j.rce.2024.05.005","DOIUrl":"10.1016/j.rce.2024.05.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Oral anticoagulation (OAC) is key in atrial fibrillation (AF) thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).</p></div><div><h3>Materials and methods</h3><p>This retrospective study included AF patients on OAC from 15 Spanish hospitals (2014-2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.</p></div><div><h3>Results</h3><p>Among 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy were included, 80.7% receiving Vitamin K antagonists (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA₂DS₂-VASc score. The most frequent treatment switch was from DOAC to acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, apixaban was the most chosen (35.2%).</p></div><div><h3>Conclusions</h3><p>Utilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 428-436"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712102","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":"Valor de la ecografía multimodal en la evaluación de la sarcopenia en pacientes en hemodiálisis de mantenimiento","authors":"X. Zhang,&nbsp;Y. Yang","doi":"10.1016/j.rce.2024.05.004","DOIUrl":"10.1016/j.rce.2024.05.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients.</p></div><div><h3>Methods</h3><p>MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients.</p></div><div><h3>Results</h3><p>The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y<!--> <!-->=<!--> <!-->13.511<!--> <!-->-<!--> <!-->0.121<!--> <!-->*<!--> <!-->MT<!--> <!-->-<!--> <!-->0.609<!--> <!-->*<!--> <!-->CSA<!--> <!-->-<!--> <!-->0.172<!--> <!-->*<!--> <!-->PA<!--> <!-->+<!--> <!-->0.011<!--> <!-->*<!--> <!-->EI<!--> <!-->-<!--> <!-->2.205<!--> <!-->*<!--> <!-->MV (p<!--> <!-->&lt;<!--> <!-->0.05), with a cut-off value of 0.69.</p></div><div><h3>Conclusions</h3><p>Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 437-444"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014256524001085/pdfft?md5=8ecec82e5ec35e8b5bf4ad9296880e9c&pid=1-s2.0-S0014256524001085-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El internista joven a la vanguardia de la investigación clínica","authors":"F. Pérez-Jiménez ,&nbsp;P. Pérez-Martínez","doi":"10.1016/j.rce.2024.05.002","DOIUrl":"10.1016/j.rce.2024.05.002","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 479-480"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950830","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":"Determinantes sociales de la salud y su impacto en la medicina interna","authors":"M. Montserrat Chimeno Viñas ,&nbsp;P. Pérez-Martínez","doi":"10.1016/j.rce.2024.04.013","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.013","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 398-399"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294881","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 los niveles séricos de α-Klotho y la prevalencia de osteoartritis entre adultos de mediana edad y mayores: un análisis de la National Health and Nutrition Examination Survey 2007-2016","authors":"Q. Xu ,&nbsp;J. Wang ,&nbsp;H. Li ,&nbsp;Y. Gao","doi":"10.1016/j.rce.2024.04.007","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>As individuals age, the prevalence of osteoarthritis tends to increase gradually. α-Klotho is a hormone renowned for its anti-aging properties. However, the precise role of serum α-Klotho in osteoarthritis is still not fully comprehended.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. Serum α-Klotho levels were measured using an enzyme-linked immunosorbent assay (ELISA). Osteoarthritis was assessed through self-reported questionnaires. Through univariate and multivariate logistic regression analyses, smooth curve fitting, threshold effect analysis, and subgroup analyses, we delved into the potential association between them.</p></div><div><h3>Results</h3><p>The study encompassed a cohort of 10,265 participants. In fully adjusted models of multivariate logistic regression analysis, we identified a negative correlation between serum ln α-Klotho and OA (OR<!--> <!-->=<!--> <!-->0.77, 95% CI: 0.65-0.91, p<!--> <!-->=<!--> <!-->0.003). When stratifying serum α-Klotho levels into tertiles, individuals in the highest tertile exhibited a 26% reduced risk of OA compared to those in the lowest tertile (OR<!--> <!-->=<!--> <!-->0.84, 95% CI: 0.73-0.97, p<!--> <!-->=<!--> <!-->0.014). Subsequent analyses indicated a linearly negative association. In subgroup analyses, we explored the relationship between serum ln α-Klotho and osteoarthritis across diverse populations, revealing the persistence of this association in the majority of subgroups.</p></div><div><h3>Conclusion</h3><p>Serum α-Klotho levels exhibit a significant negative linear correlation with the prevalence of osteoarthritis in middle-aged and elderly populations in the United States.