array:24 [
  "pii" => "S2254887422000017"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2021.09.004"
  "estado" => "S300"
  "fechaPublicacion" => "2022-03-01"
  "aid" => "1995"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "rev"
  "cita" => "Rev Clin Esp. 2022;222:176-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256521001843"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2021.09.005"
      "estado" => "S300"
      "fechaPublicacion" => "2022-03-01"
      "aid" => "1995"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "rev"
      "cita" => "Rev Clin Esp. 2022;222:176-9"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "176"
            "paginaFinal" => "179"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Beyond acute SARS-CoV-2 infection&#58; A new challenge for Internal Medicine"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "I&#46; Mart&#237;n-Garrido, F&#46;J&#46; Medrano-Ortega"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Mart&#237;n-Garrido"
              ]
              1 => array:2 [
                "nombre" => "F&#46;J&#46;"
                "apellidos" => "Medrano-Ortega"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887422000017"
          "doi" => "10.1016/j.rceng.2021.09.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000017?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001843?idApp=WRCEE"
      "url" => "/00142565/0000022200000003/v1_202202260624/S0014256521001843/v1_202202260624/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887421001764"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2021.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "1991"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "rev"
    "cita" => "Rev Clin Esp. 2022;222:180-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Incretin-based therapy for glycemic control of hospitalized patients with type 2 diabetes&#58; a systematic review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "180"
          "paginaFinal" => "189"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Terapia basada en incretinas para control gluc&#233;mico de los pacientes hospitalizados con diabetes tipo 2&#58; una revisi&#243;n sistem&#225;tica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2054
              "Ancho" => 2917
              "Tamanyo" => 372869
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proposed algorithm for the management of hyperglycemia in patients hospitalized with type 2 diabetes mellitus&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">1</span>The choice of regimen is based on patients&#8217; individual characteristics&#58; &#40;i&#41; consider a dipeptidyl peptidase-5 &#40;DPP-4&#41; inhibitor&#44; a glucagon-like peptide-1 &#40;GLP-1&#41; receptor agonist&#44; or a basal-plus insulin regimen according to the following&#58; blood glucose between 180 and 240&#8239;mg&#47;dL&#44; glycosylated hemoglobin &#40;HbA1c&#41; &#60;9&#37; without prior use of insulin or use at a dose of &#8804;0&#46;5 U&#47;kg&#47;day&#44; patient who is fasting or with poor food intake&#44; elderly patients or those with kidney failure&#59; &#40;ii&#41; prioritize a basal-bolus insulin regimen in the following scenarios&#58; blood glucose &#62;240&#8239;mg&#47;dL&#44; previous insulin therapy at a dose &#62;0&#46;5 U&#47;kg&#47;day&#44; or HbA1c &#8805;9&#37;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">2</span>Consider incretin-based therapy with the following formulations&#58; &#40;i&#41; DPP-4 inhibitors&#58; &#40;50&#8211;100&#8239;mg&#47;day&#41;&#44; linagliptin &#40;5&#8239;mg&#47;day&#41;&#44; saxagliptin &#40;2&#46;5&#8211;5&#8239;mg&#47;day&#41;&#44; vildagliptin &#40;50&#8239;mg&#47;twice per day&#41;&#59; &#40;ii&#41; GLP-1 receptor agonists&#58; liraglutide &#40;0&#46;6&#8211;1&#46;2&#8239;mg SC&#47;day&#41;&#44; exenatide &#40;5&#8239;&#956;g&#47;SC&#47;twice per day&#41;&#44; dulaglutide &#40;0&#46;75&#8239;mg SC&#47;week&#41;&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">3</span>Incretin therapy can be given alone or in combination with basal insulin &#40;long-acting insulin at a dose of 0&#46;15&#8211;0&#46;25&#8239;U&#47;kg&#47;day&#41;&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">4</span>Use a dose of 0&#46;15 U&#47;kg&#47;day in patients &#62;70 years or those with a glomerular filtration rate &#60;30&#8239;mL&#47;min&#47;1&#46;73&#8239;m<span class="elsevierStyleSup">2</span>&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;E&#46; Gracia-Ramos, M&#46;P&#46; Cruz-Dom&#237;nguez, E&#46;O&#46; Madrigal-Santill&#225;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;E&#46;"
              "apellidos" => "Gracia-Ramos"
            ]
            1 => array:2 [
              "nombre" => "M&#46;P&#46;"
              "apellidos" => "Cruz-Dom&#237;nguez"
            ]
            2 => array:2 [
              "nombre" => "E&#46;O&#46;"
              "apellidos" => "Madrigal-Santill&#225;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256521001776"
        "doi" => "10.1016/j.rce.2021.09.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001776?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001764?idApp=WRCEE"
    "url" => "/22548874/0000022200000003/v1_202202260708/S2254887421001764/v1_202202260708/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887422000054"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2022.01.001"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "2012"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2022;222:174-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Towards a comprehensive and multidisciplinary care in heart failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "174"
          "paginaFinal" => "175"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hacia una atenci&#243;n integral y multidisciplinar en insuficiencia card&#237;aca"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; M&#233;ndez-Bail&#243;n, J&#46; Com&#237;n-Colet"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "M&#233;ndez-Bail&#243;n"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Com&#237;n-Colet"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256522000054"
        "doi" => "10.1016/j.rce.2022.01.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256522000054?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000054?idApp=WRCEE"
    "url" => "/22548874/0000022200000003/v1_202202260708/S2254887422000054/v1_202202260708/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Beyond acute SARS-CoV-2 infection&#58; A new challenge for Internal Medicine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "176"
        "paginaFinal" => "179"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "I&#46; Mart&#237;n-Garrido, F&#46;J&#46; Medrano-Ortega"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "I&#46;"
            "apellidos" => "Mart&#237;n-Garrido"
            "email" => array:1 [
              0 => "isamartinga@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;J&#46;"
            "apellidos" => "Medrano-Ortega"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Biomedicina de Sevilla&#44; Hospital Universitario Virgen del Roc&#237;o&#47;CSIC&#47;Universidad de Sevilla y CIBERESP&#44; Sevilla&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infections caused by the new coronavirus SARS-CoV-2 have reached epidemic proportions&#44; with over 155 million confirmed cases and more than 3 million deaths around the world<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; In response&#44; the scientific community has been working at an unprecedented rate to analyse this new virus&#44; discover its biological characteristics&#44; and diagnose&#44; treat&#44; and prevent COVID-19&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevertheless&#44; limited studies have been conducted to date on the follow-up and long-term effects of SARS-CoV-2 infection&#44; though there are ever-increasing data that support the numerous patients infected by SARS-CoV-2&#44; even those with mild symptoms or who are asymptomatic&#44; who develop either long-term symptoms that affect their quality of life&#44; or sequelae that may be incapacitating or decisive in terms of their survival&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To approach this reality in an adequate manner&#44; the first issue we must address is the definition of uniform criteria to describe such a polymorphous and heterogeneous clinical presentation beyond the severe infection phase&#46; In this regard&#44; on 18 December 2020&#44; the National Institute for Health and Care Excellence published a guideline defining the stages of COVID-19 