Anales de la Real Academia Nacional de Medicina最新文献

{"title":"Cardiovascular toxicity of anticancer drugs: the dark side of success","authors":"J. Tamargo","doi":"10.32440/ar.2023.140.02.rev05","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev05","url":null,"abstract":"Cancer represents the second cause of death in the European Union after cardiovascular diseases, accounting for 27% of all deaths. Anticancer drugs (ACDs) have poor cell selectivity and a narrow therapeutic margin, in such a way that small increases in their plasma levels lead to the appearance of adverse reactions in multiple tissues. The FACs can produce a wide range of adverse cardiovascular reactions (named cardiotoxicity) that increase morbidity and can even lead to death in some patients whose cancer has been cured by the ACD. The risk of cardiotoxicity increases with age, and since up to two-thirds of cancer patients are older than 65 years of age, cancer, cardiovascular diseases whose incidence increases with age and CAD-induced cardiotoxicity will coexist in this population. The diagnosis, prognosis, follow-up, and treatment of cardiotoxicity induced by CAFs represent a challenge in daily clinical practice that makes teamwork among cardiologists, oncologists, and hematologists essential. The recent guidelines on cardio-oncology of the European Society of Cardiology represents the first experience of this joint work to comprehensively address the cardiotoxicity due to anticancer drugs.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599681","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":"Oral small molecules: new therapeutic targets in psoriasis","authors":"L. Martos-Cabrera, R. Sampedro-Ruiz, M. Llamas-Velasco, H. de la Fuente, E. Daudén","doi":"10.32440/ar.2023.140.02.rev04","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev04","url":null,"abstract":"Psoriasis is a chronic immune-mediated skin disease frequently associated with different comorbidities, among which psoriatic arthritis stands out, with a high impact on the quality of life of patients. We have an important therapeutic arsenal that includes topical agents, phototherapy and systemic drugs. In recent years, biological therapy has brought about a true revolution in the treatment of moderate to severe psoriasis, due to its great efficacy and safety. However, it has some limitations such as its exclusively parenteral administration, its high cost and the lack of efficacy and tolerance in some cases. Therefore, based on a better knowledge of the pathophysiology of psoriasis, new therapeutic options have emerged: the small molecules. They represent an enrichment for the clinician in the therapeutic management of psoriasis. Some of those have approved indication and others under investigation. The objective of this review is to analyze the efficacy and safety data of these molecules that include phosphodiesterase inhibitors (apremilast), Janus kinase inhibitors (tofacitinib, baricitinib), selective tyrosine kinase 2 inhibitors (deucravacitinib), agonists G protein-associated A3 adenosine receptor (piclidenoson), orphan T-gamma receptor inverse agonists (vimirogant), and sphingosine-1-phosphate receptor antagonists (ponesimod). In addition, new molecular targets are discussed. In short, the frontline of new systemic treatment for psoriasis.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599699","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":"Advances in Xenotransplantation, 3D Additive Bioprinting and Gene Therapy for the future of Heart Transplantation","authors":"C. García- Montero Blanco","doi":"10.32440/ar.2023.140.02.rev06","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev06","url":null,"abstract":"Heart transplantation (HTx) has proved itself to be the definite therapy for patients with end- stage cardiac failure. While HTx remains the cornerstone of the surgical armamentarium, it,s long- term success has resulted in an unbalanced supply- demand equation due to severe scarcity of valid organ donors. Therefore, further developments in the field of transplant therapy remain curtailed, unless other resources are encouraged. The present report is a review on the concept evolution, present status and reasonable outlook of three different, but confluent, emerging therapies, namely, a) xenotransplantation, b) 3D additive bioprinting and c) gene therapy.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599376","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":"Sickle cell disease phenotype. Relationship of haplotypes and polymorphisms in the β cluster, BCL11A and HBS1L-MYB. Pilot study","authors":"P. Ropero, M. Peral, L. J. Sánchez-Martínez, S. Rochas, M. Gómez-Álvarez, J. M. Nieto, F. González, A. Villegas, C. Benavente","doi":"10.32440/ar.2022.139.03.rev09","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev09","url":null,"abstract":"Sickle cell disease (SCD), despite being a monogenic disease, presents a highly variable phenotype that essentially depends on the amount of fetal hemoglobin (HbF), constituting the main modulator of the disease. The variation of HbF levels between patients is genetically regulated. HbF determines both the phenotype of the disease and the response to treatment with the main drug used, hydroxyurea. Researchers’ efforts have focused on discovering the genetic factors responsible for its variation; mainly describing the haplotypes of the β cluster and SNPs in three different loci: BCL11A, HBS1L-MYB and the β-globin cluster. Objective: To determine, in a cohort of patients with SCD, the possible relationship between the number of SNPs and haplotypes with higher levels of HbF. A positive association could explain why certain