Revista clinica espanola最新文献

{"title":"Carta al editor sobre «Los retos de la bioética en la práctica clínica del siglo XXI»","authors":"M.F. García Aguilera , N. García Méndez , E. Álvarez Muñoz , J. Lagarda Cuevas","doi":"10.1016/j.rce.2024.02.007","DOIUrl":"https://doi.org/10.1016/j.rce.2024.02.007","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823547","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":"Sospecha clínica, diagnóstico y seguimiento de la amiloidosis cardíaca: documento de actualización y resumen ejecutivo","authors":"S. Yun ,&nbsp;J. Casado ,&nbsp;J. Pérez-Silvestre ,&nbsp;P. Salamanca ,&nbsp;P. Llàcer ,&nbsp;R. Quirós ,&nbsp;R. Ruiz-Hueso ,&nbsp;M. Méndez ,&nbsp;L. Manzano ,&nbsp;F. Formiga","doi":"10.1016/j.rce.2024.03.007","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.007","url":null,"abstract":"<div><p>In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the “red flags” to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823534","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":"Interrelación multidimensional de la fragilidad en los pacientes mayores con diabetes mellitus","authors":"M.C. Gamero-Sánchez ,&nbsp;I. Barreto ,&nbsp;J.C. Arévalo-Lorido ,&nbsp;J. Maese-Calvo ,&nbsp;N. Mayoral-Testón ,&nbsp;J. Carretero-Gómez ,&nbsp;D. Fernández-Bergés","doi":"10.1016/j.rce.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.002","url":null,"abstract":"<div><h3>Background and objective</h3><p>Patients with diabetes mellitus (DM) experience accelerated aging and, thus, a high prevalence of frailty. Our aim is to outline the type of frailty and prefrailty from a multidimensional perspective and the interaction of these dimensions in this scenery.</p></div><div><h3>Material and methods</h3><p>Observational study of patients with DM over 60 years-old. Variables related to nutrition, cognitive and emotional status, physical and instrumental functional capacity and social resources were collected. They were divided into three groups (robust, prefrail and frail) according to the Fried scale. Each of the variables in the groups were compared and a correspondence analysis was carried out to see the influence of some dimensions with others in each stage of frailty.</p></div><div><h3>Results</h3><p>188 patients (mean age 72.6<!--> <u>+</u> <!-->7.5) were analysed. Of them, 105 patients had prefrailty and 66 were frail. With the exception of social resources, the rest of the variables had an increasing prevalence depending on the stage of frailty. However, in the correspondence analysis (with 22.9% of variation explained by two dimensions) it was only patients with frailty who were associated with worse functional capacity, cognitive and emotional situation and mild to moderate social incapacity.</p></div><div><h3>Conclusions</h3><p>In our sample there was a high prevalence of prefrailty, and frailty associated with an increase in the prevalence of other different dimensions except social resources. However, the interaction between these dimensions was only evident in the case of patients with frailty.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823541","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":"Eventos cardiovasculares graves en asistentes a partidos de la liga nacional de fútbol antes y después de la COVID-19","authors":"L. Consuegra-Sánchez ,&nbsp;J.A. Martínez","doi":"10.1016/j.rce.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.005","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823546","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":"Anchura del bulbo de la arteria carótida interna: un nuevo parámetro potencial para la predicción de enfermedades vasculares cerebrales","authors":"İ. Ökçesiz ,&nbsp;H. Dönmez ,&nbsp;M. Mustafa Etleç ,&nbsp;A. Öztürk","doi":"10.1016/j.rce.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the relationship between the width of the internal carotid artery (ICA) bulb and cerebral vascular diseases including stroke and intracranial aneurysms.</p></div><div><h3>Material and methods</h3><p>In total 300 patients who had supra-aortic computed tomography angiography (CTA) were enrolled in this study from 2015 to 2021. The study groups consisted of 100 ischemic stroke patients, 100 patients with intracranial aneurysms, and 100 control subjects. The intracranial aneurysm patient group was divided into two subgroups according to the presence of subarachnoid hemorrhage (SAH). The largest diameters of the ICA C1 (cervical) and C2 (petrous) segments in all individuals were measured bilaterally on CTA images. The ICA diameter ratios of the cases were measured using the formula (C1-C2)/C1. The relationship between the age and ICA vessel analysis was evaluated as well.