disease<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; The guideline defines the acute phase of infection as the start of infection through to 4 weeks of evolution&#46; &#8220;Ongoing symptomatic COVID-19&#8221; is defined as cases in which signs and symptoms of disease are present from 4 to 12 weeks&#44; and &#8220;post-COVID-19 syndrome&#8221; as when the signs and symptoms developed during or after an infection compatible with COVID-19 continue for more than 12 weeks and cannot be explained via an alternative diagnosis&#46; The guideline also uses the term &#8220;long COVID&#8221; to describe signs and symptoms that continue or develop after acute COVID&#8209;19&#44; with both post-COVID-19 syndrome and ongoing symptomatic COVID-19 included under this umbrella term&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Along these lines&#44; in Spain&#44; the Spanish Society for General Medicine &#40;SEMG according to the Spanish acronym&#41; published the data from its survey of patients with &#8220;long COVID&#8221;&#44; a term the society uses to refer the set of symptoms affecting multiple organs of patients who have had COVID-19 &#40;without or without a confirmed diagnosis&#41;&#44; and who continue to experience symptoms after what is considered to be the acute phase of the disease has ended<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; A total of 2&#44;120 patients participated in the survey&#44; of which 1&#44;834 presented symptoms compatible with long COVID&#46; All age groups were represented in the survey&#46; A total of 79&#37; of the surveyed individuals were female with a mean age of 43 years&#46; A total of 200 symptoms that fluctuated over time were gathered with an average of 36 symptoms per person&#46; An interesting datum from this survey was the significant impact on quality of life resulting from these ongoing symptoms&#44; with considerable incapacity in terms of performing activities of daily living&#58; personal hygiene&#44; working outside the home&#44; familial obligations&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; a &#8220;living&#8221; systematic review has been created &#40;a term alluding to a system that is continuously updated with new data as they are generated&#41; as well as a meta-analysis analysing COVID-19 symptoms following the acute phase of the disease&#46; Both are in the pre-publication phase<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The living systematic review includes studies through September 2020<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; It analyses 28 studies&#58; 16 cohort studies&#44; 10 cross-sectional studies&#44; and 2 case series&#46; The analysis included 9&#44;442 adults with COVID-19 from 13 different countries&#46; The longest average follow-up time was 111 days after hospital discharge&#46; A wide range of systemic&#44; cardiopulmonary&#44; gastrointestinal&#44; neurological and psychosocial symptoms are listed&#44; of which the most common were dyspnoea&#44; altered sense of smell and taste&#44; the presence of fatigue&#44; and anxiety&#46; Persistent symptoms were described in both admitted patients and those seen in outpatient services&#46; However&#44; the quality of the evidence of the studies included in this review is low&#44; with an elevated risk of bias and extensive heterogeneity in terms of disease prevalence&#46; In addition&#44; its external validity is very limited&#44; with no control groups and limited studies including children&#46; None were performed in developing countries or a primary care setting<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The meta-analysis conducted by Lopez-Leon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> includes 15 studies published through 1 January 2021 with a total of 47&#44;910 patients&#46; A total of 55 long-term effects were detected&#46; The follow-up time ranged from 14 to 110 days from disease diagnosis&#46; Age ranged between 17 and 87 years&#46; Some 80&#37; &#40;95&#37; CI&#58; 65-92&#37;&#41; of the patients infected with SARS-CoV-2 developed one or more long-term symptoms&#46; The five most common symptoms were&#58; fatigue &#40;58&#37;&#41;&#44; headache &#40;44&#37;&#41;&#44; attention impairment &#40;27&#37;&#41;&#44; hair loss &#40;25&#37;&#41;&#44; and dyspnoea &#40;24&#37;&#41;&#46; All the specific meta-analyses showed medium &#40;n&#8239;&#61;&#8239;2&#41; to high heterogeneity &#40;n&#8239;&#61;&#8239;13&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Another significant problem we are facing is that we currently do not know why certain individuals experience a full recovery or continue to suffer specific long-term symptoms&#46; The main sequelae observed in other coronaviruses &#40;SARS&#44; MERS&#41; are of a respiratory&#44; musculoskeletal&#44; and neuropsychiatric nature<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; In patients with COVID-19&#44; admission to ICU due to acute respiratory distress syndrome is associated with long-term functional disability with both pulmonary and extrapulmonary conditions<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; The data on disease prevalence varies greatly&#58; some studies estimate that 20&#37; of patients present symptoms at 4 weeks and 10&#37; at 12 weeks<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; while others detect up to 70&#37; 4 months post-onset of COVID-19<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To date&#44; three theories have been suggested in an attempt to explain the pathogenesis of long COVID manifestations&#58; the presence of the virus in immunologically privileged locations such as the central nervous system&#44; an abnormal immune response&#44; and autoimmune phenomena secondary to infection<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Along these lines&#44; Gaebler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> studied the evolution of humoral and cell immunity for 6&#46;2 months in a cohort of 87 patients after infection with SARS-CoV-2 and observed that the titres of IgM and IgG antibodies against the receptor-binding domain &#40;RBD&#41; of the SARS-CoV-2 spike protein decreased significantly over this time period&#44; with IgA being less affected&#46; By contrast&#44; the number of RBD-specific memory B cells remained unchanged following infection&#46; The memory B cells showed clonal turnover after 6&#46;2 months and the antibodies they express had greater somatic hypermutation&#44; resistance to the RBD mutations&#44; and higher potency&#44; which could indicate continuous evolution of the humoral response&#46; On the other hand&#44; immunofluorescence and PCR analyses of intestinal biopsies obtained from asymptomatic individuals at 4 months post-onset of infection revealed the persistence of fragments of nucleic acid from the SARS-CoV-2 virus and the presence of immunoreactivity in the small bowel in 7 out of 14 individuals&#44; which could cause the chronic inflammation that is responsible for long-term symptoms&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A recent study in the pre-publication phase using the high-throughput technique Rapid Extracellular Antigen Profiling to identify autoantibodies against 2&#44;770 extracellular and secreted proteins in a cohort of 194 patients with SARS-CoV-2 infection and a control group of healthy healthcare workers&#44; showed a dramatic increase in autoimmune reactivities in the infected subjects&#44; particularly against immunomodulatory proteins&#44; including cytokines&#44; chemokines&#44; complement components and cell surface proteins<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In a murine model of SARS-CoV-2 infection&#44; it was found that equivalent autoantibodies altered the immune response and impaired virological control by inhibiting immunoreceptor signals and modifying the distribution of peripheral immune cells&#44; thereby exacerbating disease severity&#46; The analysis of autoantibodies targeted against tissue antigens revealed their association with specific clinical characteristics and disease severity<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Many of those cell antigens are found in specifically affected tissue and organs in patients with long COVID&#44; though their potential association with this clinical presentation has not yet been studied&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another challenge we face is how to therapeutically manage patients with persistent symptomatology&#44; which to date has been symptom-based and with few satisfactory results&#46; The National Library of Medicine database has currently recorded 58 clinical trials with