haplotypes, such as Senegal or Arab-Indian, have higher levels. of HbF and less severe disease. Methods: To verify this hypothesis, the characterization of the haplotypes was carried out using the PCR-RFLP technique and the genotyping of three SNPs representative of the three loci with the greatest association with the variation of HbF: XmnI (rs7482144), BCL11A (rs4671393) and HBS1L-MYB (rs9376092). Results: A greater number of SNPs has been reported in the haplotypes related to higher HbF and a lower number in those with less HbF, although only the SNP XmnI (rs7482144) has shown a statistically significant association. Conclusions: A direct relationship between haplotypes and the number of SNPs has been found, reporting that haplotypes with higher levels of HbF and thus a less severe phenotype, had a greater number of SNPs. Thus, the Benín and Bantu haplotypes traditionally associated with poor prognosis are the ones that have shown a lower number of mutated SNPs.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672341","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":"The well-being of the gynecological surgeon improves with the robot-assisted surgery","authors":"P. C. Coronado Martín, M. Gracia, M. Ramírez Mena, M. Bellón del Amo, J. García-Santos, M. Fasero Laiz","doi":"10.32440/ar.2022.139.03.rev10","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.rev10","url":null,"abstract":"Objectives: To demonstrate that robotic surgery benefits the ergonomics of the surgeon and his assistant compared to conventional laparoscopy through an ergonomics and satisfaction survey. Methods: Cross-sectional observational study of consecutive gynecological surgeries, which involve at least one hysterectomy, performed with robotic assistance (Da Vinci System) or with conventional laparoscopy at the Hospital Clínico San Carlos during the years 2008 and 2021. A questionnaire was administered to the main surgeon and the assistant in order to know their subjective impressions regarding comfort, ergonomics, and satisfaction with the da Vinci robotic system or laparoscopy. The responses were collected using a visual analog scale that scored from 1 (worst condition) to 10 (best condition). The comparison of the variables was made using the Student’s t test or the Mann-Whitney U test for independent samples. Significance was considered with a value of p<0.05. Results: A complete response to the questionnaire was obtained in 384 out of 451 cases (242 robotic and 142 laparoscopic). With equal difficulty perceived by the main surgeon, robotic surgery was rated as less tiring, more comfortable, and with less limb and back pain than laparoscopic surgery (p<0.001). The surgeon considered that the 3D vision, the articulation of the instrument and the ergonomics offered by robotics were relevant, as well as that robotics, was an advance over laparoscopy and open surgery regardless of the level of experience or the complexity of the procedure. No differences were found between robotic and laparoscopic surgery in the assistant assessment, except when the assistant was a senior surgeon, who found a better degree of comfort and less limb pain in the robotic approach (p<0.05). Conclusions: Robotic surgery has clear advantages for the surgeon, since it increases the degree of satisfaction and comfort, reducing fatigue and discomfort due to the position compared to conventional laparoscopy regardless surgeon’s experience and complexity of the intervention.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69672382","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":"Strategy to improve undergraduate learning of medical imaging","authors":"S. Pedraza","doi":"10.32440/ar.2023.140.02.ed01","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.ed01","url":null,"abstract":"Medical Imaging and Image-guided treatment add great healthcare value to modern medicine and therefore it is very important to improve their learning during university. The objective of this article is to provide the following proposals for improving the learning of radiology and nuclear medicine in medical schools: 1) Compulsory subjects model with a subject of basic concepts and multiple subjects focused on the medical image of each anatomical area. 2) Presence of optional subjects about advances in diagnostic imaging, interventional radiology, artificial intelligence, radiomics or theragnosis. 3) Self-directed learning of the student with methods that stimulate their participation such as problem-based learning, the flipped classroom or online learning. 4) Simulation of the value of medical imaging in clinical settings with methods such as virtual worlds or gamification techniques. 5) Internationalization of the learning of Radiology. 6) Promotion of practices in the Radiology and Nuclear Medicine services. 7). Increase in the number of final degree projects about radiology and nuclear medicine. 