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Análisis de las características clínicas y pronóstico de los pacientes con amiloidosis cardiaca ingresados en los hospitales españoles (2016-2021) 西班牙医院收治的心脏淀粉样变性患者的临床特征和预后分析(2016-2021 年)。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-19 DOI: 10.1016/j.rce.2024.10.007
A. Esteban-Fernández , M. Anguita-Sánchez , N. Rosillo , J.L. Bonilla-Palomas , J.L. Bernal Sobrino , N. del Prado , C. Fernández Pérez , L. Rodríguez Padial , F.J. Elola Somoza

Introduction and objectives

Cardiac amyloidosis (CA) is a prevalent yet underdiagnosed heart condition characterized by the abnormal accumulation of amyloid fibres, frequently resulting in heart failure (HF), particularly in older people. Despite advancements in non-invasive diagnostic techniques and treatments, the epidemiology of CA patients remains inadequately understood. This nationwide retrospective observational study sought to comprehensively investigate CA patients’ characteristics, mortality, and readmission patterns.

Methods

A retrospective observational study encompassed all patients hospitalized with CA between 2016 and 2021 across Spanish hospitals. Standardized incidence rates were calculated using age and sex-adjusted methods, utilizing the Spanish population as the reference. The investigation delved into demographic variables, comorbidities, mortality during the index episode, and 30 and 365-day readmissions for circulatory system diseases. Predictors of readmission were also examined.

Results

A total of 5,739 index episodes were identified, with CA being the primary cause of admission in 14.1% of cases. The mean age was 81.4 ± 9.9 years, predominantly males (70.3%). The age and sex-standardized hospital attendance rate was 3.90 admissions per 100,000 population (95% CI: 3.82-3.98), higher in males. Common comorbidities included HF (96.4%), atrial fibrillation (46.3%), and renal failure (44.4%). The mortality rate during the index episode was 11.7%, with cardiogenic shock (OR: 9.03; 95% CI: 4.22-19.32) and major psychiatric disorders (OR: 3.36; 95% CI: 1.42-7.94) identified as predictors.
Over the follow-up period, 13.1% were readmitted at 30 days and 36.6% at 365. Nephritis (IRR: 2.05; 95% CI: 1.42-2.96) and asthma (IRR: 1.52; 95% CI 1.11-2.07) were associated with increased 30-day readmissions, while renal failure (IRR: 1.43; 95% CI: 1.28-1.59) and chronic pulmonary disease (IRR: 1.40; 95% CI: 1.18-1.67) were linked to higher 365-day readmissions. Predictors of mortality risk in 365-day readmissions included advanced cancer (HR: 1.31; 95% CI: 1.00-1.71), cardiogenic shock in the index episode (HR: 2.72; 95% CI: 1.33-5.57), and a higher number of readmissions during that period (HR: 1.64; 95% CI: 1.56-1.73).