different approaches to treating this clinical process&#46; One of them&#44; Esperanza COVID&#44; is conducted in Spain using montelukast&#59; others are aimed at therapies with naltrexone&#47;food supplements with NDA&#43;&#44; or drugs already used in patients with myalgic encephalomyelitis&#47;chronic fatigue syndrome &#40;ME&#47;CFS&#41;&#59; another with deupirfenidone &#40;LYT-100&#41;&#44; with leronlimab&#44; monoclonal antibody against the CCR5 cell receptor&#44; with physical exercise-based therapy or psychological therapy&#44; as well as antivirals such as remdesivir or favipiravir&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">When determining the healthcare system&#8217;s response to the COVID-19 pandemic&#44; we must consider the full cost of the chronic consequences of SARS-CoV-2 infection&#44; and we must design strategies to provide comprehensive care to individuals suffering from these sequelae&#46; In this regard&#44; in December 2020&#44; the prestigious journal Nature Medicine posed a challenge to the scientific community&#58; to address and produce solutions for long COVID syndrome<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Caring for patients with long COVID may require the participation of multiple specialists&#44; resulting in a logistical nightmare for patients seeking diagnosis and treatment&#46; As such&#44; a more comprehensive approach is needed to take the weight off of patients and to improve their care&#46; Along this line&#44; multidisciplinary units are being established to care for patients with long COVID such as those implemented at Mount Sinai hospital in New York and Penn-Presbyterian hospital in Pennsylvania&#44; or the clinics established in the United Kingdom&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Specialised units or clinics have also been founded in Spain to care for patients with long COVID&#46; These have drafted various consensus documents and interdisciplinary collaboration agreements&#44; such as the &#8220;MARCO-19 project for the care of individuals with long COVID&#8221;&#44; promoted by the SEMG and with the participation of 27 scientific societies<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The complex nature of post-COVID-19 sequelae surpasses and exceeds the specific competencies of the different medical specialties&#46; Therefore&#44; according to the various consensus documents&#44; these specialised units should include specialists in internal medicine&#44; neurology&#44; mental health&#44; and rehabilitation&#44; as well as support from nursing staff&#44; particularly that involved in case management&#44; and in close contact with primary care professionals and other specialists&#46; These units should also rely on collaboration from basic researchers in the fields of virology&#44; genetics and immunology&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The fundamental aims of these units will be to&#58; define the clinical spectrum&#44; pathogenesis&#44; pathophysiology&#44; and natural history of the disease&#44; rule out patients with suspected long COVID in the presence of other processes unrelated to the infection&#44; evaluate functional affectation&#44; identify groups of patients with specific needs and characteristics in order to schedule specific interventions&#44; and evaluate the safety and efficacy of specific interventions or treatments in controlled clinical trials&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There is a clear need to conduct controlled&#44; prospective cohort studies that include different at-risk populations and settings&#46; Likewise&#44; there is also a clear need to gather data in a standardised manner through national and international platforms in order to take the utmost advantage of all the scientific work that is being done&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Internal Medicine must not remain indifferent to these initiatives&#44; considering the leading role it has played from the very start of the effort to address the pandemic in Spain&#46; This effort can be seen in the COVID-19 patient registry from the Spanish Society for Internal Medicine&#44; one of the largest in the world&#44; which has already gathered data on more than 18&#44;000 patients<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Internal Medicine&#44; with its comprehensive vision and holistic training of its specialists&#44; which has enabled them to adapt and respond to the wide-ranging challenges and crises that have arisen in recent years<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; is in a strategic position to take on the challenge of creating and coordinating multidisciplinary units to care for patients with persistent symptoms post-SARS-CoV-2 infection&#46; On the other hand&#44; beyond the symptomatology of long COVID&#44; we cannot forget both the physical as well as psychological or psychiatric sequelae that patients who have overcome severe COVID-19 may present and that are currently still unknown to us&#46; Nor must we forget the repercussions that SARS-CoV-2 infection may have on the evolution of common chronic diseases such as ischaemic heart disease&#44; COPD or diabetes mellitus&#46; In this scenario&#44; the role of Internal Medicine is once again fundamental to the post-COVID-19 era&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-05-10"
    "fechaAceptado" => "2021-09-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1484335"
          "palabras" => array:4 [
            0 => "Long COVID"
            1 => "Post-COVID syndrome"
            2 => "Post-acute COVID-19"
            3 => "Long COVID haulers"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1484334"
          "palabras" => array:4 [
            0 => "COVID persistente"
            1 => "S&#237;ndrome COVID-19 prolongado"
            2 => "S&#237;ndrome pos-COVID"
            3 => "S&#237;ndrome pos-COVID-19 agudo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infection with the new SARS-CoV-2 coronavirus has reached pandemic proportions&#44; with a very high death toll worldwide&#46; Despite the scientific community&#39;s strenuous efforts to address this disease in its acute phase&#44; as well as in prevention through the development of vaccines in record time&#44; there remains another important workhorse&#58; understanding and treating the persistence of symptoms beyond the acute phase&#44; the so-called protracted COVID-19 syndrome or persistent COVID&#46; These persistent manifestations affect several organs and systems and may depend on both the pathogenic mechanisms of the virus and the pathophysiological response of the patient&#46; One year after the onset of this pandemic&#44; there is an urgent need to address this situation from a comprehensive approach&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por el nuevo coronavirus SARS-CoV-2 ha alcanzado proporciones de pandemia&#44; con un n&#250;mero de muertes muy elevado en todo el mundo&#46; A pesar del esfuerzo &#237;mprobo desarrollado por la comunidad cient&#237;fica para abordar esta enfermedad en su fase aguda&#44; as&#237; como en la prevenci&#243;n mediante la creaci&#243;n de vacunas en tiempo r&#233;cord&#44; a&#250;n queda otro caballo de batalla importante&#58; comprender y tratar la persistencia de s&#237;ntomas m&#225;s all&#225; de la fase aguda&#44; el llamado &#171;s&#237;ndrome COVID-19 prolongado&#187; o &#171;COVID persistente&#187;&#46; Estas manifestaciones persistentes afectan a varios &#243;rganos y sistemas y podr&#237;an depender tanto de los mecanismos patog&#233;nicos del virus como de la respuesta fisiopatol&#243;gica del paciente&#46; Un a&#241;o despu&#233;s del inicio de esta pandemia es una necesidad urgente abordar esta situaci&#243;n desde un enfoque integral&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;n-Garrido I&#44; Medrano-Ortega FJ&#46; M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna&#46; Rev Cl&#237;n Esp&#46; 2022&#59;222&#58;176&#8211;179&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ritchie H&#44; Ortiz-Ospina E&#44; Beltekian D&#44; Mathieu E&#44; Hasell J&#44; Macdonald B&#44; et al&#46; Coronavirus Pandemic &#40;COVID-19&#41;&#44; OurWorldInData&#46;org &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://ourworldindata.org/coronavirus">https&#58;&#47;&#47;ourworldindata&#46;org&#47;coronavirus</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; WHO Coronavirus Disease &#40;COVID-19&#41; Dashboard &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://covid19.who.int/">https&#58;&#47;&#47;covid19&#46;who&#46;int&#47;</a>&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Institute