</p></div><div><h3>Results</h3><p>The mean ICA bulb width values in the ischemic stroke patient group and the intracranial aneurysm patient group were significantly higher than the control group (<em>P</em>&lt;.001). The ICA C1 and C2 segment diameter values and ICA diameter ratio were smaller in the intracranial aneurysm patients with SAH than those who had not (<em>P</em>= 0.7). There was a statistically significant but weak relationship between the age and ICA diameter ratios in all study groups (R-squared value of 0.26, <em>P</em>= 0.03).</p></div><div><h3>Conclusion</h3><p>ICA bulb width is a parameter that can be easily evaluated with neuroimaging modalities and is a successful method that may be used for predicting the risk of ischemic stroke or the presence of an intracranial aneurysm.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823539","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":"Factores determinantes de la precisión de la oximetría de pulso: revisión bibliográfica","authors":"D. León-Valladares ,&nbsp;L.A. Barrio-Mateu ,&nbsp;N. Cortés-Carmona ,&nbsp;G. Fuentes-Lizana ,&nbsp;A.M. Cabanas ,&nbsp;K. Latorre-Progulakis ,&nbsp;M. Fuentes Guajardo ,&nbsp;P. Martín-Escudero","doi":"10.1016/j.rce.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.001","url":null,"abstract":"<div><h3>Objective</h3><p>Identify and reach consensus on the variables that affect the measurement of oxygen saturation (SpO₂) using pulse oximetry.</p></div><div><h3>Methods</h3><p>We applied inclusion and exclusion criteria to select relevant studies in databases such as EBSCO and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results.</p></div><div><h3>Results</h3><p>Twenty-three studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in SpO₂ measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO₂, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency<!--> <!-->&gt;<!--> <!-->150<!--> <!-->bpm, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal.</p></div><div><h3>Conclusions</h3><p>The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO₂, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823544","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":"Preguntas PICO y metodología DELPHI para mejorar el manejo de los pacientes con porfiria hepática aguda","authors":"A. Riera-Mestre ,&nbsp;J.S. García Morillo ,&nbsp;J. Castelbón Fernández ,&nbsp;M.E. Hernández-Contreras ,&nbsp;P. Aguilera Peiró ,&nbsp;J. Jacob ,&nbsp;F. Martínez Valle ,&nbsp;E. Guillén-Navarro ,&nbsp;M. Morales-Conejo","doi":"10.1016/j.rce.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Acute hepatic porphyrias (AHPs) are a group of rare diseases that encompasses acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and 5-aminolaevulinic acid dehydratase deficiency porphyria. Symptoms of AHP are nonspecific which, together with its low prevalence, difficult the diagnosis and follow-up of these patients.</p></div><div><h3>Material and methods</h3><p>This project used DELPHI methodology to answer PICO questions related to management of patients with AHPs. The objective was to reach a consensus among multidisciplinary porhyria experts providing answers to those PICO questions for improving diagnosis and follow-up of patients with AHP.</p></div><div><h3>Results</h3><p>Ten PICO questions were defined and grouped in four domains: 1.<!--> <!-->Biochemical diagnosis of patients with AHP. 2.<!--> <!-->Molecular tests for patients with AHP. 3.<!--> <!-->Follow-up of patients with AHP. 4.<!--> <!-->Screening for long-term complications of patients with AHP.</p></div><div><h3>Conclusions</h3><p>PICO questions and DELPHI methodology have provided a consensus on relevant and controversial issues for improving the management of patients with AHP.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S001425652400078X/pdfft?md5=1e297bb47359b16d1dcd021f490e6adf&pid=1-s2.0-S001425652400078X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823540","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":"Análisis de la expresión del gen SERPINA1 en la infección por SARS-CoV-2: estudio de un nuevo biomarcador","authors":"M. Pintanel-Raymundo ,&nbsp;S. Menao-Guillén ,&nbsp;J.J. Perales-Afán ,&nbsp;A. García-Gutiérrez ,&nbsp;I. Moreno-Gázquez ,&nbsp;M. Julián-Ansón ,&nbsp;M. Ramos-Álvarez ,&nbsp;S. Olivera-González ,&nbsp;I. Gutiérrez-Cía ,&nbsp;M.A. Torralba-Cabeza","doi":"10.1016/j.rce.2024.03.002","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The <em>SERPINA1</em> gene encodes the protein Alpha-1 Antitrypsin (AAT1). Possible imbalances between the concentrations of proteases and antiproteases (AAT1) can lead to the development of serious pulmonary and extrapulmonary pathologies. In this work we study the importance of this possible imbalance in patients with COVID-19.</p></div><div><h3>Objectives</h3><p>To correlate the severity of the symptoms of SARS-CoV-2 infection with the AAT1 concentrations at diagnosis of the disease.