Conclusions

This study contributes valuable insights into the significant prevalence of CA, which is often overlooked and underestimated. Afflicting predominantly elderly males with concomitant HF and multiple comorbidities, CA poses a significant clinical challenge. The findings underscore the need for enhanced awareness, early detection, and a multidisciplinary approach to manage this complex cardiac condition.
简介和目的心脏淀粉样变性(CA)是一种普遍但未被诊断的心脏疾病,其特征是淀粉样纤维的异常积累,经常导致心力衰竭(HF),特别是在老年人中。尽管非侵入性诊断技术和治疗取得了进步,但CA患者的流行病学仍未得到充分了解。这项全国性的回顾性观察性研究旨在全面调查CA患者的特征、死亡率和再入院模式。方法一项回顾性观察性研究纳入了西班牙各医院2016年至2021年间所有CA住院患者。以西班牙人口为参照,采用年龄和性别调整方法计算标准化发病率。该调查深入研究了人口统计学变量、合并症、指数发作期间的死亡率,以及循环系统疾病30天和365天的再入院率。再次入院的预测因素也被检查。结果共发现5739例指标发作,14.1%的病例以CA为主要入院原因。平均年龄81.4±9.9岁,男性居多(70.3%)。年龄和性别标准化的医院出勤率为每10万人3.90人次(95% CI: 3.82-3.98),男性更高。常见的合并症包括HF(96.4%)、心房颤动(46.3%)和肾衰竭(44.4%)。指标发作期间死亡率为11.7%,其中心源性休克(OR: 9.03;95% CI: 4.22-19.32)和严重精神障碍(OR: 3.36;95% CI: 1.42-7.94)被确定为预测因子。在随访期间,13.1%的患者在30天内再次入院,36.6%的患者在365天内再次入院。肾炎(IRR: 2.05;95% CI: 1.42-2.96)和哮喘(IRR: 1.52;95% CI 1.11-2.07)与30天再入院增加相关,而肾功能衰竭(IRR: 1.43;95% CI: 1.28-1.59)和慢性肺部疾病(IRR: 1.40;95% CI: 1.18-1.67)与较高的365天再入院率有关。365天再入院的死亡风险预测因子包括晚期癌症(HR: 1.31;95% CI: 1.00-1.71),心源性休克在指数发作(HR: 2.72;95% CI: 1.33-5.57),在此期间再入院人数较高(HR: 1.64;95% ci: 1.56-1.73)。结论:本研究对经常被忽视和低估的CA的显著患病率提供了有价值的见解。主要折磨老年男性伴有心衰和多种合并症,CA提出了重大的临床挑战。研究结果强调需要提高认识,早期发现和多学科方法来管理这种复杂的心脏疾病。
{"title":"Análisis de las características clínicas y pronóstico de los pacientes con amiloidosis cardiaca ingresados en los hospitales españoles (2016-2021)","authors":"A. Esteban-Fernández ,&nbsp;M. Anguita-Sánchez ,&nbsp;N. Rosillo ,&nbsp;J.L. Bonilla-Palomas ,&nbsp;J.L. Bernal Sobrino ,&nbsp;N. del Prado ,&nbsp;C. Fernández Pérez ,&nbsp;L. Rodríguez Padial ,&nbsp;F.J. Elola Somoza","doi":"10.1016/j.rce.2024.10.007","DOIUrl":"10.1016/j.rce.2024.10.007","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiac amyloidosis (CA) is a prevalent yet underdiagnosed heart condition characterized by the abnormal accumulation of amyloid fibres, frequently resulting in heart failure (HF), particularly in older people. Despite advancements in non-invasive diagnostic techniques and treatments, the epidemiology of CA patients remains inadequately understood. This nationwide retrospective observational study sought to comprehensively investigate CA patients’ characteristics, mortality, and readmission patterns.</div></div><div><h3>Methods</h3><div>A retrospective observational study encompassed all patients hospitalized with CA between 2016 and 2021 across Spanish hospitals. Standardized incidence rates were calculated using age and sex-adjusted methods, utilizing the Spanish population as the reference. The investigation delved into demographic variables, comorbidities, mortality during the index episode, and 30 and 365-day readmissions for circulatory system diseases. Predictors of readmission were also examined.</div></div><div><h3>Results</h3><div>A total of 5,739 index episodes were identified, with CA being the primary cause of admission in 14.1% of cases. The mean age was 81.4<!--> <!-->±<!--> <!-->9.9<!--> <!-->years, predominantly males (70.3%). The age and sex-standardized hospital attendance rate was 3.90 admissions per 100,000 population (95%<!--> <!-->CI: 3.82-3.98), higher in males. Common comorbidities included HF (96.4%), atrial fibrillation (46.3%), and renal failure (44.4%). The mortality rate during the index episode was 11.7%, with cardiogenic shock (OR: 9.03; 95%<!--> <!-->CI: 4.22-19.32) and major psychiatric disorders (OR: 3.36; 95%<!--> <!-->CI: 1.42-7.94) identified as predictors.</div><div>Over the follow-up period, 13.1% were readmitted at 30<!--> <!-->days and 36.6% at 365. Nephritis (IRR: 2.05; 95%<!--> <!-->CI: 1.42-2.96) and asthma (IRR: 1.52; 95%<!--> <!-->CI 1.11-2.07) were associated with increased 30-day readmissions, while renal failure (IRR: 1.43; 95%<!--> <!-->CI: 1.28-1.59) and chronic pulmonary disease (IRR: 1.40; 95%<!--> <!-->CI: 1.18-1.67) were linked to higher 365-day readmissions. Predictors of mortality risk in 365-day readmissions included advanced cancer (HR: 1.31; 95%<!--> <!-->CI: 1.00-1.71), cardiogenic shock in the index episode (HR: 2.72; 95%<!--> <!-->CI: 1.33-5.57), and a higher number of readmissions during that period (HR: 1.64; 95%<!--> <!-->CI: 1.56-1.73).</div></div><div><h3>Conclusions</h3><div>This study contributes valuable insights into the significant prevalence of CA, which is often overlooked and underestimated. Afflicting predominantly elderly males with concomitant HF and multiple comorbidities, CA poses a significant clinical challenge. The findings underscore the need for enhanced awareness, early detection, and a multidisciplinary approach to manage this complex cardiac condition.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 131-139"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479089","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
Hospitalizaciones por el síndrome de Takotsubo en España. Datos del CMBD por comunidades autónomas (años 2008-2021) 西班牙塔克氏综合征住院病例。按自治区分列的 CMBD 数据(2008-2021 年)
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-07 DOI: 10.1016/j.rce.2024.10.009
N. Rosillo , N. del Prado , P. Pérez , J.L. Bernal , I. Núñez-Gil , Á. Gamarra , L. Vilches , J. Salamanca , J. Elola , F. Alfonso

Background and objectives

Takotsubo syndrome (TTS) is an infrequent cause of acute coronary syndrome much better diagnosed in recent years. This study sought to assess the clinical profile of patients admitted with TTS in Spain and to elucidate potential regional differences in admissions and in-hospital mortality between the years 2008 and 2021.