for Health and Care Excellence&#46; COVID-19 rapid guideline&#58; Managing the long-term effects of COVID-19&#46; Disponible en&#58; <a target="_blank" href="https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-thelongterm-effects-of-covid19-pdf-66142028400325">https&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ng188&#47;resources&#47;covid19-rapid-guideline-managing-thelongterm-effects-of-covid19-pdf-66142028400325</a>&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de M&#233;dicos Generales y de Familia&#46; COVID-19 persistente&#46; Encuesta &#91;consultado 30 Abr 2021&#93;&#46; Disponible en&#58; https&#58;&#47;&#47;www&#46;semg&#46;es&#47;images&#47;2020&#47;Noticias&#47;20201111&#95;Resultados&#95;Encuesta&#95;COVID Persistente&#46;pdf&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Michelen M&#44; Manoharan L&#44; Elkheir N&#44; Cheng V&#44; Dagens D&#44; Hastie C&#44; et al&#46; Characterising long-term COVID-19&#58; A rapid living systematic review&#46; medRxiv preprint &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.12.08.20246025">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;12&#46;08&#46;20246025</a>&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Lopez-Leon S&#44; Wegman-Ostrosky T&#44; Perelman C&#44; Sepulveda E&#44; Rebolledo PA&#44; Cuapio A&#44; et al&#46; More than 50 Long-term effects of COVID-19&#58; a systematic review and meta-analysis&#46; medRxiv &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2021.01.27.21250617">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2021&#46;01&#46;27&#46;21250617</a>&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic widespread musculoskeletal pain&#44; fatigue&#44; depression and disordered sleep in chronic post-SARS syndrome&#59; a case-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Moldofsky"
                            1 => "J&#46; Patcai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2377-11-37"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Neurol"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "37"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One-year outcomes in survivors of the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Herridge"
                            1 => "A&#46;M&#46; Cheung"
                            2 => "C&#46;M&#46; Tansey"
                            3 => "A&#46; Matte-Martyn"
                            4 => "N&#46; Diaz-Granados"
                            5 => "F&#46; Al-Said"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa022450"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "348"
                        "paginaInicial" => "683"
                        "paginaFinal" => "693"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Office for National Statistics&#44; United Kingdom&#46; The prevalence of long COVID symptoms and COVID-19 complications &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications">https&#58;&#47;&#47;www&#46;ons&#46;gov&#46;uk&#47;news&#47;statementsandletters&#47;theprevalenceoflongcovidsymptomsandcovid19complications</a>&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Dennis A&#44; Wamil M&#44; Kapur S&#44; Alberts J&#44; Badley A&#44; Decker GA&#44; et al&#46; Multi-organ impairment in low-risk individuals with long COVID&#46; medRxiv&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.10.14.20212555">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;10&#46;14&#46;20212555</a>&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term immunological health consequences of COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "British Society for Immunology"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "WWW" => array:2 [
                        "link" => "https&#58;&#47;&#47;www&#46;immunology&#46;org&#47;sites&#47;default&#47;files&#47;BSI&#95;Briefing&#95;Note&#95;August&#95;2020&#95;FINAL&#46;pdf"
                        "fecha" => "2021"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of antibody immunity to SARS-CoV-2"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Gaebler"
                            1 => "Z&#46; Wang"
                            2 => "J&#46;C&#46;C&#46; Lorenzi"
                            3 => "S&#46; Finkin"
                            4 => "M&#46; Tokuyama"
                            5 => "A&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41586-021-03207-w"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2021"
                        "volumen" => "591"
                        "paginaInicial" => "639"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33461210"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Wang EY&#44; Mao T&#44; Klein J&#44; Dai Y&#44; Huck JD&#44; Liu F&#44; et al&#46; Diverse Functional Autoantibodies in patients with COVID-19&#46; medRxiv&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.12.10.20247205">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;12&#46;10&#46;20247205</a>&#46;"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Meeting the challenge of long COVID"
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/s41591-020-01177-6"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nat Med"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1803"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33288947"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/s41591-020-01177-6"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1038&#47;s41591-020-01177-6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Barquilla-Garc&#237;a A&#44; del Corral E&#44; D&#237;az-Pedroche C&#44; Lumbreras-Bermejo C&#44; Mart&#237;n-S&#225;nchez V&#44; Moran-Bay&#243;n A&#44; et al&#46; Protocolo para la continuidad asistencial del paciente con diagn&#243;stico de COVID19&#46; Disponible en&#58; <a target="_blank" href="https://www.fesemi.org/sites/default/files/documentos/776.pdf">https&#58;&#47;&#47;www&#46;fesemi&#46;org&#47;sites&#47;default&#47;files&#47;documentos&#47;776&#46;pdf</a>&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de directivos de la salud&#46; Documento para la atenci&#243;n integral al paciente post-COVID&#46; Disponible en&#58; <a target="_blank" href="https://sedisa.net/wp-content/uploads/2020/10/DocumentoAtencionIntegralPost-Covid.pdf">https&#58;&#47;&#47;sedisa&#46;net&#47;wp-content&#47;uploads&#47;2020&#47;10&#47;DocumentoAtencionIntegralPost-Covid&#46;pdf</a>&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gu&#237;a cl&#237;nica para la atenci&#243;n al paciente Long COVID&#47;COVID persistente&#46; Disponible en&#59; <a target="_blank" href="https://www.semg.es/images/2021/Documentos/GUIA_CLINICA_COVID_Persistent_20210501_version_final.pdf">https&#58;&#47;&#47;www&#46;semg&#46;es&#47;images&#47;2021&#47;Documentos&#47;GUIA&#95;CLINICA&#95;COVID&#95;Persistent&#95;20210501&#95;version&#95;final&#46;pdf</a>&#46;"
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sis&#243;-Almirall A&#46; Manifestaciones persistentes de la COVID-19&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica&#46; Societat Catalana de Medicina Familiar i Comunit&#224;ria &#40;CAMFiC&#41;&#46; ISBN&#58; 978-84-121938-5-5&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de Medicina Interna&#46; Registro SEMI COVID-19&#46; Available from&#58; <a target="_blank" href="https://www.fesemi.org/investigacion/proyectos/registro-semi-covid-19">https&#58;&#47;&#47;www&#46;fesemi&#46;org&#47;investigacion&#47;proyectos&#47;registro-semi-covid-19</a>&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La Medicina Interna ante las crisis sanitarias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Bianchi-Llave"
                            1 => "M&#46;D&#46; Mart&#237;n-Escalante"
                            2 => "E&#46;J&#46; Calder&#243;n-Sandubete"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actual Med"
                        "fecha" => "2020"
                        "volumen" => "105"
                        "paginaInicial" => "135"
                        "paginaFinal" => "136"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022200000003/v1_202202260708/S2254887422000017/v1_202202260708/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48740"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022200000003/v1_202202260708/S2254887422000017/v1_202202260708/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000017?idApp=WRCEE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Review
Beyond acute SARS-CoV-2 infection: A new challenge for Internal Medicine
Más allá de la infección aguda por SARS-CoV-2: un nuevo desafío para la Medicina Interna
I. Martín-Garridoa,
Corresponding author
isamartinga@gmail.com

Corresponding author.
