Revista clinica espanola最新文献

英文中文

Incidencia de embolia pulmonar relacionada con el embarazo en España 2016-2021: un estudio observacional retrospectivo de base poblacional 2016-2021 年西班牙与妊娠相关的肺栓塞发病率：基于人群的回顾性观察研究。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.014

J.A. Rueda Camino , A. Azcoaga-Lorenzo , R. Noguero Meseguer , D. Joya Seijo , M.A. García , D. Trujillo , C. Miranda , R. Barba-Martín

Objective

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.

Methods

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.

Results

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 (P=.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.

Conclusion

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.

本研究旨在估算2016年至2021年西班牙妊娠相关肺栓塞（PE）的总发病率和年度年龄标准化发病率，探讨妊娠期和产后PE事件的分布情况，确定潜在的风险因素，并估算入院期间的死亡率。方法在一项基于人群的回顾性观察研究中，分析了西班牙国家医院出院数据库的数据，以确定妊娠相关PE住院发作的妇女。主要结果是妊娠相关 PE 的总发病率和年度年龄标准化发病率，次要目的包括孕期和产后事件的分布以及入院期间年龄标准化死亡率的计算。结果在 2016-2021 年间的 2178805 名新生儿中，有 522 名妇女被诊断为妊娠相关 PE，总年龄标准化发病率为每万名新生儿 2.83 例。从每万名新生儿 2.43 例到 4.18 例，呈非显著上升趋势（P=.06）。合并症较少，但 PE 与最近两年感染 SARS-CoV-2 有明显关联。与妊娠有关的 PE 的死亡率为 2.8%，产后 PE 的发病率较高。与 SARS-CoV-2 感染的关联强调了对孕妇进行警惕性监测和管理的重要性，尤其是在流行病期间。这项研究提供了西班牙与妊娠有关的 PE 发病率和特征的具体数据，强调了在对孕妇和产后妇女进行鉴别诊断和管理策略时考虑 PE 的必要性。

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引用次数: 0

Documento de posicionamiento sobre la oclusión arterial de la retina. SEMI-SERV 关于视网膜动脉闭塞的立场文件。SEMI-SERV

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.012

R. García-Alonso , L. Arias-Barquet , L. Castilla Guerra , M. Martín Asenjo , A.J. Gómez-Escobar , E. Gutierrez-Sánchez , J. Pagán Escribano , A. Lorenzo Hernández , O. Madridano Cobo , F. Jaén Águila , M.E. Salguero Cámara , N. Muñoz-Rivas

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.

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.

视网膜是经常受到缺血性病变影响的器官。视网膜动脉闭塞在表现、管理和治疗方面可被视为等同于中风。在这份共识文件中，我们旨在提供有关这种在我们的临床实践中较为常见的病理现象的最新信息，同时考虑到早期和系统性治疗的重要性。

引用次数: 0

Retraso diagnóstico y oportunidades perdidas en la detección precoz de la fibrilación auricular: estudio transversal 心房颤动早期检测中的延迟诊断和错失良机：一项横断面研究

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.011

F. Richard Espiga , M. Almendro Delia , F. Caballero Martínez , D. Monge Martín , F. Neria Serrano , R. Quirós López

Introduction

We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.

Methods

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.

Results

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.

Conclusions

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.

引言我们分析了新诊断患者中房颤（AF）延迟诊断的频率及其相关因素。方法这是一项描述性、横断面、多中心研究。通过病历审查和在西班牙心脏病科、内科、初级保健科和急诊科就诊时进行的访谈，收集了新诊断的房颤患者的数据。结果共有 201 名医生参与了研究（64.2% 为心脏病专家，21.4% 为内科医生）。共纳入 948 名患者（58% 为男性；平均年龄 72.8 岁）。41.8%的患者在诊断时被归类为阵发性房颤，30.9%的患者被归类为持续性房颤，27.3%的患者被归类为永久性房颤。37%的患者的诊断是巧合。49.3%的患者被认为是诊断延迟。这种延迟与存在永久性或持续性房颤、年龄较大或瓣膜疾病有关。74.8%的患者在前一年与医疗系统有过一些接触。50.7%的病例可在 1-6 个月前确诊，20.1%的病例可在 6 个月前确诊。54.4%的患者之前出现过与房颤相似的症状。结论在很大一部分心房颤动病例中，诊断存在延误。许多有类似症状的人既不就诊，也不与医疗系统设施联系。因此，丧失了早期诊断的机会。