</p></div><div><h3>Methods</h3><p>An observational, prospective, cross-sectional, non-interventional, analytical study was carried out where 181 cases with COVID-19 admitted to the “Lozano Blesa” University Clinical Hospital of Zaragoza were selected. The concentration of AAT1 was studied in all of them and this was correlated with the clinical aspects and biochemical parameters at hospital admission.</p></div><div><h3>Results</h3><p>141 cases corresponded to patients with severe COVID and 40 patients with mild COVID. AAT1 levels were positively correlated with the days of hospitalization, severity, C-Reactive Protein, ferritin, admission to Intensive Care, and death, and presented a negative correlation with the number of lymphocytes/mm3. AAT1 concentrations higher than 237.5<!--> <!-->mg/dL allowed the patient to be classified as “severe” (S72%; E78%) and 311.5<!--> <!-->mg/dL were associated with the risk of admission to Intensive Care or Exitus (S67%;E79%).</p></div><div><h3>Conclusions</h3><p>Levels of the SERPINA1 gene expression product, AAT1, correlate with the severity of COVID-19 patients at diagnosis of the disease, being useful as a prognostic biomarker.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823542","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 de la hipocloremia como factor pronóstico en pacientes con insuficiencia cardíaca, estudio de cohortes retrospectivo","authors":"P. de Peralta García ,&nbsp;M. Bolzoni ,&nbsp;M. Yebra Yebra ,&nbsp;M. Asenjo Martinez ,&nbsp;M. Arrondo Turrado ,&nbsp;M.A. Domínguez Sepúlveda ,&nbsp;J.A. Rueda Camino ,&nbsp;R. Barba Martín","doi":"10.1016/j.rce.2024.03.004","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Some studies suggest that hypochloremia is a risk factor in the prognosis of heart failure (HF) in patients with recent decompensation.</p></div><div><h3>Materials and methods</h3><p>Retrospective cohort study of patients discharged due to HF decompensation who began follow-up in a specialized clinic. Two groups are defined: patients with hypochloremia (chloride &lt;<!--> <!-->98<!--> <!-->mmol/L) and normochloremic patients (chloride &gt;<!--> <!-->98<!--> <!-->mmol/L) in the initial assessment within the first month after discharge. The rate of intravenous diuretic rescue, emergency department visits, readmission for HF and cardiovascular (CV) death are compared using a Cox proportional hazards model.</p></div><div><h3>Results</h3><p>165 patients were included (59% women, mean age 85<!--> <!-->years), with 60 (36%) having hypochloremia. Both groups were comparable in terms of baseline characteristics, except for female sex, presence of peripheral artery disease, moderate-to-severe liver disease (more prevalent in the hypochloremia group), PROFUND index, and baseline furosemide dose (higher in patients with hypochloremia). The incidence of the primary event was higher in subjects with hypochloremia than in normochloremic subjects (HR: 1.59; 95%<!--> <!-->CI: 0.97-2.62), mainly due to the need for intravenous diuretic rescue (HR: 1.86; 95%<!--> <!-->CI: 1.07-3.24).</p></div><div><h3>Conclusions</h3><p>Hypochloremia following admission for HF decompensation is associated with a greater need for intravenous diuretic rescue therapy and probably worse overall prognosis across the spectrum of the disease, regardless of left ventricular ejection fraction (LVEF).</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823537","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":"Diagnóstico y tratamiento de la trombosis venosa profunda de las extremidades inferiores y superiores. Recomendaciones del grupo de enfermedad tromboembólica de la Sociedad Española de Medicina Interna 2024","authors":"A. Gil Díaz ,&nbsp;J. Martín Guerra ,&nbsp;P. Parra Caballero ,&nbsp;G. Puche Palao ,&nbsp;N. Muñoz Rivas ,&nbsp;N. Ruiz-Giménez Arrieta","doi":"10.1016/j.rce.2024.03.003","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.003","url":null,"abstract":"<div><p>Deep vein thrombosis (DVT) of the limbs is a common disease and causes significant morbidity and mortality. It is frequently the prelude to pulmonary embolism (PE), it can recur in 30% of patients and in 25-40% of cases they can develop post-thrombotic syndrome (PTS), with a significant impact in functional status and quality of life. This document contains the recommendations on the diagnosis and treatment of acute DVT from the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI).</p><p>PE and thrombosis of unusual venous territories (cerebral, renal, mesenteric, superficial, etc.) are outside its scope, as well as thrombosis associated with catheter and thrombosis associated with cancer, which due to their peculiarities will be the subject of other positioning documents of the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI).</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823543","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}