, F.J. Medrano-Ortegaa,b
a Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla y CIBERESP, Sevilla, Spain
Read
1338
Times
was read the article
25
Total PDF
1313
Total HTML
Share statistics
 array:24 [
  "pii" => "S2254887422000017"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2021.09.004"
  "estado" => "S300"
  "fechaPublicacion" => "2022-03-01"
  "aid" => "1995"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "rev"
  "cita" => "Rev Clin Esp. 2022;222:176-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256521001843"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2021.09.005"
      "estado" => "S300"
      "fechaPublicacion" => "2022-03-01"
      "aid" => "1995"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "rev"
      "cita" => "Rev Clin Esp. 2022;222:176-9"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "176"
            "paginaFinal" => "179"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Beyond acute SARS-CoV-2 infection&#58; A new challenge for Internal Medicine"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "I&#46; Mart&#237;n-Garrido, F&#46;J&#46; Medrano-Ortega"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Mart&#237;n-Garrido"
              ]
              1 => array:2 [
                "nombre" => "F&#46;J&#46;"
                "apellidos" => "Medrano-Ortega"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887422000017"
          "doi" => "10.1016/j.rceng.2021.09.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000017?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001843?idApp=WRCEE"
      "url" => "/00142565/0000022200000003/v1_202202260624/S0014256521001843/v1_202202260624/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887421001764"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2021.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "1991"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "rev"
    "cita" => "Rev Clin Esp. 2022;222:180-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Incretin-based therapy for glycemic control of hospitalized patients with type 2 diabetes&#58; a systematic review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "180"
          "paginaFinal" => "189"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Terapia basada en incretinas para control gluc&#233;mico de los pacientes hospitalizados con diabetes tipo 2&#58; una revisi&#243;n sistem&#225;tica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2054
              "Ancho" => 2917
              "Tamanyo" => 372869
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proposed algorithm for the management of hyperglycemia in patients hospitalized with type 2 diabetes mellitus&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">1</span>The choice of regimen is based on patients&#8217; individual characteristics&#58; &#40;i&#41; consider a dipeptidyl peptidase-5 &#40;DPP-4&#41; inhibitor&#44; a glucagon-like peptide-1 &#40;GLP-1&#41; receptor agonist&#44; or a basal-plus insulin regimen according to the following&#58; blood glucose between 180 and 240&#8239;mg&#47;dL&#44; glycosylated hemoglobin &#40;HbA1c&#41; &#60;9&#37; without prior use of insulin or use at a dose of &#8804;0&#46;5 U&#47;kg&#47;day&#44; patient who is fasting or with poor food intake&#44; elderly patients or those with kidney failure&#59; &#40;ii&#41; prioritize a basal-bolus insulin regimen in the following scenarios&#58; blood glucose &#62;240&#8239;mg&#47;dL&#44; previous insulin therapy at a dose &#62;0&#46;5 U&#47;kg&#47;day&#44; or HbA1c &#8805;9&#37;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">2</span>Consider incretin-based therapy with the following formulations&#58; &#40;i&#41; DPP-4 inhibitors&#58; &#40;50&#8211;100&#8239;mg&#47;day&#41;&#44; linagliptin &#40;5&#8239;mg&#47;day&#41;&#44; saxagliptin &#40;2&#46;5&#8211;5&#8239;mg&#47;day&#41;&#44; vildagliptin &#40;50&#8239;mg&#47;twice per day&#41;&#59; &#40;ii&#41; GLP-1 receptor agonists&#58; liraglutide &#40;0&#46;6&#8211;1&#46;2&#8239;mg SC&#47;day&#41;&#44; exenatide &#40;5&#8239;&#956;g&#47;SC&#47;twice per day&#41;&#44; dulaglutide &#40;0&#46;75&#8239;mg SC&#47;week&#41;&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">3</span>Incretin therapy can be given alone or in combination with basal insulin &#40;long-acting insulin at a dose of 0&#46;15&#8211;0&#46;25&#8239;U&#47;kg&#47;day&#41;&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">4</span>Use a dose of 0&#46;15 U&#47;kg&#47;day in patients &#62;70 years or those with a glomerular filtration rate &#60;30&#8239;mL&#47;min&#47;1&#46;73&#8239;m<span class="elsevierStyleSup">2</span>&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;E&#46; Gracia-Ramos, M&#46;P&#46; Cruz-Dom&#237;nguez, E&#46;O&#46; Madrigal-Santill&#225;n"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;E&#46;"
              "apellidos" => "Gracia-Ramos"
            ]
            1 => array:2 [
              "nombre" => "M&#46;P&#46;"
              "apellidos" => "Cruz-Dom&#237;nguez"
            ]
            2 => array:2 [
              "nombre" => "E&#46;O&#46;"
              "apellidos" => "Madrigal-Santill&#225;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256521001776"
        "doi" => "10.1016/j.rce.2021.09.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001776?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001764?idApp=WRCEE"
    "url" => "/22548874/0000022200000003/v1_202202260708/S2254887421001764/v1_202202260708/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887422000054"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2022.01.001"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "2012"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2022;222:174-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Towards a comprehensive and multidisciplinary care in heart failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "174"
          "paginaFinal" => "175"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hacia una atenci&#243;n integral y multidisciplinar en insuficiencia card&#237;aca"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; M&#233;ndez-Bail&#243;n, J&#46; Com&#237;n-Colet"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "M&#233;ndez-Bail&#243;n"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Com&#237;n-Colet"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256522000054"
        "doi" => "10.1016/j.rce.2022.01.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256522000054?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000054?idApp=WRCEE"
    "url" => "/22548874/0000022200000003/v1_202202260708/S2254887422000054/v1_202202260708/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Beyond acute SARS-CoV-2 infection&#58; A new challenge for Internal Medicine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "176"
        "paginaFinal" => "179"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "I&#46; Mart&#237;n-Garrido, F&#46;J&#46; Medrano-Ortega"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "I&#46;"
            "apellidos" => "Mart&#237;n-Garrido"
            "email" => array:1 [
              0 => "isamartinga@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;J&#46;"
            "apellidos" => "Medrano-Ortega"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Biomedicina de Sevilla&#44; Hospital Universitario Virgen del Roc&#237;o&#47;CSIC&#47;Universidad de Sevilla y CIBERESP&#44; Sevilla&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infections caused by the new coronavirus SARS-CoV-2 have reached epidemic proportions&#44; with over 155 million confirmed cases and more than 3 million deaths around the world<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; In response&#44; the scientific community has been working at an unprecedented rate to analyse this new virus&#44; discover its biological characteristics&#44; and diagnose&#44; treat&#44; and prevent COVID-19&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevertheless&#44; limited studies have been conducted to date on the follow-up and long-term effects of SARS-CoV-2 infection&#44; though there are ever-increasing data that support the numerous patients infected by SARS-CoV-2&#44; even those with mild symptoms or who are asymptomatic&#44; who develop either long-term symptoms that affect their quality of life&#44; or sequelae that may be incapacitating or decisive in terms of their survival&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To approach this reality in an adequate manner&#44; the first issue we must address is the definition of uniform criteria to describe such a polymorphous and heterogeneous clinical presentation beyond the severe infection phase&#46; In this regard&#44; on 18 December 2020&#44; the National Institute for Health and Care Excellence published a guideline defining the stages of COVID-19 disease<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; The