Methods

Retrospective observational study of patients admitted to acute general hospitals of the Spanish National Health System with a main or secondary diagnosis of STT, using the minimum basic data set.

Results

A total of 12.952 hospitalization for TTS were identified. The number of hospital admissions increased exponentially from 210 in the year 2008 to 1,918 in 2021. Most patients (79.1%) were women and mean age was 72.0 ± 12,5 years (72.5 ± 12,2 in female; 69.9 ± 13,4 in men; P<.001). Associated comorbidities were frequent (44.9% arterial hypertension, 31.2% heart failure) and differed in men and women. Overall, crude in-hospital mortality was 7%. Notably, admission and in-hospital mortality rates, adjusted by age and gender, were different among the different autonomous communities.

Conclusions

TTS usually presents in elderly women with associated comorbidities and has a significant in-hospital mortality. Age and comorbidities differ between men and women. Relevant regional differences exist regarding admission and in-hospital mortality rates.
背景与目的akotsubo综合征(TTS)是近年来诊断较好的一种罕见的急性冠脉综合征病因。本研究旨在评估西班牙TTS患者的临床概况,并阐明2008年至2021年间入院率和住院死亡率的潜在区域差异。方法采用最小基本数据集,对西班牙国家卫生系统急性综合医院主要或次要诊断为STT的患者进行回顾性观察研究。结果共鉴定出12.952例TTS住院病例。入院人数呈指数增长,从2008年的210人增加到2021年的1918人。患者以女性为主(79.1%),平均年龄72.0±12.5岁(女性72.5±12.2岁);男性69.9±13.4;术;措施)。相关合并症很常见(44.9%为动脉高血压,31.2%为心力衰竭),且在男性和女性中存在差异。总体而言,院内粗死亡率为7%。值得注意的是,按年龄和性别调整的住院率和住院死亡率在不同的自治区之间有所不同。结论stts常见于老年妇女,并伴有相关合并症,住院死亡率高。男性和女性的年龄和合并症不同。住院率和住院死亡率方面存在着相关的区域差异。
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引用次数: 0
Diagnóstico y tratamiento de la embolia pulmonar. Recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 2024 肺栓塞的诊断和治疗。西班牙内科医学会血栓栓塞性疾病小组的建议 2024
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-06 DOI: 10.1016/j.rce.2024.08.007
M.A. Fidalgo Fernández , O. Madridano Cobo , C. Sánchez del Hoyo , A. Rodríguez Iglesias , A.N. Muñoz-Rivas , M. Martín Asenjo
Pulmonary embolism (PE) is a disease with a rising incidence rate. This article presents the recommendations for the diagnosis and treatment of PE of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine (SEMI). The main objective is to facilitate decision making to improve the diagnostic and therapeutic approach based on published evidence. The final justification of the document is to improve the comprehensive care of the patient with PE.
肺栓塞(PE)是一种发病率不断上升的疾病。本文介绍了西班牙内科医学会(SEMI)血栓栓塞性疾病小组对肺栓塞诊断和治疗的建议。其主要目的是促进决策制定,以便根据已发表的证据改进诊断和治疗方法。该文件的最终目的是改善对 PE 患者的综合治疗。
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引用次数: 0
Fracaso en la consecución de los objetivos de c-LDL e infrautilización de tratamientos hipolipemiantes en pacientes con riesgo cardiovascular alto y muy alto: subpoblación española del estudio europeo SANTORINI 未能实现c-低密度脂蛋白的目标以及在高心血管风险和非常高心血管风险患者中低血脂治疗的利用率不足:欧洲桑托里尼研究的西班牙亚人群
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.09.004
J.M. Mostaza , L. García-Ortiz , M.A. Suárez Tembra , P. Talavera Calle , J. Chimeno García , V. Escolar Pérez , J.L. Díaz-Díaz , L. Manzano-Espinosa , A.L. Catapano , K.K. Ray , G. Díaz Moya , J. Pedro-Botet Montoya , en representación del grupo de investigadores de SANTORINI España

Introduction

There are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk.

Methods

SANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1018 Spanish participants, were separately analyzed and were put into perspective with the European cohort without Spanish participants.

Results

According to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT.