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 366-378"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294893","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":"Tiempo dedicado a la actividad física entre los residentes médicos: ¿existen diferencias basadas en el género o el tipo de especialidad?","authors":"O. Pujol ,&nbsp;L. Vila-Castillo ,&nbsp;C. Álvaro ,&nbsp;M. Aguilar ,&nbsp;N. Joshi ,&nbsp;J. Minguell","doi":"10.1016/j.rce.2024.04.009","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Physical activity (PA) is associated with positive health outcomes such as prevention of chronic diseases, psychological well-being and improved work performance. Medical residents are subjected to sleep deprivation, extended work schedule and high burnout prevalence. These conditions may lead to the neglect of personal health and the restriction of time dedicated to PA. The objective of the present study was to analyze the time dedicated to PA of medical residents, comparing women vs men residents and surgical vs clinical residents.</p></div><div><h3>Methods</h3><p>It is a cross-sectional study performed in a Spanish third-level university hospital. All medical residents from our institution were invited to voluntarily participate in the study answering a web-based questionnaire on June 2022. Data regarding demographics, residency and PA practice was recorded.</p></div><div><h3>Results</h3><p>The response rate was 20.73% (114/550). The 32.5% of the residents considered themselves to be physically inactive and mean time dedicated to PA in a regular week was 3.62<!--> <!-->±<!--> <!-->2.22<!--> <!-->hours. Men residents dedicated more time to PA than women residents (4.23<!--> <!-->±<!--> <!-->2.42<!--> <!-->hours vs 3.14<!--> <!-->±<!--> <!-->1.95<!--> <!-->hours, p<!--> <!-->=<!--> <!-->0.012) and surgical residents dedicated more time than clinical residents (4.33<!--> <!-->±<!--> <!-->2.36<!--> <!-->hours vs 3.23<!--> <!-->±<!--> <!-->2.05<!--> <!-->hours, p<!--> <!-->=<!--> <!-->0.01).</p></div><div><h3>Conclusions</h3><p>One third of the medical residents consider themself physically inactive. Women and clinical residents practice PA less time than men and surgical residents. Efforts should be made to encourage PA among residents, especially in women and non-surgeons.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 387-392"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294509","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":"Carta al editor sobre el artículo «Resumen ejecutivo del documento de consenso sobre el manejo de la anemia perioperatoria en España»","authors":"F.J. Teigell Muñoz,&nbsp;M. Mateos González","doi":"10.1016/j.rce.2024.04.011","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.011","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Page 418"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294890","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":"Rendimiento comparativo del exudado vulvovaginal frente al endocervical para la detección de Chlamydia, Gonorrhea, Mycoplasma genitalium y Tricomoniasis: un estudio transversal en España","authors":"M. Linares-Rufo ,&nbsp;P. Galicia ,&nbsp;A. Rojas ,&nbsp;Á.M. Benito ,&nbsp;J. Cuadros-González ,&nbsp;J.M. Ramos-Rincón","doi":"10.1016/j.rce.2024.04.014","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.014","url":null,"abstract":"<div><h3>Introduction</h3><p>The global increase in sexual transmitted infections (STI) makes it necessary to seek public health strategies that facilitate rapid and minimally invasive diagnosis. The objective was to evaluate the concordance between vaginal and endocervical samples for STI diagnosis.</p></div><div><h3>Materials and methods</h3><p>A retrospective cross-sectional study was carried out on vaginal and endocervical samples from women attended in our reference area with symptoms suggestive of vulvovaginitis or for STI screening during the study period.</p></div><div><h3>Results</h3><p>A total of 130 paired samples were analyzed; fifty-seven and 59 samples were positive for vaginal and endocervical specimens (Kappa index of 0.969 (Standard error<!--> <!-->=<!--> <!-->0.022). The sensitivity of the vaginal samples was 96.5% (IC95%: 87.2-99.4), with a specificity of 100% (IC95%: 93.0-100).</p></div><div><h3>Discussion</h3><p>The introduction of STI screening in vaginal samples in our environment can facilitate rapid and effective diagnosis and allow early treatment of STI. Additionally, it facilitates sample collection and diagnosis in the community setting, essential for optimal screening.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 393-397"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294510","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}