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引用次数: 0

El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria 高级糖化终产物可溶性受体与冠心病肾损伤呈正相关。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.016

L. Chen , X.-J. Zeng , X.-Y. Guo , J. Liu , F-H. Du , C-X. Guo

Aims

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.

Materials and methods

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.

Results

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 < 30 mg/g) [2.08 ± 0.70 vs. 1.75 ± 0.61 μg/L, P < .05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (r = 0.196, P < .05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [odd ratio = 2.62 (1.12-6.15), P < .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), P < .01].

Conclusions

Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.

目的血清可溶性高级糖化终产物受体（sRAGE）发生变化的冠心病（CHD）患者会出现微量白蛋白尿，甚至肾功能障碍。然而，sRAGE 在冠心病微量白蛋白尿中的作用仍未确定。材料和方法在这项横断面研究中，对接受冠状动脉造影术的住院 CHD 患者的 sRAGE 和尿白蛋白肌酐比值（uACR）进行了测量，以评估 sRAGE 和 uACR 之间的区别和相关性。结果127 名冠心病患者（平均年龄：63.06 ± 10.93 岁，男性 93 人）的 sRAGE 为 1.83 ± 0.64 μg/L。肾损伤组（uACR ≥ 30 mg/g）的 sRAGE 水平高于无肾损伤组（uACR < 30 mg/g）[2.08±0.70 vs. 1.75±0.61 μg/L，P < .05]。此外，在冠心病患者中，血清 sRAGE 与 uACR 呈显著正相关（r = 0.196，P < .05）。二元逻辑回归表明，sRAGE 是冠心病患者微量白蛋白尿的预测因子[奇异比 = 2.62 (1.12-6.15)，P < .05]。结论血清 sRAGE 与 uACR 呈正相关，可作为预测 CHD 患者早期肾损伤的潜在标志物。

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引用次数: 0

Perspectiva clínica de las miopatías necrotizantes inmunomediadas anti-HMG-Co-A-reductasa: análisis de tres casos 抗-HMG-Co-A 还原酶免疫介导的坏死性坏死性肌病的临床视角：三个病例的分析

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.07.002

J.P. de la Fuente Peñaloza , L. Quintana Cabezas , M.C. Yubini Lagos

引用次数: 0

Anemia de la inflamación y metabolismo del hierro en las enfermedades crónicas 慢性疾病中的炎症性贫血和铁代谢

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.013

S. Conde Díez , R. de las Cuevas Allende , E. Conde García

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.

炎症性贫血的起因是免疫系统被激活，细胞因子随之释放，导致血色素升高，造成低铁蛋白血症，并因缺铁而抑制红细胞生成。贫血通常为轻度/中度、正常红细胞/正常虹膜色素沉着，是继缺铁性贫血之后发病率最高的一种贫血，在慢性病患者、老年人和住院病人中最为常见。贫血会影响患者的生活质量，并对生存产生负面影响。治疗的目的应是改善基础疾病，纠正贫血。静脉注射铁剂、促红细胞生成素和脯氨酰羟化酶抑制剂是目前治疗的基础，但未来的治疗将针对血红素，因为血红素是造成贫血的最终原因。

引用次数: 0

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 西班牙内科医学会 2025-2029 年战略思考执行摘要，以确保在高价值的国家卫生系统中为病人提供全面护理。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.08.001

J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de la SEMI

Aims

To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).

Methods

Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.

Results

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.

Conclusions

SEMI seeks to be a key player in the transformation of the Spanish healthcare system.