Conclusions

Baseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting. ClinicalTrials.gov Identifier: NCT04271280.
在欧洲心脏病学会(ESC)和动脉粥样硬化学会(EAS) 2019年指南发布后,很少有研究评估降脂治疗(llt)和低密度脂蛋白-胆固醇(LDL-C)目标的实现。本文显示了来自SANTORINI研究(即SANTORINI西班牙)的西班牙亚群的基线数据,该数据涉及心血管风险高和极高的患者LDL-C目标的实现和llt的使用。ssantorini是一项跨国、前瞻性、观察性研究,涉及来自14个欧洲国家初级保健和专业医疗机构的高和极高心血管风险患者。对1018名西班牙参与者的社会人口统计数据、血脂水平和血脂治疗进行单独分析,并与没有西班牙参与者的欧洲队列进行比较。结果295人(29.0%)心血管风险高,723人(71.0%)心血管风险极高。总体而言,26.5%的患者达到了2019年欧洲指南推荐的基于风险的LDL-C目标,其中23.1%的患者心血管风险高,27.9%的患者心血管风险极高。21.8%的患者在单药治疗中使用高强度他汀类药物治疗,41.2%的患者使用LLT联合治疗,10.7%的患者未接受任何LLT治疗。来自圣托里尼西班牙人群的基线数据显示,在高风险和极高风险患者中,只有约四分之一的患者达到了2019年ESC/EAS指南推荐的LDL-C目标。尽管存在心血管风险,但患者似乎没有得到充分治疗,高强度和联合LLT似乎没有充分用于现实环境中的心血管疾病预防。ClinicalTrials.gov标识符:NCT04271280。
{"title":"Fracaso en la consecución de los objetivos de c-LDL e infrautilización de tratamientos hipolipemiantes en pacientes con riesgo cardiovascular alto y muy alto: subpoblación española del estudio europeo SANTORINI","authors":"J.M. Mostaza ,&nbsp;L. García-Ortiz ,&nbsp;M.A. Suárez Tembra ,&nbsp;P. Talavera Calle ,&nbsp;J. Chimeno García ,&nbsp;V. Escolar Pérez ,&nbsp;J.L. Díaz-Díaz ,&nbsp;L. Manzano-Espinosa ,&nbsp;A.L. Catapano ,&nbsp;K.K. Ray ,&nbsp;G. Díaz Moya ,&nbsp;J. Pedro-Botet Montoya ,&nbsp;en representación del grupo de investigadores de SANTORINI España","doi":"10.1016/j.rce.2024.09.004","DOIUrl":"10.1016/j.rce.2024.09.004","url":null,"abstract":"<div><h3>Introduction</h3><div>There are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk.</div></div><div><h3>Methods</h3><div>SANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1018 Spanish participants, were separately analyzed and were put into perspective with the European cohort without Spanish participants.</div></div><div><h3>Results</h3><div>According to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT.</div></div><div><h3>Conclusions</h3><div>Baseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting. ClinicalTrials.gov Identifier: <span><span>NCT04271280</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 78-84"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137448","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}
引用次数: 0
Estudio ecológico para estimar la prevalencia de pacientes con déficit de esfingomielinasa ácida en España. Estudio PREVASMD 一项生态学研究,估计西班牙酸鞘磷脂酶缺乏症患者的患病率。研究PREVASMD
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.003
J. Villarrubia , M. Morales , L. Ceberio , I. Vitoria , M. Bellusci , I. Quiñones , L. Peña , M. Ruiz de Valbuena , M. O’Callaghan , en representación del grupo de estudio PREVASMD

Background and objective

Prevalence studies of acid sphingomyelinase deficiency (ASMD) are scarce and different in Spain. The objective of the present study was to determine the estimated prevalence of patients diagnosed with ASMD (types A/B and B) in Spain.

Material and methods

PREVASMD was a descriptive, multicenter, and ecological study involving 21 physicians from different specialties (mainly Internal Medicine, Pediatrics and Hematology), of different autonomous communities, with experience in ASMD management.

Results

Between March and April 2022, specialists were attending a total of 34 patients with ASMD diagnosis, 10 pediatric patients under 18 years of age (29.4%) and 24 adult patients (70.6%). The estimated prevalence of patients (pediatric and adult) diagnosed with ASMD was 0.7 per 1,000,000 inhabitants (95% confidence interval, 95% CI: 0.5-1.0), 1.2 per 1,000,000 (95% CI: 0.6-2.3) in the pediatric population and 0.6 per 1,000,000 inhabitants (95% CI: 0.4-0.9) in the adult population. The most frequent symptoms that led to suspicion of ASMD were: splenomegaly (reported by 100.0% of specialists), hepatomegaly (66.7%), interstitial lung disease (57.1%), and thrombocytopenia (57.1%). According to the specialists, laboratory and routine tests, and assistance in Primary Care were the most relevant healthcare resources in the management of ASMD.