guideline defines the acute phase of infection as the start of infection through to 4 weeks of evolution&#46; &#8220;Ongoing symptomatic COVID-19&#8221; is defined as cases in which signs and symptoms of disease are present from 4 to 12 weeks&#44; and &#8220;post-COVID-19 syndrome&#8221; as when the signs and symptoms developed during or after an infection compatible with COVID-19 continue for more than 12 weeks and cannot be explained via an alternative diagnosis&#46; The guideline also uses the term &#8220;long COVID&#8221; to describe signs and symptoms that continue or develop after acute COVID&#8209;19&#44; with both post-COVID-19 syndrome and ongoing symptomatic COVID-19 included under this umbrella term&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Along these lines&#44; in Spain&#44; the Spanish Society for General Medicine &#40;SEMG according to the Spanish acronym&#41; published the data from its survey of patients with &#8220;long COVID&#8221;&#44; a term the society uses to refer the set of symptoms affecting multiple organs of patients who have had COVID-19 &#40;without or without a confirmed diagnosis&#41;&#44; and who continue to experience symptoms after what is considered to be the acute phase of the disease has ended<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; A total of 2&#44;120 patients participated in the survey&#44; of which 1&#44;834 presented symptoms compatible with long COVID&#46; All age groups were represented in the survey&#46; A total of 79&#37; of the surveyed individuals were female with a mean age of 43 years&#46; A total of 200 symptoms that fluctuated over time were gathered with an average of 36 symptoms per person&#46; An interesting datum from this survey was the significant impact on quality of life resulting from these ongoing symptoms&#44; with considerable incapacity in terms of performing activities of daily living&#58; personal hygiene&#44; working outside the home&#44; familial obligations&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; a &#8220;living&#8221; systematic review has been created &#40;a term alluding to a system that is continuously updated with new data as they are generated&#41; as well as a meta-analysis analysing COVID-19 symptoms following the acute phase of the disease&#46; Both are in the pre-publication phase<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The living systematic review includes studies through September 2020<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; It analyses 28 studies&#58; 16 cohort studies&#44; 10 cross-sectional studies&#44; and 2 case series&#46; The analysis included 9&#44;442 adults with COVID-19 from 13 different countries&#46; The longest average follow-up time was 111 days after hospital discharge&#46; A wide range of systemic&#44; cardiopulmonary&#44; gastrointestinal&#44; neurological and psychosocial symptoms are listed&#44; of which the most common were dyspnoea&#44; altered sense of smell and taste&#44; the presence of fatigue&#44; and anxiety&#46; Persistent symptoms were described in both admitted patients and those seen in outpatient services&#46; However&#44; the quality of the evidence of the studies included in this review is low&#44; with an elevated risk of bias and extensive heterogeneity in terms of disease prevalence&#46; In addition&#44; its external validity is very limited&#44; with no control groups and limited studies including children&#46; None were performed in developing countries or a primary care setting<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The meta-analysis conducted by Lopez-Leon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> includes 15 studies published through 1 January 2021 with a total of 47&#44;910 patients&#46; A total of 55 long-term effects were detected&#46; The follow-up time ranged from 14 to 110 days from disease diagnosis&#46; Age ranged between 17 and 87 years&#46; Some 80&#37; &#40;95&#37; CI&#58; 65-92&#37;&#41; of the patients infected with SARS-CoV-2 developed one or more long-term symptoms&#46; The five most common symptoms were&#58; fatigue &#40;58&#37;&#41;&#44; headache &#40;44&#37;&#41;&#44; attention impairment &#40;27&#37;&#41;&#44; hair loss &#40;25&#37;&#41;&#44; and dyspnoea &#40;24&#37;&#41;&#46; All the specific meta-analyses showed medium &#40;n&#8239;&#61;&#8239;2&#41; to high heterogeneity &#40;n&#8239;&#61;&#8239;13&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Another significant problem we are facing is that we currently do not know why certain individuals experience a full recovery or continue to suffer specific long-term symptoms&#46; The main sequelae observed in other coronaviruses &#40;SARS&#44; MERS&#41; are of a respiratory&#44; musculoskeletal&#44; and neuropsychiatric nature<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; In patients with COVID-19&#44; admission to ICU due to acute respiratory distress syndrome is associated with long-term functional disability with both pulmonary and extrapulmonary conditions<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; The data on disease prevalence varies greatly&#58; some studies estimate that 20&#37; of patients present symptoms at 4 weeks and 10&#37; at 12 weeks<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; while others detect up to 70&#37; 4 months post-onset of COVID-19<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To date&#44; three theories have been suggested in an attempt to explain the pathogenesis of long COVID manifestations&#58; the presence of the virus in immunologically privileged locations such as the central nervous system&#44; an abnormal immune response&#44; and autoimmune phenomena secondary to infection<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Along these lines&#44; Gaebler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> studied the evolution of humoral and cell immunity for 6&#46;2 months in a cohort of 87 patients after infection with SARS-CoV-2 and observed that the titres of IgM and IgG antibodies against the receptor-binding domain &#40;RBD&#41; of the SARS-CoV-2 spike protein decreased significantly over this time period&#44; with IgA being less affected&#46; By contrast&#44; the number of RBD-specific memory B cells remained unchanged following infection&#46; The memory B cells showed clonal turnover after 6&#46;2 months and the antibodies they express had greater somatic hypermutation&#44; resistance to the RBD mutations&#44; and higher potency&#44; which could indicate continuous evolution of the humoral response&#46; On the other hand&#44; immunofluorescence and PCR analyses of intestinal biopsies obtained from asymptomatic individuals at 4 months post-onset of infection revealed the persistence of fragments of nucleic acid from the SARS-CoV-2 virus and the presence of immunoreactivity in the small bowel in 7 out of 14 individuals&#44; which could cause the chronic inflammation that is responsible for long-term symptoms&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A recent study in the pre-publication phase using the high-throughput technique Rapid Extracellular Antigen Profiling to identify autoantibodies against 2&#44;770 extracellular and secreted proteins in a cohort of 194 patients with SARS-CoV-2 infection and a control group of healthy healthcare workers&#44; showed a dramatic increase in autoimmune reactivities in the infected subjects&#44; particularly against immunomodulatory proteins&#44; including cytokines&#44; chemokines&#44; complement components and cell surface proteins<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In a murine model of SARS-CoV-2 infection&#44; it was found that equivalent autoantibodies altered the immune response and impaired virological control by inhibiting immunoreceptor signals and modifying the distribution of peripheral immune cells&#44; thereby exacerbating disease severity&#46; The analysis of autoantibodies targeted against tissue antigens revealed their association with specific clinical characteristics and disease severity<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Many of those cell antigens are found in specifically affected tissue and organs in patients with long COVID&#44; though their potential association with this clinical presentation has not yet been studied&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another challenge we face is how to therapeutically manage patients with persistent symptomatology&#44; which to date has been symptom-based and with few satisfactory results&#46; The National Library of Medicine database has currently recorded 58 clinical trials with different approaches to treating this clinical process&#46; One of them&#44; Esperanza COVID&#44; is conducted in Spain using montelukast&#59; others are aimed at therapies with naltrexone&#47;food supplements with NDA&#43;&#44; or drugs already used in patients with myalgic encephalomyelitis&#47;chronic fatigue syndrome &#40;ME&#47;CFS&#41;&#59; another with deupirfenidone &#40;LYT-100&#41;&#44; with leronlimab&#44; monoclonal antibody against the CCR5 cell receptor&#44; with physical exercise-based therapy or psychological therapy&#44; as well as antivirals such as remdesivir or favipiravir&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">When determining the healthcare system&#8217;s response to the COVID-19 pandemic&#44; we must consider the full cost of the chronic consequences of SARS-CoV-2 infection&#44; and we must design strategies to provide comprehensive care to individuals suffering from these sequelae&#46; In this regard&#44; in December 2020&#44; the prestigious journal Nature Medicine posed a challenge to the scientific community&#58; to address and produce solutions for long COVID syndrome<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Caring for patients with long COVID may require the participation of multiple specialists&#44; resulting in a logistical nightmare for patients seeking diagnosis and treatment&#46; As such&#44; a more comprehensive approach is needed to take the weight off of patients and to improve their care&#46; Along this line&#44; multidisciplinary units are being established to care for patients with long COVID such as those implemented at Mount Sinai hospital in New York and Penn-Presbyterian hospital in Pennsylvania&#44; or the clinics established in the United Kingdom&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Specialised units or clinics have also been founded in Spain to care for patients with long COVID&#46; These have drafted various consensus documents and interdisciplinary collaboration agreements&#44; such as the &#8220;MARCO-19 project for the care of individuals with long COVID&#8221;&#44; promoted by the SEMG and with the participation of 27 scientific societies<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;18</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The complex nature of post-COVID-19 sequelae surpasses and exceeds the specific competencies of the different medical specialties&#46; Therefore&#44; according to the various consensus documents&#44; these specialised units should include specialists in internal medicine&#44; neurology&#44; mental health&#44; and rehabilitation&#44; as well as support from nursing staff&#44; particularly that involved in case management&#44; and in close contact with primary care professionals and other specialists&#46; These units should also rely on collaboration from basic researchers in the fields of virology&#44; genetics and immunology&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The fundamental aims of these units will be to&#58; define the clinical spectrum&#44; pathogenesis&#44; pathophysiology&#44; and natural history of the disease&#44; rule out patients with suspected long COVID in the presence of other processes unrelated to the infection&#44; evaluate functional affectation&#44; identify groups of patients with specific needs and characteristics in order to schedule specific interventions&#44; and evaluate the safety and efficacy of specific interventions or treatments in controlled clinical trials&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There is a clear need to conduct controlled&#44; prospective cohort studies that include different at-risk populations and settings&#46; Likewise&#44; there is also a clear need to gather data in a standardised manner through national and international platforms in order to take the utmost advantage of all the scientific work that is being done&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Internal Medicine must not remain indifferent to these initiatives&#44; considering the leading role it has played from the very start of the effort to address the pandemic in Spain&#46; This effort can be seen in the COVID-19 patient registry from the Spanish Society for Internal Medicine&#44; one of the largest in the world&#44; which has already gathered data on more than 18&#44;000 patients<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Internal Medicine&#44; with its comprehensive vision and holistic training of its specialists&#44; which has enabled them to adapt and respond to the wide-ranging challenges and crises that have arisen in recent years<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; is in a strategic position to take on the challenge of creating and coordinating multidisciplinary units to care for patients with persistent symptoms post-SARS-CoV-2 infection&#46; On the other hand&#44; beyond the symptomatology of long COVID&#44; we cannot forget both the physical as well as psychological or psychiatric sequelae that patients who have overcome severe COVID-19 may present and that are currently still unknown to us&#46; Nor must we forget the repercussions that SARS-CoV-2 infection may have on the evolution of common chronic diseases such as ischaemic heart disease&#44; COPD or diabetes mellitus&#46; In this scenario&#44; the role of Internal Medicine is once again fundamental to the post-COVID-19 era&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-05-10"
    "fechaAceptado" => "2021-09-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1484335"
          "palabras" => array:4 [
            0 => "Long COVID"
            1 => "Post-COVID syndrome"
            2 => "Post-acute COVID-19"
            3 => "Long COVID haulers"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1484334"
          "palabras" => array:4 [
            0 => "COVID persistente"
            1 => "S&#237;ndrome COVID-19 prolongado"
            2 => "S&#237;ndrome pos-COVID"
            3 => "S&#237;ndrome pos-COVID-19 agudo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infection with the new SARS-CoV-2 coronavirus has reached pandemic proportions&#44; with a very high death toll worldwide&#46; Despite the scientific community&#39;s strenuous efforts to address this disease in its acute phase&#44; as well as in prevention through the development of vaccines in record time&#44; there remains another important workhorse&#58; understanding and treating the persistence of symptoms beyond the acute phase&#44; the so-called protracted COVID-19 syndrome or persistent COVID&#46; These persistent manifestations affect several organs and systems and may depend on both the pathogenic mechanisms of the virus and the pathophysiological response of the patient&#46; One year after the onset of this pandemic&#44; there is an urgent need to address this situation from a comprehensive approach&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por el nuevo coronavirus SARS-CoV-2 ha alcanzado proporciones de pandemia&#44; con un n&#250;mero de muertes muy elevado en todo el mundo&#46; A pesar del esfuerzo &#237;mprobo desarrollado por la comunidad cient&#237;fica para abordar esta enfermedad en su fase aguda&#44; as&#237; como en la prevenci&#243;n mediante la creaci&#243;n de vacunas en tiempo r&#233;cord&#44; a&#250;n queda otro caballo de batalla importante&#58; comprender y tratar la persistencia de s&#237;ntomas m&#225;s all&#225; de la fase aguda&#44; el llamado &#171;s&#237;ndrome COVID-19 prolongado&#187; o &#171;COVID persistente&#187;&#46; Estas manifestaciones persistentes afectan a varios &#243;rganos y sistemas y podr&#237;an depender tanto de los mecanismos patog&#233;nicos del virus como de la respuesta fisiopatol&#243;gica del paciente&#46; Un a&#241;o despu&#233;s del inicio de esta pandemia es una necesidad urgente abordar esta situaci&#243;n desde un enfoque integral&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;n-Garrido I&#44; Medrano-Ortega FJ&#46; M&#225;s all&#225; de la infecci&#243;n aguda por SARS-CoV-2&#58; un nuevo desaf&#237;o para la Medicina Interna&#46; Rev Cl&#237;n Esp&#46; 2022&#59;222&#58;176&#8211;179&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ritchie H&#44; Ortiz-Ospina E&#44; Beltekian D&#44; Mathieu E&#44; Hasell J&#44; Macdonald B&#44; et al&#46; Coronavirus Pandemic &#40;COVID-19&#41;&#44; OurWorldInData&#46;org &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://ourworldindata.org/coronavirus">https&#58;&#47;&#47;ourworldindata&#46;org&#47;coronavirus</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; WHO Coronavirus Disease &#40;COVID-19&#41; Dashboard &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://covid19.who.int/">https&#58;&#47;&#47;covid19&#46;who&#46;int&#47;</a>&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Institute for Health and Care Excellence&#46; COVID-19 rapid guideline&#58; Managing the long-term effects of COVID-19&#46; Disponible en&#58; <a target="_blank" href="https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-thelongterm-effects-of-covid19-pdf-66142028400325">https&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ng188&#47;resources&#47;covid19-rapid-guideline-managing-thelongterm-effects-of-covid19-pdf-66142028400325</a>&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de