目的为西班牙内科学会（SEMI）的政策和活动设计一个战略框架。结果西班牙内科学会的座右铭改为 "为患者提供全面护理"。确定了七项战略方针：为医疗系统的转型做出贡献；参与大学教学；保证为患者提供全面的医疗服务；为内科住院医师和内科医生提供在21世纪医疗领域执业的技能；促进内科研究和科学证据的产生；结合技术创新和数字工具；将SEMI定位为医疗政策的示范机构。

{"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 , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , 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}

引用次数: 0

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 在加泰罗尼亚实施 DP-TRANSFERS 项目的结果：在初级保健中改进糖尿病筛查和预防的转化方法。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.017

J.J. Cabré , F. Barrio , J. Vizcaíno , A. Martínez , T. Mur , R. Sagarra , S. Dalmau

Introduction

DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.

Objective

Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.

Methodology

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 >11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.

Results

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.

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.

Conclusions

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.

简介：DP-TRANSFERS 是一项生活方式干预转化项目，遵循 DE-PLAN-CAT 研究中描述的先前方案。筛查后，干预包括基本模块和持续模块。按照群组（医疗中心）进行分层，从2016年至2020年对代表性样本（中心、专业人员和参与者）进行评估（FINDRISC>11和/或糖尿病前期）。结果123个中心中有95个可行，647名专业人员中有343名参与了干预。在筛选出的 2381 名受试者中，1713 人参加了基础模块，其中 1186 人完成了第一年的学习，776 人完成了第二年的学习。双变量分析表明，受糖尿病影响的受试者在以下方面存在差异：之前的血糖状况、A1c、高密度脂蛋白胆固醇、FINDRISC 评分和对地中海饮食的坚持程度，以及在研究开始和结束时体重、体重指数和腹围的差异。结论与之前估计的标准化干预相比，强化干预大大降低了糖尿病的发病率（23.6%）。以下因素起到了保护作用：较好的血糖状况、较低的基线风险、较高的高密度脂蛋白胆固醇，或在研究期间实现了体重或腹围的减少。

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引用次数: 0

La amiloidosis cardiaca empeora el pronóstico en los pacientes con insuficiencia cardiaca: hallazgos del estudio PREVAMIC 心脏淀粉样变性会加重心力衰竭患者的预后：PREVAMIC 研究的发现

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.06.006

R. Ruiz Hueso , P. Salamanca Bautista , M.A. Quesada Simón , S. Yun , A. Conde Martel , J.L. Morales Rull , I. Fiteni Mera , D. Abad Pérez , I. Páez Rubio , Ó. Aramburu Bodas , en representación del grupo de trabajo PREVAMIC

Background and objectives

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.

Material and methods

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.

Results

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 < 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 = 0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) p < 0.001), confusion (HR 2.05 (1.01-4.17), p = 0.048), and the presence of CA (HR 1.77 (1.11-2.84), p = 0.017).

Conclusion

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.

背景和目的心脏淀粉样变性（CA）是老年患者的一种常见病症，通常表现为心力衰竭（HF）。然而，与其他病因引起的心力衰竭相比，与心力衰竭相关的心脏淀粉样变性是否预后更差，目前尚不清楚。根据患者是否患有交流性心脏病对队列进行了划分。结果共有 484 名患者纳入分析。研究对象为老年人（中位数为 86 岁），49% 为女性，23.8% 的患者患有冠心病。在CA组中，糖尿病和瓣膜病的发病率较低。随访一年后，CA患者的死亡率明显高于非CA患者（33.0% vs.14.9%, p <0.001）。不过，两组患者在急诊就诊和再入院方面没有差异。在多变量分析中，可预测随访一年后全因死亡率的变量是慢性肾病（HR 1.75 (1.01-3.05) p = 0.045）、NT-proBNP 水平（HR 2.51 (1.46-4.30) p < 0.001）、精神错乱（HR 2.05 (1.01-4.17)，p = 0.048）和CA的存在（HR 1.77 (1.11-2.84)，p = 0.017）。早期病理诊断和多学科治疗有助于改善患者的预后。

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引用次数: 0

Pneumocystis jirovecii en la enfermedad humana, ¿sólo neumonía? 人类疾病中的肺孢子虫，仅仅是肺炎吗？

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.07.001

E.J. Calderón , V. Friaza

引用次数: 0

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