Conclusions

This first study carried out in Spain shows an estimated prevalence of patients of 0.7 per 1,000,000 inhabitants: 1.2 per 1,000,000 inhabitants in the pediatric population and 0.6 per 1,000,000 inhabitants in the adult population.
背景与目的酸性鞘磷脂酶缺乏症(ASMD)的患病率研究在西班牙缺乏且存在差异。本研究的目的是确定西班牙诊断为ASMD (A/B型和B型)的患者的估计患病率。材料和方法sprevasmd是一项描述性、多中心、生态学研究,涉及来自不同自治区不同专业(主要是内科、儿科和血液)的21名具有ASMD管理经验的医生。结果在2022年3月至4月期间,专家共接诊了34例ASMD患者,其中18岁以下儿童患者10例(29.4%),成人患者24例(70.6%)。诊断为ASMD的患者(儿童和成人)的估计患病率为每100万居民0.7例(95%置信区间,95% CI: 0.5-1.0),儿科人群为每100万居民1.2例(95% CI: 0.6-2.3),成人人群为每100万居民0.6例(95% CI: 0.4-0.9)。导致怀疑ASMD的最常见症状是:脾肿大(100.0%的专家报告)、肝肿大(66.7%)、间质性肺疾病(57.1%)和血小板减少(57.1%)。专家认为,实验室和常规检查以及初级保健援助是ASMD管理中最相关的医疗资源。在西班牙进行的第一项研究显示,患者的患病率估计为每100万居民0.7例:儿童人口为每100万居民1.2例,成人人口为每100万居民0.6例。
{"title":"Estudio ecológico para estimar la prevalencia de pacientes con déficit de esfingomielinasa ácida en España. Estudio PREVASMD","authors":"J. Villarrubia ,&nbsp;M. Morales ,&nbsp;L. Ceberio ,&nbsp;I. Vitoria ,&nbsp;M. Bellusci ,&nbsp;I. Quiñones ,&nbsp;L. Peña ,&nbsp;M. Ruiz de Valbuena ,&nbsp;M. O’Callaghan ,&nbsp;en representación del grupo de estudio PREVASMD","doi":"10.1016/j.rce.2024.10.003","DOIUrl":"10.1016/j.rce.2024.10.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prevalence studies of acid sphingomyelinase deficiency (ASMD) are scarce and different in Spain. The objective of the present study was to determine the estimated prevalence of patients diagnosed with ASMD (types A/B and B) in Spain.</div></div><div><h3>Material and methods</h3><div>PREVASMD was a descriptive, multicenter, and ecological study involving 21 physicians from different specialties (mainly Internal Medicine, Pediatrics and Hematology), of different autonomous communities, with experience in ASMD management.</div></div><div><h3>Results</h3><div>Between March and April 2022, specialists were attending a total of 34 patients with ASMD diagnosis, 10 pediatric patients under 18 years of age (29.4%) and 24 adult patients (70.6%). The estimated prevalence of patients (pediatric and adult) diagnosed with ASMD was 0.7 per 1,000,000 inhabitants (95% confidence interval, 95% CI: 0.5-1.0), 1.2 per 1,000,000 (95% CI: 0.6-2.3) in the pediatric population and 0.6 per 1,000,000 inhabitants (95% CI: 0.4-0.9) in the adult population. The most frequent symptoms that led to suspicion of ASMD were: splenomegaly (reported by 100.0% of specialists), hepatomegaly (66.7%), interstitial lung disease (57.1%), and thrombocytopenia (57.1%). According to the specialists, laboratory and routine tests, and assistance in Primary Care were the most relevant healthcare resources in the management of ASMD.</div></div><div><h3>Conclusions</h3><div>This first study carried out in Spain shows an estimated prevalence of patients of 0.7 per 1,000,000 inhabitants: 1.2 per 1,000,000 inhabitants in the pediatric population and 0.6 per 1,000,000 inhabitants in the adult population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 70-77"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137449","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}
引用次数: 0
La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia 心力衰竭中的营养不良。评估充血和骨骼肌减少症的重要性
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.09.005
J. Carretero Gómez , T.F. Galeano Fernández , A.S. Vidal Ríos , S. Tolosa Álvarez , M. Sánchez Herrera , C. García Carrasco , F.J. Monreal Periañez , P. González González , J.C. Arévalo Lorido

Objective

This work aims to describe nutrition and sarcopenia in inpatients with heart failure (HF). It also aims to assess factors associated with in-hospital and short-term prognosis related to nutrition and sarcopenia.

Methods

We collected data on consecutive HF patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the screening test, SARC-F scale, and handgrip strength test.

Results

190 patients were analyzed, mean age 82.1 (± 8.2), 54.2% women, median follow up 106 days. Patients were classified into three groups based on MNA-SF score: group 1 (12-14 points, no risk) included 50 patients, group 2 (8-12 points, high risk of malnutrition) included 81 patients, group 3 (0-7 points, malnourished) included 59 patients. Group 3 had significantly more inflammation (lower albumin and higher C-reactive Protein (CRP)) and congestion (mea-sured by NT-ProBNP levels). In-hospital mortality was related to poor muscle function, CRP, andNT-ProBNP, but not to malnutrition. The poorest short-term outcomes were related to malnutrition and comorbidity. However, when the variable of muscle function was introduced, it could act as a poor prognostic factor related to CRP and NT-ProBNP, which were the main determinantsof survival.