M&#233;dicos Generales y de Familia&#46; COVID-19 persistente&#46; Encuesta &#91;consultado 30 Abr 2021&#93;&#46; Disponible en&#58; https&#58;&#47;&#47;www&#46;semg&#46;es&#47;images&#47;2020&#47;Noticias&#47;20201111&#95;Resultados&#95;Encuesta&#95;COVID Persistente&#46;pdf&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Michelen M&#44; Manoharan L&#44; Elkheir N&#44; Cheng V&#44; Dagens D&#44; Hastie C&#44; et al&#46; Characterising long-term COVID-19&#58; A rapid living systematic review&#46; medRxiv preprint &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.12.08.20246025">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;12&#46;08&#46;20246025</a>&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Lopez-Leon S&#44; Wegman-Ostrosky T&#44; Perelman C&#44; Sepulveda E&#44; Rebolledo PA&#44; Cuapio A&#44; et al&#46; More than 50 Long-term effects of COVID-19&#58; a systematic review and meta-analysis&#46; medRxiv &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2021.01.27.21250617">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2021&#46;01&#46;27&#46;21250617</a>&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic widespread musculoskeletal pain&#44; fatigue&#44; depression and disordered sleep in chronic post-SARS syndrome&#59; a case-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Moldofsky"
                            1 => "J&#46; Patcai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2377-11-37"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Neurol"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "37"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One-year outcomes in survivors of the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Herridge"
                            1 => "A&#46;M&#46; Cheung"
                            2 => "C&#46;M&#46; Tansey"
                            3 => "A&#46; Matte-Martyn"
                            4 => "N&#46; Diaz-Granados"
                            5 => "F&#46; Al-Said"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa022450"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "348"
                        "paginaInicial" => "683"
                        "paginaFinal" => "693"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Office for National Statistics&#44; United Kingdom&#46; The prevalence of long COVID symptoms and COVID-19 complications &#91;consultado 8 May 2021&#93;&#46; Disponible en&#58; <a target="_blank" href="https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications">https&#58;&#47;&#47;www&#46;ons&#46;gov&#46;uk&#47;news&#47;statementsandletters&#47;theprevalenceoflongcovidsymptomsandcovid19complications</a>&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Dennis A&#44; Wamil M&#44; Kapur S&#44; Alberts J&#44; Badley A&#44; Decker GA&#44; et al&#46; Multi-organ impairment in low-risk individuals with long COVID&#46; medRxiv&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.10.14.20212555">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;10&#46;14&#46;20212555</a>&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term immunological health consequences of COVID-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "British Society for Immunology"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "WWW" => array:2 [
                        "link" => "https&#58;&#47;&#47;www&#46;immunology&#46;org&#47;sites&#47;default&#47;files&#47;BSI&#95;Briefing&#95;Note&#95;August&#95;2020&#95;FINAL&#46;pdf"
                        "fecha" => "2021"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of antibody immunity to SARS-CoV-2"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Gaebler"
                            1 => "Z&#46; Wang"
                            2 => "J&#46;C&#46;C&#46; Lorenzi"
                            3 => "S&#46; Finkin"
                            4 => "M&#46; Tokuyama"
                            5 => "A&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41586-021-03207-w"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "2021"
                        "volumen" => "591"
                        "paginaInicial" => "639"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33461210"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Wang EY&#44; Mao T&#44; Klein J&#44; Dai Y&#44; Huck JD&#44; Liu F&#44; et al&#46; Diverse Functional Autoantibodies in patients with COVID-19&#46; medRxiv&#46; Disponible en&#58; <a target="_blank" href="https://doi.org/10.1101/2020.12.10.20247205">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1101&#47;2020&#46;12&#46;10&#46;20247205</a>&#46;"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Meeting the challenge of long COVID"
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/s41591-020-01177-6"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nat Med"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1803"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33288947"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/s41591-020-01177-6"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1038&#47;s41591-020-01177-6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Barquilla-Garc&#237;a A&#44; del Corral E&#44; D&#237;az-Pedroche C&#44; Lumbreras-Bermejo C&#44; Mart&#237;n-S&#225;nchez V&#44; Moran-Bay&#243;n A&#44; et al&#46; Protocolo para la continuidad asistencial del paciente con diagn&#243;stico de COVID19&#46; Disponible en&#58; <a target="_blank" href="https://www.fesemi.org/sites/default/files/documentos/776.pdf">https&#58;&#47;&#47;www&#46;fesemi&#46;org&#47;sites&#47;default&#47;files&#47;documentos&#47;776&#46;pdf</a>&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de directivos de la salud&#46; Documento para la atenci&#243;n integral al paciente post-COVID&#46; Disponible en&#58; <a target="_blank" href="https://sedisa.net/wp-content/uploads/2020/10/DocumentoAtencionIntegralPost-Covid.pdf">https&#58;&#47;&#47;sedisa&#46;net&#47;wp-content&#47;uploads&#47;2020&#47;10&#47;DocumentoAtencionIntegralPost-Covid&#46;pdf</a>&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gu&#237;a cl&#237;nica para la atenci&#243;n al paciente Long COVID&#47;COVID persistente&#46; Disponible en&#59; <a target="_blank" href="https://www.semg.es/images/2021/Documentos/GUIA_CLINICA_COVID_Persistent_20210501_version_final.pdf">https&#58;&#47;&#47;www&#46;semg&#46;es&#47;images&#47;2021&#47;Documentos&#47;GUIA&#95;CLINICA&#95;COVID&#95;Persistent&#95;20210501&#95;version&#95;final&#46;pdf</a>&#46;"
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sis&#243;-Almirall A&#46; Manifestaciones persistentes de la COVID-19&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica&#46; Societat Catalana de Medicina Familiar i Comunit&#224;ria &#40;CAMFiC&#41;&#46; ISBN&#58; 978-84-121938-5-5&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de Medicina Interna&#46; Registro SEMI COVID-19&#46; Available from&#58; <a target="_blank" href="https://www.fesemi.org/investigacion/proyectos/registro-semi-covid-19">https&#58;&#47;&#47;www&#46;fesemi&#46;org&#47;investigacion&#47;proyectos&#47;registro-semi-covid-19</a>&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La Medicina Interna ante las crisis sanitarias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Bianchi-Llave"
                            1 => "M&#46;D&#46; Mart&#237;n-Escalante"
                            2 => "E&#46;J&#46; Calder&#243;n-Sandubete"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actual Med"
                        "fecha" => "2020"
                        "volumen" => "105"
                        "paginaInicial" => "135"
                        "paginaFinal" => "136"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022200000003/v1_202202260708/S2254887422000017/v1_202202260708/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48740"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022200000003/v1_202202260708/S2254887422000017/v1_202202260708/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422000017?idApp=WRCEE"
]
Article information
ISSN: 22548874
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 October 32 0 32
2024 September 17 0 17
2024 August 22 0 22
2024 July 24 0 24
2024 June 24 0 24
2024 May 25 0 25
2024 April 23 0 23
2024 March 21 0 21
2024 February 9 0 9
2024 January 30 0 30
2023 December 38 0 38
2023 November 48 0 48
2023 October 54 0 54
2023 September 25 0 25
2023 August 27 0 27
2023 July 36 0 36
2023 June 30 0 30
2023 May 33 3 36
2023 April 28 0 28
2023 March 41 3 44
2023 February 21 0 21
2023 January 32 0 32
2022 December 41 0 41
2022 November 31 0 31
2022 October 39 2 41
2022 September 44 0 44
2022 August 25 3 28
2022 July 43 3 46
2022 June 39 0 39
2022 May 46 2 48
2022 April 90 4 94
2022 March 135 2 137
2022 February 96 3 99
2022 January 44 0 44
Show all

Follow this link to access the full text of the article

Idiomas
Revista Clínica Española (English Edition)