8) Introduction of Radiology problem cases in the practical exams of Structured Objective Clinical Evaluation","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"275 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599378","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":"Herpes zoster: burden of disease and current prevention strategies in Spain","authors":"A. Gil de Miguel, I. Jimeno Sanz","doi":"10.32440/ar.2023.140.02.rev09","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev09","url":null,"abstract":"Herpes zoster, as we all know, is produced by the Varicella-Zoster Virus and appears after the reactivation of the virus due to a situation of immunosuppression, either due to an illness or after 60 years of age, related to the phenomenon of immunosenescence, This happens when that person has suffered a primary infection that produces chickenpox, given that subsequently, this virus has the capacity to remain in the dorsal ganglia of the spinal cord or cranial pairs for long periods of time and reactivate in the aforementioned situations producing a lesion that we call herpes zoster. Although it can occur in any age group, the main triggering factor is the decrease in immunity measured by cells associated with natural immunosenescence due to aging and/or immunosuppression due to oncological and chronic pathologies and/or immunosuppressive drug treatments. It is estimated that up to 30% of the population will develop a clinical picture of herpes zoster during their lifetime. It is known that the burden of disease caused by herpes zoster in the population &gt;50 years of age is so high that it would justify routine vaccination of the population. These patients have a higher risk of reactivation of the virus, higher probability of PHN, higher risk of hospitalization and worse quality of life, especially in immunocompromised patients and in those over 60-65 years of age. This burden of disease represents a high health expenditure and consumption of resources. It is therefore necessary to support the vaccination strategies implemented by the health authorities and to implement systematic vaccination, at least in &gt;65 years of age, as the population group at greatest risk, as the main preventive measure to avoid the appearance of cases requiring hospitalization.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"293 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135600229","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":"Pancreaticoduodenectomy in octogenarian patients with tumors in the head of the pancreas and periampular region","authors":"C. Jiménez Romero, E. Moreno González, A. Marcacuzco Quinto","doi":"10.32440/ar.2023.140.02.rev07","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev07","url":null,"abstract":"Aging of the Spanish population has been demonstrated throughout the years. Thus, in the year 2021, the number of octogenarians in Spain was 2.285.352 people, confirming that Spain was the European country with the longest life expectancy (82.3 years in 2020). On the other hand, population aging has been associated with a higher incidence of tumors, including pancreatic cancer (PC) with a total number of 8,697 cases in Spain during 2021. It has been estimated that PC will soon surpass breast cancer in Europe to become the third most common cause of cancer-related death. Pancreaticoduodenectomy (PD) associated with chemotherapy is the standard therapy for potentially curing tumors of the pancreatic head and periampular region. However, PD is not a universally accepted therapy in octogenarian patients with pancreatic head tumors due to the presence of an associated high comorbidity and low expected survival with surgery. On the other hand, a significant decrease in postoperative mortality and increased survival (mortality rate between 25-27% and 5-year patient survival rate of 25% during the period 1975-1985 in the past century, versus <5% of postoperative mortality and 5-year survival of 15% in the present century), has encouraged highly experienced surgeons to perform increasingly a PD for pancreatic head cancer due to the good results reported. In this review we analyze the diagnostic procedures, indications for surgical therapy and chemotherapy, and results using PD technique in octogenarian patients suffering from tumors located in the head of the pancreas or periampular region.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135600251","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":"Multitracer PET-CT study for characterization of liver mass","authors":"A. Cabrera Villegas, X. B. Boulvard Chollet, M. Mangas Losada, P. Garrastachu Zumarán, R. D. Delgado Bolton, R. Ramírez Lasanta","doi":"10.32440/ar.2022.139.03.cc01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.03.cc01","url":null,"abstract":"We present the images corresponding to a hepatic PET-CT scan through a multitraceal study of a patient with chronic hepatitis C virus, on the waiting list for transplantation and with a lesion suspected of hepatocarcinoma.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69671972","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":"Aspirin in Cardiovascular Primary Prevention","authors":"J.R. de Berrazueta Fernández","doi":"10.32440/ar.2023.140.02.rev02","DOIUrl":"https://doi.org/10.32440/ar.2023.140.02.rev02","url":null,"abstract":"Willow bark and leaves have been used for thousands of years for their analgesic and anti-inflammatory effect, and Aspirin was synthesized from them at the end of the 19th century. From the 70s of the 20th century, we know its mechanisms of action well. Through the blockade it exerts on the synthesis of prostaglandins derived from arachidonic acid, both in the vascular endothelium and in platelets. We understand the mechanism of action on the formation of platelet thrombus and we know from multiple clinical trials which are its indications in the prevention of complications of cardiovascular disease. With a precise indication in secondary prevention in patients who have suffered a coronary or ischemic stroke, but with more controversial data in the case of primary prevention, which is the reason for this updated review of the action of Aspirin. In these cases, the decision to start treatment should be shared between the clinician and the patient, and risk tables and calculators should be used to help determine the level of CVD and bleeding risk.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135599709","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}