Conclusion

In malnourished patients with HF, inflammation and congestion were related to in-hospital mortality. Malnutrition along with comorbidity may play a role in decreasing short-term survival. Early identification through proactive nutritional and functional screenings should be a key element of assessing HF patients.
目的探讨心力衰竭(HF)住院患者营养与肌肉减少症的关系。它还旨在评估与营养和肌肉减少症相关的住院和短期预后相关的因素。方法收集同一中心内科病房连续收治的心衰患者的资料。患者于2021年5月和10月招募。营养不良通过迷你营养评估简表(MNA-SF)确定,肌肉减少症通过筛选试验、SARC-F量表和握力测试确定。结果分析190例患者,平均年龄82.1(±8.2)岁,女性54.2%,中位随访106天。根据MNA-SF评分将患者分为3组:1组(12-14分,无风险)50例,2组(8-12分,营养不良高风险)81例,3组(0-7分,营养不良)59例。第3组有明显更多的炎症(较低的白蛋白和较高的c反应蛋白(CRP))和充血(通过NT-ProBNP水平测量)。住院死亡率与肌肉功能差、CRP和nt - probnp有关,但与营养不良无关。最糟糕的短期结果与营养不良和合并症有关。然而,当引入肌肉功能变量时,它可能作为与CRP和NT-ProBNP相关的不良预后因素,而CRP和NT-ProBNP是生存的主要决定因素。结论在营养不良的心衰患者中,炎症和充血与住院死亡率有关。营养不良与合并症可能在降低短期生存率中起作用。通过积极的营养和功能筛查进行早期识别应该是评估心衰患者的关键因素。
{"title":"La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia","authors":"J. Carretero Gómez ,&nbsp;T.F. Galeano Fernández ,&nbsp;A.S. Vidal Ríos ,&nbsp;S. Tolosa Álvarez ,&nbsp;M. Sánchez Herrera ,&nbsp;C. García Carrasco ,&nbsp;F.J. Monreal Periañez ,&nbsp;P. González González ,&nbsp;J.C. Arévalo Lorido","doi":"10.1016/j.rce.2024.09.005","DOIUrl":"10.1016/j.rce.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>This work aims to describe nutrition and sarcopenia in inpatients with heart failure (HF). It also aims to assess factors associated with in-hospital and short-term prognosis related to nutrition and sarcopenia.</div></div><div><h3>Methods</h3><div>We collected data on consecutive HF patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the screening test, SARC-F scale, and handgrip strength test.</div></div><div><h3>Results</h3><div>190 patients were analyzed, mean age 82.1 (±<!--> <!-->8.2), 54.2% women, median follow up 106 days. Patients were classified into three groups based on MNA-SF score: group 1 (12-14 points, no risk) included 50 patients, group 2 (8-12 points, high risk of malnutrition) included 81 patients, group 3 (0-7 points, malnourished) included 59 patients. Group 3 had significantly more inflammation (lower albumin and higher C-reactive Protein (CRP)) and congestion (mea-sured by NT-ProBNP levels). In-hospital mortality was related to poor muscle function, CRP, andNT-ProBNP, but not to malnutrition. The poorest short-term outcomes were related to malnutrition and comorbidity. However, when the variable of muscle function was introduced, it could act as a poor prognostic factor related to CRP and NT-ProBNP, which were the main determinantsof survival.</div></div><div><h3>Conclusion</h3><div>In malnourished patients with HF, inflammation and congestion were related to in-hospital mortality. Malnutrition along with comorbidity may play a role in decreasing short-term survival. Early identification through proactive nutritional and functional screenings should be a key element of assessing HF patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 92-100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137918","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
¿Qué factor predice mejor el pronóstico en pacientes con COVID-19: los biomarcadores analíticos o la relación PaO2/FiO2? 分析性生物标志物还是PaO2/FiO2比率更能预测2019冠状病毒病患者的预后?
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.002
M. Rubio-Rivas , J.M. Mora-Luján , A. Montero Sáez , M.D. Martín-Escalante , V. Giner Galvañ , G. Maestro de la Calle , M.L. Taboada Martínez , A. Muiño Míguez , C. Lumbreras-Bermejo , J.M. Antón-Santos , on behalf of the SEMI-COVID-19 Network

Background

The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.

Methods

Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st,2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5,314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.

Results

Higher in-hospital mortality was found in the groups with PAFI< 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, P<.001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI>300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age (OR = 1.06; 1.05-1.06), moderate (OR = 1.87; 1.49-2.33) and severe (OR = 2.64; 1.96-3.55) degree of dependency, dyslipidemia (OR = 1.20; 1.03-1.39), higher Charlson index (OR = 1.19; 1.14-1.24), tachypnea on admission (2.23; 1.91-2.61), the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender (OR = 0.77; 0.65-0.90) and the use of RDSV (OR = 0.72; 0.56-0.93) were found to be protective factors.

Conclusions

The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.
本研究旨在通过PaO2/FiO2 (PAFI)和炎症程度描述患者的特征和结局。方法回顾性队列研究,收集2020年3月1日至2023年3月1日来自西班牙半covid -19登记处的患者数据。在入院前48小时内接受糖皮质激素(CS)治疗COVID-19的PAFI数据(<100 vs. 100-200 vs. 200-300 vs. >300)的非院内患者被纳入研究。5314例患者符合本研究的纳入标准。主要终点是住院死亡率。结果pafi组住院死亡率较高;100(51.5%比41.2% vs 25.8%比12.3%,术中;措施)。他们还需要更多的NIMV、IMV和ICU住院,并且住院时间更长。PAFI>;300和4-5高危标准的患者死亡率高于PAFI 200-300和1-2分析性炎症标准的患者。与较高住院死亡率相关的危险因素有:年龄(OR = 1.06;1.05-1.06),中度(OR = 1.87;1.49-2.33)和重度(OR = 2.64;1.96-3.55)依赖度、血脂异常(OR = 1.20;1.03-1.39),较高的Charlson指数(OR = 1.19;1.14-1.24),入院时呼吸急促(2.23;1.91-2.61),入院时高危标准数较高,入院时PAFI较低。女性(OR = 0.77;0.65-0.90)和RDSV的使用(OR = 0.72;0.56 ~ 0.93)为保护因素。结论PAFI越低,COVID-19患者炎症程度越高,住院死亡率越高。炎症升级先于呼吸恶化,应作为决定使用抗炎/免疫抑制治疗的严重程度的早期预测因子。
{"title":"¿Qué factor predice mejor el pronóstico en pacientes con COVID-19: los biomarcadores analíticos o la relación PaO2/FiO2?","authors":"M. Rubio-Rivas ,&nbsp;J.M. Mora-Luján ,&nbsp;A. Montero Sáez ,&nbsp;M.D. Martín-Escalante ,&nbsp;V. Giner Galvañ ,&nbsp;G. Maestro de la Calle ,&nbsp;M.L. Taboada Martínez ,&nbsp;A. Muiño Míguez ,&nbsp;C. Lumbreras-Bermejo ,&nbsp;J.M. Antón-Santos ,&nbsp;on behalf of the SEMI-COVID-19 Network","doi":"10.1016/j.rce.2024.10.002","DOIUrl":"10.1016/j.rce.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to describe patient characteristics and outcomes by PaO<sub>2</sub>/FiO<sub>2</sub> (PAFI) and degree of inflammation.</div></div><div><h3>Methods</h3><div>Retrospective cohort study with data on patients collected from March 1<sup>st</sup>, 2020 to March 1<sup>st</sup>,2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (&lt;100 vs. 100-200 vs. 200-300 vs. &gt;300) who received corticosteroids (CS) for COVID-19 in the first 48<!--> <!-->h of admission were included in the study. 5,314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>Higher in-hospital mortality was found in the groups with PAFI&lt;<!--> <!-->100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, <em>P</em>&lt;.001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI&gt;300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age (OR<!--> <!-->=<!--> <!-->1.06; 1.05-1.06), moderate (OR<!--> <!-->=<!--> <!-->1.87; 1.49-2.33) and severe (OR<!--> <!-->=<!--> <!-->2.64; 1.96-3.55) degree of dependency, dyslipidemia (OR<!--> <!-->=<!--> <!-->1.20; 1.03-1.39), higher Charlson index (OR<!--> <!-->=<!--> <!-->1.19; 1.14-1.24), tachypnea on admission (2.23; 1.91-2.61), the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender (OR<!--> <!-->=<!--> <!-->0.77; 0.65-0.90) and the use of RDSV (OR<!--> <!-->=<!--> <!-->0.72; 0.56-0.93) were found to be protective factors.</div></div><div><h3>Conclusions</h3><div>The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 57-69"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137895","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
Insuficiencia suprarrenal secundaria debida al tratamiento con ipilimumab/nivolumab por cáncer renal metastásico 因ipilimumab/nivolumab治疗转移性肾癌引起的继发性肾上腺功能不全
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.004
D. Rico-López , A. Ortiz-Parra , F. Vázquez-Alonso , R. Roa-Chamorro
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引用次数: 0
¿Cuál es la formación en bioética de los residentes de Medicina Interna en España? 西班牙内科居民的生物伦理学培训是什么?
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.005
P. Martínez de la Cruz , C. Font Puig , S. Ibáñez Barceló , A. Blanco Portillo
{"title":"¿Cuál es la formación en bioética de los residentes de Medicina Interna en España?","authors":"P. Martínez de la Cruz ,&nbsp;C. Font Puig ,&nbsp;S. Ibáñez Barceló ,&nbsp;A. Blanco Portillo","doi":"10.1016/j.rce.2024.10.005","DOIUrl":"10.1016/j.rce.2024.10.005","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 114-116"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137921","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
Papel de la ecografía pulmonar en el seguimiento ambulatorio de pacientes tras COVID-19. Revisión sistemática de la literatura 肺超声在COVID-19后患者门诊随访中的作用。系统的文献审查
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.006
F. Navarro Romero , J. Olalla Sierra , M.D. Martín Escalante

Introduction and aim

Currently, the usefulness of lung ultrasound in the follow-up of patients after hospital discharge for SARS-CoV-2 pneumonia is not well known. The main objective of this systematic review is to investigate the persistence of alterations in lung ultrasound of patients who have had COVID-19 pneumonia.

Methods

A systematic review has been carried out following the PRISMA regulations in the PubMed, EMBASE, Web of Science and Google Scholar database from January 2020 to May 2023 using the combination of MeSH terms: «lung ultrasound», «ultrasonography», «lung alterations», «persistence», «follow-up», «consequences», «hospital discharge», «COVID», «COVID-19», «SARS-CoV-2». Studies were selected that described alterations in the lung ultrasound of patients after having suffered from COVID-19 pneumonia. The JBI Critical Appraisal Tools were used to assess the risk of bias of the studies. No meta-analysis techniques were performed, the results being compared narratively.

Results

From two to six months after COVID-19 pneumonia, pulmonary ultrasound abnormalities appear frequently and are proportional to the intensity of the initial episode. The most frequent anomalies are irregularities in the pleural line, the presence of B lines and/or subpleural consolidations, predominantly in the basal regions of the thorax. These findings seem to correlate with those of the chest CT.

Conclusions

Lung ultrasound offers technical and economic advantages that should be considered for the study of patients after hospital discharge for COVID-19.
目前,肺部超声在SARS-CoV-2肺炎患者出院后随访中的作用尚不清楚。本系统综述的主要目的是调查COVID-19肺炎患者肺部超声改变的持久性。方法根据2020年1月至2023年5月在PubMed、EMBASE、Web of Science和谷歌Scholar数据库中的PRISMA规定,使用MeSH术语组合:“肺超声”、“超声”、“肺改变”、“持续性”、“随访”、“后果”、“出院”、“COVID”、“COVID-19”、“SARS-CoV-2”进行系统综述。我们选择了描述COVID-19肺炎患者肺部超声改变的研究。使用JBI关键评估工具评估研究的偏倚风险。没有进行meta分析技术,结果被叙述比较。结果新型冠状病毒肺炎后2 ~ 6个月,肺部超声异常频繁出现,且与首发发作强度成正比。最常见的异常是胸膜线不规则,B线和/或胸膜下实变,主要发生在胸基底区。这些发现似乎与胸部CT的结果有关。结论超声在新冠肺炎患者出院后的研究中具有技术和经济优势。
{"title":"Papel de la ecografía pulmonar en el seguimiento ambulatorio de pacientes tras COVID-19. Revisión sistemática de la literatura","authors":"F. Navarro Romero ,&nbsp;J. Olalla Sierra ,&nbsp;M.D. Martín Escalante","doi":"10.1016/j.rce.2024.10.006","DOIUrl":"10.1016/j.rce.2024.10.006","url":null,"abstract":"<div><h3>Introduction and aim</h3><div>Currently, the usefulness of lung ultrasound in the follow-up of patients after hospital discharge for SARS-CoV-2 pneumonia is not well known. The main objective of this systematic review is to investigate the persistence of alterations in lung ultrasound of patients who have had COVID-19 pneumonia.</div></div><div><h3>Methods</h3><div>A systematic review has been carried out following the PRISMA regulations in the PubMed, EMBASE, Web of Science and Google Scholar database from January 2020 to May 2023 using the combination of MeSH terms: «lung ultrasound», «ultrasonography», «lung alterations», «persistence», «follow-up», «consequences», «hospital discharge», «COVID», «COVID-19», «SARS-CoV-2». Studies were selected that described alterations in the lung ultrasound of patients after having suffered from COVID-19 pneumonia. The JBI Critical Appraisal Tools were used to assess the risk of bias of the studies. No meta-analysis techniques were performed, the results being compared narratively.</div></div><div><h3>Results</h3><div>From two to six months after COVID-19 pneumonia, pulmonary ultrasound abnormalities appear frequently and are proportional to the intensity of the initial episode. The most frequent anomalies are irregularities in the pleural line, the presence of B lines and/or subpleural consolidations, predominantly in the basal regions of the thorax. These findings seem to correlate with those of the chest CT.</div></div><div><h3>Conclusions</h3><div>Lung ultrasound offers technical and economic advantages that should be considered for the study of patients after hospital discharge for COVID-19.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 101-110"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137919","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
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Revista clinica espanola
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